The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little.

— Franklin D. Roosevelt

We drove into rural Arkansas to serve 2 years in the Public Health Service, into a town where movie houses had been shuttered when integration became law. I had come to pay my debt to the country in exchange for 2 years’ tuition for medical school. My husband, also a physician, had decided to accompany me, and together we arrived in a flat land where the dusk was alive with mosquitoes and rice and cotton fields bumped up against the houses. My husband’s office would be adjacent to the hospital. Mine would be in a small town along a border of the Mississippi that changed when the river flooded, leaving some lands in Arkansas, some in Tennessee.

There is an implicit privilege in serving as a physician in public health, although I was slow to understand this. We were outsiders to the South by religion, by politics, and by language. For weeks, my nurse translated Arkansan dialect, while I wondered what planet I’d landed on. One of the family practitioners advised me during my first week to buy the morning paper each day and bring it to clinic: “You might need it to deliver a baby.” I had trained in the intensive care unit. I could start a central line, intubate a patient in respiratory failure, and insert a pacemaker. Babies were not on my list.

Nor were fishhooks. My first patient came in with one through his finger, holding up his thumb with the filthy barb penetrating the flesh, fishing line still attached. “Now hold on, Doctor, I’ll run next door and get my husband’s wire cutters,” my nurse said. “You numb up the finger, OK?” At least I think that’s what she said. I put in a digital block. She cut the barb off, I ran the loop through the wound, irrigated it, prescribed antibiotics, and administered a tetanus shot. No training, no supervision — but no one else to do it.

In the hospital, we learned about other aspects of rural medicine. When my husband, reading EKGs, came upon a grossly abnormal tracing with peaked T waves from a patient who was scheduled for surgery, he called the surgeon. “He’s fine,” the surgeon chuckled. “He’s 32, exercises regularly, and I’m fixing his hernia. Housekeeping runs the EKGs; you might ask them if there was any problem.” The “EKG technician,” mop in hand, reported that when the tracing was too small, she would increase the gain to make it easier to read.

Sometimes the epidemics that swept through our population were initiated by drug detailers, who left samples of a new medication in all the primary care offices, making bold claims about efficacy. The first ill effect that we diagnosed was from long-acting digoxin: the tablets caused an epidemic of heart block in the community. At other times, the biggest problems were not in diagnosis but in finding a farm truck that was free for a day to take a child into Little Rock for emergency surgery. Vaccinating the children born uncounted on the islands in the Mississippi, learning about “gigging” frogs by flashlight in the night, eating barbecued goat for the Fourth of July — such activities marked a time of transformation for us.

In the little houses clustered by the fields, there was a rural violence that I’d never seen before, bred by poverty and ignorance. Bullet holes pockmarked every signpost along the road. I learned to recognize the old black men who worked in the cotton gin by their missing fingers. I learned about hard lives and about children who died or disappeared. I hadn’t known that so many black Americans were still living without running water, that physicians could be on call every night, that one could eat squirrel, or that long, well-embroidered country stories could make one double over with laughter.

At the outset, we Northern doctors had a kind of truce with the mid-South physicians. Young and inexperienced in life, we were swindled on our house, mocked for our politics, and bruised by the apparent indifference to the poverty of blacks — though we had come from Boston, which had its own kind of racism. Through the practice of medicine, these differences were muted by our common purpose — and soon transformed, as our clinics became integrated and our presence in the community welcomed. We learned that medicine is a passport as valuable as citizenship and that goodwill goes far in diminishing political divides. One night near the end of our 2 years in Arkansas, I approached the bedside of a man with unremitting angina to start an IV. We had been at odds forever, over integration, women in medicine, public health, religion, politics, you name it; we had no common ground. As I started the IV and my husband ran in the medication, this moment in a rural emergency room shrank the differences to naught. What language could not bridge, medicine did.

There were other lessons to learn in rural medicine. Our new world was rich with lives, stories from the warm earth, island dialects that chopped words in half, and a sense of time that was distinctly foreign:

Physician: “How long have you had chest pain?”

Patient: “Oh, for quite some time . . . uh huh, quite some time.”

Physician: “For a few weeks?”

Patient, head shaking: “Oh more than that, honey, more than that.”

Physician: “Months?”

Patient, softly chortling: “Not that long.”

I was graced to learn about an America I did not know.

One compelling reason to serve your country in this way is to learn from people you had intended to teach. To stop your car at the side of a road in rural Arkansas as the funeral cars passed, in respect for a country tradition. To yield to a small community’s intrusion on your privacy. And to absorb what you could of the extraordinary medicine. I hadn’t known that a person could live with a serum potassium just over 1, or survive the night when septic with clostridia, a diagnosis made when all the blood-culture bottletops had popped off by morning. The double dose of diuretics prescribed was stopped. The underlying colon cancer was identified and treated. Without an Internet, diagnoses such as histoplasmosis, recluse spider bites, inhalation toxicity from pesticides only slowly dawned on us, as we read chapters in Harrison’s that we once saw as without merit. The experience informed the way I practice medicine. As I cared for patients discharged from Memphis teaching hospitals, I came to respect the time needed for healing, to value listening as much as technology, and to have confidence in my own ability to solve a problem. Later, I learned the quintessential medical skill — to touch patients with a kindness and competence that brings trust and hope to troubled lives.

I often think of Arkansas these days, as I listen to Congress wrangle over health care. I think about the people without voices in this country, the single mothers, the legal immigrants, and the poor. I hope the notion of public service is reconsidered, as Americans struggle for jobs, equity, and economic security — and that it is implemented more thoughtfully, with a plan for longer-term investment of teams in a community. Such experiences expand our understanding of each other and invest life with meaning and insight. That is the enduring legacy of public health service.