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  1. University of Arkansas for Medical Sciences
  2. Medicine and Meaning
  3. 3 – Non-fiction

3 - Non-fiction

A Life of Faith: Sister Marietta Fecteau

by Susan Van Dusen

Image of a Second Place medal and ribbon

Second Place,
The Drs. Paulette and Jay Mehta Award in Creative Writing


No one knows how long the tattered box lay by the side of the road. Maybe a week passed before a curious traveler stopped to peel back the tape and take a peek inside. Or perhaps it took months for the rain and snow to slowly erode its precious contents. Either way, the box, and everything it contained, was lost to Lilianne.

“Attendez! Arrêtez! Une boîte est tombée!” She pleaded when the box fell from the precarious pile in the back of their truck. “Wait! Stop! A box has fallen!” Surely he would stop, she thought. Why wouldn’t he? She leaned over to implore him, wanting to grab the wheel but not daring to, lest more boxes — and children — might topple onto the bumpy country road. Their possessions were so few that each and every one held value to their life and family and future.

“Nous ne nous arrêtons pas!” The answer was quick, and the decision final. They would not stop. The box, and whatever it held, was gone forever. Lilianne turned toward the window. The passing pine trees blurred as tears filled her eyes. “Dieu soit avec nous,” she prayed, silencing her mind to the rattle of the engine and the voices of eight of her children clattering in the background. “God be with us.” She looked down at little Marietta snuggled securely in her lap and hugged her a bit tighter as they continued to roll away from their old life and toward an uncertain future.

Only two years old at the time, Marietta would not remember any of this — not the box or the truck or the little white house they left behind. But when I asked about her childhood 65 years later, she recounted the story in such intimate detail, I assumed she was pulling it from her own distant memory. Having heard it over the years from Lilianne and her older siblings, Marietta’s vivid retelling indicated this moment was a turning point in both her own life and the life of her family.

It would be years before Lilianne revealed the contents of that long-forgotten box. Her husband had never asked, and she had no one else in which to confide such a personal loss. A simple question by one of her sons — “Mama, why are there no baby pictures of us?” — brought back the memories of that day and what she discovered missing as she unpacked the remaining boxes and settled into a house in the Québec countryside outside her hometown of Coaticook. She pictured the truck with its cargo packed to the brim and her children tucked into nooks and crannies, filled with anxiousness and wonder about what lie ahead. She closed her eyes as she remembered the box tumbling to the ground and being left behind as little more than trash tossed onto a heap.

“Don’t blame your father,” she told them. “He just lost his job and was very angry. He didn’t know what he was doing.” With her gentle voice, she urged them to forgive Lionel for his shortcomings and reminded them — as she often did — that God has a plan for every soul.

“My mother always told us that God had protected us from the dangers of riches and the pleasures of having too much. He wanted it this way so we would know that happiness doesn’t come from material possessions but from His love instead,” Marietta said. That faith and eternal optimism were what carried Lilianne and her children through years of hardship most people would find unimaginable. Instead of dwelling on those challenges, though, Marietta came to understand them as the hand of God guiding her, step by step, toward a life of servanthood and devotion more than one thousand miles away from her quiet beginnings in the Canadian countryside.

Nestled in southeastern Québec, the quaint town of Coaticook rests just thirty minutes from the Vermont border. Split down the middle by the winding Coaticook River and surrounded by expansive forests, the area, whose name is derived from the Abenaki Native American word for “river of the land of pine trees,” is known for both its scenic beauty and fertile farmland. Orchards and farms dot the landscape, offering not only bountiful supplies of fresh fruits and vegetables, but also a place where men like Lionel could envision a self-sufficient life working a plot of land to support his young family.

Founded in 1830, Coaticook had been on the map for 120 years when Marietta came into the world. The ninth child of Lionel and Lilianne Fecteau, her arrival was greeted with joy and relief by her young parents, who had married at the tender ages of 19 and 14 respectively. Just one year prior, Marietta’s sister, Chantal, had nearly died shortly after her birth, striking fear in her parents’ hearts that any future children might suffer the same fate.

“When my mother was pregnant with me, my father would often put his hands on her and bless me so I would be healthy,” Marietta said. Healthy she was, and three days after her birth on March 30, 1950, she was baptized and consecrated to the Virgin Mary in the parish church of St. John the Evangelist.

The first two years of her life, Marietta was later told, were relatively uneventful. The family rented a small house across from Lilianne’s parents and lived as normally as a family with nine children could. Roger, the eldest, left to join the Navy not long after Marietta was born, and the other children filled the house with noise and activity from morning till night.

Although small in stature, Lionel boasted a larger than life personality. A jack-of-all- trades, he would often entertain his family and friends with the violin, playing by ear songs he heard on the radio or television. At times, he would play for money, passing a hat and collecting a healthy sum from generous strangers. In his lifetime, Lionel would hand-construct eighteen violins and teach some of the children to play alongside him, including left-handed Marietta, whose early attempts sounded “more like a cat crying than anything else,” she said.

Annual New Year’s Day family get-togethers, even after hard times struck, were always filled with lively music and dancing. Lilianne would often sing along in a soft melodious voice that captivated young Marietta. In later years, Marietta realized that Lilianne’s singing became a type of therapy, providing an escape from the harshness and challenges that would follow much of her life.

Whatever caused Lionel to lose his job prior to the family’s ill-fated move to the country is lost to time. However, his decision to take up the difficult and unfamiliar life of farming did not serve his family in the way he had hoped. Even with friends offering support, Lionel had no training and lacked the knowledge to successfully operate a profitable farm. The older children often skipped school to help in the fields, but the crops didn’t grow and the family’s problems soon went from bad to worse. With the stress mounting, Lionel found himself spending more and more time at the taverns with his friends, his meager income buying rounds of alcohol instead of necessities for his family.

As food at the Fecteau home became more and more scarce, Lionel’s drinking and violent outbursts intensified.

“My mother cried a lot and very often went without meals so we could have a little something to eat,” Marietta recalled. Despite their worsening situation, Lilianne never allowed the children to show disrespect or resentment to their father. Instead, she told them to pray for him and refrain from judgement. Even now, Marietta speaks of her father with mixed emotions, recalling him both as an intense man prone to drinking and obscenities, as well as a talented musician and artist who always begged forgiveness and remained steadfastly faithful to her mother through more than fifty years of marriage and a debilitating illness.

“When my father was sober, he was a wonderful person, a hard worker, and the heart of any party. He could speak with anyone about anything,” she said. Unfortunately, Lionel’s artistic talents and outgoing personality were not enough to lift his family from the poverty that had set in, and, in 1954, life changed significantly for Marietta and two of her sisters.

A Beacon of Hope

Sister Maria made her slow, methodical walk up and down the aisles of the elementary school lunchroom. She watched as the children removed carefully wrapped sandwiches, fruit, and cookies from metal lunch boxes, many of which were adorned with images of cowboys on horseback and characters with silly names like Howdy Doody and Casper the Friendly Ghost. Although their faces didn’t mean much to Sister Maria, she knew the 1950s had brought televisions into most homes and the children’s attention was being drawn more and more toward these worldly diversions and away from their schoolwork and prayers.

Today, however, as she made her lunchroom rounds, she didn’t think about the lunchbox characters or the hushed giggles of the children secretly swapping their meals under the table. Instead, she stopped and watched from across the room as 11-year-old Lise Fecteau and her three brothers pulled single pieces of bread from crumpled paper bags. She had noticed the Fecteau children before, their unkempt hair and downward gaze indicating something in their lives was not as it should be.

As she watched them remove the bread, something unbelievable caught her eye. Lise’s piece was green with mold, and it was the only thing the girl had to eat. Shocked, Sister Maria slipped out of the lunchroom and into the kitchen, where Sister Garand was busy cleaning. “I’m concerned about the Fecteau children,” she said. “We must tell Sister Gabriel.”

Sister Mary Gabriel the Archangel was a dignified woman with a joyful sense of humor and “a great capacity for love,” as Marietta recalled decades later. As Mother Superior, she was charged with making decisions and overseeing operations for the Coaticook convent of the Sisters of the Presentation of Mary and the school they operated for the local children. Sometimes these decisions were easy, and sometimes — as she was about to be reminded — they deeply touched her heart. In the years that followed, Sister Gabriel would become a formative figure for Marietta, greatly influencing her own decision to become a religious woman and leave Canada for a life of service more than 1,500 miles from home. For now, however, she would quietly become a beacon of hope for the Fecteau family at the moment they needed it most.

An Unexpected Gesture

As Lise and her classmates continued their lessons that afternoon, the door to their classroom opened and Sister Gabriel appeared.

“Lise,” she said. “Would you please come with me?” Wide-eyed and apprehensive, the young girl arose, straightened her skirt, and followed Sister out the door and down the long, wide hallway. When they reached the dining room, Sister Gabriel stopped, pushed open the door and gestured for Lise to enter. Hesitantly she stepped forward, and there she saw it: A steaming plate of hot food set waiting for her.

“We thought you might be hungry,” Sister Gabriel said. Lise hesitated, unsure of what to say or where this unexpected gesture had come from. Her tears began to flow. Casting her eyes to the floor, she whispered, “I have two little sisters at home, and they don’t have anything to eat. Sometimes my mother doesn’t eat, just so we can have a little something.”

Sister Gabriel’s heart sank. This was clearly a much bigger problem than one meal could fix. After sending Lise back to the classroom, Sister Gabriel took a seat to ponder her next step.

If the Fecteau children were indeed living in such extreme poverty, the Sisters were not only capable of helping, but morally responsible as well. She quickly made arrangements to call on the family and see for herself the situation facing Lise and her siblings.

A few days passed and Lise had not told a soul about her unsettling encounter with Sister Gabriel in the school kitchen. Now, however, as Sister Gabriel and Sister Garand walked in the front door of her house, she was afraid that perhaps she had revealed too much. Was she in trouble? Would she get suspended from school? What would her parents say? The pit in Lise’s stomach grew as her mother quickly shuttled the curious children out of the room so she could speak to the Sisters in private.

Huddled together, Lise, four-year-old Marietta, and their siblings pressed their ears to the door in the hopes of hearing a bit of the conversation occurring behind it. It wasn’t often they had visitors, and even less often were they as important as the women who currently stood next to their mother in the kitchen. In fact, the entire scene was unprecedented. Dressed in their immaculately clean and pressed black habits, the Sisters’ presence was a stark contrast to the faded backdrop of the family’s country home.
Sister Gabriel had spent the days since her encounter with Lise praying for guidance. While it was no secret the Fecteau family was struggling, no one realized the extent of their plight. Now, here in their home, she knew what must be done. It didn’t, however, make it any easier for her, and it certainly would not be easy for their mother.

As they sat down at the kitchen table, Lilianne wondered what was about to transpire. The children had gotten in trouble at school before, but never had Mother Superior come to their home to discuss the matter. This is serious, she thought, as her stomach tied itself in knots. How will I tell Lionel? What will he say?

The women surveyed each other. An uneasy nervousness filled the space between them. On one side, a young mother filled with devotion and faith, but plagued by exhaustion and hunger and a deep longing for her children to have a better life. On the other, two gentle nuns who had no worries about where their next meal would come from or if a clean bed would be waiting for them when they were ready to turn in for the night. Although their circumstances were miles apart, in that moment, they were one in the same — three women of God, who cared for nothing more than the health and well-being of the children huddled in the next room.

Lilianne listened intently as Sister Gabriel spoke. Her proposal was simple, yet shocking. Uplifting, yet heartbreaking. The three youngest girls — Lise, Marietta, and Chantal — could leave the farm and move just a few minutes away to live with the nuns at their boarding school and convent. They would have plenty of food, warm beds, and the unwavering love and attention of the Sisters. It would be an honor, Sister Gabriel, said to have the children grow up under their watchful eye.

Lilianne could not believe what she was hearing. An honor to have my children live with you? My children, Lilianne thought. How dare this woman I barely know come to my house and tell me that she can raise my children better than I? I could never consider such a thing!

As Lilianne opened her mouth to tell Sister Gabriel that her offer was kind, but unnecessary, something deep inside made her stop. She closed her eyes and took a breath. How many times she had prayed for her children to have enough to eat? For the crops to grow? For Lionel to find a job that paid a salary they could depend on? How many times had she set out on foot, walking four miles to mass as an ever-faithful and obedient servant? Hundreds of times, she thought. She had prayed morning, noon, and night with the promise that God heard every prayer and wept along with her as the children went to bed tired and hungry. Could this be what she was asking for all along? Was the nun in front of her the answer to her prayers? As a tear streamed down Lilianne’s cheek, she knew the answer.

A few days later, a taxi pulled up to the Fecteaus’ front door. Dressed in long, faded t-shirts that seemed to swallow their fragile bodies, the girls stepped out of the house to greet Sister Gabriel and prepare for the short drive to their new home just a few miles away. Lilianne had sat them down and explained that eleven-year-old Lise, five-year-old Chantal, and four-year- old Marietta were going to live with the nuns who taught at the school that Lise and their brothers attended. Over objections, questions, and tears she explained that the girls would not be gone forever and that they would be cared for, with plenty to eat, and a warm place to sleep. While it was hard to understand how leaving their home could be for the best, the girls had no choice but to trust their mother, whom they loved with all their hearts.

After hugs were given and goodbyes said, the three sisters crowded into the backseat of the unfamiliar car. The engine started and Marietta turned to sit on her knees and wave to her mother through the open window. The tears on Lilianne’s cheeks glistened as she blew her girls a silent kiss as the car pulled away. As the farmhouse slipped out of sight, Marietta back turned around, shifted her gaze straight ahead, and wondered what came next.
Years later, when Marietta recalled that moment and how it set in motion a series of life- altering events, she spoke fondly of her mother and the sacrifices she made for her family.

“My mother was a great woman of faith, although she suffered a lot and at times was discouraged. It was hard for her to let her little ones go away from her. She made a big sacrifice, but she knew we were in the best of care with those good nuns,” she said.

Marietta’s New Life

“Have you seen Marietta,” whispered one of the Sisters to another. “She’s not in her bed.” After four years, the Sisters of Presentation of Mary were familiar with Marietta’s antics and mischievous nature. She was a spirited, creative girl who loved to dance and spent her playtime pretending to be the saints she learned about in religion class. Living at the convent’s boarding school gave Marietta the freedom to experience childhood “with my whole heart,” as she later described it. She performed in talent shows, learned gymnastics, and made up songs she sang with gusto during recess on the school’s playground. Most significantly, though, Marietta found at the convent the seeds of a deeply fervent faith that would plant in her heart and grow stronger with each passing year.

That’s why it was no surprise that particular evening when Marietta was not where she was supposed to be. Everyone knew she had a reputation for keeping the nuns on their toes. This evening’s infraction, however, was not one for which they could find a reason to punish her.

“Look,” said the Sister, pointing into the darkened room. “There she is.” Beside the twin bed, almost hidden from view, eight-year-old Marietta knelt on the floor with her head bowed down to the ground. Her mouth moved as she silently repeated the Pardon Prayer delivered in 1916 by the Angel of Peace at Fatima, Portugal:

“My Lord, I believe, I adore, I hope, and I love You. I ask pardon for those who do not believe, do not adore, do not hope, and do not love You.”

Marietta heard the story of Fatima from the nuns and grew fascinated by the fact that Mary appeared from on high to three lowly shepherd children, who were not unlike herself. She often imitated the children by kneeling with her head to the ground and repeating the prayer over and over again.

“I prayed a great deal; also, I wanted to see the Blessed Mother. I thought that if I pray a lot and I say many rosaries I would see her someday,” she said. To keep track of her devotion, Marietta made a note of each prayer and rosary she recited, marking it in a small book she carried with her.
“The blessed Virgin Mary said many souls go to hell because there is no one to pray for them. I was nearly obsessed with that, so I prayed a lot and many times.”

Even before Marietta began her daily routine of praying for souls to find their way to heaven, the Sisters were praying for her. Shortly after moving to the boarding school, her innate curiosity brought cause for alarm when she became ill from eating one of the mud pies she and her sister made in the schoolyard. With Marietta’s stomach and intestines “full of worms,” the doctor prescribed medicine, but told the nuns it was not guaranteed to be a cure. Taking the matter into her own hands, Sister Gabriel gathered Marietta up in her arms and carried her down a long hallway to the statue of Mary, where she asked for the young girl to be healed. The proceeding nights and days saw the nuns taking turns at Marietta’s bedside, entertaining her with a doll that had a smiling face on one side of her head and a crying face on the other, until finally the combination of prayers and medication took effect and she was back to her old mischievous self.

Even as Marietta grew up safely ensconced in the bubble of the convent’s boarding school, the reality of the outside world began to seep in. Her father eventually abandoned his quest to be a farmer, found another job, and moved the family back to Coaticook, but the years of poverty and strife had taken a toll. Her brothers engaged in behavior that frightened and worried Marietta to the point that she avoided returning home for any reason, a decision that would haunt her for the rest of her life.

“I loved my mother very much, and I felt so bad to stay away from her, but I found myself unable to return home,” she said.

During the summers, when Marietta was required to go home, she attended as many church services as possible to avoid her family’s turmoil. It was at church where she felt the comforting embrace of God, Mary, and her guardian angel. It also was where she developed a great love for Saint Joseph, Mary’s husband, whom she secretly prayed to become her own father.

Even after moving their family back into town, Lilianne and Lionel’s struggles continued. Lilianne, who was by now living with severe headaches and the early stages of multiple sclerosis, would often stay with friends, leaving the younger children in the care of their elder siblings, a situation that Marietta says her mother truly believed was safe, but in reality was “a nightmare.” But just as Marietta was reluctant to tell Sister Gabriel about her teacher’s maltreatment, she also never divulged the true cause of her distress to her parents. Instead, she chose to live under the care of the nuns for more than eleven years, never returning to her family’s home for longer than a brief visit.

“I actually felt sorry for my parents, so I endured a lot,” she said. “My mother taught me many things, and to this day I remember the good things she said, even during times when the suffering was impossible to describe.”

Returning Home

It was mid-December 1964 when Marietta boarded a bus and arrived at her parents’ home in Coaticook to celebrate Christmas. Now fourteen, she had outgrown the boarding school, and Sister Gabriel arranged for her to live in nearby Drummondville at a college that also was operated by the Sisters of the Presentation of Mary. Marietta began tucking money away from her job cleaning stairs and drying silverware in the college’s kitchen to purchase a bicycle, which she rode to and from classes at the Immaculate Conception School.

Marietta’s sister, Chantal, had long since left the Sisters and moved back home; her mother had given birth to another girl, Jacinthe, now eight years old; and Lise had married, divorced, and moved to nearby Lennoxville with her two young children. Marietta and her mother had pleaded with Lise to reconsider her decision to marry at only eighteen, but strong- willed Lise moved forward, unaware that her decision would not only impact her own future, but Marietta’s as well.

While she was worried about Lise and the emotional fallout from her divorce, Lilianne knew her own failing health prevented her from making a trip to check on her daughter and grandchildren. Instead, Lilianne appealed to Marietta, asking if she would mind repacking her bags and traveling to Lennoxville, where Marietta could spend the Christmas holiday with Lise’s family and ensure Lilianne they were being properly cared for. Sensing her mother’s anxiety, Marietta agreed, and soon she was on the road again, traveling about thirty minutes from her parents’ home, a world away from her little room at the college, and straight into a new, unexpected phase of her life.

A Life-Changing Encounter

For all practical purposes, Marietta should not have been in the basement of Saint Anthony of Padua Catholic Church on that December night. Lise had been invited to a Christmas party by a priest who befriended her during a recent hospitalization, and since Marietta was visiting, she agreed to accompany her sister to the party. As the Fecteau sisters admired the festive desserts and decorations, the priest approached them with a smile.

“Ladies, there is someone I’d like you to meet,” he said, glancing toward the young couple beside him.

“Let me introduce myself,” the man said, extending his hand in a greeting to the sisters. “I’m Jean-Louis Dionne, and this is my wife, Theresa.”

As the foursome began to talk and the story of how Lise and Marietta came to be at the church party unfolded, the first flickers of a spark ignited in Marietta’s heart for this young, devout couple — a spark that was returned in equal measure by the Dionnes.

While it’s impossible to know exactly what drew the couple so intensely to Marietta, it is obvious they were immediately captivated by the young girl’s engaging personality and story of growing up among the nuns. After the party, they made plans to visit Marietta at the college in Drummondville, and as she become acquainted with them and their young daughters, a great love and respect developed. It was a bond that, apart from her deep affection for her mother, Marietta was not accustomed to feeling for most of her biological family, but found readily apparent in others whom God placed in her path.

The bond between Marietta and the Dionnes grew stronger with each passing month. “They were like parents to me. I loved them so much,” Sister Marietta said. She fondly recalled Jean-Louis’ devotion to the Church and her hours spent with Theresa at a nursing home where they organized bingo games Theresa would kindheartedly rig so everyone got a chance to win.

“She taught me to be cunning,” Sister Marietta said with a smile, using the word she often referred to when describing her own personality.

With Marietta’s graduation drawing near, Jean-Louis and Theresa invited her to spend her summer vacation at their home. Together, they enjoyed the simple pleasures of a normal family life, and as each day passed, Marietta felt her dream of following in Sister Gabriel’s footsteps coming closer to reality. She already attended a vocational event where she visited fourteen convents near her home, including the one where Sister Gabriel and the other nuns had lovingly raised her, and went so far as to write a letter to the convent’s Superior saying she would like to join them, if that was where the Lord called her.

One evening at home, Marietta told Jean-Louis and Theresa about her visits to the convents and how she longed to find one with a boarding school, where she could work with children and return the favor that God had granted her when she was four years old, hungry, and unsure where her next meal would come from.

Although there were plenty of convents with boarding houses nearby, an inner voice must have told Jean-Louis that those were not the places Marietta sought. He asked if she knew about his sister, Fernande, who lived as a Sister of Charity in America. After pulling out a projector and screen, Jean-Louis, Theresa, and Marietta watched a film about Fernande’s order and the work they did with children in their community of Hot Springs, Arkansas. Marietta was captivated by the nuns and smiling children that filled the screen, creating an image she found both familiar and comforting. After the film ended, Jean-Louis handed Marietta a pamphlet for the monastery that also pictured a nun surrounded by happy children. Although French-speaking Marietta could not read the English words, something sparked in her heart as she looked at the pamphlet and then placed it on the bread box before retiring to her room for the night.
It was around midnight when a sleepless Marietta arose and made her way out of the bedroom and down the dark hallway.

“I looked around, and everything was very quiet. I was looking out the window at a beautiful sky full of stars, but one star seemed bigger and more sparkly than the others. I then tiptoed toward the kitchen and walked to the bread box. I reached out and picked up the pamphlet. More and more I thought that the nun in that picture could be me,” she said, positive that she had finally found what she was looking for.


Susan Van Dusen was the communications manager for the Winthrop P. Rockefeller Cancer Institute.

Filed Under: 3 - Non-fiction

On Ethics and Authenticity in the Practice of Medicine

By Bill Ventres, M.D., M.A.

For all of my over 30 years in medicine, and not unlike many other clinicians in the United States, the four principles of autonomy, beneficence, nonmaleficence and justice have been the dominant ethical tenets by which I have conducted my practice while attending to my patients’ physical and emotional needs. Into this decision-making mix of ethical practice and clinical medicine, at the interface of biology, psychology, anthropology and spirituality, I have recently also added important perspectives from narrative, feminist, virtue and Latin American ethics as well as points of view on social justice and professionalism. As I am able, I strive to be informed about weighty matters that influence my daily interactions with patients.

Over the years, I have tried to listen to my patients’ concerns with an ear for hearing not only their stories, but also the metaphorical voices by which they communicate these stories, voices that routinely blend sincerely held beliefs with all-too-human emotions. In doing the ethical work of being a medical practitioner, I have sought to help patients and their families manage the challenges of making tough decisions when moral concerns are paramount and personal values differ among stakeholders. I have endeavored to understand how people make sense of modern medical care in light of contemporary ethical standards and such timeless concerns such as confusion, anxiousness and fear.

I am proud of my work—not because I have been universally successful in guiding my patients and their families through the maze of medical decision-making with alacrity, and certainly not because I have managed to avoid those dreaded situations when clinicians and their patients are in direct ethical conflict and resolution seems impossible. Some of my most cherished professional memories have arisen out of my labors to bridge such deep divides. Some of my most painful ones have resulted from my inability to realize that same accomplishment. 

I am proud because I have worked very hard over the years to grow a sense of trust in myself vis-à-vis my patients, their loved ones and the communities in which they live. I have learned to present my genuine self in encounters with those in my care, relatively free of the emotional reactivity and professional anxieties that often intruded upon my early work as a family physician. I have developed an accurate evaluation of my knowledge, an honest appreciation of my attitudes (including my biases), and a fair assessment of my clinical skills. I have also come to acknowledge the intentions with which I approach my professional endeavors and nurture the therapeutic relationships that I have cultivated with those who have sought my care.

Simply put, I have worked hard to use self-reflection and self-awareness as tools to bring my authentic, fully human self to my interactions with patients, especially in circumstances involving ethics and ethical decision-making. 

Five process-oriented attributes have helped me cultivate my own authenticity in my medical practice:

  • Genuine Curiosity. An inquisitiveness reciprocally derived from and supportive of an anthropological gaze, inquiry is what guides much of my work with patients. It supports the use of open-ended questions to explore both everyday clinical presentations and complex ethical dilemmas, whether of technological, informational or epistemological origin. By inviting open reflection on both sides of the stethoscope, this questioning approach helps to relieve me of the emotional burdens I face when challenged by interpersonally “difficult” patients or attempting to navigate conflictual circumstances when the means to moving forward seem unclear.
  • Situational Awareness. Being ethically aware means that I systematically attend to the situational milieus that surround these conflictual circumstances in medical practice. Enhancing my ethical awareness means developing my ability to examine the intricate social, psychological and moral dynamics that influence decision-making, including issues not usually considered pertinent to medical ethics such as poverty, classism, racism and other social determinants that adversely affect health. I have forged this awareness through a process of bringing into my conscious mind both other people’s personal histories and my own lived experience; I continue to shape it now, reflecting, ruminating and writing at this very moment.
  • Deep Understanding. The willingness to open my mind is a crucial step toward honestly understanding the root causes of ethical conflict. Such an understanding, even a semblance thereof, comes from being able to gain insight into the lives of others and the environments in which they live, as well as acknowledging that this ability is bidirectional. Gaining insight into the creation and manifestation of my own socialization as a clinician is equally as important. As played out in the world of medical ethics, understanding means discerning how suffering and resiliency affect the cognitive, emotional, relational and transcendent qualities on both sides of the decision-making equation.
  • Heartfelt Compassion. Compassion is the cognitive, emotional and relational experience that moves me to both recognize and work to reduce other people’s suffering. Compassion is more than just a virtuous precept and much more than an empathetic response. In matters of ethical decision-making, it includes the co-creation of a shared presence among involved stakeholders, one in which uncomfortable thoughts and feelings can be explored, out of which a healing alliance can emerge and from which therapeutic actions can ensue. Compassion is the philosophical, affective and interpersonal touchstone to which I return, day in and day out, as moral concerns both big and small arise in my clinical work.
  • Reasoned Humility. Lest I think that I have a lock on the truth, humility is what keeps me honest: my work is conditioned on the reality that in medicine, many factors influence the course and outcomes of the clinical encounters and ethical decision-making I share with patients. Humility offers me a nuanced view of my role in curing illness and promoting health, the capacity to learn from of those whose perspectives and behaviors challenge ideas and attitudes born of my particular professional background, and an openness to appreciate how people assign meaning to their lives. 

I imagine that some might refer these attributes as “optimized” traits, virtues to honored and learned through study. I see them instead as ways of knowing and being, habits of thought and feeling that have as their source my day-to-day work, a practice that values person- and people-centeredness in the application of a biologically-based approach to clinical evaluation, diagnosis and management. I also submit such distinctions are beside the point. These attributes of authenticity have helped me attend to both straightforward and complex ethically informed decision-making along the course my own professional path. They have helped me hold my own ideas and emotions with equanimity such that I am better able to approach my patients and their concerns with a non-anxious presence. They have helped me come to terms with my imperfections, idiosyncrasies and professional failures so as to offer those in my care a chance to recognize the worth their own human nature, inclusive of both the frailties and resiliencies with which they present. They have helped me balance the delicate interplay between philosophy and practice, between the culture of medicine and the culture of patients, and between my own sense of self and an understanding of others’.

Are any or all of these attributes of authenticity relevant to other clinicians or clinicians-in-training? That they have so significantly enriched both my professional sense of self and my way with patients, their families and my colleagues, and have helped me develop my own professional identity as a competent, capable and caring family physician, I like to believe they also might be of aid to others as they walk their professional paths. More important, however, is the rituals of reflection to which they speak. I invite others, young and old, learning and learned, to pay attention to the thoughts and feelings that arise in their interactions with patients. I invite them, through a process of awareness, recognition and integration, over time, to build a personal repertoire of applied attributes to help them nurture their own abilities to be considerate and compassionate clinicians.

I strongly suspect that our current methods of teaching ethical and decision-making principles will continue to leave many clinicians and clinicians-in-training struggling as they try to use those principles in practice. I suspect that they will similarly have to find their own sense of authenticity despite, not because of, the standard curricula and models of instruction that are currently in vogue. For authenticity will not automatically appear as a consequence of studying or applying the biomedical sciences, even when combined with such informative and enlightening adjuncts as narrative studies, patient simulations or mindfulness. It will neither arise from having read any number of articles in the literature of philosophy or decision sciences directed at medical practice, nor materialize out of the four principles or other aforementioned theories of ethics when explored as preordained templates to employ rather than as habitually considered concepts from which to gain insight. It will also not result from the codes of conduct that currently define professionalism, absent the emotional intelligence to embrace them. 

Authenticity will emerge from the hard work of being curious, growing one’s consciousness of and ability to recognize other peoples’ realities, acknowledging their suffering while simultaneously engaging in activities to ameliorate it and, along the way, being humble in the face of the knowledge that we are all, metaphorically, in the same boat in life. We are all human. 

And when it comes time to take down our shingles, whether that be in the not-too-distant future (as in my case) or many years hence (as in the case of younger colleagues), may we all be better clinicians and better human beings for having done this work and, as we were able, brought authenticity to our daily work with patients.


Bill Ventres is the Ben Saltzman, M.D., Distinguished Chair in Rural Family Medicine in the Department of Family and Preventive Medicine at UAMS.

Filed Under: 3 - Non-fiction

White Coats and Blue Collars

By Eric Moorehead

A sultry, sunny day greeted denizens of the mid-Atlantic region in July 2016. I was driving on Pulaski Highway—U.S. Route 40—with my wife, son and daughter on an exhausting, albeit enjoyable road trip that carried us through most states east of the Mississippi River and Ontario, Canada. Some 100 miles southwest of Philadelphia where we stopped earlier, I drove into another big city in a neighboring state. I exclaimed to them, “This is where I was born.” The grit of the city shrouded business after business and rowhouse after rowhouse that we passed as Pulaski Highway turned into Orleans Street. I drove under a railroad overpass with large letters spelling out “BALTIMORE.” We arrived in Maryland’s largest city – its indelible blue-collar image starkly contrasting that of the elite nation’s capital 40 miles to the southwest, its quirky ambience as colorful as the state flag. I wanted to show my family Johns Hopkins Hospital, my father’s employer when I was a small child.

We parked our mini-van on the street, got out and began to walk around the perimeter of the hospital campus to take pictures. “So this is where Dr. Ben Carson got started,” my wife said, referring to the man of Gifted Hands fame. 

All I knew is that Johns Hopkins Hospital appeared unrecognizable to me overall from those erstwhile days of my childhood, with several modern buildings constructed decades after my last visit with my father when I was around five or six years old. Only the old red Queen-Anne style building – the original hospital, now the administration building – captured any familiarity. The old hospital was the place I remember telling my father’s work friends there that I wanted to be a doctor when I grow up. I didn’t know any better.    

Let me continue to take you back seemingly eons before the revitalized Inner Harbor (which I haven’t seen) and The Wire (which I have). In my childhood, Johns Hopkins Hospital symbolized Maryland as much as the clams, the crab cakes and the Colts — pre-Indianapolis. My father worked there for three years. He was not a doctor – he was a technician who worked on medical machines. In fact, he worked on a machine that saved the life of my uncle following a brain aneurysm. He was one of several relatives of mine who lived in Baltimore in the 1960s. All of those relatives are gone. The historically black Provident Hospital where I was born is gone. P.S. 69 where my two older brothers and I attended school is gone. Yet, this historic Star Spangled Banner city lives on. I was happy to show my family a city that I really knew only as a boy. Of course Johns Hopkins Hospital still symbolizes Maryland – in the modern Ravens era.

My father earned an associate’s degree from Maryland Technical Institute – a trade school that no longer exists – in 1959. Shortly afterward, he started his new job at Johns Hopkins. Unbeknownst to me, as a kid I didn’t know Johns Hopkins was world renowned in medicine, but I was too young to grasp that concept anyway. I just took it for granted, like any other place. To me, the hospital was no different from Sinai Hospital in northwest Baltimore where my brothers and I would go to get vaccinations or anyplace else that required a trip to the hospital.

Then there was my mother. I don’t want to say she followed in my father’s footsteps, but she too worked at a hospital. I believe about a year after her first job as a cashier at a dairy store on Liberty Heights Avenue, a job that according to her lasted about three weeks (she admitted she wasn’t cut out for it – counting money fast wasn’t her forté), she began her first real job as a nurse’s aide at what was then known as St. Joseph’s Hospital, a suburban Catholic hospital in Baltimore County. I must have been six years old, maybe seven. Anyway, this job ushered in a long and more successful stint of similar positions at hospitals in Havre de Grace and the Army base at Aberdeen Proving Ground. 

My mother held those jobs after my family moved out of Baltimore to be closer to my father’s next job in Cecil County. Following his years at Johns Hopkins, he began work at the VA Medical Center in Perry Point – a residential government village in the northeast corner of the state between Baltimore and the Delaware line and across the Susquehanna River from Havre de Grace – and spent four years commuting on the 80-mile round trip between there and Baltimore on Route 40 before we settled there in 1966. The facility houses many Maryland veterans with psychiatric disorders; its idyllic campus with stately, early-20th-century architecture and white facades sits at the point where the Susquehanna flows into Chesapeake Bay.    

Perry Point was an interesting place for a child to grow up. Forty miles from Baltimore, 75 miles from Washington and 60 miles from Philadelphia, this quaint, Mayberry-esque village  was a world away from urban life. It comprised World War I-era houses, a police station, fire station, post office, credit union and community center, but no grocery stores – those were in nearby Perryville and Havre de Grace. Farms dotted the landscape a few miles to the north. Quiet streets where I rode my bike graced the neighborhood. Little League baseball occupied my brothers’ time as I, a less gregarious kid, was more interested in just watching Orioles games on TV. And all the working residents – primarily men – held positions at the VA hospital. Many of them were doctors. My neighbor friend’s father was a doctor, many of the guys I knew in Boy Scouts – that is, the ones who lived in Perry Point — had fathers who were doctors, and just about all the residents who lived on the street overlooking the Susquehanna were doctors. Yet again, my dad was a blue-collar technician.  

It was during this time – elementary school and high school – that I vacillated in my dreams of a chosen profession. I wanted to be either a doctor or a writer. Medical dramas like Marcus Welby, M.D. — one of my favorite shows from the early 1970s – inspired me, with Robert Young as the friendly family doctor walking into his office wearing a stethoscope around his neck and donning a white coat. However, since I figured my parents didn’t have the cold hard cash and I didn’t have the scientific acumen for medical school, a reality check set in with a penchant for the latter profession (more precisely, a newspaper writer in my adult years). On summer days I would sit in my room writing stories when I wasn’t hanging out with my best friend, whose dad was a psychiatrist. By the way, we’re still friends some 50 years later as two old guys – he has long since left Cecil County. 

I earned my driver’s license at age 16 around the time my father announced his training for a new job at a VA hospital in Little Rock, Arkansas. This occurred around the time he simply wanted to make a change for the family, as my middle brother and I set our plans for college. The nearest four-year school was the University of Delaware, 20 miles away, and apparently plans for living on any college campus were out. Anyway, due to the training, he would fly between Baltimore and Little Rock for weeks at a time over a period of roughly six months.              

On return trips home, my father would mention the grades he received on tests in his training. Overall they were pretty good, even though I didn’t remember all the scores. I distinctly remember his pride in telling my mother, middle brother and me (my oldest brother had left home to join the military by this time) about an A he received on one test. 

An adventurous type, I always liked to travel and experience new places. By this time I anticipated rather than dreaded the move not only to a new state, but also a new part of the country –   well, new to me since I never considered Maryland a real Southern state like Arkansas, not entirely new to my parents since they grew up in Louisiana. However, I was dating, and I knew I would forfeit my senior year at Perryville High School in the town next to Perry Point, so I was prepared to eventually tell the girl and my classmates goodbye by June of 1975. Two months prior to that month, my dad made it official when he came home from work and asked me, “How would you like to move to Arkansas?” I expressed my OK. Due to his job transfer, my mother would leave her job at the Army hospital in Aberdeen for a same job at the VA hospital in Little Rock. 

Initially he had prepared to move the family to Little Rock until some of his acquaintances at the VA hospital told him about a college town called Conway, 30 miles north of the city. I suppose he anticipated my brother and I attending college there following high school – yes, a new high school with a new mascot. My dad’s acquaintances told him about a Wampus Cat and he had fun explaining it to me.  

I remember sitting in my bedroom and getting out a road map showing Arkansas as I tried to locate Conway, then wondered if the town was in proximity to mountains. I heard Arkansas had mountains. No, it wasn’t the desert, as my high school French teacher envisioned.

Summer break arrived as we began the 1,100-mile drive across four states from Perry Point to Conway. As my dad drove across the Susquehanna River bridge on Route 40 with my mother in the front seat, I sat in back, turned around and glanced in the rear windshield at Perryville, wondering if I will ever see that town and Perry Point again. 

His official title as biomedical engineering technician, my father would commute to work at the VA hospital, a reprise of his commute to work during my formative years in Maryland — this time on Interstate 40 instead of U.S. 40, this time to Pulaski County instead of on Pulaski Highway. Gone was the camaraderie of kids whose parents were mostly in the medical field. Gone was the quaint village where those parents resided. Gone were the banks of the Susquehanna River where I played as a kid. I adjusted to a new environment of friendly high school students with Southern accents. I simply lived in a 1960s-era subdivision in Conway. I discovered a different river — the Arkansas River — and an adjacent place called Toad Suck. Furthermore, nobody rooted for the Colts – they called the Hogs.  

Unlike the verdant surroundings and unique architecture of the Perry Point VA hospital, the Little Rock hospital was situated amid urban, bustling surroundings, its brown, high-rise structure towering above Roosevelt Road and Interstate 30. I don’t remember ever entering the hospital with my father, at least during his early years there. I certainly don’t remember meeting any doctors there. Anyway, both my parents felt contentment about the move away from the East Coast. So did I, although I found the tornado drill at my high school quite unnerving.  

Eight years later, 1983. I had moved to Los Angeles almost two years earlier and returned to Arkansas to visit my parents for the Christmas holidays during a bitterly cold December. At least one night the temperature dropped close to zero degrees Fahrenheit and the snow stayed on the ground in what seemed like the entire two weeks of my visit. Anyway, I found it a nice change of scenery and climate from an early winter in Southern California.

I met some of my dad’s fellow technicians in the hospital basement. Talk among them and other hospital employees referred to the move to a new VA hospital under construction in midtown Little Rock. Many employees eagerly anticipated the move to more modern facilities compared to the dated atmosphere of the Roosevelt Road location, an east Little Rock landmark since the late 1940s. 

A year passed until my next visit to Arkansas, again for the Christmas holidays. My father showed me the new VA hospital where he and my mother were employed for just a few months. I remember as he drove up to the hospital with what I viewed as its avant-garde architecture, he revealed it to me like a long-awaited Christmas present. “Ol’ Blue Eyes,” he called the hospital, referring to the blue circular shadows surrounding the outer windows of the octagonal pods on the upper floors, much of the hospital still surrounded by soil from the new construction. 

We went inside. Its surroundings impressed me, quite futuristic I thought. It even had a robot that would roam up and down the halls like a voiceless teacher pacing back and forth. The interior kept the theme of the exterior circular designs in some of the walls. This time I did see some doctors but I don’t remember my father introducing me to any of them. 

My father would remain employed at the new VA hospital until his retirement in 1988, ending a 29-year career as a technician working on medical machines, 26 with the VA. My mother, as a nurse’s aide, would then carry the mantle of the commute between Conway and Little Rock until her retirement a few years later.

       *            *            *

It’s the 21st century, a new millennium, a new age in medicine. In my layman’s mind I still demonstrate some interest in the field. Long ago I kicked Marcus Welby to the curb and recently streamed an episode of ER. I have an administrative position at a medical facility but insistently denied to my uncle in Louisiana – my dad’s youngest brother – that I followed in my father’s footsteps, even with my move back to Arkansas, even with my father’s pleading back in the ‘80s that I should apply for a job at the VA where I am not employed. Yet my closest inclination to anything technical is my love of electronics – audio and video equipment and computers, that is. Medical machines? Nada. 

In February and March 2005, I would walk to the VA hospital to visit my father. Long retired, he wasn’t an employee this time – he was a patient. Gravely ill, he was connected to a machine – that very tool that epitomized his long career. Oftentimes in his critical state he would ask about my work, his work at his former employer remaining a distant memory. One day in March, I drove from home with my mother to visit him – it was a Sunday. That day would be my last time to see him before he passed away, in the very same place where he loved his career. 

Neither of my parents had a four-year degree, nor did they have the desire to earn one. But if there’s one example they set for me, it is that anyone who contributes to the medical profession is just as important as the scientists and researchers at the forefront. I carried that notion back when I was a kid and still do today.  

Almost five years after that road trip, I muse wistfully about my Maryland childhood and accept the reality that I can never get those times back. I’m settled in central Arkansas where fine health care exists without the marquee hospital names. I may never see Johns Hopkins Hospital again, except through documentaries and Hollywood-style renderings in movies like the Ben Carson one. However, through my blue-collar parents, I’ll never forget how hospitals managed to shape my life, regardless of my title or my attire. I’m also grateful for the professionals with whom I collaborate, and I’m grateful to be one of them without an M.D. or Ph.D. after my name. Most of those professionals work in administration, but I’m proud to say that I get to rub elbows with a few of those who don white coats.


Eric Moorehead, part of the Medicine and Meaning staff, is an administrator for the Institutional Review Board, Division of Research and Innovation. 

Filed Under: 3 - Non-fiction

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