Why Be of Service?
By Lee Rachelle Wolfer, MD, MS, Clinical Fellow, Center for Spine, Sports & Occupational Rehabilitation (CSSOR), Rehabilitation Institute of Chicago

[Editor's note: Dr. Wolfer was formerly a Resident in Physical Medicine & Rehabilitation at Spaulding Rehabilitation Hospital; in October 2003, she returned to HMS to receive an HMS/HSDM Dean's Community Service Award in recognition of her work with Community Rowing, Inc.]

Why be of service? Medicine is, after all, a service profession, isn't it? I think many doctors want to "help people," however, this statement has become so empty and clichéd, that it is a "red flag" raised against those seeking admission to medical school. How do we articulate or demonstrate our commitment to a career in medicine? As a physician, my viewpoint is informed by having been temporarily disabled from chronic back pain before going on to become a Physical Medicine and Rehabilitation doctor specializing in Spine and Sports Medicine. My road to recovery was made possible by years of working as a disability activist. Here is one story about being of service.

First, I learned that helping is not about doing things for or to the less fortunate. Service offered with empathy, not sympathy, is the model that respects human rights. This is particularly true in working with persons with disabilities. In the last two decades, our society has moved from a patronizing medical model of "curing" the pitiful victims of disability to a civil rights model of affirming that people with disabilities are deserving of the full rights and protections offered to persons regardless of sex, race, national origin and so forth. As a community, people with disabilities number near 50 million as defined by the Americans with Disabilities Act (ADA 1990).

Physical Medicine and Rehabilitation (PMR) or Physiatry is one of Harvard's newest residency programs. Physiatrists treat many people with disabilities. At Spaulding Rehabilitation Hospital in Boston, MA, physiatrists care for patients with traumatic brain injury, amputation, stroke, spinal cord injury and orthopedic injuries. In the outpatient sector, physiatrists work in musculoskeletal medicine, including interventional spine physiatry, pain management, electromyography, occupational medicine and sports medicine. The focus in Physiatry is on quality of life and return to function.

I became temporarily disabled in 1986. I was a final candidate for the US National Rowing team and while training for club nationals, I herniated a lumbar disc. Today, I have only occasional back trouble due to a successful rehabilitation. My experience as a patient included six weeks of strict bed rest (23.5 hours/day), a failed laminectomy back surgery, chronic sciatica, living on welfare and disability benefits, rigid custom-bracing, and so on. I entered the University of California Berkeley - UC San Francisco Joint Medical Program (MD & MS) as a disabled student and became actively engaged in the local Independent Living Movement. During this time I decided to become a Physiatrist. The negative beliefs and attitudes of my colleagues towards disability and the specialty I had chosen still stand out.

While on a rotation in the intensive care unit as a medical student, I asked to be assigned to a patient who had both C5-tetraplegia and a left-sided stroke causing hemiparesis and expressive aphasia. The nurses said this was a waste of my time because there was nothing to learn from this patient. My senior resident said: "I would rather be dead than end up like that." As a future Physiatrist, how would I hold out hope and optimism for those with disabilities?

I remember in the first week in Boston for my PMR residency. On an early morning, I walked down to the Charles River to see the crew boats. As I watched the boats pass by, I simply sat down and cried. Here I was 14 years later and not being able to row still broke my heart. In that moment I resolved to row in the Head of the Charles Regatta. This idea was a longshot, if not an impossible dream, because I still had significant back pain and functional limitations.

Fortunately, in the years since my original injury, the approach to spine rehabilitation had changed dramatically. I completed an aggressive spine rehabilitation program of weight-lifting, flexibility training, and core strengthening. Rehabilitation also included mental training to teach me about "safe pain" and how to undo fear avoidance beliefs and behaviors I had adopted as a chronic pain patient. After completing the rehabilitation program, the back pain decreased dramatically and my functional abilities increased likewise. I got the green light to row again! I joined the only all-access boat club on the river ‹ Community Rowing Inc. (CRI) ‹ and learned how to scull (row a one-person boat).

I entered the Head of the Charles Regatta as a charity participant in support of Community Rowing Inc., one of the five official charities. I supported CRI because they make both the river and rowing accessible to all. CRI was the first organization with an Adaptive Rowing program for persons with disabilities, offering rowing lessons for students at the Perkins School for the Blind. CRI also challenged the longstanding class and race barrier in rowing by offering rowing lessons to African-American adolescent girls.

In 2003, I rowed in the Head of the Charles Regatta for AccesSportAmerica, a national non-profit organization dedicated to the discovery of higher function and fitness in children and adults of all disabilities. Spaulding Rehabilitation Hospital partnered with AccesSportAmerica two years ago, to open a $1.5 million dock on the Charles River, devoted to adaptive sports for inpatients and outpatients and offering high-challenge sports including: rowing, windsurfing, kayaking, water-skiing and so forth.

I recovered from the myriad layers of chronic back pain by being of service to other persons with disabilities. Each of us can find her/his own path to service in medicine. I might go so far as so say that the clearest path you find will be the one that is most authentic. Who are you and why do you want to be a doctor? Go back to your embarrassing personal statement, if you must, to re-kindle that vision and enthusiasm. Many of us have been shaped and shifted by an experience with an ill loved-one or friend, a family doctor, a homeless person, a brilliant researcher, or someone else significant in our lives.

What I hope this story articulates is that I found my power, my career and truly my happiness from a great big disaster. I missed out on making the US National Rowing Team, had a failed back surgery and became the chronic pain patient from hell (that most doctors dread). My greatest strengths were ultimately born out of vulnerability and pain. My rehabilitation was made possible by being a member of and being of service to the disability community. In the end, the truth is that I have received much greater gifts in return through this experience than I have ever given through community service.

I will leave you with the vision that one day the Head of the Charles Regatta will have rowers with disabilities, just as the Boston Marathon has racers in wheelchairs.