FACULTY DEVELOPMENT | Volume 17 | Winter 2004
Why Be of Service?
By Lee Rachelle Wolfer, MD, MS, Clinical Fellow, Center for Spine,
Sports & Occupational Rehabilitation (CSSOR), Rehabilitation Institute
[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
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
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.