Editor’s note: The following is a continuing series of excerpts from “Come to the Edge: Arrival and Survival in Del Norte County” by College of the Redwoods English Professor Ruth Rhodes.

Katrina Groves provides a physician’s perspective on living and working in Del Norte County, including challenges faced by her patients at Open Door Clinic:

I came to Del Norte County in August 1992 at the age of 31. Working at Open Door Community Health Center was my very first job as a family physician. What brought me here? Two words: loan repayment. I had twelve years of education debts from college, graduate school, and medical school. There was an opportunity for a loan repayment through the National Health Services Corp for those willing to work in an underserved area. So, to be honest, that’s what drew me to Del Norte.

In my residency program in San Bernardino, I met my future husband, Warren, who is also a physician. Warren actually wanted us to look for job opportunities more north, up into Oregon, Washington or even Alaska, which was his dream. He’s from Minnesota and not afraid of weather. But I’m from sunny, southern California. So we argued about it and I eventually refused to go past the state line!

Little did I know that Northern California is like a whole different state. I interviewed with Herrmann Spetzler, the patriarch of the Open Door. He and his wife Cheyenne helped start the first clinic in Humboldt County and then added the Del Norte Community Health Center on A Street in 1991, near the old Sutter Coast Hospital. Herrmann saw an opportunity to get two doctors—myself and Warren—to a medical shortage area, so he hired us on.

Herrmann just recently passed away and we all mourn his loss. Over the years, he and his wife Cheyenne have worked tirelessly to build many more Open Door Community Health Centers serving the North Coast. I’m very proud to be a part of this legacy. But, to be honest, when we came to this small rural town, we had no idea we would still be here twenty-six years later.

I was forty by the time I was able to pay off my loans. Yes, we’d been thinking of moving elsewhere. But by that time, we had children, and we all saw the advantages of staying in the area. Living near these amazing redwood trees, the clean air and water, the swimming and kayaking, the hiking, the ocean, the fishing. It was just paradise—a safe and healthy environment compared to Los Angeles where I was raised.

But it took us a while to really believe we could stay here. It was hard for me at first without the malls and the culture. Growing up in L.A., I was able to go to see plays like Phantom of the Opera and go to symphony orchestras with my mom. We saw movies like 2001: A Space Odyssey at the gigantic Cinerama Dome. We saw Baryshnikov and went to many ballets. Even driving the freeways was exciting for me. We had so much access to so many activities.

When I first came here and heard on the radio “There’s a little red bike lost around 9th street. Please call KPOD if anyone has seen it,” I thought to myself, “What kind place is this?” The fog and the cold got to me. I would bundle up with extra layers even inside the office. I had to have space heaters at work in the summer! It was both a cultural and environmental shock.

Early on, Warren and I would talk. I would say, “Okay, we’ll only be here for a few years, and then we’ll leave because I’m sure the schools aren’t very good.” But once we had our two boys, we found the schools were actually great. The preschool teacher was kind and patient. All the teachers at Mary Peacock from K-6 seemed excellent. As a parent volunteer, I got to know the faculty and saw how hard they worked and how much they cared for all their students.

You have to understand, Del Norte schools were not like the schools I went to when I was growing up. I was moved around a lot due my dad’s work. We ultimately landed in L.A. where classrooms were huge and kids were sort of invisible. But here we found a close knit community with people who cared for each other and helped each other through crises.

We thought about moving again when the kids were in middle school and then “for sure” before high school, but by then we were hooked. It’s just amazing how much there is for kids to do here if you get them involved: jujitsu classes, music lessons with Sybil Wakefield, the GATE program, the Madrigal Choir events and the Steel Drum Band led by Dan Sedgwick. He recently was proclaimed Teacher of the Year by the Northern California Band Directors and Choral Directors Association!

Everywhere we looked to move, we just couldn’t help comparing it to here. All the otherplaces were just lacking.

But before kids, before all that, it took a while to adjust to the culture shock. The first few years I was in hiding. I did not want to get to know my neighbors or make friends. In my world, that just wasn’t done, and I thought we would be moving soon, anyway. So we’d drive down to Eureka and go to Costco or over to Ashland to the Oregon Shakespeare Festival, or go have Indian food in Medford. We’d drive anywhere to get to a bigger city with more things to do and more variety.

But once we had our boys we stayed home more and found ourselves going to community events instead. Our best friends wereour anchors then. They still are. Athena Csutoras is this amazing“earth mother” who can grow a huge garden, feed any number of people who just happen to drop by, make a picnic table from scratch, and fix pretty much anything that breaks. My boys and I were lucky enough to be included into her family, and we learned so much from her. Her husband Jimmy was a fisherman, so we learned to live more off the land. This reminded me of growing up with my dad, who was a country boy and used to take my sisterand me on camping trips and other family adventures. So living in Del Norte County was like going back to what is really important—family, friends and nature. I got used to it again, and after a while, we hardly ever left town at all.

Now my perspective has changed. I hate the “long” ninety minute drive down to Eureka. I don’t miss the malls. I don’t like those big city freeways anymore. This place became my home.

I miss a little of the cultural events available in an urban setting, but we have found our own culture here. My husband and I enjoy singing in the North Coast Chorale. Christie Lynn Rust is the most energetic and fun director! With her passion for travel we have been able to visit Europe twice and sing in incredible cathedrals in Poland, France and Germany. I never even knew I could sing before! I also took viola lessons while my kids were learning violin, and I even got to play with the local orchestra in Lighthouse Repertory Theatre’s rendition of Oklahoma. I have such special memories of my dad and mom who came to watch these performances. I could never have played in an orchestra in a big city.

Coming to a small town helped me get out of my preconceived notions of who I was. I thought I was a city person, but once I allowed myself to be at home here, things started to feel right. In Los Angeles, you don’t know your neighbors. You don’t want to know your neighbors. You don’t want to know the person you’re driving next to. But here in Del Norte County, I’ll be riding with a friend, and I’m shocked as she’s driving down the highway and saying “Oh, there’s so-and-so” going by in their car or walking down the street. And everybody waves! Well, now I wave too.

As far as the medical care here, when Warren and I looked at other places to move, we kept comparing other jobs with the clinic in Crescent City. We did not see anything better than where we already were, except perhaps an increase in salary. I love the mission of the clinic—to compassionately care for all people, regardless of their ability to pay, regardless of their race, language, sexual orientation or religion. People tend to stereotype our patients at the clinic. Many people think that our clinic is “just for people on Medi-Cal.” But we have many people who have good insurance and can go anywhere and they choose, but they come to us because we provide excellent care. Some of our patients often do have difficult life challenges and conditions which are hard to treat. But I love providing care for these folks, even if the clinic can’t compensate me as much as other places might.

For me, it’s not about money or status. I don’t want to work in some boutique practice where they’re just about giving Botox or something. I don’t want a mink coat or a Jaguar. I’d much rather be able to practice medicine one person at a time than worry about the business end of things. I have a roof over my head and live in a beautiful place. My kids have gone to college and are doing well.

My life is about my connection to people—people who every day share intimate details of their lives with me and trust me to help them through tough health care problems. You ask about what contributes to poor health outcomes here. Poverty, mental illness, drug use—yes. Just like many small towns across America. Unfortunately, people are being stigmatized and judged for these problems. In our county, and all across the country, there is a pervasive attitude that people on Medi-Cal or people who are homeless must somehow want to be like that, and they are “weak or lazy.” I have found just the opposite. Many people have had traumatic childhoods and haven’t had all the blessings in their lives that we have had. The stigma—the judgmental attitude of others, though, makes it hard for people to get the health care they need. Having to go out of town to see specialists and having no way to get there, for example, is a serious challenge. I think as a community, we are only as healthy as our least healthy resident.

If we all try to have more compassion and empathy, we can help lift people out of poverty and homelessness. Homelessness won’t go away by ignoring it or covering it up or shipping people off somewhere else.

One of the most rewarding parts of my practice has become treatment of addiction. The opioid crisis has been sweeping the United States, and it’s in our little corner of the world, too. In the late 1990’s, physicians like myself were taught that pain was the “5th vital sign” and that prescribing even high doses of narcotics to prevent pain was the right and humane thing to do. But now the pendulum has swung the other way, as some of those people treated with opioids got addicted, and many were still having pain despite their pills.

I felt that if I helped create the problem, I should try to help fix it. So we started the Suboxone recovery treatment program at the clinic in 2009. It began with just six people and it has grown to over one hundred.

There are a lot of misunderstanding and judgmental about addiction. The old-school thinking is that if you punish people enough (like sending them to jail or prison), they’re going to learn to stop using drugs. But we have seen over and over again that punishment just doesn’t work. We need to switch that mindset. Drug addiction is a brain disease. It’s not a character flaw or a weakness.

In order to get better, people with addiction need compassionate treatment, medication, and behavioral skill and life skill training, just like patients living with any other chronic disease. These folks have PTSD, depression, anxiety and other problems, and they often come from terrible backgrounds. They are often traumatized. They’re covering up their pain and their emotions with drugs. Yes, they need to do their jail time for things they did while under the influence, but then if you can get them into a treatment program, over time you can help them heal and show them how to change their behavior. Otherwise the majority will be right back to the streets and the vicious cycle continues.

We need to remember that when somebody’s addicted, they have an illness. We should treat them as such. If a diabetic eats a whole chocolate cake, are you going to kick them out of your practice because their blood sugar levels are too high? If we as physicians could see the people who are addicted in our community as people with a disease and work to help them help themselves, we could really make some headway.

There is a great quote I’ve seen about people who suffer from addiction: “We are not bad people trying to be good, we are sick people trying to get well.”

I see people every day who have turned their lives around and are going back to school, getting jobs and taking care of their families— engaging in a full life—and that is the most rewarding part for me.

How does the methamphetamine problem compare with the opioid problem here? Well, meth is a serious issue as well. And to compound the problem, some addicts use heroin and meth together.

In my practice, we focus on opioid addiction because we can do something about that with medications like Suboxone. But to date, there’s no antidote or “drug blocker” for meth, though I hope and pray there is one soon. Research is ongoing. Sometimes we have seen people be able to get off meth as well as opioids when they get into a recovery program.

Many crimes are directly related to drug use, and so if we can get these people in treatment, the crime rate will go down and our community will be safer for all of us. But sometimes law enforcement officers see things differently. They look down on addicts because they see them at their worst—committing crimes and injuring others. They just want to think of them as “bad guys.”

But other law enforcement officers are beginning to see that we need to work together for the good of the community. Our local Sheriff, Eric Apperson and our local Superior Court Judge, William Follett, have been very open and willing to look at ways they can help break the cycle of drug addiction and crime. They see that we need to offer these people treatment.

Open Door Community Health Clinic is also working with the local Opioid Coalition, along with the Public Health Department, other community physicians, a local pharmacist, mental health care providers, and law enforcement. We’re doing some really important work, helping to spread the word that treatment is available for addiction. We’re also trying to get the narcotics off the street by prescribing them less often and in lower quantities. We’re also trying to get more Narcan out in the community, which can save lives when someone has overdosed.

I think it is terrific how a small town can really get things done when people work together for a common goal. We’re making inroads into looking at systems and policy change locally, but we still have a long way to go. It’s hard to change preconceived beliefs about drug use.

Stigma also makes helping homeless people more difficult. Moving them out of the county is not the answer. We need a homeless shelter here. Most of the homeless population suffers from mental health issues, and often from drug addiction. Ironically, in a lot of communities, being homeless disqualifies you for drug treatment. The outcomes for recovery are so poor when you don’t have a home. So it’s a terrible cycle that just perpetuates itself.

I have been impressed by acts of kindness that have had big payoffs here. Del Norte County Mental Health Department went into a homeless area recently and brought a person into a recovery house, and then into our drug treatment program. That person is now getting needed medical care for the first time in forty years.

They went in to get him. Sometimes, to help people, it has to happen one person at a time.

Do I plan to stay in Del Norte County? I wish I could. My mother died about a year and a half ago, and so my sister and I have been taking turns looking after my dad. But it’s been a challenge doing that and working.

After twenty-six years, I’ve had to tell my patients that I’m leaving. This has been one of the hardest things I’ve ever had to do.

Lots of tears. Leaving the clinic staff feels like leaving my family.

I knew I was going to be sad, but I can’t believe how sad I really feel. I can’t believe how upset my patients are, too. Not only have I helped them over the years with their health problems, I’ve also cheered them on through their successes. They watched me go through my pregnancies and were so understanding during my own ups and downs in life. Of course there are professional boundaries, but I felt it was okay for me to be human, too, sometimes. I learned that here. Connection was one of the things I was most afraid of coming from the big city, and yet it’s turned out to be one of the greatest thing about being a doctor here.

I love these people, and I’m having to leave them. Sometimes I feel like a traitor. But my husband and my patients tell me that I am doing what I need to do to be a good daughter, and I do believe that. I know that doctors will come to replace me. But no matter where I go, I will always have a special place in my heart for this place and these people.

The closer I get to leaving, the more I find there is to do. So many things to wrap up. That’s part of the reason I wanted to do this interview, so people can understand what it has meant to me to be a doctor in this town for so long.

We’ve lost of medical providers at the clinic many times. They join us, and then they leave for various reasons, often because of the isolation. We’ve had to just pick up the pieces and be there for the patients. Now, I guess other people will have to pick up the pieces for me.

But my heart will always be here. And who knows. I may come back.

— May 3, 2018