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Her Debt of Gratitude

A doctor repays kindnesses that saved her life
by living the Brody mission in Appalachia


By Jessica Creson Nottingham '06 '08   *   Photography by Jay Clark

 Dr Leslie Smith with Patient
“I’ve had patients come in wrapped in layers of
clothes only to find out they couldn’t afford heatingfuel and were living without heat in their homes in the dead of winter. I will go the extra mile and buy a tank of kerosene or a gift card to a grocery store for my patients. I feel obligated because someone once did it for me. It’s my way of paying folks back for their investment in my life.”


Dr. Leslie Smith

As Dr. Leslie Smith catches up with Mable Jones (right) during an appointment at her office in Boone, N.C., they chat about Jones’ vegetable garden, which slopes a third of an acre up the side of a mountain. She says tending to it depends largely on how her squeaky knees are feeling.

Jones is supposed to use a cane, she says, but substitutes a hoe in the garden. Hearing this, Smith is both concerned and relieved. She knows Jones enjoys gardening, the exercise is good for her and the fresh produce supplements her diet.

Smith, 52, knows how important something as basic as fresh vegetables can be to people living on the edge of survival. She understands her patients’ rural isolation. She also knows firsthand how hard it is for some people to see a doctor.

Roughly 25 years ago, Smith was homeless and nursing third-degree burns on more than a third of her body. She lived mostly in a shelter near Moore Square in downtown Raleigh, struggling for food and survival. For years she walked and rode buses to and from doctors’ offices and state aid agencies. Those experiences fueled the desire to be where she is today—a doctor focusing on underserved people.

Smith chose the Brody School of Medicine because its mission matches hers: to change how disadvantaged patients receive health care in North Carolina.

“Brody offered a small-town feel and a supportive atmosphere,” says Smith, who was in medical school here from 1998 to 2002. “Its focus on primary care and rural access to care issues are the reason I chose this school. My goal from day one was to work in the Appalachian Mountains in primary care. I also enrolled in the Rural Health Scholars program, which prepared me for rural medicine.”

The door to medical school opened when Smith received the UNC Board of Governors’ Medical Scholarship. As a medical student she embraced rural living. “I lived in Stokes (about 10 miles northeast of Greenville) and commuted to campus,” she says. “My neighbors, Joyce and Johnnie Briley, fed me every night during medical school. They are farmers and really epitomize country living and good old-fashioned hospitality.”


Graces that truly save

Smith was 24 when she was discharged from UNC Jaycee Burn Center in Chapel Hill. A lawyer drove her to the Raleigh Rescue Mission because Smith had nowhere else to go. She was instructed to go to Social Services for further treatment, but wearing bandages from her neck to her ankles made mobility difficult. Urban Ministries was closer, so she went there instead. And that’s when she asked Sister Helen Wright about city bus tickets.

A native of Canada, Wright had joined the Sisters of Notre Dame after graduating from college in Boston. She received a doctorate in theology in Toronto, then served many years as a teacher and counselor at several colleges, including a time at Harvard University. She came to Raleigh in 1981 to lead the Urban Ministry Center.

With one look at Smith, Wright knew she needed much more than bus tickets. In a couple of hours, Wright had arranged several medical appointments for Smith and secured donations for the bandages, bus passes and food and pharmacy vouchers she needed to get on the road to recovery. These were not Wright’s typical duties, and Smith, who grew up in a broken home, was so shocked by her kindness that she was determined to make the nun’s efforts worthwhile.

“Sister Helen was very motherly when I was on the streets,” Smith remembers. “But then, as the years went on, she became my mentor and she kept me grounded. The relationship took a turn when she ended up in a nursing home. She was 94 and outlived all her family members. She had no one to be with her and I became her family member. I was holding her hand while she died. It was really sad.” Wright died this past April.

Smith spent a few more years living in the streets, sleeping in shelters and temporary homes and traveling to the burn center three times a week for follow-up care. Her recovery took longer because of her lack of access to health care and proper nutrition. At one low point, Smith was standing in line at a shelter, weighing just 69 pounds with ailing skin grafts. Another homeless person took notice and sat down with her on the curb, both losing their places in line. He left to go begging for spare change and returned with a bag of chips and a soda that they shared.

These experiences shape the relationships Smith has with her patients. “I’ve had patients come in wrapped in layers of clothes only to find out they couldn’t afford heating fuel and were living without heat in their homes in the dead of winter,” says Smith. “I will go the extra mile and buy a tank of kerosene or a gift card to a grocery store for my patients. I feel obligated because someone once did it for me. It’s my way of paying folks back for their investment in my life.”

During her frequent trips from Raleigh to the burn center in Chapel Hill, Smith got to know the bus station manager. He learned her schedule and would greet her with hot tea and conversation. “I enjoyed the trips to the burn center after that,” Smith said at one point during a 2008 speech to the World Burn Congress meeting at the Raleigh Convention Center. “He made me feel normal as a homeless person.”

At that point, it had been five years since the burn accident. Her left arm had a muscle and skin contracture so severe that she used a wheelchair to avoid falling. Weak from malnutrition and the injuries, she was admitted to a nursing home. Three meals a day and the care from full-time nursing staff restored her strength.

She became a member of an organization called Handicapped Encounter Christ. During a weekend retreat with this group, she met a woman who worked in pharmacology, a field that interested Smith. On a leap of faith, this woman put her in contact with Dr. John Drake of the National Institute of Environmental Health Science (NIEHS) in Raleigh, who gave Smith an interview for a volunteer research position. To prepare for the interview, Smith needed a bath but her nurse was out sick. For the first time since her accident, she gave herself a bath.


Recovering and finding success

Smith began volunteering in a lab at the NIEHS; the job eventually became a paid position. She moved into an apartment with help from an independent living program and returned to physical therapy, which allowed her to ditch the wheelchair. While these were huge steps forward, she accomplished the seemingly impossible next. She found a plastic surgeon willing to correct the skin contracture after visiting a few who turned her down.

“I remember sitting in a plastic surgeon’s office trying to get a contracture release done on my left arm so I could use it again,” says Smith. “The plastic surgeon did not want a homeless person in his office and made it very clear I wasn’t welcomed there. I never forgot how that made me feel. My life was no less valuable than a woman who would come in with cash for cosmetic surgery, yet I felt worthless on that particular day.”

“I will never let my patients feel that way,” Smith continues. “Each person who comes into my office is important and gets my undivided attention during their appointment.”

Drake encouraged Smith to enroll in summer classes at N.C. State University to better understand the work done at the NIEHS lab. With a few classes under her belt, she grew more confident to take it another step. She had heard about a scholarship GlaxoWellcome, the pharmaceutical giant headquartered in Research Triangle Park, offered students who had overcome adversity. She applied for and earned the scholarship, which paid all her undergraduate expenses to a university of her choice. Before she knew it, she was studying biochemistry at Duke University. She graduated from Duke in 1997.

Smith initially was interested in earning a Ph.D. in genetics after deciding against medical school. She felt she could never be in the same social class as doctors, based on the rejection she’d experienced as a homeless person. She had to be convinced otherwise.
Still very involved with Handicapped Encounter Christ, she needed the help of a physician to be present at the group’s events. Dr. Warren Newton, who is now the vice dean for education at the UNC School of Medicine, agreed to attend a fundraiser with the stipulation that Smith would agree to discuss attending medical school.

“He said some things that really haunted me,” says Smith. “Particularly, if we don’t get people in (medicine) for the right reason, it’s not going to change. And, ‘who better to change the system than somebody who’s been through it?’ That’s why I changed courses, but I certainly couldn’t have done it without the Board of Governors scholarship.”

Smith earned the UNC Board of Governors’ Medical Scholarship, which paid her way through medical school. She completed her residency in Louisville, Ky., then returned to North Carolina to practice medicine.


Paying her debts

Since 2003, Smith has served western North Carolina as a physician in private practice and by helping out at health departments, free clinics for farm workers, hospice and mission work. Patients frequently drop off baked goods and vegetables from their gardens.

“I still don’t believe I am a physician,” says Smith. “I feel grounded to where I was on the streets and how I grew up. My patients say I am easy to talk to. It is because I sit down with them and talk to them like we are neighbors. I don’t put myself above them, and I strive to live a simple life of service.”

Smith’s patients find her unchanging warmth and positive attitude to be something special, and her love for dogs is often shared. After a devastating ice storm, Smith ended up practicing in Marion, a small town 50 miles south of Boone, for roughly a year while her home was being repaired. Mable Jones, a longtime patient, said she “about cried” when she learned Smith had to leave. “She’s always the same every time you talk to her,” Jones says. “She don’t beat around the bush or use big words. I can call her at home and I’ve gone to see her three wonderful dogs.”

Judy and Robert Plane were in dire need of a physician and had heard stories about Smith. During Smith’s storm-induced absence, they waited patiently for a doctor they had never met and even considered moving because they could not find a doctor in the Boone area. “I can’t say too much about her,” says Robert Plane. “She’s a wonderful doctor and human being, and that means a lot more. You can’t be one without the other. A lot of people are good at what they do, but have no personality. She’s the same every day when most people are good one day and bad another.”

Traveling to remote mountain communities to practice medicine is another passion Smith has developed. As a member of the Rotary Club of Boone, she takes a yearly mission trip to a third-world country. “Since becoming a physician, I have stayed in adobe huts in Ghana, in tents in school yards in Honduras and deep in the mountains of Kenya during the rainy season,” Smith says. “I am just as comfortable in these places as I am in my home. I think it is because I know what it’s like to be without a home. I have learned a home is where your family and friends support and value you.”

Honoring Smith’s wish for privacy, this story omits the painful circumstances related to her homelessness and the cause of her injuries.

It has taken a village of people for Smith to become a doctor and to make a difference. The small acts of kindness did just enough to steer her in the right direction. “The people of North Carolina picked me up when I was down and I will always be indebted to them for that,” says Smith. “When I die, I am going to leave this state with my debt paid. That is my goal and my aspiration.”