Rachel Langley served in the Air Force for over a decade, most recently as a flight surgeon on a base in Germany. She is also one of my oldest friends. We talk about her path to becoming a doctor, the challenge of separating from the military and her new work in a direct care model practice.
Mentioned in this episode:
– Pine Ridge Family Medicine (the Direct Primary Care Practice that Rachel works at)
00:05 Speaker 1: This is Do Good, Be Good, the show about helpful people and the challenges they face in trying to do good. Your host is Sharon Tewksbury-Bloom, a career do-gooder who also loves craft beer and a good hard tackle in rugby. Sharon speaks to everyday people about why they do good and what it means to be good.
00:25 Sharon Tewksbury-Bloom: Welcome back. This is your host, Sharon Tewksbury-Bloom, with another episode of the Do Good, Be Good podcast. Today we have a treat in store because one of my longest friends, we have been friends since preschool, agreed to join me for a conversation about her work. I often refer to my friend Rachel Langley as Captain Doctor Mommy, though I believe she’s actually went above the rank of Captain, because she is Officer in the Air Force, she is a doctor, a medical doctor, and she’s a mother of four. She is one of the hardest working people I know and is always thinking about how to help others and do good. So who better to interview for this show? Thank you for patience with the sound quality on today’s episode. I interviewed Rachel remotely as she now lives in Colorado Springs, Colorado, so the sound quality on her side of the conversation is not perfect, but I think it’s pretty good, and hopefully it doesn’t detract from the conversation.
01:33 ST: Rachel has been one of my best friends since we were in preschool, and I’ve known ever since we were very little that she had the propensity to be a doctor. I remember her prescribing me with medication when we were in elementary school. Don’t worry, the medication was just M&M’s, but she kept them in a real prescription bottle, so it looks pretty realistic. She also loved anything medical even though I’m a fainter, I would be completely grossed out, had to run out of the room, and she just wanted to dig right in and learn all of the details and look at anything that was bleeding or pussing or gross. So yeah, Rachel has had that tendency since she was really little, and we start off today’s conversation talking about how she got interested in medicine and how she got started on the path of becoming a doctor.
02:32 ST: I just watched a comedy special by Mike Birbiglia, and he talks about his first realization, maybe in high school, maybe even in elementary school, that there were certain things he was learning that he was not gonna retain.
02:47 Rachel Langley: That is a profound realization.
02:49 ST: And he talked about the first one being photosynthesis.
02:53 RL: Right. Oh, man. I remember the structure of a cell just blowing my mind. Okay, first of all, this cell is the smallest thing you can possibly imagine. Forget atoms, forget anything smaller than that. It has stuff inside it. And you’re supposed to comprehend that. That must have been eighth grade, and I was just baffled. This stinks, I’ll never understand this, this is too small to ever imagine.
03:15 ST: My mom said she gave up on science when she learned about atoms. [chuckle]
03:20 RL: [laughter] I’m never gonna get it.
03:22 ST: She said she believes they exist, but she just… It blew her mind to the point where she just couldn’t process it anymore, the fact that your body was made up of these things and that they were moving.
03:33 RL: Yeah. Little things, and they’re mostly space anyways. You’re like, how do I even have substance?
03:39 ST: Yeah, exactly. She said it started to just send her into existential dread or something and she couldn’t go further.
03:47 RL: So yeah, I became a middle school teacher because everyone told me how being a doctor is awful and the worst thing you can possibly do. So when I graduated from college, even though I’d taken pre-med everything, I went and became a middle school teacher for two years. And it was really, really, really great, but I still wanted to be a doctor.
04:04 ST: I remember it was also really, really hard.
04:07 RL: Being a teacher?
04:08 ST: Yeah.
04:08 RL: Yeah, but who am I to say, “No, it’s too hard, I’m not gonna… “
04:14 ST: I happen to remember those years as being years where you were really struggling with, “How am I gonna do this?” and “I don’t think I wanna do this for the rest of my life.”
04:23 RL: I grew so much… In a way, it’s parenting. I learned how to discipline kids and how to relate to kids, and how much relationship is important to getting kids to listen to you. If you don’t have a relationship where they love you and trust you, you’re not gonna get them to do anything. So learning how to build that with kids has really been a benefit as a parent in the future. And, oh man, you would just grade papers all weekend. It was so miserable.
04:50 ST: So instead, you went to be a doctor in the military, a much easier path.
04:56 RL: Right, exactly.
04:57 ST: So you said you had that inkling you wanted to be a doctor and you got off course for a bit, but then you got back on course to do that. What led you to pursue being a doctor through the military?
05:10 RL: My family is military, so I knew what it was gonna be like-ish. They were offering me a whole lot of money. It sounds really nice to not be in debt. I figured that you’re in debt one way or another. You’re either serving your country or you’re in debt to the bank, and I prefer to serve my country, so that’s why I chose to go that way. And also, working out wasn’t a big deal to me. I’d already grown up with the military mindset a lot and moving around, and I hated fashion, so the idea of putting on a uniform every day was fantastic. I am totally about wearing combat boots to work everyday. That was really nice. I’m struggling with fashion now. So that was a pretty easy fit to join the military and get everything paid for, for just a few measly years of my life.
06:00 ST: [chuckle] You mentioned being in a military family and already knowing what that entailed to go into the military, what was something that surprised you or wasn’t what you expected once you entered the Air Force?
06:00 RL: It’s hard to tease apart what was military and what was medical. Residency shocked me in how hard it was. It was really hard. But on the flip side, residency… When I was going through medical school, I mean, that’s really hard too, but I just accepted, hey, there was something we would tell each other when we were really struggling with the test. And you know what they call the person who gets the lowest score on their test on the graduation day? Doctor. So stop stressing about getting everything right, do the best you can and get through this. So I never thought of myself as anything special or anything fantastic in medical school. I was just gonna be an average doc. I thought of myself as a pretty darn good teacher and so I pushed myself a little bit further to go to medical school. So I was gonna be an average to average doctor and I was okay with that. We need more doctors, we need more family doctors especially so, an average doctor who just refers people out to other places for hard things, that was fine with me. It sounded like a good living, I could deal with that. But then in residency, I don’t know if it was because it was military or residency in itself. But that’s where I felt like I… They pushed me to become an amazing doctor.
07:31 ST: I asked Rachel if having a baby during medical school was also part of what made it hard?
07:38 RL: So yeah, I’ve had a baby at each stage of my medical career, one in med school, one in residency, one in my first assignment, one in my second assignment, I just like to collect them from various places. But those medical school adventures were indeed interesting. It was my fourth year of medical school so I was trying to figure out where I wanted to go to residency. So I was gonna Florida and to Las Vegas and to the DC area for my top picks. And my husband had a job because I wasn’t making much as a med student, even supported by the military. So he was back home doing his job, and I really wanted to continue to breastfeed my baby who was three-ish months old, three to four months old. So I took her with me, and the military wasn’t very happy with that, you’re not supposed to take people who are not on your orders to your places that they’re ordering you to go to, for example, I went to Las Vegas, and I had gone around the rules by trying to make like a hotel reservation on base.
08:32 RL: You could only reserve it for three days at a time if you were travelling with a baby, dependent. So I had, me and my husband had called every other day to make three day reservation blocks throughout the month. And apparently, the day before I showed up, they saw that and figured me out and cancelled all my reservations. So I showed up and they said, “No, you’re not allowed to do that.” And I said, “Well, I’m here. I’ve got my work that I’m supposed to do. What am I gonna do? I have a baby, I wanna keep nursing. I had childcare for them during the day, you’re really gonna kick me out?” And I stood there in the lobby and sobbed for them a little. Second lieutenant in uniform with her baby on her hip, just sobbing. And it was, I mean, maybe it’s not so feminist of me, but I’m definitely willing to bust out the tears if things are just ridiculous. And I was not holding back at that point. And I got my hotel reservation, they kicked me out for a week because they said they didn’t have space for a certain week.
09:31 RL: So they paid for me to live off base for a week and it was very hectic trying to move everything that I had for a month of living there with a baby by myself but we survived. And then we went on to another month in the DC area and lived with your very generous parents. And I would wake up at 3:30 in the morning, get ready as much as I could while my baby slept, get my baby ready, eat breakfast and then with traffic cause for an inpatients rotation, I had to be there I think at 5:00 AM, and then drop off Monica at a care provider that I had interviewed for one second before I chose her. Yeah, and I trusted her for a month with my child and it all worked out. So, but it was crazy. It was hard. But it was so worth it. And now I have fun stories to tell. And that’s one of my favorite things about hard things in life is that then you have an awesome story to tell and a way to encourage other people.
10:27 ST: Isn’t that part of your family motto? Is it, Langley’s do it the hard way. [laughter]
10:34 RL: It’s true we do. We try to keep a strong family culture with certain phrases like that that are mildly motivated perhaps when you’re on a hike in the rain with your, how old was she? We did a three mile hike with my six year old and it rained the entire time and that’s one of our favorite stories to tell her to remind her that she can do amazing and hard things.
10:56 ST: Definitely seems like a military family to me but…
11:00 RL: Military families are [11:01] ____ or.
11:08 ST: I just want to take a quick break to remind you that you can find the show notes for today’s episode and more information about our show at dogoodbegoodshow.com. And in order to get every episode in your podcast player right away, you can subscribe for free, through Spotify, Stitcher, Google music, Apple podcasts, whatever your podcast app of choice is. If you prefer to listen on live streaming through the website, that’s just a Do Good, Be Good show. And also you can follow the show and comments, share in the conversation on Facebook at facebook.com/dogoodbegoodshow. If you have suggestions for other guests or any ideas, feel free to contact me at firstname.lastname@example.org. Now as we get back into the conversation, Rachel and I talked about how her transition is going as she has recently separated from the Air Force.
12:07 RL: It’s been a big change and they do a really good job of really pushing you while you’re in the military. Up to a year before you separate or retire, you can go through this week long class, it’s an intensive class that teaches you how to do a resume and job interviews and really think about, have you thought about what you’re gonna do for health insurance once you leave the military? Have you thought about what vehicle? Where you’re gonna live? Every little detail that tends to get skipped sometimes. We need to talk about that and we’re gonna pay you to step away from your job for a whole week, all day every day and really analyze these things.
12:43 RL: ‘Cause they’re… Homeless vets is a huge thing and they’re trying to avoid that. So I thought I was all set. I got the waiver to not even attend the job part ’cause I had a job. Admittedly, it was a part-time job that would not support my family on its finances, but forget that, I’m sure I could survive on, no matter… I’m a tough person, I can find a way to survive with zero money. You can just watch me, I’ll live in a tent by the side of the road with my kids. It’ll be okay. It was not okay, it was very hard. And it was even harder than I thought it would be with the culture as well. I was really comfortable in having that you automatically be accepted into and have these support systems there to help you get integrated after you move. It was hard not to have that. And I even moved to an area with lots of military, but I didn’t have that support system because I wasn’t on base.
13:35 RL: And even though a lot of people are used to having military around, I wasn’t in it anymore. So that was more difficult than I thought it would be, and it’s been tough to let go of a lot of the military-isms that I thought I hated at the time, but now I kind of miss. And so now I’ve been hustling for the past couple months as much as I can. I’ve got three other jobs on top of my part-time gig. I want to make my part-time gig my ultimate future. It’s the best job I’ve ever had, it’s a great clinic, and it’s everything I love about medicine. It’s just not paying the bills right now.
14:14 ST: Well, you alluded to the fact that there were things that you thought you hated about the military that now you weirdly miss, so what would be one or two examples of that?
14:25 RL: All the military people are gonna hate me for saying this but the stupid trainings that you have to go through when you go there. Even the computer-based training sometimes was actually kinda useful. I would gather little tidbits that was helpful. It was an hour of stupidness with maybe three tidbits that were helpful, but still, those three tidbits turned out to be rather important. And the little checklist that you had to go through… It seemed it would take a month before I could actually do my job once I got to a new base, which I thought I hated, but I was definitely all set up to do my job by the time that month was up. So having that leniency of making sure that, “Hey are you settled in your house?” “Hey, do you have all your household goods moved in with you?” I remember coming to work and them saying, “Oh those are nice shoes,” and then the next day they said, “Oh, those are still nice shoes.” “Oh, those are still nice shoes” the next day. “Do you have any other shoes?” No, I actually don’t have any other shoes because my household goods have not arrived with my extra shoes and this is it for the next six to eight weeks, so I’m glad you like ’em.
15:29 ST: Yeah, I wonder if some of that also is just the comfort in knowing that there’s plenty of people who have done this before you, and they’ve set up this process for you, and it may be boring or routine or whatever, but at least you know like this is what everyone goes through and when I’m done with this, I’ll be ready.
15:47 RL: Right, there’s a certain aloneness that was very surprising separating from the military. I always had my community, and all of a sudden there wasn’t everyone looking out for me and watching my back and making sure that I was doing everything right and checking all the boxes. There were a lot fewer boxes, which was a relief. I didn’t have two pages of stupid signatures to get in order to in-process. But man oh man, I didn’t have those boxes anymore. What was I supposed to do? Where do I find people? Where do I get my extra jobs?
16:16 ST: Specifically on the fact that this is a radically different medical practice than practicing within the system of the military, I’d love to hear a little bit about what makes the clinic you’re at different and why that results in you making videos on YouTube about pap smears.
16:35 RL: It’s actually not that different. The thing I loved most about TRICARE, which is the medical insurance of the military, is, man, it takes care of the money part. It can be hard to get the referrals you want to get the exact medication you want, but you’re also not worried about the co-pays that everyone else in the world is, and it’s easy to forget that when you’re in the military. But that meant that, man, anything in that formulary, which was an impressive number of medications… It didn’t have every single one, especially for special diagnoses, but I could go through the system of requesting those special ones and I knew I could hook my little 18-year-old airmen that really didn’t know what to buy at the counter… I could give them some Afrin, some Sudafed, and some ibuprofen right there and not be worried that they’d pick up some… I’m not a big fan of those combo cold medications that have every medication under the sun and you’re taking medication that you don’t really need for symptoms that you don’t have.
17:32 RL: I could tailor-make these stupid cold packs, as obnoxious as it was to see someone for a cold, but these little 18-year-olds often had no idea how to take care of themselves. They didn’t own a thermometer, they didn’t know what a fever was, and I could be there and help them through that and not have to worry about, hey, if they start getting sick in another couple days and they’re getting worse, are they gonna be able to afford the co-pay to come back for a bacterial infection, or do I need to just shirk all my medical knowledge and give them an antibiotic for a viral illness that’s not gonna make them feel better because I know they probably won’t afford the co-pay to come back for the antibiotics when they get worse and they need one. So that was beautiful. I love being able to do everything I can for my patients. In medical school, we did get a lot of opportunities to work in non-military facilities, and that was so stressful that every single appointment, you kept a tab open with the four-dollar list of what prescriptions were available for four dollars at Walmart and Walgreens and CVS that these people could actually afford. And so I had to change my medical plan to whatever fit their four-dollar list to make it work, because otherwise they weren’t gonna be able to afford this.
18:41 RL: And that’s good that we have that list, but man, it added another dimension to medical care that I really didn’t like. So the clinic that I’m involved in right now is a direct primary care clinic, meaning that we don’t take insurance, which right away everyone is like, oh, you don’t care about poor people, you only wanna provide medical care for the rich and get rich yourself. Some people even call it concierge medicine, which I hate, ’cause again, it sounds like rich people. But a lot of my patients are uninsured and a lot of my… I even have some homeless patients on my empanelment. So I have been learning from my colleague, who’s been doing this for eight years, all these cool tricks about how to get people prescriptions that they can afford. And what’s extra awesome is they haven’t already blown a thousand dollars just on their health insurance that month, that they have basically a thousand dollars that they’ve saved that they.
19:32 RL: If they had $1,000 in the first place that they can use towards actual medications or imaging, or seeing me that is actually helping them that month. So I have a… How it works is you have an enrollment fee, and you pay every month, a certain amount, less than a 100 bucks for everyone of all ages per month to see me as much as they want. I do all the procedures I can at cost. So if you need that mole removed, I’ll cut it off for free. I’ll give you the numbing medicine for free. You just have to pay for sending it to the pathologist to look at it under the microscope to see what it is. So that’s 50 bucks. That’s a better deal and you’ll find that anywhere. I mean, that’s what most people’s co-paids are just to see you. But we can make it work because my boss was paying ridiculous amounts of money every month for working with insurance. So for all the coding that doctors have to do, all the extra charging that doctors have to do and the putting this in the right format on the right forums to see this.
20:31 RL: We have to this insurance, but a different form for that insurance. And oh, you need another form for this one because you requested this medication that was like three staff members that he was able to say to find other jobs for and not pay to do just insurance stuff. So as a result, he doesn’t have to make as much money for overhead costs. And he’s able to cut down on the number of patients he allows to see in his clinic, and is able to spend a lot more time with the patients that he does have. So I’m spending at least a half hour with every patient if not an hour for new patients, especially or complicated patients, patients that just need more of my time. And it’s such a beautiful system. I love it so much. I’m able to spend so much time with my patients and really get to know them and really have conversations with them that aren’t, “Okay, you need this? Ah, okay? And okay and then we gotta get going because I got another three patients that are waiting for me.” I really think it’s the thing that’s gonna save our healthcare system. I love it so much.
21:31 ST: So how does that result in you making videos on YouTube about [chuckle] pap smears?
21:37 RL: Yeah, though in the military, we call it Opsec that there’s a lot of things that we don’t want to say in social media or talk about in public that could compromise the safety of our co-workers. That always terrified me. I don’t want…
21:49 ST: Wait, what do you call it?
21:50 RL: Opsec, Operation Succeed. So if you’re ever following a common thread on Facebook, and someone says “Opsec.” It’s because they think that someone else has commented a little bit too much in detail of what should be shared in such a casual way.
22:05 ST: And just to clarify for a sec, is Opsec saying too much that would, ’cause I know like government employees aren’t really allowed to speak politically. Is it more about, saying something that could put the military in a bad light or is it something that could put your safety at risk because people would know where you are or know something that…
22:29 RL: It’s the latter.
22:31 ST: Okay.
22:31 RL: It’s putting people at risk. Opsec usually is referring to your husband is coming home from deployment on this date, on this flight. I wonder if a lot of military people are coming home on that flight? If terrorists were trying to bomb a flight, would that be one that they would wanna target? Because that would be terrible to contribute to. So that was one example of Opsec. So it’s better to just not say anything about your family or when they’re coming home or how much you miss them ’cause you might say too much. That’s the reason why I kept off social media. But it was always itching at me a little bit, like I’m saying the same blurb to my patients with eczema over, and over, and over again, because it’s a good blurb. It’s my favorite blurb. I really think that it’s helpful and useful and lots of people have eczema, lots of people’s kids have eczema, but man, it would be really cool to just post something on the internet.
23:19 RL: And they could reference it, ’cause I’m saying a lot of information, ’cause I’ve learned a lot about eczema over the last couple years. I bet they’re not taking it in as well as they could, wish I could just post my blurb on the internet and they could watch it as many times as they want and get as much out of it as they possibly could, an unreasonable goal. So now I can do that. And now I can make videos and post my favorite handouts. And it’s kind of fun. And hopefully it’ll get me some more patients ’cause I would love to actually cut down on the number of jobs that I have.
23:52 ST: I had another thought when I knew I was gonna be talking to you. I thought about the fact that your profession, like some other professions, is sort of something that doesn’t have much of an off switch. I know, I reached out to you sometimes with questions about medical things happening in my life just as like, you’re my friend who’s a doctor, what do you know about this? I’m sure you get that from people in your everyday life and then also, the fact that you actually could get called upon like on an airplane, they say, “Is there a doctor on board?” Or just you happen upon something and you suddenly are thrust into your role as a doctor. So I’m curious what your experiences have been about that and kind of what that’s like to have a career that’s not just a career. It’s sort of something that’s part of what you carry with you everywhere all the time.
24:49 RL: My first time doing medicine in a weird place was in church when an old lady in front of me fell over. She was just sitting there and she fell to the side and then a whole bunch of people rushed to help her. And my husband was, “You’re a doctor.” I was, “What? They’ve got it, look at it.” They were, doing chest compressions horribly, ’cause she didn’t have a pulse. And it was so bad. I couldn’t do it. And he finally elbowed me until I got up and started taking over. But she died. I mean, it’s a good place to die in a church, I suppose. But we got her too, we did the best we could and we sent her to the ER and they took care of her and I called the hospital the next day to see how she done. And she passed and it’s okay. And then on the side of the road once I saw, we were driving by and there had been a big accident like a minute before we drove by a motorcyclist to the car. He went over the yellow line. And so I did chest compressions on a motorcyclist for a while. And he didn’t make it.
25:30 ST: From what I understand chest compressions often don’t actually save lives, right?
25:30 RL: They don’t absolutely know that. They do to young people all the time, right?
25:30 ST: Well, there’s particular things I know around here, we have a lot of lightning strikes. And so what I’ve heard is lightning is one of the few situations in which chest compressions have a higher success rate?
25:30 RL: Yeah. And on young people in general that their bones aren’t brittle enough to break at every point, are generally also spry enough in general that they can recover from CPR. CPR is not a nice, a kind… And I mean it’s saving lives but man it’s a brutal way to save a life. And I highly recommend older people that wouldn’t want to come back and try to bounce back after multiple rib fractures, to get on a DNR, a Do Not Resuscitate Order to avoid CPR. ‘Cause at a certain point, you’d rather just go, it’s your time rather than having a lengthy hospital stay. All the bills accompanied by that, all the pain and suffering accompanied by that. Sometimes it’s just better to go.
27:00 ST: So do you… [chuckle] Do you have any stories of doing medicine in a non-medical setting that had a positive outcome? [laughter]
27:08 RL: There’s a lot of little phone calls that we do to just settle people’s concerns, which I feel like is the most common thing that I’m doing that actually has a lot of positive outcome to be able to reassure someone over the phone. “Hey, these are the warning signs to look for for things being bad, but right now the things that you’re describing are not bad.” I do that a lot with kids that fall and hit their head. There’s a beautiful little score call… Little test I guess, PECARN score, P-E-C-A-R-N, that helps you to evaluate “Hey these are the symptoms that are really worrisome for something going on in the brain after a kid has hit their head.” But most the time, at least the kids that I’m seeing they do not need an ER visit, they do not need a CT scan. And to be able to save people that worry, and time, and expense, and radiation from the CT is a beautiful benefit of being able to practice medicine the way that I am.
28:04 ST: Well, I’ll ask you my final question…
28:05 RL: What does it mean to do good and be good?
28:08 ST: What does it mean to you? To be…
28:10 ST: This show is called Do Good, Be Good. What does it mean to you to be good? That means you’ve actually listened to my podcast, which is good. [chuckle]
28:19 RL: Listen to every episode, I am a devoted listener and I can’t wait to hear about this bone marrow thing. Man come on! This is my thing and my best friend, and bone marrow, and saving lives. It’s all my favorite things. What does it mean to do good and be good? I asked my husband, ’cause he’s a philosopher…
28:39 RL: But this is like six months ago, ’cause I was like, “Someday I’m gonna be on her show and I want a good answer.” And he gave me a good answer and then I forgot it and didn’t ask him this morning, and…
28:48 ST: That doesn’t count, ’cause it’s his answer anyway.
28:50 RL: But it’s such a good answer. He’s probably not gonna be on your show. So I get to steal it. What does it mean to do good and or be good?
29:02 ST: I actually usually just ask people what it means to them to be good.
29:06 RL: Oh, ’cause it’s a balance. I see so many people with mental health things, that that comes to my, foremost on my mind that you know going out and volunteering all the time and doing all the things for all the people, and all the PTA meetings and all the community homeowner’s association meetings. If you’re exhausted, isn’t good! But then again, I also see lots of people that take care of their kids all day and make meals and are just so tired they don’t have time to work out, let alone go out and help people. But man, if they spent an hour in a soup kitchen a week, I really think it would help to balance what they’re seeing in their life so much. So doing good is taking care of yourself, and pushing yourself, just a little bit, everyone’s a little bit different as to what pushing is, and it also changes so much over your time of your life and the seasons of your life, but making sure that you get out and are doing things for other people, not only for them but also for your mental health.
30:18 ST: I told Rachel that I thought her explanation of what it meant to be good was like a prescription for health, so fitting. I hope you enjoyed our conversation, thank you so much to Rachel Langley my best friend for joining me on the podcast. Again, you can find the show notes for today’s show, including a full transcript at dogoodbegoodshow.com. And you can subscribe in your podcast app of choice, it’s always free to subscribe, you can find out more about our show at dogoodbegoodshow.com and you can follow us on Facebook, Facebook.com/dogoodbegoodshow. Music in this episode was “Bathed in Fine Dust” by Andy G Cohen, released under an international attribution Creative Commons license and found in the free music archive. We have a new show coming out every two weeks, so until then, this is Sharon Tewksbury-Bloom signing off.