Interview with Raleigh Bowden
Tracy Sprauer:
Raleigh, you are such a leader in this community. I am curious who some of your formative influences are?
Raleigh Bowden:
I’ve always had people in my life, who I have looked to emulate. Early on in life I assigned a personal board of directors of people that really inspired me. Like my aunt, who actually lives in the house across from our property. She’s now almost 90. She was one of these real movers and shakers in Seattle. She’s a civic leader. She helped start City Club and Leadership Tomorrow, all kinds of things like this-mostly women. I always go to her. But I do meet with my board (who have no idea that they are on my personal board of directors) and share what is happening with me both professionally and personally, and ask for a little advice, invite them for a cup of tea. Another is my medical school advisor, he saved my life. He helped me through hard times and he had a very gentle way and a wonderful smile. He made me feel happy that I was going into medicine. I have those personal board members, but of course I have people I think about, who I have never met, like Ruth Bader GInsberg and Martin Luther King. These people who stand for values that I want to be my values, values that I want to live out every day.
As I contemplate the importance of these influences in my life, I think this has resulted in me making decisions in my career that most people don’t make. Like, after I finished an 18 year career in academic medicine, in a big cancer center, Fred Hutchinson, I decided I wanted to work for free. I wanted to work with a challenged community in the area that I was good at, which was end of life decision making, when there were difficult choices to be made in terms of health. I picked the African American community in Seattle and I started my only non-profit, called the Seattle African American Comfort Program. I was the only white person in the organization. It was a journey to live my values of equity and try to level the playing field.
I think this thread of following my values has led me to make all kinds of choices that have brought me to where I am today. After I left that stint in Seattle, and my husband and I relocated here to the Methow Valley, I came in with a similar question. Where can I put my attention where there are unmet needs? I chose to try and bring this concept of empowering people to make their own decisions about their health to another group of people here, and I started the Lookout Coalition in 2010. I wanted to help folks here in a rural area navigate through really difficult times. I also wanted to teach the healthcare professionals how to be more culturally tuned into the needs of people facing their own mortality. It is lovely to be both a physician and advocate for these patients, because I wear both hats. I am well-versed in the medical viewpoint AND I try to see life through the patients’ eyes. What’s most important to you? Let me listen to that and let me help you make the best decision for yourself. And that is the crux of the Lookout coalition. That is what we do. Our mission is to help people facing difficult health challenges including aging and end of life and help people to stay in their homes. We had that mission before Methow At Home was formed, which is why becoming a partner with Methow At Home is such a good fit for the Lookout Coalition.
Tracy:
How long have you been in medicine?
Raleigh:
Well, I've been in medicine since I was born. I was born with dislocated hips and so I entered the medical system quite early in my life, as a patient. When I was seven I had hip surgery and that’s when I decided I would be a doctor. It seemed like the only choice, right. I saw these other kids and saw such a huge need. When I grew up I did become a pediatrician. It was one of the first things I became. I’ve become a lot of things since then.
When I was in the eighth grade I started working in the lab in Seattle Children’s Hospital, and I worked in the lab through the summers all the way through college. I worked in two different labs one was infectious disease in the microbiology lab and the other was hematology/oncology. Sure enough when I grew up I was board-certified in oncology and infectious diseases because of that experience. I took a pretty traditional route through medical school, I didn’t take any breaks or gap years.
Tracy:
What do you see are some of the strengths of the US medical system?
Raleigh:
You’re asking this question at a very challenging time. I work with some of the most vulnerable people and the most disenfranchised, and I am often thinking about what isn’t working. And so when you asked me what are the strengths of the US health system, what comes to mind is that the people that go into healthcare are exceptional. Well I certainly know there are physicians and providers that don’t have a very good bedside manner, but they really are a minority. I think most people who go into medicine, they go into it with tremendous heart. They go into it to learn more than biochemistry and genetics. They are really interested in learning communication skills, they want to learn to listen better. They want to be a team player. They are coming into this profession with a lot of heart, which is why this time right now is such a tragedy to me. To watch them struggle with COVID is painful. Because I’m worried this is going to push out the people with heart, because it is so heartbreaking.
My job right now is working with resiliency. I am doing some work locally with healthcare provider teams on building resiliency. I’m really interested to see if we can transpose this work across our county. Just in recognition that it’s a really hard time to be in healthcare.
The people are a real asset in our healthcare system. The other area of strength I see in the US is our technology. We have the technology to provide the best care, but the system often makes that dysfunctional in terms of who gets what treatment. I do think that if you have a complicated disease you can find the right brilliant people with the right technology to actually get better here. I think we’re very fortunate in this country. I am just sorry it’s bogged down with high drug costs and insurance problems. I wish this country could make better decisions around universal healthcare, so everybody could have access to at least something.
Tracy:
Are there areas of the medical system besides the soaring costs you see that need attention?
Raleigh:
I’ve devoted my current work to helping patients who have complicated medical conditions navigate the health system, because I think without good navigation you are at the mercy of the health system. I think that’s really hard for some people. I also have been devoting a certain amount of time to teaching healthcare providers how to have difficult conversations, the ones that matter. These conversations take time. One of the defects in the system is that doctors don’t have time to have these in-depth conversations. They often have only 15 or 20 minutes per appointment. My typical conversations around an important issue could take an hour. Just one conversation about values and about how you are going to make a decision around whether you can stay in your home now that you’ve had a stroke, or what if you get a stroke are long conversations. And then you have to have another one in a few weeks, because you can’t cover it all in one. We’re trying to teach providers how to start the conversation and open the door.
The one cost area that I am rabid about are drug costs. I cannot believe that in this country we don’t regulate drug costs, because they do in every other country. Because I’m in the cancer field, you can have one dose of cancer treatment and it will cost $20,000. That is ridiculous. If you don’t have insurance or just marginal insurance you may not even be offered that treatment. I think drug costs are the lowest hanging fruit we could fix with one swipe of the pen.
Tracy:
Did any of your children go into medicine?
Raleigh:
Yes I have two children and my oldest daughter is in social justice medicine. I never talked to my kids about my work because I didn’t want them to feel pressured to choose that path. Somehow she escaped and went into it anyway.
Tracy:
What were some of the needs that you observed when you came here that led to the formation of the Lookout Coalition?
Raleigh:
I talked to people about what the needs were. It seemed like the aging population was growing. We moved here in 2009 and I started The Lookout Coalition in 2010. It seemed like an area where I could have a positive impact. I had a lot of end-of-life training, which lends itself to an aging population. There can be real challenges in having a fixed income and there’s also a fierce independence here in the valley, and it just made sense to reach out to those folks. I’ve had the chance to see parts of the valley I wouldn’t have experienced had I not started The Lookout Coalition. I’ve been to amazing settings here and I’ve met amazing people. And I love that. I love getting outside of my own experience and learning from people who live differently than I do. Certainly once we started, word of mouth spread that we were around and it seems like we’ve never had any problem finding people to serve. We are all volunteers, The Lookout Coalition still is made up of six trained healthcare professionals. We never had to become a nonprofit, because we haven’t had to raise any money except for a brochure. It has been remarkably sustainable for over 10 years. Some of the same people who helped start it are still with us. And there are new people joining as well as more medical professionals retiring to the valley. It seems like we always have someone interested to do something with us.
Tracy:
In all of your work with people facing the end of life, what are some of the things that you have gleaned to help one prepare or even accept our own mortality? It seems like having these important conversations is one important piece.
Raleigh:
I have learned that it is beneficial to have that conversation when one is younger before the issues really arise. It’s a hard time to have “the” conversation when the issues aren’t in your face. Just this morning I was walking with a friend and asking their thoughts on where they are going to live when they get older. I think having these conversations frequently makes it easier to have the conversation when the going gets rough. It takes practice and society hasn’t encouraged these kinds of conversations. So we don’t always have the skill.
I’ve also learned that we all have the same basic needs. We all get scared. We all can feel shame about asking for help or expressing sadness and grief. I think one of our jobs as humans is just to normalize our humanness, our human experience. I spend a lot of time normalizing things for people. I think it’s very comforting to know that you’re not losing your mind. It is normal when our emotional wavelength starts shooting up and taking up our nervous system, we can’t remember the phone number of even our own son. Or we get to the store and don’t know what was on our grocery list because we left it on the table. I think we have really unrealistic expectations of us as human beings. I spend a lot of time normalizing peoples’ experiences. But I think it’s really valuable because I see people breathe a sigh of relief and say I think I can handle it now.
Another thing I’ve learned is that as a doctor I focused on how to fix things, I spent 30 years doing that. And then I spent the next 30 years on unlearning a lot of that, and instead learning how to listen and be present. There is a lot of value in just witnessing someone’s journey. It is so powerful and any of us can do it. We can do that for each other.
We get very uncomfortable sitting with suffering. My visceral response is still visceral. When I see somebody suffering. I have to check myself that I don’t just jump into action, but just listen. Just be present. I’ve had to train myself to do that, because I’m a fixer. I have to get in touch with my body and I have to take a deep breath and move into what I think will be more helpful than offering suggestions. Although some people do want that. But many people don’t realize that they need just to be listened to.
Tracy:
Raleigh, thank you so much for sharing your time and your insights here today. We at Methow At Home look forward to deepening our relationship with the Lookout Coalition.
Raleigh:
You are welcome. Yes, I think with our similar missions, we really are a good fit to work together.