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A detour from med school changed this MD’s take on health care

Local doc served poorest of the poor as a Lutheran Volunteer Corps conscript

Getting outside your comfort zone can make a world of difference. Stuart Cox, a St. Olaf College senior at the time, discovered that truth by accident. On the road to medical school at the University of Minnesota, he decided to take a time out instead.
“I’d talked to others who had gone to med school. They had told me horror stories. I’d heard it could be brutal. Not everybody finishes. Those who do, end up going through a wringer. I wasn’t sure I was ready for that.”
In fact, his father, a professor in the University of Minnesota School of Veterinary Medicine, hoped his son would enroll in veterinary medicine. Stuart thought about it, but held back. “I was actually accepted into grad school,” he says, “but I didn’t want to go. At least not right then.”
Having taken a college course in “religion and poverty,” he decided a stint volunteering overseas might make sense. So he set his sights on Africa, a place where he hoped to teach and, perhaps, also do medical work. But that was not to be. He couldn’t get a visa.
When one door closed, another opened. Cox had classmates at St. Olaf who were signing up for Lutheran Volunteer Corps (LVC). “It’s a Lutheran Peace Corps. They ask [for] a one-year commitment. I decided to try it. The year I started, in 1989, our stipend was $85 a month. It provided housing and food.”
Cox embraced the three tenets of LVC. “They asked us to live in community, live simply, and work for justice.” But it was an immersion experience to open one’s eyes — quickly. “It’s a tough year. I came from a Twin Cities suburb. When you study at a school like St. Olaf, you live a pretty sheltered life for four years. My time with LVC, in Washington, D.C., was nothing like any of that.”
So, what was it like for Cox? “I worked at a place called Christ House, not far from the U.S. capitol building. It’s a medical care center for homeless men. If a homeless person had been hospitalized and was released, still in need of medical care, he’d come to Christ House. It was a transitional community for these folks.”
The center was run by a physician. “Her name was Janelle [Goetcheus], and she was truly a saint. She expected me to function mainly as a social worker. I wasn’t really sure I was up to it. She told me, ‘If you’re smart enough to get into med school, you can do this.”
He discovered she was right. But it was a struggle. The challenges seemed overwhelming and the resources were few. “You’re surrounded by tragedy and desperation. By mid-year I was probably clinically depressed.”
But he persisted. And the stories began to accumulate. “A homeless man got beat up, hit on the head with a baseball bat. After a visit to the emergency room, he came to Christ House. We got him in for surgery. I learned from people like him that we really do have health care rationing in this country. When you hear people in the current debate warn about that possibility, be aware: we have it now.”
Cox says, “We need to think about the cost of care when so many people can’t get it. The poorest are the least likely to get help.”
Early on he learned how to deal with street beggars. “My supervisor told me what to do when people ask you for money. She said, ‘The biggest thing is looking them in the eye and treating them like human beings. The money is secondary.’”
What did Stuart Cox take away from his LVC experience? He learned deep sensitivity toward vulnerable people, and a conviction that there needs to be attention paid, in our health care system, to those who cannot advocate for themselves.
He has come to understand and affirm the words of Walter Brueggemann, a noted theologian and biblical scholar. “Brueggemann talks about how we are all broken. Healing comes through opening one’s self to the poor.”
Now established as a Twin Cities physician, Cox serves on a legislative committee for health care for the State of Minnesota. He helps to lobby for better policy. “It’s incredibly complicated,” he admits.
He believes health care is a right, not a privilege. Everyone deserves it. “But the problem is,” he says, “how much can and should we provide? We need to decide, what’s the minimum? What does everyone deserve?”
Cox has come to some conclusions about health care that might surprise many who advocate for policy reform. “There are six determinants for healthy living,” he says. “You can rank them, starting with the most determinative. They are these:
1.) Whether or not you smoke;
2.) whether or not you are obese;
3.) whether or not you abuse alcohol;
4.) your socio-economic status;
5.) whether or not your environment includes basic sanitation; and (finally)
6.) the quality of health care you can access.
“I’m a head and neck surgeon. I deal with cancer. I remember when a Twin Cities bar owner was pushing back against the new regulations prohibiting smoking in public places. He wrote a letter to the editor of one of our daily newspapers, saying, ‘The smoking ban will put me out of business.’ I responded with a commentary piece in which I said, ‘The smoking ban will put me out of business as well. And I hope it does.’”
Says Cox, “Our obesity rates are through the roof in this country. We need to reverse that. But we’re fighting some pretty persuasive marketing.” A generation ago he would have said that about tobacco.
After 20 years, what does Cox think about LVC? “I would recommend anybody finishing college to consider it. It’s great for teaching empathy and compassion. And, incidentally, in case you’re considering it as a career path, doing a stint in LVC will also dramatically improve your chances of getting into med school.”