Multiple Guests 

• Why Cherokee Nation partnered with Oklahoma State University to build a medical school on tribal land (03:49)
• How Native American traditions impact student doctors in Talequah (10:48)
• The challenges of providing medical care to rural and underserved communities (17:07)
• The trait of so many young students that is offering hope for the future of medicine (21:57)
• Who inspired OSU student and Cherokee Nation member Megan Tramel to become a doctor (27:52)

FRANK BLAKE: So I'll be honest, there are so many things I'd want to talk to you about.

We, as a country, open up so few new medical schools, so that on its own would be an extraordinary thing that you have accomplished.

I also understand you opened your doors in the middle of the pandemic.

So, that probably is its own series of dramatic stories, but obviously, what I'd really like to talk to you about is you have a really first of, if not one of the only medical school of its kind that's aligned with Cherokee Nation.

I'd love just as a start if you each would give a few words on what our listeners should know about why it was important to establish such a medical school aligned with the Cherokee Nation and why you were drawn to it.

I'll start with you, Natasha, and then Doug.

NATASHA BRAY: Okay. That's perfect.

So, Oklahoma has a physician shortage, and if we look at where physicians are located for practice, they're located primarily in Tulsa or Oklahoma City.

So, we know that we don't have enough physicians serving our rural and tribal communities across the state.

When we look at the mission of Oklahoma State University's College of Osteopathic Medicine, the mission is to train primary care physicians for Oklahoma's rural and underserved communities.

So, that aligned perfectly with the Cherokee Nation's need and desire to have physicians to serve their community.

DOUGLAS NOLAN: My story is a little bit different. I grew up in Tahlequah, Oklahoma. This is hometown for me.

After graduating from residency, I decided to return here to work and working with the Indian Health Service.

FRANK BLAKE: Tahlequah for our listeners, is it fair to call it the capital of Cherokee Nation? How would you describe it?

DOUGLAS NOLAN: It is.

FRANK BLAKE: First, did I pronounce it right?

DOUGLAS NOLAN: No, you pronounced it correct.

It's capital of the Cherokee Nation, which happens to be the largest tribal nation in the United States, but that was home for me.

So, I was returning home, but the question I kept getting asked was why would you go to work for Indian Health Service?

So as I returned and started working, I was seeing friends, I was seeing family, and that worked out well.

Then later we started accepting students from Oklahoma State College of Osteopathic Medicine working here.

It ended up being a great relationship. As we've done that, a lot of the students that came through ended up eventually working for Cherokee Nation.

So, it ended up being just a wonderful partnership, and then others saw the benefit of taking care of Native Americans.

FRANK BLAKE: How big is Tahlequah? How big a town or city is it?

DOUGLAS NOLAN: The town itself is about 17,000. So, it's not a very large town.

We have a lot of people that live in the rural community, and with the rural community, you're probably, it would maybe increase to about 50,000.

Now when you look at the reservation, the reservation's a little bit different.

It covers about a 7,000 square mile area in Northeastern Oklahoma.

So, the Cherokee Nation is larger than that, but Tahlequah is very small. It's about 17,000 people.

FRANK BLAKE: Of the 17,000, how many are Cherokees?

DOUGLAS NOLAN: That's a great question.

I would say probably about 40%, but that is just the percent that's off the top of my head.

FRANK BLAKE: As you were starting the medical school, one of the things that would occur to me is a question of are you going to be able to attract students to live in Tahlequah, Oklahoma?

Dr. Bray, was that an issue at the start of this or did you know you'd have demand?

NATASHA BRAY: Well, I think yes and yes.

You mentioned earlier that to open a new medical school, there's not a lot.

We know that there's a lot of people who want to go to medical school.

So, the short answer is we have a lot of really talented youth who are really committed to serving their communities through becoming physicians. So, we knew we'd be able to pull on that.

But then the question becomes are they actually going to want to be in Tahlequah? Do they want to be in a rural environment? Do they want to work with a Native American population?

Is this really aligned to what their true mission and goals are?

We want to find those students who are maybe from rural communities who have Native American heritage or are enrolled members of a federally recognized tribe so that we give them the opportunity to be successful in an environment that aligns to what they hope that their practice environment will eventually be.

FRANK BLAKE: Dr. Nolan, you could probably speak to this since you've returned to Tahlequah.

DOUGLAS NOLAN: You're exactly right. That's always been the question.

How do you draw physicians to the rural area? We've had several communities around here where now a student may not have to live in the Tahlequah area.

We've had several residents that came through and students who came through from a town called Westfield, which is about 40 miles northeast of Tahlequah.

It's on the Cherokee Reservation. It's a town of about 3,500 people.

We've had about four students that I can think of off the top of my head that have come to medical school here are now in residency.

Some of them later went on, before they came to the Tulsa campus, did residency here in Tahlequah, are now working for the Cherokee Nation.

So, basically they're like my story. They returned home.

FRANK BLAKE: Can I ask why did you decide to return home?

Because I'm sure many, many different places you could have gone.

DOUGLAS NOLAN: That's a great question.

I would say probably I had family here, and at the same time, this was actually a second career for me.

I'd served in the military and I taught for a few years. I've been a physician now for a little over 25 years.

But I was just returning home, from a rural area, wanted to work in a rural area, and returning home. It's been such a great experience.

FRANK BLAKE: What are some of the challenges that Indian reservations in particular pose both medically and otherwise?

DOUGLAS NOLAN: Right, much of it's the recruitment.

There's a lot of differences depending on which tribal nation you're looking at or which Indian Health Service that you'd work for because finances. It's very expensive to run a health system.

If you look at the amount of money that they're provided from the government to provide the healthcare, it's very limited.

So, as they work now, many of the tribal nations now, they bill just as other insurances would to help supplement that, but they turn everything back into providing the healthcare for their citizens.

We take care of all tribal nations.

That doesn't matter what your heritage is or whether it's with the Choctaws, Chickasaws, whatever tribal nation, if you show up, they're going to provide the care.

Over the years, there's always been a stigma, but we've done wonders to overcome that.

I think now hopefully through the work that we've done, we've provided the experience, the students are getting exposed to that, and now we're having a much easier time being able to recruit because the patients are wonderful and the ability to provide overall quality healthcare is very rewarding.

NATASHA BRAY: I think what I would add to that is if we look at the overall wellness of the community, the tribal nations through their self-governance and sovereignty process take very seriously the care for the health and well-being of their communities.

They've deeply invested in that. We're beginning to see the rewards from that.

The infrastructure to actually provide wraparound health services to patients is outstanding and I would argue probably better than it is outside of IHS or tribally operated healthcare systems.

Part of that is because it's been placed as a priority. It's a cultural priority to take care of the people who are members of your community and to take care of the elders.

You see that reflected in the healthcare system.

So, what that means on our side is that's a great place to train future physicians.

Being able to have them interact with patients who are willing to engage with learners, who are willing to share their stories, their different approaches to health and wellness and what that means to them as an individual and to their family and community allows our students to really have an understanding of what outside of just a disease process impacts the health and wellness of that individual.

I think we can talk about everything from transportation and how we get to doctor's appointments to disruption to work and school days by having to sit in a waiting room to some of the challenges with cost of expensive medications or the lack of access to care because specialists are only located in large cities and academic healthcare centers.

So, understanding how we begin to partner with our patients and support them in their journeys to health becomes really important.

The students that are here get to see that. They get to live it. They're part of the community. So, it very much is real.

FRANK BLAKE: Now, I know you've only had one graduating class so far.

Do you expect that most of your students will practice on the reservation or will they go elsewhere?

Do you think this experience is going to draw them to medicine in rural areas, or how do you think that's going to work out over time?

NATASHA BRAY: So I'm going to say yes, and that's our hope and that's our investment, is we want to take people who are from rural and tribal communities, train them in rural and tribal communities, and keep them for practice.

But as an educator, my goal is to support students in their service, whatever that looks like.

So, we want to mentor them towards careers in primary care with our tribal nations and with our rural communities and other underserved populations, but we want to give them the knowledge and skills to be successful no matter what specialty they choose to pursue.

Whether they stay in Oklahoma or they end up in a large urban environment, we want them to be successful because we know that patients need access to care everywhere in the United States.

FRANK BLAKE: This is a tribally aligned medical school. What does that actually mean?

Do you have somebody on your board who represents the tribes? How does that work out in practice?

NATASHA BRAY: So we have what might be said a complex relationship because we are aligned with the Cherokee Nation, but we're also a state university system.

So, we are located on tribal land. Our medical school was built by the Cherokee Nation for us, and we technically leased the inside of the building.

So, the faculty and staff-

FRANK BLAKE: It was tribal money that built this medical school.

NATASHA BRAY: That built this medical school. I think that that really demonstrates their commitment to the partnership and the success that we've had so far.

The faculty and staff are OSU employees and we use the normal OSU application and admission process for medical school. So, you begin to see where these overlaps are.

The facility itself is beautiful. When you walk into our facility, there is over 200 pieces of art from Cherokee artists.

All of our signs are in both English as well as syllabary, so the Cherokee language.

All of those are purposeful in setting the stage that healthcare looks different for people from different communities.

So, it allows us to have conversations about what is the approach to health? How do we begin to think about health?

What is the intersection between western medicine and traditional healing practices?

So we can have those conversations with our students throughout the course of their education. We have really tight communication with the tribe at multiple levels.

So, I think that that's one of the things that's allowed us to be successful is we have relationships at the leadership level, at the level of the chief and deputy chief, but we also have relationships at the level of the directors of Cherokee Nation Health Services.

FRANK BLAKE: Doug, you were practicing in Cherokee Nation before.

Was it, is this, do you look at this and say, "Boy, this just obviously fills an enormous need that's inside the nation or mostly outside the nation"?

How do you look at it as a change from your perspective?

DOUGLAS NOLAN: It's been a great experience. I continue to see patients at Cherokee Nation. I go over a day a week and see patients in the clinic. So, I continue to see patients for Cherokee Nation.

But it's been a great experience for both the students and the patients and as well as the physicians, because the students keep you on your toes.

You have to stay up to date as they ask questions and as they see things. The patients enjoy it because they feel like they're part of the student's education.

Then the students learn by interacting with the patients, which it's really a win for everyone.

What we're also doing is unfortunately, there's a high burden of pathology within the Native American community, especially when you look at diabetes and other disease processes.

So, the students actually learn a lot through dealing hands-on with the patients.

So, the patients are good in that they don't mind sharing their experience and talking about their story. They actually like it a lot.

But as a physician, it keeps you on your toes when you're talking to students because things change with time. So, it works very well.

FRANK BLAKE: So the needs for doctors in rural areas of the country, I mean it's an enormous need generally.

Is there something unique about the needs within the tribal community, or is it largely the same as you'd see in the needs with any rural area?

DOUGLAS NOLAN: I think the needs are similar. There is some difference because you're only seeing Native Americans, but at the same time, you're in the rural community.

You don't have as much access as Dr. Bray mentioned to some of the specialists.

So, you have to sometimes work things up a little bit further than you might have to if you were in a larger urban area.

But at the same time, there are more obstacles because with the travel, maybe not as many, again, specialists and other things that you may have in a larger urban area.

But at the same time, it's a very rewarding experience to be able to deal with people because as you're downtown or maybe you're shopping or you're at some of the ball games, you often run into your patients.

You can't hide like you are in the urban areas.

There's been a number of times you're someplace and someone says, "Hey, Doc. Can I ask you a question?" You can't hide like you can in the urban areas.

So, it does take a special person who's willing to say, "I want to know my patients on that more personable level."

FRANK BLAKE: How many tribal citizens are there in the area?

DOUGLAS NOLAN: The Cherokee Nation I think is about 400,000 patients, 400,000 citizens all over.

That's nationwide. On the reservation, I'm not exactly sure.

I want to say about 150,000. Dr. Bray, you may know that number.

NATASHA BRAY: That's the number that I've seen most recently.

FRANK BLAKE: Is that incredibly dispersed? So for our listeners thinking about this, when you think about your served population, how broad an area is covered by that?

NATASHA BRAY: So two things that I'll say.

One, if we look across the country, there are tribes in all across the United States that have tribal reservation lands or have historic lands where you have large populations of tribal citizens living.

But the other thing that's really important to understand is that today the majority of our tribal populations aren't living on a reservation.

They're living all across the country in rural communities and in cities. Cherokee Nation has a large percentage of their citizens who live in California or who live in Florida.

So, it's important to know, and this is really hard, right, because we want to think about a population and we want to put boundaries around them and think about where they are and what the impact is.

But when Dr. Nolan says that we have about 150,000 plus or minus Cherokees living within the Cherokee Nation reservations, we also have Choctaw citizens and Chickasaw citizens and Muscogee Creek and Osage and Pawnee.

So, we have lots of tribal citizens that are living in the community that are going to access healthcare through the Cherokee Nation Health Services.

In the United States, most of your Native Americans are going to seek care in our community-based facilities.

Now, we do have a lot of tribally operated healthcare systems.

We have facilities that are operated by Indian Health Services, and then we have urban Indian clinics that all fall under the umbrella of how Native Americans obtain their health.

So, I think when we're thinking about it, it's really nice to think, "Okay, well, we have a group of Native Americans who are living on a tribal reservation and we're providing healthcare services to them."

But when we actually realize the complexity of the healthcare needs of our neighbors, of our community members across the United States, it begins to be a lot more meaningful and a lot more in-depth to understand the complexity of where this care is happening.

FRANK BLAKE: Dr. Nolan, you're the associate dean that's got direct responsibility for tribal affairs.

What does that mean on a practical day-to-day basis?

DOUGLAS NOLAN: What that actually means is my job is to develop a relationship with the tribal nations.

I meet with various tribes around the state and actually just visit with them about how we can work with them.

How can we partner, because not only to allow for an improved recruitment by getting students to be able to rotate with them, but we want to actually be able to serve the different tribal nations.

So, are there services that we can provide to them to work with them as true partners?

It's actually been very rewarding. We've partnered with the last number I saw was I think 24 different tribal health systems across the state to be able to allow our students to rotate within those areas because we want to be able to share those experience with our students to see or to get a firsthand experience on working within those health systems and also allow the different tribal nations and Indian Health Service clinics to be able to have an opportunity to recruit physicians for the future.

FRANK BLAKE: Now you're coming up on the fifth year of the medical school being in existence, coming up on your second graduating class.

Ask again to both of you, if you're looking back, what has been the surprise? What's the biggest surprise over the last five years?

NATASHA BRAY: The positive surprise I have seen is how talented and dedicated our students are.

I don't know that that's a surprise, but it's something that gives you hope and joy.

This generation of people who are coming into medicine who want to become physicians are extremely dedicated to this concept of service.

They want to provide service to their patients. They want to provide service to their community.

They're very comfortable with this concept of advocacy and advocating for their patients' needs at a local level, at a state level, and at a national level.

So, it really gives you a lot of hope that we are going to be able to continue to care for and hopefully care much better for the people in our communities that we all want to make sure have access to high quality healthcare.

DOUGLAS NOLAN: My experience of it that's been so positive has been that seeing some of the students that have applied and been accepted into medical school and then seeing them go through.

Many kids from this area, I'll give the example.

There is a student I wrote a letter for previously. He's graduated with the radiology, but when he applied for medical school, what he mentioned to me is we do ask students, "Are they interested in rural medicine?"

I knew he was interested in rural medicine because he told me he wanted to eventually work in Tahlequah for Cherokee Nation.

When he applied, he marked no. So, I asked him, "What do you mean you marked no? You told me you wanted to work at Cherokee Nation."

He said, "Yeah, but that's not rural."

He's from a community of 14,000. In his mind, that was not rural.

So, as we get these students, they believe that's normal to return to these areas.

It's been very rewarding to see the number of students that actually do want to work in the rural for the tribal nations. I just think it's only going to grow even more.

So, it's been a great experience to see some of these students that may became their first generation college graduates.

Many in their family had never attended college, and yet they're shooting very high aspirations to become physicians. It's very rewarding to see that.

FRANK BLAKE: Now we'd like to introduce one of those students who aspires to be a physician - and in fact, she'll soon start her residency.

Megan Tramel is a fourth-year student who will graduate from the College of Osteopathic Medicine at the Cherokee Nation in May.

Megan, welcome to the show. Tell us: What was special about your experience as a student at the College?

MEGAN TRAMEL: Honestly, a lot. OSU is really helpful for all their students.

I felt really supported throughout my entire journey with them, like constant emails of support, especially in challenging areas of school, like before boards or going into interview season.

And they always have contact information for people that you can reach out to if you need mental health help or things like that.

They're always happy to get you in touch with the right person, or stop and talk to you themselves.

FRANK BLAKE: How did you hear about the school, and why did you decide to attend it?

MEGAN TRAMEL: My mom is a nurse practitioner. She used to be a nurse, and she had different connections within that.

So throughout my whole upbringing I would hear about OSU, because I grew up in Grove, Oklahoma, and obviously a lot of the physicians have trained at OSU who are still practicing in Oklahoma.

And so I heard about it through the grapevine, and it sounded like a great fit for me.

FRANK BLAKE: I've read a quote from you in the newspaper, and I'll sort of paraphrase it, where you said, "It's incredible that you get to represent the tribe that I'm part of and enter into medicine."

So for our listeners, what's your tribal heritage, and how has that influenced you?

MEGAN TRAMEL: I am a Cherokee Nation citizen or member.

I have the CDIB card and all the things to prove I'm part of the tribe. But I've been connected through different things in high school, like trying to connect with the tribe, like representing at school and school clubs.

But I haven't been able to take the time as much in med school and go to the powwows and things like that. So I don't try to overstep my connectedness in any way.

But Cherokee Nation has been very supportive of me all throughout school.

They have graciously had scholarships that I've been able to apply for and help support me financially through school, which has been very helpful.

And of course I go to the Tahlequah campus at OSU, so we're affiliated with Cherokee Nation, and I've done most of my rotations there.

I am continuing my residency actually at that same spot, and I'm really excited about that.

FRANK BLAKE: Good for you, good for you. So in addition to your residency, where do you think you'll start your practice?

MEGAN TRAMEL: That's the golden question right now. Everyone wants to know.

And I'm not sure right now. My family is from here. I love Oklahoma.

I've always wanted to give back to Cherokee Nation in particular, which is why I'm so excited to start there in just a couple short months now, because I've grown up as a patient in Cherokee Nation, and then of course a medical student getting on the other side and seeing how things work.

And here soon I'll be a doctor, or resident physician, I should say, serving that population.

So I'm really excited for that. And I would love to stay on and continue that journey once I'm done.

But my boyfriend is from Springfield, Missouri, so I don't know if we would find a middle ground between the two of us, or how exactly that will shake out, but I'm sure we'll end up back here with our families being close.

FRANK BLAKE: When you were getting healthcare as you were growing up in Grove, did you ever think, "I want to be a doctor, I want to be helping this community as a doctor"?

MEGAN TRAMEL: Yeah, that's honestly how I got into it, is going to my own doctor's appointments or physicals as an athlete and meeting physicians and piquing my interests, and of course my mom telling me stories from her job.

And she worked numerous fields as a nurse.

She worked in the OR and she worked at an ob-gyn clinic, and now she's a nurse practitioner doing her own family practice.

So hearing those stories all made me perk up and think it might be a good fit for me.

FRANK BLAKE: What advice would you give to a young person considering becoming a doctor?

MEGAN TRAMEL: I would tell people to take their time.

I personally was someone who rushed through each leg of my education.

I graduated high school and I went to undergrad, and I decided I wanted to graduate early and go straight to medical school.

And luckily the chips fell for me where I could do that, because if I hadn't been accepted, I wouldn't have been able to fast-track myself in the way that I did.

FRANK BLAKE: Was there anything, do you think, that was special about your experience in the medical school, since this was sort of a first of its kind?

MEGAN TRAMEL: Yes, especially being partnered with Cherokee Nation and me being a Cherokee native, that has been incredibly special to me, and I love telling people about that.

And especially since the school in Tahlequah is new, people don't know about it.

And so I'll rotate and people will be like, "Oh, you go to Tulsa?" And I'm like, "Actually, I don't. I go to Tahlequah." And I'm very proud of that.

I selected this campus and I wanted to stay in a smaller class size, a smaller town, and have a more intimate connection with my classmates and my professors and the staff and everything like that.

And I'm really grateful for that. And I think that has certainly enhanced my experience going through medical school.

FRANK BLAKE: Thank you, Megan.

It's so great to hear that you've had such an awesome experience at the College of Medicine at the Cherokee Nation.

I'd now like to turn back to Dr. Nolan. Doctor, you are from Tahlequah originally.

What's the impact you've seen the medical school have on the community?

DOUGLAS NOLAN: It's tremendous. When I talk to people that I grew up with around here, that's one of the big statements everyone makes is can you believe Tahlequah would have a medical school?

Never in my wildest dreams growing up would I ever have believed something like this would occur. It's amazing.

Again, going back with some of the people that I've known over the years, to see some of their children come in and are students here and knowing that they're going to return, their families are very proud.

Then we have a lot of people, they're now discussing their careers with their children, their grandchildren, because it's opened a lot of people's eyes about what is available out there.

FRANK BLAKE: So Dr. Bray, what got you to this position? You didn't come from Tahlequah. You always have a heart for rural medicine.

What's your backstory on this?

NATASHA BRAY: So I was born into medicine, and I mean that quite literally.

My dad was a family practice physician in rural western Oklahoma, and I was born when he was a first year medical student.

So, I grew up with this concept of rural family medicine, cradle-to-grave approach to care. So, that was something that was always important to me.

Going to medical school, I became an internist. So, usually we think about internists being in hospitals, and I did all that.

I had the opportunity to work in a large public hospital system in South Florida where I oversaw medical education.

My husband and I were high school sweethearts. So, that's important to the story.

My husband is from Muldrow, Oklahoma, which is a small town in Sequoia County, part of the Cherokee Nation reservation.

My husband and his family is Cherokee, and we were in South Florida with, at the time, a three- and four-year-old little boys. We really wanted to come home. That had been important to us.

So, when the opportunity to come back to Oklahoma presented itself, we very quickly accepted it and moved back to Oklahoma.

I just feel very lucky to have the opportunity to work with an outstanding team of medical educators and of community support and hopefully be able to train the next generation of physicians who are going to serve the communities where I live and where my children live and where my parents and my husband's parents and grandparents all still are.

So, I just feel very lucky to be here.

FRANK BLAKE: I think both of you and your students and your faculty have such an amazing story of giving back.

I do think probably a lot of us who don't live in very rural areas have no idea of the health challenges and what you mean.

I mean your presence, how meaningful that is to the community.

I'm going to ask two questions just out of curiosity.

First is how many students do you think you'll have, or is this pretty much steady state, the number of students that you have now?

NATASHA BRAY: Yeah. So, on this campus, we take 50 students per year.

So, we've got an enrolled student body of approximately 200. We have no plans of increasing that.

Our Tulsa campus takes 115 students per year. So, today, that's the right size for us to be at.

FRANK BLAKE: So I don't want to take a shot at this for our listeners.

I think you would help me by explaining what the difference is between osteopathic medicine and allopathic medicine, just because people may listen and not fully understand that.

NATASHA BRAY: Osteopathic medicine is very much based on an educational approach of holistic approach to the person recognizing that people are more than just a disease presenting with a disorder that may be affecting them or a chronic illness, but people are complex beings who are part of a social network that is important for them to obtain health.

So, when someone gets sick, that illness affects not only their physiology, what's happening within their body, but it affects their ability to interact and earn a living, how they engage with their environment and their family.

So, we very much put the patient at the center of education from the first day of medical school.

Our students also have the opportunity to learn osteopathic manual medicine, which is based on the philosophy that people are meant to be in motion, and that if we have musculoskeletal things that impact our ability to be in motion and to engage, that's going to impair healing.

So, in addition to all the medicines and surgeries that you'll get from an MD physician, osteopathic physicians have this other musculoskeletal component that allows them to evaluate and potentially add additional services to help our patients approach health and wellness in a different way.

FRANK BLAKE: Thank you. As I understand, it's actually additional training over and above.

NATASHA BRAY: It's about 240 hours of additional coursework during the first two years of the curriculum.

FRANK BLAKE: Yeah. Well, thank you very much for that.

So, I ask everybody who appears on the show to tell the audience who's done a crazy good turn for you.

So, I think you both, and as I said, all your faculty and your students are doing crazy good turns in your community.

Who's done a crazy good turn for you? I'll start with you, Dr. Nolan.

DOUGLAS NOLAN: I would have to say probably Dr. Bill Pettit. He was the inaugural dean of the school.

But when I was working for Cherokee Nation early on, Dr. Pettit came and visited about we need to start a residency program.

So, as we started working on that, it ended up I was the physician who met all the requirements to be a program director to start a family medicine residency program here in Tahlequah.

So, as we applied and progressed, we trained a lot of physicians after they graduated medical school through their family medicine residency and hired them on.

That really was the beginning of me participating in medical education and then ultimately when this position came open, the Cherokee Nation encouraged me to apply.

It's been a great experience. I'm not sure I would have ever been in this position if it wasn't for Dr. Bill Pettit.

FRANK BLAKE: Dr. Bray?

NATASHA BRAY: That was a good one.

I'm going to take a little bit of a different approach, and really it's two people, but it was the same situation, my husband and my mother.

So, I think one of the challenges for females who have families is having the support that they need to be able to pursue their dreams and to develop in the way that they need to as a professional to be successful.

If my husband wasn't amazingly supportive and engaged and committed to the work that I am able to do and my mother had not been willing to come and live with us when I had my first child for his first 12 months of his life, I wouldn't have been able to accept the opportunities that I had to become a medical educator and to be prepared to do the work that I'm able to do today.

I'm willing and humble enough to admit that I can't do it all myself. If it wasn't for those amazing support, I wouldn't be able to do the things that I do.

FRANK BLAKE: Megan, we'd like to ask the same question of you. Who has done a Crazy Good Turn for you?

MEGAN TRAMEL: I would say Dr. Willis. She is a pediatrician in Vinita, Oklahoma. She works at that Cherokee Nation site with my mom.

And she wrote my letter of recommendation in the medical school. She has taken me on for rotations.

She even took me on for a last minute elective I had to finish out when my schedule got changed due to my grandpa passing this past December.

She didn't bat an eye and she just answered me right back and was like, "Absolutely. Get in here and we will get you taken care of so that you can meet your requirements for school," essentially.

And honestly, I can't thank her enough. She has helped me just in little ways, and encouragement coming through the grapevine from my mom and things like that.

And I always appreciate that and think that's important to give it back.

FRANK BLAKE: So final question, because as great as it all sounds and it does, I mean rural medicine and the commitment to it, I also know that it comes with a lot of sacrifices and a lot of difficulties associated with it that we haven't spent so much time talking about, but that's a fact.

What is it in the midst of those difficulties that still you say, this is what I think about and that keeps me positively oriented even when things are tough?

I'll turn to you first, Dr. Nolan.

DOUGLAS NOLAN: I would have to say my faith. We're supposed to work then to God, not in the man.

So, by taking care of others, it's very rewarding.

To believe that God has given us the abilities to take care of others, if we will actually do what we're supposed to do, which is to treat others as we wish they would treat us, it's very rewarding.

So, at the end of the day, we remember, we've been given a gift. And to who much has been given, much is required.

NATASHA BRAY: Yeah, I don't know how I top that.

FRANK BLAKE: No, you're right.

NATASHA BRAY: I think it's leaning into service.

A lot of the decisions and sometimes it's hard when you look through a lens of what is best for the people that we serve, whether that's an individual seeking healthcare or that's our students or it's our community.

A lot of decisions become clear because there are really difficult things.

We're balancing budgets and we're balancing time and we're balancing educational requirements and the needs of individuals and people and communities. That can get very hard and very heavy at times.

But if we remember that we're here to be of service to others and grant ourselves the grace of recognizing that we are not perfect and we can't anticipate everything.

So, we make the best decisions we can today with the information that we have and then we remain flexible enough to pivot when we need to pivot.

As long as we keep that service mentality in the center of our mindset, I think we do the best we can.

FRANK BLAKE: Well, thank you. Thank you both, and thank you truly for what you do.