Dena Krishnan wraps her stethoscope around her neck, stuffs her notebook into the front pocket of her crisp, white lab coat and, her examination complete, gets ready to leave 30-year-old Sabrina Hensley's remote hillside home. Just then, Sabrina's mother, Judy, 58, takes Krishnan's hands into her own. Her adult daughter suffers from cerebral palsy, respiratory distress, blindness and, now, a rapidly spreading infection. "Please," pleads Judy, speaking over the hum of Sabrina's ventilator. "Please practice medicine here. Please help us."
That appeal is one Krishnan, a fourth-year medical student at Lincoln Memorial University-DeBusk College of Osteopathic Medicine in Harrogate, Tenn., hears repeatedly as she makes her rounds in the heart of Appalachia. "We desperately need doctors," says Dr. Ray E. Stowers, dean of the medical school. Unlike most medical programs, LMU-DCOM's requires aspiring physicians to complete a rural rotation in which they not only see patients in hospital and clinic settings, but hone their healing skills going house to house in some of the most underserved parts of the country. In dozens of communities in Tennessee, Kentucky and Virginia-where the local hospital has a handful of beds and complicated illnesses require patients to be transported by helicopter to a regional trauma center-Krishnan has glimpsed a hidden world of poverty, pride and persistence. "I've met families without electricity or indoor plumbing who have never been to a doctor," says Krishnan, a bubbly 28-year-old who grew up in the comfortable suburb of Perrysburg, Ohio. The daughter of Indian immigrants-dad Ajay is a physical therapist and mom Bessy a jewelry designer-Krishnan turned down medical school in New York City to learn in a place where, she says, "people have been ignored for so long. I can be useful here."
COMFORTING A DYING CHILD
Walking into the dimly lit living room of the Wise family in New Tazewell, Tenn., on a steamy July afternoon, Krishnan sits on the couch, and 3-year-old Kaylee, fascinated with this exotic-looking visitor, scrambles into her lap. Kaylee has Leigh's disease, a rare and fatal neurometabolic disorder diagnosed in March 2009 after parents Sarah and Joshua spent months searching for answers-and driving hours to doctors-as to why their baby wouldn't gain weight. "I know she won't recover. It's very hard to deal with," says Sarah, 26, who, with Joshua logging long hours as a construction worker, often sleeps just a few hours a night on account of caring for Kaylee, who requires liquid feedings through an abdominal tube. "But it's so helpful to have doctors stop in. At least she's not in pain now." As Kaylee scribbles in Krishnan's notebook and fiddles with her stethoscope, Sarah tells her the little girl has already outlived doctors' predictions, and Krishnan fights back tears. "There's nothing harder than treating sick children," she says as she drives her yellow SUV to her next appointment. Recalling the pain of her younger brother Joshua's near-fatal case of encephalitis when he was only 19, she says, "I wish I could do more."
Krishnan climbs the wooden stairs leading to a dilapidated trailer home in nearby Speedwell, where Ronald Moyers, 55, lives with his brother, mother and stepfather. Moyers has Down syndrome, diabetes and high blood pressure, but mom Josephine, 74, often can't make the 25-mile drive to town. Krishnan watches as Dr. Carroll Rose, 66, reviews Moyers' medical history. The medical student smiles as Moyers pulls out a dirty, torn teddy bear from a box on the cracked tile floor and shows it to her. "How are you feeling?" Krishnan asks, patting Moyers' knee before she checks his pulse and takes his temperature. "I've learned to build trust," she says later. "You become like part of the family."
CHECKUP, CAKE AND TEA
In a tidy trailer not far from the rippling river where her 17-year-old son accidentally drowned some three decades earlier, Frances Hilton, 69, is sitting in a recliner, recovering from hip-replacement surgery. Dr. John Short, 43, who sees 4,000 families in his rural practice, is checking on her progress, with Krishnan on hand to assist. Fred Hilton, 70, grabs his wife's prescriptions from a coffee can as Krishnan listens to her heart. Krishnan notices Frances' hand is swollen-she has rheumatoid arthritis and gout and already has circulatory problems-and listens as Dr. Short reviews her medications. Late for the next house call, Krishnan and Short heed Frances' friendly order to stay for pineapple upside-down cake and sweet tea. "I'd been concerned about whether I'd be accepted as a woman of color," she reflects."But I feel a warmth from families here."
EXAM ON THE PORCH
Twins Loyd and Milum "Mutt" Stewart, 81, stand on their well-worn front porch, their freshly washed clothes flapping in the breeze on the laundry line. Loyd kills flies with a blue swatter as Krishnan and Dr. Short listen to Mutt's breathing to see if the pneumonia in his right lung has cleared. "You sound much better," Dr. Short says to Mutt, handing the stethoscope to Krishnan for a listen. Mutt locks eyes with Krishnan. "I know I've seen you before," he insists, though this is her first visit. He tells her his mother has died, and starts to cry; Loyd tears up too, though their mother passed away 20 years ago, Dr. Short later explains. "I want you to come back real soon," Mutt says. Krishnan smiles: "I will."
She'll log six more house calls that day before driving back to the rental home in Crossville she shares with fiance and fellow med student Shawn Wilson, 28, who's often out on house calls himself. The routine can be grueling, but Krishnan says she's getting a medical education like no other. "I'm seeing every single diagnosis you can imagine, really sick people," she says. "It's exciting and it's terrifying." She's not sure where she'll end up when she graduates next year-she thinks about practicing in a poor neighborhood in a city. Wherever she goes, she says, the patients she's cared for here have changed her forever. "I want to help struggling communities," she says. "I've stepped out of my own little bubble. My dreams are bigger now."