IN THE EARLY DAYS of the Bayview clinic, circa 2007, I was driving through the neighborhood when the car in front of me stopped suddenly.
At first, it was a mere annoyance. My mind was already thirty minutes into the future, engaging in a community meeting at the Bayview YMCA. About fifteen seconds passed before I realized it was time to swing the wheel left and go around. But just as I was about to make that move, a car coming from the other direction pulled up beside me and stopped.
A little alarm in my lizard brain started to go off. What’s going on here? This looks shady. I checked the rearview mirror and got ready to jam the car into reverse, but before I could put my hand on the gearshift, another car wheeled around the corner and blocked me from behind.
I was trapped.
I could feel my body tense. With one hand on the steering wheel, I slowly reached for the automatic door locks. The guy in the first car got out and swaggered by me with a package. As he leaned forward to make the handoff to the guy in the car next to me, his shirt slid up to reveal the heel of a gun poking out from his waistband. Holy crap! My mind raced. This is a drug deal! What if the deal goes bad and they start shooting? What if this guy sees me and decides I’m a witness? My heart began to double-time it and my brain was like a radio locked on one station: How the Hell Do I Get Out of Here! I slouched down in my seat, willing myself to be invisible and, if possible, bulletproof.
Then, without so much as a look in my direction, the guy walked back to his car and drove away.
Minutes later, as I sat in my car unscathed, the radio station of my brain changed suddenly to the Holy Crap What Just Happened station.
After I finished freaking out, I immediately thought of my patients. On that day in 2007, I was still getting used to Bayview, but for my pediatric patients, this kind of thing could happen on their way to school or to the store any day of the week.
I learned early on that the threat of gun violence is a daily reality in Bayview, something you have to think about every time you walk to the corner store for a quart of milk. Years later, I met the district attorney of San Francisco, Kamala Harris, at a fundraiser right around the time we’d launched the mindfulness project at the Bayview clinic, and our conversation naturally turned to what we both saw as a devastating problem in a neighborhood we both loved. I’d heard Harris speak before, both on television and at events, and it was immediately obvious to me why people always talked about her as being the real deal, someone who was getting things done. She was young, charismatic, and knew how to energize a room. At first, I’d been a little hesitant to talk to her, but Harris was more approachable than I could have hoped, and pretty quickly my nervousness disappeared and we had a great conversation. She was curious about our work in Bayview and wanted to know more about toxic stress. It was refreshing to meet a politician who wasn’t just delivering sound bites about how to make things better for people; I could tell she was actually listening. She seemed genuinely receptive to hearing different approaches to solving the community’s problems.
When I started talking about Felitti and Anda’s ACE Study, I discovered that Harris loved numbers as much as I did. She told me about an internal study she had done with the San Francisco Police Department. The department wanted to get a detailed look at the victims of homicide in the community, and one of the insights that emerged from that analysis had to do with the high rate of young murder victims. Among other things, the study found that 94 percent of murder victims under the age of twenty-five in San Francisco were school dropouts. As DA, Harris was the top prosecutor; her job was to be the official voice of the victims and go after perpetrators of crimes. But she wanted to know whether the city could find a way to prevent people from becoming victims of crime in the first place. What would that look like? She thought if she could devise a smart approach to stem the dropout tide, it would save lives. After all, kids who were in school weren’t out on the streets, which meant they weren’t victims of drive-by shootings.
Harris was interested in getting to the root of the problem, preventing rather than simply responding to the downstream effects once the chain of violence had been set in motion. Prevention is not something you hear DAs talk about every day, so when she told me about the redirection program she was developing to keep kids in school, I was seriously impressed. I told her I thought she was right and that I believed we could go even further. I had recently heard a story about a pediatric emergency medicine doctor in Kansas City, Missouri, that seemed to point to the root of both of our problems.
Like Harris, Dr. Denise Dowd had been looking for ways to keep kids from getting shot. Her quest had started over a decade and a half earlier, in 1992, when a colleague of hers in the emergency department showed her an article in a local newspaper, the Kansas City Star. A journalist had profiled all the young people in the city who had died of gunshot wounds over the past year. The article included their photos and full names, and as the two doctors flipped through the profiles, they realized that a majority of the victims had been their patients. Many of the families used the ED as if it were their primary-care office, coming in any time their children needed to see a doctor. Over time, Dr. Dowd and her colleagues grew to know and develop relationships with their repeat customers. Now it was impossible not to wonder: Was there something they could have done? Could they find a way to recognize the next high-risk kid when he was sitting in front of them in the ED and help him before it was too late?
Dr. Dowd decided to do a chart review of all the pediatric firearm injuries in Kansas City for that year, looking for any factors that might be a common thread and possibly preventable. She obtained the health records, hospital admissions, EMS records, and coroner’s reports of every child who had been killed by gun violence in the preceding year. What she found was that their medical histories revealed a pattern that repeated itself with tragic consistency. A typical story looked like this: A patient first comes in as a nine-month-old baby with a suspicious bruise, and the case is referred to Child Protective Services. The investigation is inconclusive. The next notation in his chart is from his pediatrician and details several missed visits for immunizations. At age four his preschool teacher complains that he won’t sit still, has frequent tantrums, and hits other kids when he gets upset. He is diagnosed with ADHD and put on meds. At age ten, he’s fighting and disruptive in school. This time, he’s diagnosed with oppositional defiant disorder and put on more meds. At age fourteen he comes into the ED with a fracture of the fifth metacarpal, the bone in the hand that forms the knuckle of the pinky finger. Doctors call it a boxer’s fracture because that’s the bone that typically breaks when someone punches an object. The final entry in his medical record is at sixteen when he’s brought into the ED for multiple gunshot wounds. This time he doesn’t walk out.
In 2009, it seemed obvious to me that Dr. Dowd’s prototypical patient was a clear example of untreated toxic stress. But in 1992, when Dr. Dowd was reviewing these charts, Felitti and Anda’s research was still in the future. Dr. Dowd saw these similarities in medical history as a disturbing pattern, but the biological links had not yet been made.
After talking more about the ACE Study and other research on toxic stress, Harris and I agreed that we were looking at the same problem, just from different vantage points. I was trying to address kids’ medical problems and she, like Dr. Dowd, was trying to keep kids safe. But what if we could put our heads together and address the potential root of both problems—ACEs. For the population of kids who were victims of gun violence, Dr. Dowd’s research suggested we were likely to be dealing with a lot of high ACE scores. That meant a lack of impulse control and an impaired ability to focus—huge obstacles for getting kids successfully through school. For a kid with a dysregulated VTA (Vegas, baby!), pretty much anything from a trip to Taco Bell to smoking a bowl could easily win out over sitting in history class. How could we keep kids in school and safe and address the underlying biology that was putting kids at risk in the first place?
Harris and I continued our conversation about the profound social implications surrounding ACEs, health care, and the criminal justice system. One day I went to meet with her at the infamous Hall of Justice at 850 Bryant Street. (Anyone who has gotten a car towed in San Francisco knows that address all too well.) As we sat in her wood-paneled office, I shared with her some of my ideas that had coalesced since our initial meeting. I was convinced that if we could get more physicians like Dr. Dowd and myself to identify the kids in need of intervention early on, we could work to start healing their dysregulated stress responses so lifesaving programs like Harris’s had an even better chance for success. We could prevent not only adverse health outcomes but also adverse social outcomes. I thought maybe she could use her position as DA to get the city to invest in research and data collection to find out if using the ACEs lens might make a difference.
Harris listened intently until I finished. Then she paused and looked me straight in the eye.
“Nadine, you need to be the one to make all these things happen. Start a center.”
I laughed. “Girl, I’ve got my hands full doing what I’m doing.”
“You and Victor could do it together. Think about it,” she said in a kind, resolute voice that made it seem more like a foregone conclusion than a suggestion. She was the one who had introduced me to Victor Carrion and kindled the partnership that led to our chart review of patients at the clinic.
Harris would go on to become California’s attorney general and then a senator, which gives you a good idea of how convincing she can be. I was flattered that she thought I could add the rigorous research and commitment to changing broad-scale awareness to the work that we were already doing, but I walked out that day thinking that she was vastly overestimating my abilities. She had the wrong woman. My experience starting the Bayview clinic, even with the full backing of one of the Bay Area’s top-rated hospitals, was grueling. Long days, never enough money, fundraising, creating protocols, staff turnover—it felt like we had just gotten things working reasonably smoothly at the clinic. Starting an organization is really hard, and I wasn’t in any hurry to do it again.
While a whole new center seemed out of reach, my discussion with Harris broadened my perspective. If ACEs were affecting not only health but social outcomes, I wasn’t going to be able to work only the medical-community angle. I would need to talk to folks in education and criminal justice to learn more about how toxic stress related to the problems they were seeing.
The more people I met and spoke to about ACEs, the more I understood that the solution to this problem needed to be a lot bigger than the Bayview clinic. I knew from Dr. Felitti’s data that 67 percent of Kaiser’s middle-class, mostly Caucasian population had at least one ACE and that one in eight folks had four or more. It’s one thing to read research papers that talk about prevalence rates and odds ratios. It’s another thing entirely to meet the Marjories of the world and hear their stories. When statistics have faces, they feel a lot heavier. The worst part for me was thinking of the men, women, and children struggling with the effects of ACEs and toxic stress, walking around every day without knowing what the problem was and, harder still, not knowing that there were effective treatments. Their doctors don’t tell them because chances are, their doctors don’t know. To anyone looking at the day-to-day practice in the average doctor’s office—or looking anywhere else in society—it was as if the research didn’t exist. The more I knew, the more intolerable it felt to me that almost no one seemed to have this information.
As a result, I became even more vocal (if that’s possible). Now when I went to medical and public-health conferences, I actively tried to influence the agenda to promote awareness about ACEs and toxic stress. As always, my work at the Bayview clinic both grounded me and continued to stoke the fire I felt around getting the word out. The only bad thing about coming home to Bayview was the reality of the clinic’s minimal capacity for impact. There was so much urgency around doing more that conflicted with the small-potatoes nature of our operation. We had three exam rooms, one mental-health room, and one office. I shared that office with two other doctors and my research assistant Julia, which meant we couldn’t all be in there at the same time. Dr. Renschler and Dr. Clarke were sharing the mental-health room, so we had to stagger their hours. The dentists who came from our partner clinic to deliver free dental services a couple of times a month set up “portable dental chairs” (I swear they looked like lawn chairs) and did dental screenings, cleanings, and fluoride applications in the warehouse space where we also locked up our charts and ran our exercise program.
In order to be able to answer the question from the hospital council and DA Harris—What are you going to do about it?—we would need researchers to help us measure the impact of our work. That was the only way we were going to be able to convince the hospital council, the city council, the world that there was something we could do medically about toxic stress. Dr. Carrion and his team could help us design studies that would stand up to academic scrutiny, but to do that work, they would need to be embedded in the clinic, and we literally did not have the room. We were like clowns in a clown car. At one point the concept of bunk desks crossed my mind. If we wanted to make a broad impact, we needed to test-drive treatments rigorously to ensure they would work in every pediatric office, not just ours.
Fortunately there was one person who often knew when I needed help before I did. Daniel Lurie was the founder and CEO of the Tipping Point Community, a grant-making organization that had a goal of ending poverty in the Bay Area. Tipping Point had been one of my biggest backers, helping us to launch the Bayview clinic and funding our partnership with Dr. Lieberman’s program. Lurie spent a lot of time meeting with leaders of organizations that Tipping Point supported, listening to their challenges and frustrations, trying to understand how his organization could help.
In one such meeting I found myself talking to Lurie and Dr. Mark Ghaly, the medical director at the county health clinic in Bayview. At one point Lurie asked us what we thought was the biggest problem in the community. The term ACEs was out of my mouth immediately, and Dr. Ghaly agreed that he was seeing the same patterns and connections between adversity and ill health at his clinic. Lurie asked what we would do about it if money weren’t an object. Soon I was riffing, pie-in-the-sky-style, about a whole new center that would focus on working up new protocols and treatments for kids dealing with high ACEs and advocating for those solutions nationwide. Dr. Ghaly was enthusiastic and added some suggestions for how to make such a center the cornerstone of the community. At the end of the conversation, I could see the wheels in Lurie’s head turning, which is always a really good sign.
A few weeks later Lurie called me to say that he had found a way for Tipping Point to help us raise the money to create a center. The organization was going to make our project the focus of the next year’s benefit fundraiser. We would need to have a plan with a thoughtful budget and a clear vision of what we wanted to accomplish, but Tipping Point could help us get the money. It was time to put all our dreams down on paper. As Lurie talked, I was uncharacteristically quiet. This really was our chance, and this time, I would be fully prepared, not just with a statement of the problem, but with the solutions as well.
As soon as I got off the phone with Lurie, I called Victor Carrion. We talked through the kinds of resources it would take to pilot interventions for toxic stress. We dreamed of a sort of innovation lab that would do three things for our patients—prevent, screen, and heal the impacts of ACEs and toxic stress. The overarching goal was always to use the clinical science that came out of our center to change medical practice. To do that, we landed on a synergy between three pillars—clinical work, research, and advocacy. The clinical arm would be devoted to caring for patients and developing new approaches for treating toxic stress in a real-world setting. Research meant that we would hire a team to do what Dr. Clarke, Julia Hellman, and my other partners had been doing at the Bayview clinic—scouring the literature for best practices and using them to inform our clinical work. In addition, our research team would help us figure out how to validate the interventions and tools we were using and would always be on the lookout for ways to refine those practices according to the highest standards of medical science. Advocacy was the final piece. That was where we hoped to raise awareness and share the solutions that we’d found were working in our clinic so that eventually we might see broad-scale adoption by every pediatrician in America and beyond.
After putting some feelers out into the philanthropy world, we decided to join forces with Katie Albright, a tireless child advocate who was trying to create a center of her own that would offer complementary services. Housing both our organizations in the same building and fundraising as a unified front would be much more compelling to potential donors than each of us doing it individually.
Ebullient phone calls, illegible notes scrawled on the back of junk mail, and delicious spikes of adrenaline filled the days and weeks that followed as we fleshed out plans for what we would ultimately call the Center for Youth Wellness.
True to his word, Lurie had the Tipping Point throw its weight into funding our dream by making the benefit its biggest ever. The organ-izers hired a production company to make a jazzy video to promote the center’s vision and somehow even managed to land John Legend as the benefit’s headliner. The evening was a smash that I remember in surreal snatches of excitement and color. I wore a black vintage Oscar de la Renta dress scored from a consignment shop and my lucky four-inch heels that were hell on my musculoskeletal system but that made me feel like anything was possible. (When I got to sit next to John Legend at dinner, I made a mental note never to throw those shoes away.) Halfway through the night Lurie got up on the stage and introduced our plan for the center. The video completed his call to action, and he then started the bidding. The philanthropists of the Bay Area and the titans of tech responded, their glow sticks bobbing in the darkened room. The next thing I knew, Tipping Point had raised $4.3 million and John Legend had taken the stage and was belting out my favorite song. As a doctor I know you can’t die of happiness, but when I stepped out onto the dance floor in my lucky heels, for a moment it felt dangerously possible.
Now that we had the funding to start the project, we needed to figure out the steps to make the dream a reality. Dr. Carrion became a co-founder with me and it was a match made in heaven. We continued to think through approaches to treatments and research. Kamala Harris and Daniel Lurie loaned us experts from their teams to help us work out the details. Shortly after the benefit, we sat down and looked at the nuts and bolts of things, and we realized just how quickly the $4.3 million dollars would fly out the window when split among three organizations—the expansion of the Bayview clinic, the new Center for Youth Wellness, and Katie Albright’s children’s advocacy center. It had seemed like an enormous sum when I was celebrating on the dance floor, but with the crazy San Francisco real estate market, it wasn’t even enough to buy a building. In fact, renting, designing, and renovating a 26,000-square-foot building, plus meeting the stringent federal codes for a health clinic, would eat up almost all the money.
As discouraging as it was to realize we weren’t swimming in dough, we still had enough to get started. It was seed funding and it was enough to bring the Center for Youth Wellness (CYW) into the world. The Bayview clinic, supported in part by the hospital, would keep doing what it did—regular checkups for kids in the community and ACE screening. Once a patient screened positive for ACEs, the CYW clinical team would provide the multidisciplinary services focused on treating toxic stress—mental health, mindfulness, home visits, nutritional counseling, all the stuff our research told us could make a difference. The research team would track the data, and the advocacy team would get the word out. It was going to be a top-to-tail health-care home for kids and what we hoped would be a model for future organizations.
After a year of planning and fundraising for CYW, it was finally time to act on the business plan and build. In August of 2011, I transitioned from my role as medical director at the Bayview Child Health Center to become CEO of the Center for Youth Wellness. The title CEO was aspirational at the time. There was not much for me to be CEO of—I was literally working out of my kitchen. I was fortunate to have the help of Rachel Cocalis, a recent college graduate and future lawyer who volunteered to work for free as my assistant until we became official and I could pay her. I was still seeing patients at the Bayview clinic but had scaled back to one day a week and had passed the medical-director baton to my colleague Dr. Monica Singer. My real job was focusing on the CYW plan and making it happen. The critical work of hiring a team meant doing interviews in coffee shops and at my dining-room table.
Although starting CYW was one of the scariest things I had ever done, it was actually going pretty well for a bare-bones operation. Which was why I was totally unprepared for what happened next.
Though we hadn’t even opened our doors (in fact, we were still negotiating the lease on a building just a few blocks from the original Bayview clinic), we had to apply to the city for a change in the zoning code to allow the type of clinic that we were proposing. While it should have been a mundane process, funny things start to happen in Bayview when people hear that you have $4.3 million. Suddenly a small but determined group of individuals (six, to be exact) began to agitate and put up roadblocks. They didn’t want us to locate our center at the site we’d found because they alleged that it was contaminated with “toxic dust.” They had no evidence of contamination, but the rumor was enough to throw a huge wrench into the works. We paid for two rounds of environmental testing, which both came up clean. We even engaged the San Francisco Department of the Environment to do an independent sample that corroborated the findings of our experts—no toxic dust. But the group wouldn’t be dissuaded. When the planning department granted our building permits, they appealed, triggering a three-month delay. I wanted to pull my hair out. We were under the gun to get the center up and serving children, but I felt I was wasting time and money jumping through hoops.
I would learn later that this is a common practice in low-income communities. When folks hear that there is money coming into the community, there is a small contingent that essentially makes its living by trying to get a piece of it. That the community would benefit by having more high-quality services for kids is not what they were interested in. They wanted the money in their pockets. These folks create problems for the team running the project, often using race as a lightning rod, and then they’re conveniently available to be “community consultants” who can help the project move forward for a hefty fee.
While I understood the impulse to “get yours” when there was not much to go around, we weren’t some multimillion-dollar corporation with money to burn. This group of six was focusing on a number that was misleading. Yes, Tipping Point had raised $4.3 million for the entire project, but what was easily missed, unless you were in our meetings crunching numbers, was that these dollars were being split three ways. After paying for the rent and construction, we had almost nothing left, and we still had to pay the staff. Clearly, this group had an entirely wrong idea about how deep our pockets were.
One afternoon, a staff member walked into the temporary offices that CYW had rented next door to the Bayview clinic. In her hand was a flyer that said stop the massacre! DR. BURKE WANTS TO EXPERIMENT ON OUR CHILDREN!
I went quiet for a moment, taking stock of what was happening in front of me. My mind cycled through a few choice expletives that I had to try hard not to vocalize. Accusations of medical experimentation in African American communities are exceptionally loaded because they are founded on a history of shameful and unethical exploitation of blacks by the medical community. As this group undoubtedly knew, calling up that history preyed on people’s legitimate fears, triggering a long-held mistrust of medical professionals. It burned me up that they would use the trauma that came out of those situations for their own purposes.
I quickly went online to check out the community message boards and saw posts and articles about why people in the neighborhood shouldn’t trust “that Jamaican.” If I hadn’t been so upset, I almost would have laughed at the genius of it. Instead of playing the race card, they went the foreigner route, casting me as the malevolent outsider. I thought of my patients or their parents reading those signs and felt my chest tighten up and my face go hot. It took a minute for me to calm down, but I tried to convince myself that anyone in Bayview who knew me would know that this was total crap.
Until then, I had been trying to placate this group by jumping through all the hoops they set up. Now I realized it was time for a different approach.
I would need to meet one-on-one with the leader of the group, an eighty-four-year-old chain-smoking force of nature I’ll simply call Sister J. I had heard stories about her from my patients’ parents and others in the community for years, but until that moment I’d never been on the receiving end of her “advocacy.” Sister J had lived in Bayview much of her life and was a legend in her own right. A longtime activist, she had done quite a lot of good for the community. She had battled environmental issues and advocated for fair housing and jobs. Unfortunately, with her, the line between community benefit and personal benefit could get a little murky. When the City of San Francisco was moving forward with the largest municipal solar-power system in the nation, she threatened to hold up the project and insisted that Bayview residents do the work. While she did win a good number of jobs for residents of Bayview, one of the concessions included a free solar-power system for her house. At other times, the benefit to the community was less clear. When San Francisco tried to implement gun-safety measures aimed at decreasing the number of kids who were victims of gun violence, Sister J was the lead plaintiff in the NRA-supported legal effort to stop the legislation. She claimed her Second Amendment rights were being violated.
There were those on my team who wondered aloud if we should just give in to the game and “hire” her as a consultant. My answer was simple: Over. My. Dead. Body. I wasn’t about to use our limited dollars to buy into a vicious cycle of exploitation. My goal in meeting with her was to explain what we were trying to do and why it was so important. I knew that at her core she cared about the community, and I hoped that if she understood that we didn’t actually have a ton of money and were just trying to bring services to help kids, maybe she would cut us some slack.
It wasn’t long before I found myself nervously ringing Sister J’s doorbell, trying to get the stop-the-massacre flyer out of my head. I wanted to exude a sense of calm and solidarity. No small feat. When she opened the door, I had to look down. She might have been a big presence, but Sister J was just about five feet tall, with deep creases in her soft face and glasses that hung on the end of her nose. She looked the part of a matriarch, like one of those Southern grandmothers who knew how to keep generations of family together and made sure that everyone knew “our history.” She politely invited me in and we sat down in a perfectly appointed living room on a settee preserved for all time under a thick plastic cover.
Before I could say anything she handed me a business card that gave her title as Community Icon. I looked up and searched her face for concealed amusement, evidence of what I could only imagine was a self-deprecating joke. Instead, she poured us both tea and began to talk.
The power dynamic was palpable. The tea and manners were her subtle way of letting me know who was boss. Her voice was gravelly from decades of smoking, but she proceeded to hold forth for the next two hours.
Almost uninterrupted, she told me the story of her life. I understood that this monologue was meant to communicate her bona fides—what she had done for the community and why she was so respected (and feared). But I was distracted by a profound irony—her life was riddled with ACEs. The mental tally I had going in my head put her ACE score at a seven or eight by the time she wrapped up.
Finally, I had a chance to tell her why I was there. I started to explain everything that I’d seen in my patients, why the work was so important to me, and how much I thought that we could lift up not only Bayview, but many communities around the country and the world that were profoundly affected by ACEs. Before I got very far she interrupted and started talking over me. It was clear that I was there to listen, not to talk. This was never intended to be a two-way conversation. I took a deep breath and considered my options. It wasn’t looking good in terms of changing her mind about our building, and part of me wanted to down my tea and leave, but I decided to dig in and keep trying. She was the person standing between my kids and the dream of the Center for Youth Wellness. I let her continue for a few more minutes, and she got to her final tale of activism.
“I told them that I was going to blow that building up . . . but I wouldn’t do that to you, baby,” she said, finishing with a chuckle.
Out of nowhere, tears welled up in my eyes and spilled down my cheeks.
It wasn’t the veiled threat or the disappointing lack of dialogue that upset me; it was the utter futility of the past several months that I had spent trying to work with this group. I believe in the power of conversation, connection, and empathy when it comes to dealing with community problems, but I had finally hit a situation where that just flat-out didn’t work. I could have been Nelson Mandela and it wouldn’t have mattered to Sister J; her own agenda was the only one she was interested in.
She started to talk again, but for the first time, I interrupted her.
“I think we can do better by our kids,” I said, rising to my feet.
I could see her eyes narrowing, but before she could say anything I continued. “Sister J, our kids deserve better.”
And with that, I shook her hand and walked out.
For the next couple of nights, I couldn’t sleep. I had a copy of the Stop the Massacre! flyer on my nightstand next to my bed, and every night as I lay down, I felt my heart start to race. How many people had seen that flyer? There were so many people in the neighborhood I hadn’t yet met. Did anyone really believe that I was experimenting on kids? Rumors are like termites in small communities like Bayview; they work fast and do a lot of damage. Worse yet, how would the planning commission react to the allegations? I had no idea. I was beginning to see that the lack of outside investment in Bayview wasn’t only because nonresidents didn’t care; even the people who did care had to deal with ridiculous obstacles placed in front of them by a few misguided gatekeepers. I could see how easy it would be for anyone trying to do some good in Bayview to give up.
Fortunately, a few nights before the planning commission hearing, I got a call from the author and journalist Paul Tough. Before the whirlwind run-up to the launch of CYW, he had written an article in The New Yorker about the Bayview clinic and our work around ACEs and toxic stress. Being more of a medical-journal gal, I had no idea what a big deal this was until the issue hit the stands. It’s not overstating the situation to say that the article changed everything. By spotlighting the subject, it triggered a ton of interest among colleagues and new supporters and brought our work into the mainstream. Paul and I had developed a friendship over the weeks and months he’d spent walking with me to work and shadowing me at the clinic, so occasionally, he would reach out to see how things were going, and this time I spilled about Sister J. A few minutes into my sob story, I took a breath and heard a knowing laugh on the other end of the line.
“What could you possibly be laughing at?”
Paul told me that Geoff Canada, founder of the Harlem Children’s Zone and one of my personal heroes, had also faced some pushback from community members when his organization was building a new school and community center in the middle of a housing project in Harlem. Tough had written the book on the legendary educator and his organization’s work to transform educational outcomes for children in Harlem. Canada found that the opposition evaporated when people saw that the Harlem Children’s Zone was there for them and that the building and the organization was an asset.
“It’s a rite of passage,” Paul assured me. “You’ll make it through. Consider it a badge of honor.”
After my conversation with Paul I was able to step back and get a little perspective. It occurred to me that the trauma that is endemic in communities like Bayview isn’t just handed down from parent to child and encoded in the epigenome; it is passed from person to person, becoming embedded in the DNA of the society. That was exactly the kind of cycle we were hoping to break with our work at CYW. That realization caused me to look at this obstacle as a symptom of a community plagued by trauma as opposed to a sign that I was destined to fail. Paul also reminded me to stick to what I already knew: my patients and their parents were overwhelmingly supportive of our plan for CYW. Happy parents were constantly referring relatives and friends to us and asking when we were going to hire more doctors and therapists. They had seen firsthand the good we were doing in the community. We knew that a small but strident group of folks would oppose our application during the planning commission meeting, but I also knew that a hell of a lot more folks wanted to see us open the doors to a bigger and better facility. I needed to focus on harnessing that strength instead of worrying about the opposition.
In the days that followed my conversation with Paul, my team and I started to talk to our kids’ parents and others in the community. We let them know that the project was in jeopardy and that we needed them to show up at city hall. On the day of the hearing, people set up carpools and we got vans to help bring in our supporters who didn’t have transportation. Many folks had to take the day off work. For their time and effort, the best we could do was provide lunch—Subway sandwiches. As people arrived, we gave them green stickers to wear to signify their support of our project. When the meeting started, the room was packed and the crowd spilled out into the hallway. The members of the planning commission made their way through the agenda and finally got to us. A small handful of people got up and spoke out against the project.
Then it was our turn.
Family after family rose and testified. They were every shape and size and all shades of the rainbow. Some had brought their kids, and all of them talked about what we had done for their families, what it meant to them, and how much additional services were needed. With each person who spoke, I felt my body relax and my chest open up. At one point I looked over at my team and just shook my head. It was one thing to hear that kind of gratitude in the privacy of the clinic; it was another to hear it proclaimed publicly and with such feeling. In that moment, my faith in our work deepened. Here in front of me was the blueprint for our success—a community of people struggling with a legacy of ACEs, up against obstacles strengthened by historical cycles of marginalization and violence, but nonetheless coming together to advocate for a better life for their kids. These families testified that we were doing something powerful and important for their children. The cycle could be broken. Kids were staying in school instead of hitting the streets. Parents were learning to talk to their kids instead of disconnecting from them. This group in front of me saw an opportunity in CYW for their families and their community to further the process of collective healing. I realized that CYW already had the most important ingredient for success: the trust and support of the community we aimed to serve.
After everyone had spoken, the planning commission asked those who were opposed to CYW to stand up.
Four lonely figures got to their feet.
Next, the commission asked everyone who had come in support to stand up.
A sea of green stickers rose in unison, an extended family of over two hundred supporters—patients, parents, staff, friends, and family. Overwhelmed, I was struck yet again by the way that people in our community take care of one another. That moment is what Bayview looks and feels like from the inside, and I have to say, it feels pretty damn good.
When the planning commission voted unanimously in our favor, a wave of raucous cheers swept the room.