MEDEX Magazine sat down with long-time MEDEX Northwest faculty member Lois Thetford on the eve of her retirement from MEDEX. Lois was also a couple of weeks away from celebrating her 80th birthday, though you would never have known it if judging by the level of energy and degree of engagement she brought to the conversation. MEDEX Magazine has had a particularly fruitful working relationship with Lois over the years, which we have tried to reflect by including links to pertinent videos and features throughout the interview.
MEDEX Magazine: So the last time we spoke, Lois, you were off to teach your final class as a MEDEX faculty member. How did that go?
Lois Thetford: Oh, it was so great.
MM: What was the topic?
LT: The lecture was called Framing Homelessness, and it was on providing care to people who are unhoused. I was going for the big picture.
MM: Big picture in what sense?
LT: So, one of the things that’s happening in the world right now is a refugee crisis for millions and millions of people. And that’s a significant part of who unhoused or homeless people are.
Lois goes on to detail the difficult experiences of people from the Congo who have relocated to Tukwila, some 10 miles south of Seattle, of the prison industrial complex, of the systemic failures of education and healthcare, of the shrinking base of affordable housing, of buildings in King County vacated during COVID that are not being properly refitted to support housing needs, of the budget cutting that occurred in the 1980s under the Reagan-Bush administration that left things only spiraling downward ever since, and … well, going for the big picture.
MM: Wow. And why was this something you wanted to bring to this class?
LT: Because I think that it’s important to understand that housing is not just a local problem. It isn’t only due to the failure of the mayor or the city council or any of that. That this is a much bigger undertaking. It’s a national problem, a global problem.
I really like starting from the big picture and then move to the small, so I had a speaker, Grace Stokeland, join me.
MM: That same day in class?
LT: Yes. Grace is a peer outreach worker for the Youth Clinic at the 45th Street Clinic. She left home at 15 because … well, because she had to. She told the class about how she survived that period of her life. I think it’s really important for students to hear from a person with lived experience.
And then I always follow with a couple of other topics that I can pull up, depending on the class—material for the students to dig into. The experience of unhoused kids and school, for instance, or the healthcare needs of women experiencing homelessness.
So I like doing the framing, then having this lived experience speaker, and then focusing in on more specific medical things.
MM: Sounds like it was business as usual with Lois Thetford, then? Full steam ahead even though you are winding down?
LT: Yes, I guess so! In fact, I’ve really doubled down in my last month. I also volunteered to visit and evaluate five clinical sites for the MEDEX clinical team, in Port Townsend, North Bend, and Whidbey Island. It was so much fun. I just loved it.
MM: That’s not something you usually do?
LT: No, not really, but the clinical team needed some additional support. The students were happy to see me, I think, and I was thrilled to be there and see them in their rotations.
MM: Nice.
LT: Yes, very nice. How great it is to celebrate all the aspects of the didactic teaching and clinical training. I feel so devoted to all the students and to their experience of doing this stuff.
MM: And so … that’s it for Lois Thetford and MEDEX Northwest?
LT: Oh, well I’m sure I’ll come back and do some lectures and things, maybe. But no more administrative duties!
MM: How many lectures do you suppose you’ve given over these … well, over these how many years?
LT: Well, let’s see, I started just doing Basic Clinical Skills for MEDEX back in 2005. But I didn’t come on to the MEDEX faculty until 2010. So, in the past 15 years I’ve taught … oh, I’ve led so many basic skills sessions, and so many gynecological and maternal health workshops, all sorts of things.
MM: Maybe lectures is the wrong word. We’re talking workshops, presentations, demonstrations …
LT: All of the above, right. I like doing the workshops the best, because I really love to see the students interacting with the babies, or with kids, or with retirees, or with standardized patients.
MM: Is it surprising to you now, as you look back, that you have stuck it out for so long?
LT: Well, I’m turning 80 soon, and most people don’t get to be 80 years old and still do the things that they love. I feel so lucky to have been able to be here this long.
MM: And it shows, Lois. Your face and voice register such commitment and energy, even as we sit here today.
LT: I just feel so good about the work that we have done and the students that we have educated. They’re out there, you know? Out there doing good work in the world where it is so much needed. And so, I feel great.
MM: Of course this isn’t news to anyone who knows you, but since you joined MEDEX, you’ve continued to do all all kinds of work outside of it. Remind us of some of the things you’ve pursued while working with MEDEX over the past 15 years.
LT: So, I taught at the Seattle Midwifery School, which is a master’s degree at Bastyr University, from 1993 to 2013. And I was in practice at the 45th Street Clinic until 2013. And I’m affiliated with a number of community organizations, on the board, for instance.
MM: How did you fit all that in?
LT: Well I haven’t worked full-time at the clinic for many decades. And I didn’t work full-time at MEDEX while I was still working at the clinic and teaching at the Midwifery School. I just taught one course there: a course on gynecology for midwives. So, I wasn’t involved in year-round school. I gave up my clinical practice in 2005 and just continued to do my shelter work and outreach.
MM: What was behind that decision?
LT: It was just too hard. The constant changes in the clinic management, all of the things related to electronic records. I mean they were developing the program while we used it, you know? Building the plane while you’re flying it. But mostly I just got to the point where going to clinic wasn’t fun anymore. I loved seeing patients. I loved being a provider, but it just wasn’t working for me to be in the clinic.
MM: How did you make your way to MEDEX?
LT: Well, back to 2005, I was at a conference in D.C., a Healthcare for the Homeless conference, and there was a national midwifery conference and some other kinds of conferences going on in D.C. at the same time. So on the plane, coming back from D.C., there were all these people that I knew, including Ruth Ballweg [MEDEX Northwest Program Director 1985-2014]. Ruth asked me what I was up to, and I told her that I just couldn’t do the clinic thing anymore and I was kind of trying to figure things out. She said, oh, we’ve got a job for you, and she had me signed up for Basic Clinical Skills (BCS) before we were landed on the tarmac!
MM: And you are yourself a graduate of MEDEX Northwest.
LT: Yes, I graduated with Seattle Class 14 in 1981.
MM: Why did you decide become a PA? And why with MEDEX? What was your motivation at that time?
LT: So, when we founded the Fremont Women’s Clinic [which would become the 45th Street Clinic], we all trained ourselves to do every job in the clinic. We would be the lab, we would be the front desk, we would be the practitioner, we would do the laundry, we would do everything!
MM: Wow, you did do everything!
LT: Yes, but as unlicensed practitioners.
MM: Ah-ha. So … this was a problem, yes? They came down on you?
LT: They came down on us. We had a peds clinic on Tuesday nights. We had a geriatric clinic one morning a week. We had women’s clinic four nights a week. We had a midwifery clinic. We had, you know, this sort of panoply of things. But the midwifery clinic had a flyer that they gave to their clients, and one of those flyers ended up with the Department of Licensing of the state of Washington. And they were like, “You know, you are practicing without a license, which is a fine of $10,000 or a year in jail. And we would prefer not to go this route. So, we would like you all to get licensed.”
And so, the midwifery school came out of that. They wrote the bill that licensed them in the state and got it passed. And they all became licensed.
MM: And the rest?
LT: Some went to the Yale Family Nurse Practitioner Program. UW didn’t have a similar program at the time. Some people became licensed naturopaths. Others went to medical school. And others of us became PAs over time.
MM: So becoming a PA was a convenient means to an end. But was there something particularly appealing about it for you?
LT: It was actually very hard to get into MEDEX at the time, because it was only in Seattle and had only 20 seats. I applied and got turned down for three years. The third year, I was on the waiting list and finally got in. Thank goodness.
The thing that I love about being a PA is that you’re always collaborating with other people. You have your supervising physician. You have your colleagues. I love that team approach to medicine. I knew quite a few people that had become PAs. So, it was a natural move to go to MEDEX.
MM: When you joined the MEDEX faculty in 2010, this was after teaching BCS courses for the previous five years. Did you see joining MEDEX as a faculty member as a definitive career move? Or again, was it mostly a means to an end, the next job?
LT: Definitive. It made good professional sense to become affiliated with MEDEX as a faculty member. And I came to see it as, you know, a way to train my replacements. And so I really doubled down on teaching the rural and underserved course, inputting a lot of community health orientation into lectures about domestic violence and the unhoused and other kinds of underserved.
MM: Which it lacked before that?
LT: Well, it didn’t have as much, right? Because there wasn’t a person on faculty before I joined who had that experience.
MM: It sounds like you were pushing that envelope.
LT: Right. From the beginning, when we started the master’s program and the rural and underserved course was created for the summer between didactic and clinical, I would take the students to the clinic for a tour and orient them. And I’d have one of the practitioners talk to them. You know, pushing community health as an option to consider.
Because it was really important to understand the role of community health. It still is! Community health clinics take care of about 44 million people in the United States. And they fill a niche that is more and more needed. It’s an important part of our health system, or I should say non-system, the totally incoherent system that we have.
So yes, I really brought in a strong community health component to the rural and underserved course.
MM: And you have successfully sustained it all these years, would you say?
LT: Yes.
MM: Any resistance along the way?
LT: No. Most everyone agreed that this is where it belongs.
MM: It’s certainly a central element of MEDEX’s mission, after all.
LT: Yes, for sure.
MM: Lois, political and social activism has long been a centerpiece of your life. That’s fair to say?
LT: Yes.
MM: What motivates that? And how have you balanced that with being MEDEX faculty?
LT: So, I became politically active in 1968. I was at Cornell University and became involved in organizing anti-war things then around the war in Vietnam. Eventually I joined group of people that were part of a Cornell-based collective that decided to come to Seattle.
MM: You all came here as a collective? The whole lot of you?
LT: We did. We managed to secure three old mail trucks and a car. And we lumbered slowly across the country.
MM: As a collective might.
LT: Yes. The car sped ahead of the rest. I started out with the car, but then I had to go back to one of the other trucks because the car was just moving too fast.
MM: No doubt some fantastic tales to tell of that journey across the country! But for now, you get to Seattle …
LT: We get to Seattle, finally.
MM: And why Seattle?
LT: So, the large anti-war coalition that we were part of at Cornell had sent out an advance guard to check out places like Boston, New York, Baltimore, Atlanta, Chicago, LA. When they came to Seattle, they decided this was the best place to do organizing. And so, summer of 1970, 50 people from Cornell moved to Seattle.
MM: 50 people! That’s remarkable. Where did you all go?
LT: Lots of places. Some got involved with Country Doctor [Community Clinic], some with the Fremont Women’s Clinic, others in various aspects of organizing. Some of us lived in Tacoma for a while and did military organizing. I organized a clinic while I was in Tacoma. And then, I moved back to Seattle and got involved with the Fremont Clinic
There were a lot of other things, of course. We were involved in alternative radio, a radio station called KRAB. And it was run by a ragtag group. I became part of a lesbian feminist radio collective that produced two different programs on KRAB for quite a few years.
MM: What were the topics of those programs?
LT: One was a news show. And the other one was more arts oriented, literature, poetry, music, that sort of stuff.
MM: But not healthcare issues?
LT: Well, we would have themes for the non-news shows. We did a show with some of the prominent women naturopaths who were very important in Seattle at that time. We did shows on the neighborhood clinics, the history of the clinics and stuff.
MM: And then eventually you got more directly involved with healthcare, yes?
LT: Yes. Women’s health in particular. One of the organizations that I helped found was the Lesbian Mothers National Defense Fund. That was in 1974.
MM: Tell us more about that.
LT: We created and distributed an informational packet on how to organize a defense committee [around child custody issues]. Laying out things like “these are the people you will need to fight your case,” that sort of thing. Because remember, the situation then was that if you went to court as a lesbian mother, you lost custody. Period. And so we created this team and fund to support people in their struggles.
We had a psychologist from Seattle who would go to court anywhere. We would just fly him there. And he would testify in court and say that there’s nothing about the mother being a lesbian that harms the development of this child. I mean, no other people around the country were willing to say that at that time. You can’t win if your lawyer can’t even say the word lesbian. It means they are buying into the repression instead of fighting it.
MM: Because you could not win child custody if your attorney said the word lesbian? Like even uttered it?
LT: Like even uttered it. It was a big deal.
MM: Wow.
LT: We had a packet of legal cases that we copied and sent out to people. We supported people in cases all over the country. Dozens and dozens of cases.
MM: And you were yourself a lesbian mother while working against this terribly closed and prejudiced system, were you not?
LT: Yes, I was a mother. My partner Jean Rietschel was a lawyer and a part of this. And our friend Geraldine Cole was a core member of this group for so many years. She also had a child. Neither of us us had custody issues, so we could be out and vocal and work on this.
We spoke at national conferences. I spoke at an American Psychological Association conference in Atlanta. We spoke in New York. We spoke all around, on behalf of the rights of stable lesbian mothers everywhere.
Most of the time, judges were very biased. But they could be educated. And most judges or lawyers who were gay were not out then either. For instance, my partner Jean was out as a public defender, and when she became a judge she was the first out lesbian judge. We were just so lucky to be here.
MM: Just to be clear, most of the court cases would occur when divorces would happen and men, fathers, would resist sharing custody. Is that kind of what that was?
LT: That was the bulk of it. But there were aunts, uncles, grandparents who would step in, who would step in and say, “No, the mother’s not okay, we can’t have that.” There were cases in the South where the welfare department would take the child from the mother if they found out that she was out.
MM: Again, wow.
LT: But within 10 years, by the mid-80s, say, those statistics all changed to where, except in the deep South, you had at least a 50-50 chance, which you should as a parent. And there was much more willingness to think about joint custody.
I have friends whose kids were taken away from them, and we helped them get visitation. In many cases in the 70s, that was the best you could do: just get visitation. And in some cases, even that wasn’t good for the kid. There was so much conflict between the parents. One friend of mine, once she got visitation, she was with her son, and he said, “Mom, I know the court said that it’s okay for us to see each other, but it’s too hard for now.”
It was too hard for her too. So she didn’t have a relationship with him until he was an adult. Being told by the court that you are unfit to be a parent, it puts a mark on your soul. It’s just so painful.
MM: So, imagine we have MEDEX faculty member Lois Thetford standing over here, and we have social and political activist Lois Thetford standing over there. Should these two Thetfords always remain separate, or should they overlap? Your lecture on Framing Homelessness, for instance. Was presenting that a form of activism?
LT: From a political standpoint, that is education, not true activism. I have always felt professionally that it was really important to me to have those things separate.
MM: And why is that?
LT: Because at MEDEX we have a really diverse population that we are educating. And being “too political” can turn people away from views that they are not comfortable with.
MM: What’s an example?
LT: For about four years, we did miscarriage management training. And a lot of people did not like that and complained about it. And we stopped doing that workshop because of the pushback from both faculty and students, who felt like this was too aggressive for us to be teaching our students. So it’s often important to make that division because you’re going to end up losing …
MM: You’re going to end up losing what, that side of the team?
LT: That’s right.
MM: For the sake of reaching the other.
LT: That’s right, yeah.
MM: And so, has it worked, that division? Have you maintained it? Or have you found yourself mistakenly crossing the path on occasion?
LT: So, a couple of years back, the New York Times did a very in-depth, statistically accurate state-by-state evaluation of where people died during COVID. An astonishingly large number of people who died lived in red states. The article also explored how President Trump mismanaged COVID in his first term. We shared it, but there were students that really, really didn’t like that article.
So here’s the thing: it’s good to challenge people’s assumptions, but it’s not a good idea to try to address their beliefs. Good, accurate information is important, but it must be presented in a way that is more … well, neutral.
Like with the miscarriage management training, for example. A faculty colleague came to talk to me about it. She said, “You know that people think that you’re secretly trying to teach them all how to do abortions, don’t you?” And I’m like, “No, that is not our intention.” “But that’s what they think you’re doing,” she said, “when you include evacuating the uterus in order to prevent infection.” I felt like saying “No, they’re wrong, and you should have told them so.” But I didn’t.
MM: So the worry was that you were pushing people away when you had the opposite intent.
LT: Right. Because this could be a life-saving procedure, especially in Alaska where you may not be able to fly this person to Anchorage. And what if they’re bleeding out? You could do this and it could save their life. But people were shocked and horrified that we were “teaching abortion.”
MM: As you look back on your years with MEDEX, what are you most proud of?
LT: I am most proud of having mentored so many students, and of having made them feel at home at MEDEX. It can be difficult. In a class of 52 people here in Seattle, for instance, it is really hard for everyone to be on the same page. There are some classes that pull it off because they have great leadership, while there are some classes that devolve into factions.
And there are students that aren’t sure they belong here, you know? Women of color, for instance, who feel maybe they’re not good enough. And I will say, “I know that it feels really hard to be here right now. But there are people out there that need you. You need to power through this, because those people are out there waiting for you.” Because we know that patients who are people of color do better when they have a good provider who’s from their same cultural group. This is not a mystery. And it’s not racism. It’s just being understood, you know? Feeling welcomed.
MM: As anyone would want to be.
LT: As anyone would want to be. And that goes for the queer community, you know? Working with all our students, I’ve been really happy to be an advisor, or a mentor, or maybe just a friend.
MM: Any regrets from your time with MEDEX?
LT: No, I really don’t have any regrets about my work here at MEDEX. I feel like there’s still more to come from all of the students that I have worked with. Some are still struggling. And so I still see them. I go for walks with them, or have coffee with them, or I talk to them about their retaking the national exam, and so on. It’s ongoing. It’s ongoing. The only thing I would regret is if it wasn’t ongoing.
MM: Meaning if it was just ending; if you were clocking out, handing in your computer, saying adios, and just walking away.
LT: Right. But I still have all these people that I am involved with.
MM: It’s like a river flowing on or something.
LT: Flowing on, yes, exactly.
MM: So MEDEX Northwest is pushing 60 years as a program, and you’ve been affiliated with it in one way or another for a whole lot of those years. Recognizing that the last couple of years have been … well, a little rough, let’s face it, what are your hopes?
LT: Hopes for MEDEX?
MM: Yes, for the program.
LT: Well, when was a student, it was a one-year program: six months of didactic and six months of clinical. Everybody came into the program with a lot of medical experience. That was the program that Dr. Smith established. But MEDEX has grown and changed a lot since then.
MM: Alongside the PA profession itself.
LT: Absolutely. And that will continue to happen. It has to, in fact. The world is different now. Our students are different now. We need to retool, and that work is underway. We have really great people leading that work right now.
MM: So you’re hopeful?
LT: Oh, I’m very hopeful.
MM: You’ve been described as an eternal optimist. Maybe there’s not much of a difference, but it seems like you could be described as eternally hopeful as well.
LT: Oh yes, it’s true, I am very hopeful. And optimistic. I believe that optimism brings about good things. And, you know, the reason I’m sitting here right now is that I’m a person who believes in people. I believe that people are basically good. We can be easily led astray, but we do still get there, you know? The arc of justice is long, but we have changed the world, piece by piece. We have. These are optimistic approaches to life.
I do have to say that I am a person who struggled with depression for major parts of my life. So, optimism doesn’t always come naturally to me. But I really believe, you know, I really believe that if you invest in people, good things happen.
Like all of the patients and people that I have met and worked with in shelters, in family shelters and domestic violence shelters, or in homeless encampments, or in neighborhood clinics who are barely making it. So many who do not have a sense of their own value, don’t have confidence that they can get through this, or that things will get better. And, you know what? It does. Or it can. If you invest in people, good things can happen.
I’ve seen it. I’ve gotten to help people recover. I’ve gotten to see them recover and grow. I’ve gotten to see them become parents again, improve as parents and reclaim their children that have been taken away. That’s all part of the program.
MM: What do you have to say to folks who are considering the healthcare profession generally, or becoming PAs in particular, whether with MEDEX or with any other PA program? You called your own decision to become a PA definitive, very intentional. Does it strike you as being as good a move for others today as it seems to have been for you all those years ago?
LT: Yes. Absolutely. The number one thing: you are really needed. There are so many people out there who need care and who need care from people who are unbiased and non-judgmental.
The difficulty with working in our health un-system is that it kind of squeezes you, you know? With time crunches and things like that. But there are people who are finding ways to survive this. That’s one of the things I saw when I went out to the clinical sites last month. Quite a few of those providers have 30-minute visits which in mainstream medicine is mostly unheard of.
Maybe specialists can work within the squeeze. But family practice is like a novel. It’s like reading a novel. People are coming to you with six medications, let’s say. Ten minutes doesn’t do it. Even if you have your MA go over their medicines for you, it’s still not enough time to make sure that all those different conditions are being addressed. It can make you feel like your head’s going to explode, you know? So I was so thrilled to see that there are people who are finding ways to have satisfying patient visits. That’s why we go into medicine. That’s why we become PAs.
MM: So if someone were to walk in here right now, someone who maybe reminds you of a younger Lois Thetford—an engaged community leader, a committed feminist, a fearless gay and lesbian rights activist—someone who has an idea that healthcare and the PA profession, with all its warts and challenges, is maybe a way to go, would you advise her to pursue it, even if it takes three rounds of applications?
LT: Of course I would! It’s the best job in the world. You get to do so much good. And the future is bright.
MM: So nice talking to you, Lois. And working with you all these years. Thank you for all you’ve done for MEDEX, and thanks as well for all you have done for the community. Now go retire.
LT: Well, alright. But I’ll see you around.