Growing up in a tiny town of 112 people in the middle of North Dakota, Dr. Carla Rotering spent the first six years of her life living in an abandoned boxcar near the railroad tracks.
"We had no running water, and I think our electricity was borrowed," recalled Rotering, the founder of Boxcar International, an organization that provides physician coaching and leadership.
"Medicine is hard on relationships," she said. "Not just because of the pace, but because we are not well trained to navigate life. We pour all of our energy and attention into this work that is really noble work but it may not leave room for relationships, and it also may not leave space to develop the skills to manage our personal lives."
Not once during her childhood did the pulmonologist ever consider becoming a physician.
Married with two children, she worked in a medical office, typing, transcribing and making appointments. At one point, she was asked if she wanted to learn how to draw blood.
It wasn't until she read a magazine article about a woman who was completing her surgical fellowship in her 30s that she realized her destiny.
"I had this sudden epiphany — that's what I'm meant to do," said Rotering, who was in her late 20s at the time.
By the time she started medical school, she was 30 years old. Her husband was supportive but was focused on his own career objective, she said.
"For him, it was incidental," she said. "When I was accepted into medical school, then it became real for him."
Eventually, they grew apart, both focusing on their own careers.
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"Ultimately, our choices about the directions of our lives ended the relationship," she said. "We've remained really good friends. He's gone off and done his wonderful things and I've had the opportunity to do what I did."
During classes at University of North Dakota, Rotering lived in student housing with other single moms, all supporting each other. It was a lifestyle her two children accepted.
She remembers when her son, Josh, came home from kindergarten with a page full of circles drawn on it. When she asked what it represented, he told her the assignment was to draw what his parents do for a living.
"You make rounds," he told her.
"It was so natural for them," Rotering said. "Their dad had been in school since they were born. They thought people went to school. At one point, my daughter asked, 'Mom, can boys be doctors?'"
After graduating from medical school in 1982, Rotering's goal was to leave North Dakota. She ended up at St. Joseph's Hospital and Medical Center in Phoenix to begin her residency program.
She was drawn to a pulmonary fellowship, something that made sense to her after her mother died of lung cancer at the age of 35 when Rotering was 16.
"Everybody smoked back then," she recalled. "They gave cigarettes as Christmas gifts to their friends."
A volunteer with American Lung Association Asthma Educator Institutes and Camp Not-A-Wheeze, Rotering also served on the American Lung Association's women's cabinet and is a Lung Force Hero, sharing her personal stories about cancer in her family with others.
"As a 16-year-old, my mother died right before my eyes in a hospital," she said. "What was really heart-wrenching is that no one talked to me. They whisked my father away, gathered the adults and I ended up sitting in this room by myself with my mother who had just died having no idea of what to do or where to go, feeling my entire life had disintegrated."
That experience led Rotering to begin coaching other physicians and eventually start Boxcar International, reminding them that if they don't take care of themselves, how could they take care of anyone else.