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UNIVERSITY OF SAN DIEGO / Spring 2013

Class Notes Profiles

Spring 2013by Krystn Shrieve

The Ballad of Twila Noble

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Nursing alumna making a new life in new world

First there was Jed Clampett, a mountaineer from Appalachia who moved to Beverly — Hills, that is. Then there was Mary Richards, who made her way to Minneapolis to start a new life after a broken engagement. Of course, everyone’s favorite radio psychiatrist, Frasier Crane, left Boston for Seattle. What about Addison Montgomery, who took off from Seattle Grace to join a private practice in Los Angeles? And most recently, there’s high-school-quarterback-turned-crooner Sam Shepherd, the transfer student from Tennessee who moved to Ohio and joined McKinley High’s glee club.

These characters, all part of television history, needed a change of pace — just like USD’s real-life Twila Noble, who made a split-second decision that had her packing her bags and heading for a job on a reservation that’s home to the largest population in the Navajo Nation.

Noble, who graduated from the Hahn School of Nursing in 2007, was living in San Diego and working as a nurse practitioner in a house-calls practice. She cared for patients in boarding care, assisted living and nursing homes. After years of working primarily with elderly patients, she was looking for a change.

Just back from a whirlwind conference in Las Vegas, where she shook hands with countless colleagues and collected a stack of business cards, Noble answered a phone call, thinking the voice on the other end might be someone she’d met at the conference. Instead, it was a recruiter she’d contacted as a student who was calling out of the blue to ask what she thought about working on a reservation. Her answer? “Tell me more!”

That enthusiastic response changed her life.

In January of 2012, Noble and her husband, Steve Whiting, a retired computer networking specialist, crammed all their belongings into a Toyota Tacoma, a Jeep Wrangler and a U-Haul trailer and headed to Tuba City, Ariz. — located in the Painted Desert, about 50 miles from the eastern entrance to the Grand Canyon.

Her new world is beautiful. She loves to watch the sun rise and fill the sky with bursts of pinks and purples that spill over the rust-colored mesas, buttes and hoodoos — spires of rock also known as earth pyramids or fairy chimneys.

Outside her window, horses roam free. A few houses down, a family has eight sheep grazing in the yard. Cows and mules wander the streets together and horses hang out with high-schoolers in the quad.

“I got here and fell in love with everything,” says Noble. “I feel like I’m 10 years younger, maybe 20.”

Nevertheless, the move was a bit of a culture shock. She jokes that in Southern California people may drive 30 minutes or even an hour to work, but can find any amenity they need around the corner. In Tuba City, people often walk to work. But to get to the nearest, well, anything, they might have to drive more than an hour away.

Noble works at the local hospital, the Tuba City Regional Health Care Corporation. Twice a month she assists a urologist and also spends a big chunk of her time at the hospital’s clinics — a radiology clinic, a wound clinic and a walk-in clinic. Patients pour in from the region known as The Four Corners — the southeast corner of Utah, the southwest corner of Colorado, the northeast corner of Arizona and the northwest corner of New Mexico.

The nearest town to the north, Page, Ariz., is 66 miles away. The nearest town to the south is 70 miles away in Flagstaff, Ariz., where the only other hospital in the region is located.

“People come great distances,” Noble says. “They live out in places where you can’t take cars. They’ll travel 300 miles to get to us.”

She says it’s not uncommon for women to don their best outfits — colorful silk dresses, velvet tops and the most amazing turquoise jewelry — when it’s time to see the doctor. The older generation is passing on the language and the traditions and the younger people are anxious to learn.

“This is a living culture. It’s not something from the past, it’s still very much alive.”

Patients in Tuba City suffer from the same maladies as residents living elsewhere, but there are higher rates of diabetes, tuberculosis and Rocky Mountain spotted fever, a tick-borne disease that can be difficult to diagnose and fatal if not treated correctly.

When her stethoscope detects a raspiness in patients’ lungs, she knows it’s probably one of two things — either they work in the nearby uranium mines, or they burn wood or coal in their homes. It sounds like they’re smokers, she says, even if they’ve never smoked a day in their lives.

“I’ve seen it all,” she says. “Patients come in because they just got bitten by a horse, bucked off a horse or because a sheep fell on them during shearing. Once, an 85-year-old patient asked how soon she could go home because she needed to sing her sheep to sleep.”

Noble has to keep in mind that some homes don’t have electricity or running water. Even at the hospital and clinics, the electricity flickers off and on, computer systems go down and phones cut out. On occasion, she needs to send patients home with a wound vac, which applies controlled pressure on the sealed dressing of a wound using an electric vacuum pump. But if they don’t have electricity, she gives them a spring-loaded version.

By the time patients arrive at her clinics, they’ve often tried herbs, vitamins or traditional ceremonies first. Many times they’ve tried remedies such as visiting a sweat lodge, singing songs, saying traditional prayers or taking herbs, berries, teas or juniper pitch, used topically in the treatment of skin disease.

“I encourage my patients to use traditional healing ceremonies,” says Noble. “They combine the traditional treatments and the treatments we provide. Sometimes their culture and traditions are just what they need.”