Nurse practitioner, educator, volunteer wins honors for non-physician health care provider

It's some time not long after the Women's Institute of Specialized Health has closed on a hot Friday afternoon, and Charlotte Smalley is going over a patient's charts and records at her desk, with the office door open. Some of the staff linger for a few minutes after hours, most head out around 4:30 p.m.

Smalley hangs around a little longer this afternoon. Unsure what folks would find interesting about her story, she simply starts at the very beginning:

Imagine, now, the single red-light town of Maynardville, Tennessee, and Smalley's father hanging tall, green plants upside down in a drying shed.

"Our cash crop was tobacco," says Smalley, who follows it immediately with, "Which is a no-no. I shouldn't tell people that."

The long-time nurse practitioner talks fondly about her father, who still lives in Maynardville. Smalley's mother is no longer living. Neither of her parents graduated eighth grade. But Smalley's parents encouraged their children (Smalley and her brothers) to go on after high school and get a college education, to reach high in life.

Smalley's older brother, Don, took pre-pharmacy courses at the University of Tennessee in Knoxville before later moving to study at UT's Memphis campus. Smalley, meanwhile, discovered in school a passion for science, and for helping others.

"I was always taking care of people, plants and animals," she says.

But what do you do with that when you're from a place like Maynardville?

"From a small town, I never thought of going to medical school," says Smalley.

Slowly, the idea, a dream, of becoming a nurse took hold.

"I thought it sounded like a great profession," says Smalley.

The University of Tennessee in Knoxville at that time had a brand-new nursing program. Smalley wanted to go there, but was stopped by her father. He believed his daughter should go instead to Memphis to study nursing, at a program which was more established.

So off Smalley went, in brother Don's tracks. Smalley graduated from the program in Memphis with a Bachelor of Science in nursing. And she began her career by going into poor, inner-city neighborhoods, making house calls.

In Memphis, she also met Jim Smalley, a young pharmacy student she would later marry - and lose.

***

Jim Smalley was killed in a car wreck when his and wife Charlotte's little girl, Katherine, was only four years old.

Jim Smalley was a graduate of City High School. His father operated a Chattanooga pharmacy on Frazier Avenue for years. Jim Smalley himself worked in a hospital pharmacy after graduating from school in Memphis, while Charlotte worked out of a health department in South Pittsburg. At that time, outpatient clinic nurse practitioners were relegated to working only in underserved areas.

Charlotte Smalley, to her own surprise, did not like working in a hospital. She preferred the outpatient practice.

So she commuted an hour a day to South Pittsburg, where she eventually rose to the position of director of a health department there. She carried on this routine until Katherine came along, and then wanting to spend as much time with the baby as possible, Smalley took time away from all work.

The break was nice for a while - but eventually, Smalley had to work in order to retain her nursing license. She took a part-time job at the University of Tennessee at Chattanooga and volunteered at a homeless clinic in Chattanooga.

Then, disaster.

In 1992, Charlotte and Katherine Smalley lost their husband and father.

"I needed to work more, because I needed to have health insurance and take care of my daughter," says Smalley.

She put out feelers, spoke with friends.

Miller, the first woman chief of staff at Erlanger Hospital, was at the time in need of help at her outpatient office in Hixson. A friend of Smalley's recommended her for the position. Smalley and Miller met. And in December 1994, Smalley was hired.

"I wasn't sure I wanted to do women's health," she says. "I was a little hesitant."

***

Today, here is Charlotte Smalley, 22 years after being hired by Miller, tidying up after another day, another week, another month at the Women's Institute in Hixson.

"The thing that amazes me with people is how open and honest they are," she says. "They trust me. I trust them."

Dr. Miller quickly praises the nurse she hired nearly a quarter century ago, whom she describes as "my right-hand person.

"Charlotte embodies the best of what a nurse practitioner should be," Miller says. "Her commitment to service is exemplary. She is a huge advocate for health care for both insured and uninsured persons."

She has dealt with more than her share of crises in her career. And the passing of time doesn't make the hard days any easier.

Being at an office for women's health, Smalley sometimes sees patients at their worst - scared, afraid, sick and lost. This place requires more than a diagnostician. It requires a listening ear, an inquiring mind, an intuition and the ability to read between the lines.

"There are days you go home really tired," says Smalley.

Sometimes, Smalley goes home, makes a cup of coffee and sits on the back patio, alone and quiet.

"It's sort of my retreat for my mental health," she says.

Smalley talks a little about retirement. She talks a little about traveling with long-time friends, a little about Sunday School and a little about her church's supper club. She also talks some about maybe moving closer to Seattle, where Katherine recently settled.

"She's a good kid," says Smalley.

Currently, Smalley is reading about Zika, and finds herself embedded in research on the mosquito-borne illness which potentially presents devastating ill effects for pregnant women. The virus is creeping into the United States from the Caribbean, and there are confirmed cases in Hamilton County.

No, says Smalley. It isn't time to hang up the stethoscope just yet.