Paying It Forward Has Far-Reaching Effects: A Patient's Story

Kate Hitchcock, MD, PhD


August 11, 2021

"I never repaid Great-aunt Letitia's love to her, any more than she repaid her mother's. You don't pay love back; you pay it forward. The great-aunts paid their love-debt, not to their mother, but to me; and I've paid what I owed them to David and Caro; and Caro and David won't pay to me—they can't; they'll pay it to children yet unborn."

–Lily Hardy Hammond in In the Garden of Delight, 1916

Water climbs dry joists if it reaches their undersurface, as it did in so many houses in New Orleans' Lower 9th Ward on August 30, 2005. If the lumber was cured properly, and the wetting not too long, the house will stay true and can be salvaged. The floor will need to be entirely pulled out and replaced. In that place and at that time, electricity was supplied through ground cables instead of overheads, a decision ironically made to protect them from hurricane damage. If the old Ladies of the 9th were to be saved, they'd all need entirely new wiring.

One pure genius of American can-do attitude bought a 100-year-old double shotgun on the cheap during the roughly 2-year period following the storm in which essentially no rebuilding was done. He set about doing the hard repair work himself, saving his cash for materials. When he was done, the aged home had sleeping space for 19 volunteers, and it quickly filled. Each paid $20 per night for a clean, safe place to sleep while they rebuilt the city.

The double shotgun on the right and single on the left survived Katrina in New Orleans, the latter still bearing the marks of search-and-rescue teams.

Photo by Infrogmation, available in the public domain at Wikimedia Commons

Not content with this gift to his hometown, the owner would pay off his mortgage and utilities at the end of each month, then walk the streets looking for family homes trying to claw their way back to viability. He would speak awhile with the owner and learn what was needed. When he found the right kind of person, they'd wake up the next morning to a stack of plaster-and-lath materials, flooring, and heavy-duty electrical wire on their front walk, along with a clutch of experienced building volunteers. Fueled by his self-sacrifice, and that of many heroes like him, The Big Easy pulled itself up by its own bootstraps.

My patient was one of the volunteers he housed. She goes back to the city every year, looking to show gratitude for the abundant gifts of beauty and happiness she's received over decades of Jazz Festival attendance. Around the time she moved from a hotel into that bootstrapped volunteer hostel, she decided to cash in her 401(k) and donate the entire thing to the people there who were trying to find a new normal. Her family helped rebuild a school for kids left behind in their education by the 2-year break in the supply of public school learning (past a certain age, many were handed a GED study book and sent on their way). She returns to visit those she met during that time, sometimes continuing her good work by caring for them as they grow older and need a hand.

In 1951, my favorite author, Robert A. Heinlein, popularized the term "paying it forward," originally coined by Lily Hardy Hammond. That is what my patient does. That's what the volunteer hostel builder did. And that's the story and the legacy I helped preserve when I saved my wonderful patient's life.

Would you tell me a story about an incredible person you have helped with your medical skill?

Please join the discussion below, but if you need to communicate with me offline you can reach me at

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About Dr Kate Hitchcock
Kate Hitchcock, MD, PhD, is a radiation oncologist, biomedical engineer, and retired aircraft carrier driver who grew up as a Wyoming cowgirl. When she is not at the hospital, you can find her with Carolyn, Mary, Tyler, Nick, Marlee, and Colby the barking dog, enjoying the natural splendor of the great state of Florida. She thinks you should visit sometime and try to solve the puzzle of why the natives have so carefully shunted all of the tourists toward the House of Mouse. Connect with her on Twitter: @hitchcock_kate


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