"A lot of our patients have a very hard life. If we can give them five or ten minutes where they can feel like they are in control and not being looked down on and have some element of control over their situation, we usually stretch the rules to allow that."

Marcia Sablan runs a medical clinic with her husband, Oscar, in Firebaugh, a town of 7,500 on the west side of the San Joaquin Valley. I photographed her there two days before Thanksgiving, and she was nervous: they would be taking the day off on Friday, the first time they would close the clinic since opening it two decades ago. That their son had convinced them to take off one day after both Christmas and New Year’s, as well, was almost too much for her to comprehend. “We’re working on helping her draw some boundaries,” her son Tony told me with a smile.

As in many small, rural towns, the demand for health care in Firebaugh is far greater than what the two clinics in town can provide. She and Oscar see sixty or more patients a day. When people show up without appointments, they find room for them. When people come to their home with emergencies, they don’t turn them away. As Marcia sees it, their practice is different because their patients are their neighbors—she sees them at the supermarket, their kids attend the same schools. Many clients have been coming to her since they were two weeks old.

Because of this intimacy, Marcia sees health challenges as they unfold—a lost job leads to depression, poor dietary choices lead to diabetes—and she is pained by them. But the intimacy of her small community also allows her to seek prevention in a direct, ground-level way: starting a local health commission, convincing the local V.A. to use healthier foods for their pancake breakfasts, educating people outside the community about everything from ag-water issues to pesticides’ impacts on farm workers. On Thursday nights in summer, she makes cantaloupe smoothies at the farmers' market in town.

“As I get older and closer to retirement a panic sort of sets in,” she told me, “whether I could have done more, should’ve done more, or is there still time? I always try to look at it that there is still time. You have to try a lot of things before you can find one that will work.”