Interview: Sally Larwood, RN (Part 1) – Never Say Never

We spoke recently with Sally Larwood, RN, a veteran of Crossover Health and one of the first employees hired with the opening of our first onsite at Facebook Health Center in 2012. A registered nurse by training, Sally has played increasingly central roles with Crossover—Practice Manager at Facebook in 2014, Practice Director at Apple in 2015, and in 2018, Sally became our VP of Practice Management. She was recently promoted to Chief Nursing Officer, and we thought it was high time we introduced her to the world. Knowing her backstory is essential to understanding her world view as well as the unique way she approaches her work, how she manages teams, and how she processes and grows from big challenges. Sally was generous and open with her personal story, and it is quite a worthwhile read. This is Part 1 of 3. 

What’s your background?

I was born in Providence, Rhode Island. My father was a civil engineering student at the University of Rhode Island, and my mom, who was born in El Salvador, was missing the vibe and weather of Northern California where she had gone to boarding school. After supporting my father through school, she convinced him to move back “home.” At the time, Northern California was starting to come alive, so my father pursued a position in the Bay Area. We moved there around the time of my second birthday—I’ve never looked back and have never left since.

I had the privilege of seeing the valley develop. I used to walk through apricot orchards on my way to kindergarten when I lived in Sunnyvale. Later, I went to a small, private Catholic school in Mountain View and a lot of the families were the landowners who sold their family properties to Apple. They had all owned the orchards in the area and—to Apple’s credit—they preserved their memory by naming many of the streets around campus after them. When I was working at Apple, I would smile to see the names of people that I had gone to high school with on the street signs. 

You know, when I was growing up, there wasn’t a boom. The valley was quiet, people were slowly selling off the farms and the orchards . . . and I get why that is really hard for people to see now. Even my own children find it hard to imagine the valley as anything other than a bustling microcosm of global innovation. They, along with most people in the valley, have only known the growth, the big condos, the sprawling businesses, and of course, the traffic!

After I got married, my husband and I chose to raise our children in Atherton, and later, we moved to Saratoga, near the base of the Santa Cruz mountains. These locations were perfect for our family, and allowed us a unique geographic perspective—we could observe and be part of the valley while still living in an orchard near the edge of a forest. Still such a magical contrast!

What was your journey to nursing?

My grandmother was a nurse, my older sister is a nurse practitioner, and several of my aunts are nurses. As I was finishing high school—and this is not a story I’m proud of, but Scott knows it well—I didn’t have a great plan. I didn’t know what I wanted to do and everything was moving so fast, but nursing was something that was comfortable for me. I had done all sorts of volunteer work as a candy striper, so my dad said, “Great, why don’t you apply for a Bachelor’s in Nursing?” So I did—but when I applied to the nursing program at the University of San Francisco, I didn’t get in. I was devastated. But you know, I didn’t have that planned, I didn’t really do that well in the sciences, and I certainly hadn’t worked hard enough in high school. 

It’s amazing how different things were then. My father said, “Too bad.” He was a Marine, a Type A engineer, and he said, “You need to call the dean, get up there tomorrow, get an appointment and convince her you’re the right person for the program.” I said, “Oh dad, are you kidding?” I got accepted to the university but not the nursing program, so I said I’d go with the intention that I would start taking core classes and then reapply. But he was adamant—“Nope. You are going to go meet with Sister Geraldine.” It was a Jesuit college at USF at the time. The next morning, I got in my little Datsun, drove up to USF, and talked my way into a two-hour meeting with Sister Geraldine. I told her that I would work as hard as I could, that I’d be an amazing nurse, and that she should take a chance on me. And, to my surprise, she did! I started that September in the Bachelor of Nursing program.

That experience really set the framework for me not to accept ‘No’ as an answer—not just in this situation, but for a lot of things in my life. I wrote to my father (who has passed now) many times in the years afterward, thanking him for pushing me to see more in myself than maybe I did, and for giving me the courage to be the very best version of myself. It felt like grovelling at the time, but I see now how taking that one assertive moment to really go for something that I wanted, changed the course of my life.

I took the boards in my junior year, passed, and then graduated, excited for all the opportunity ahead. However, I was really disappointed to find that at that time in the Bay Area there were literally no nursing jobs. Zero. I was crushed, and I ended up taking a job as a kindergarten teacher in the Bay Area while sorting through a difficult job search. I always kept looking, and ultimately found a position at Cottage Hospital in Santa Barbara—they were very small (at the time), but had a new nursing graduate program that was just starting. I didn’t know a soul in Santa Barbara, I don’t think I had ever even been there before, but I got back into that little Datsun, drove down the 101, and convinced them I was the right person for the program. Another persuasive two-hour meeting, and I was once again fortunate enough to be accepted. 

What did you take from this experience?

In this course, there were designated assignments. They put me on an oncology floor, and right out of school, it was pretty heavy. It was when the AIDS epidemic was starting and people didn’t know what to call it. In fact, some called it “gay cancer” and the HIV-positive patients were put on the oncology floor, which was hard, because we were putting people who were imuno-compromised in with people who had heavy infections. In retrospect this combination could not have been the right approach, but it was a highly-dynamic field with little best practice and even less evidence of best treatments. 

I was very, very young, but I learned so much and literally fell in love with oncology. Without medications, we lost so many people to AIDS. I was taking care of these patients, as well as those with cancer, and we were losing more people than we were saving. I dealt with a lot of sadness, to be sure; I got close to some people, which made it hard when they died, but it felt like such an honor to be there for them. There wasn’t hospice care or many services then, so people died in the hospital, and I was humbled to be able to be with so many people and their families in their last days and moments. It was such an amazing experience. It changed my perspective, opening my eyes to how valuable life is and how short our time on earth is, which was an interesting position to be in when you’re just in your mid-twenties.

While it was an important experience, everyone in nursing said that if you put in your one year, in any kind of med-surg or cardiac speciality, you could go anywhere. While I loved Santa Barbara, it was no place to be for a struggling young person right out of college, and I missed the culture of San Francisco. So about a year and a day in, I applied to a hospital in SF, staying within oncology, and was accepted at California Pacific Medical Center. I came back to the Bay Area and spent time opening an experimental HIV unit, where patients could eat their own food, wear their regular clothes, etc. There was no hospice, so it made them feel like they were at home.

Later on, I helped open up a bone marrow transplant unit at California Pacific as well, and I’d say the same thing about bone marrow transplants. In the early years, we were losing more people than we were saving with these transplants, and it was still very hard, but I was learning how to cope with these life transitions. I felt I really could have an impact on the patients and their families. It’s been amazing to see how far the treatments have come—now a fairly healthy person can actually survive leukemia, whereas before it was a near certain death sentence. I feel incredibly lucky to have been at the forefront of some of these programs because I was able to learn so much about starting clinical services from scratch. 

I understand you left nursing for some time and then got back in again. What’s the story there?

Around the time I came back to Northern California from my initial work in Santa Barbara, I got married to someone I had met in high school. (We were married in 1989.) I was still at California Pacific and my husband ran a family printing business in Sunnyvale, an hour away from San Francisco. We had some long discussions about where we would live and I just kept thinking, “I love my job. I love the city.” To my husband’s credit, and even though he had never lived in the big city, he was willing to start our new life together in the Marina District. We were certainly surprised when I discovered shortly after our honeymoon that I was pregnant. I remember asking myself, “What kind of nurse are you? How could this happen?” This sounds flaky, but it’s definitely my story and looking back, another thing it taught me was to ride at rocket speed! My husband, who has always been very supportive, suggested that we could raise our family in the city, but I wasn’t convinced.  

As it turns out, in the next five years we had four children. It was a crazy time! I took the time off I was allowed, and moved around within California Pacific. I did the bone marrow transplant work, took a research position because I didn’t want to be around hazardous chemotherapies when I was pregnant, and so on. It was insanely busy, and we ended up buying our first house in Redwood City, because we needed a yard for the kids to play in, and I couldn’t deal with the hour commute at that point. I eventually moved from California Pacific into home care work, because as our family grew, it was getting increasingly hard to balance the kids with doing shift work that included nights and weekends in the city.

At the beginning, the new home care service was slow and I was thinking to myself, “Wow, this is a great gig!. But within a year, it seemed that all the hospital systems were simultaneously looking for ways to reduce costs by pushing everyone out of the hospitals sooner. I felt like a fireman with alarms going off every night—two, three, and four times—and I would be out all night and then have to work all day with the kids. I was pregnant with my fourth and during my maternity leave after he was born, I realized I’d had enough. 

At that time, my third child, Claire, was diagnosed with autism. This was 1993 and it was new at the time. Everyone knew about the existence of autism and Asperger’s but nobody knew what to do about it. Even the library at Stanford had very little information that I could find. With what research I did have, I had to guide my own pediatrician during the two-year annual well visit for my daughter. I had two children before I had Claire, and I knew my daughter was not following normal development patterns. The pediatrician, who I adored, brushed off my several concerns and said that my daughter was just fine. I distinctly remember standing up to go, thinking that she is the expert—and then my maternal instinct kicked in. I just unloaded on her, sharing rapid-fire examples of my daughter’s lack of interest in toys, avoiding eye contact, no speech…and that’s when all hell broke loose. All of a sudden, I was going to a neurologist, going all over the place, searching for answers through multiple tests, and ultimately felt comfortable that we had an accurate diagnosis. By then, my fourth child was born which gave me the excuse I needed to stay home while doing more research.  

Where did that research lead you during the early days of trying to understand Autism?

I was banging down everyone’s doors, but there weren’t a lot of programs for autism. There was a great one at UCLA, but I couldn’t move the kids, so I researched everything from diet to experimental treatments and took Claire all over the country. That really changed the course of my life. In dealing with her treatment, everything I had learned in nursing gave me the confidence to challenge psychiatrists and physicians, and to question everything. I knew from all my time in the ICU’s, with experimental therapy, and being part of these new care models, that the physicians and researchers—while all brilliant and talented—didn’t have the answers and were “winging it” more than the public would ever understand. I just figured, since I had seen behind the curtains of medical Oz, that I was going to do my own hand waving and fighting for the truth as well. That is what enabled me to get the access, the appointments, and the consults that most people would have never known how to do. 

My husband and his business were doing very well at the time. Software was starting to explode and he printed the training manuals that went with software, which was a sweet little niche.So, we had lots of resources and I was able to just bulldoze my way into experimental treatments and programs. I would even pay out of pocket, meeting people in dark alleys for experimental treatments. The lessons I had learned back in the day from my father and in my experiences at both USF and Cottage Hospital came into play, and I just wouldn’t take no for an answer. 

My daughter remains a low-functioning person, at about a two-year old level, but I have learned so much. I have also been fortunate to do a lot in the autism arena, including program development, fundraising, and general awareness efforts for a group called Autism Speaks. As Silicon Valley was growing, it seemed like a good time to tap into some of that money. I worked with a group of women for five or six years, putting on some very large scale events that included celebrities, athletes, and VC’s, and it got a lot of attention as autism was becoming more prevalent in the Bay Area, and Silicon Valley specifically. So many of the people we interacted with in the Valley were actually on the high-functioning end of the autism spectrum, and they were our friends, but as our own family understood so well, our daughter remained on the low-functioning end. 

But, as with all things, we persevere. We learned, we grew, and we served her as a family. The days were long, the nights were longer, and the challenges persisted, but this was our daughter, and I am so proud of all my children, and my husband, for how we rallied as a family. Claire now lives in a group home that some of us started many years ago. She has great care, lovely and dedicated caregivers, but with the shelter in place recently, we have been unable to have the caregivers available. She needs a lot of activity and exercise, so during COVID-19, we have had her back home. It has certainly been challenging—with the 50 and 60 hour work weeks every now and again a Zoom meeting gets to catch a glimpse of her streaking through the background—but it’s our family and this is how we are managing through. 

It is so interesting how these life experiences have really shaped my worldview – my view of what family means, and how I approach the care I want every one of our members to experience. I have also learned that things aren’t perfect, but they are certainly better here than in most if not all parts of the world. I am grateful for my dad, thankful for my husband, and so appreciative of my whole family—they teach me so much, all of which is directly relevant to the work I do every day. And, in many ways, this is why I have enjoyed my time at Crossover—our XOhana has been my family and is rapidly becoming my team, too, and where we take you as you are, we are grateful for your contributions, we will push you to be better, and we can overcome nearly everything together. 

Please continue the story with Part 2 of our interview with Sally Larwood, RN.  Learn more about how her career experiences and her family situation set the stage for her to be introduced to Crossover Health.