Every dynasty begins with a pioneer. When Rich Payne became the first person in his extended lineage to pursue a medical degree, he had no idea that his siblings, Todd Payne and Cara Payne Cook, would follow. Unbeknownst to anyone, Rich’s choice to become a doctor was the first of many decisions that would lead to an Ark-La-Tex with five-and-counting medicine-practicing Paynes.

The Payne family landed in Texarkana in 1980, when father and FBI agent Carroll was relocated for work. Rich was 14, Todd was 10, and Cara was 4. The children were enrolled in TASD schools. When they weren’t at school, Beech Street First Baptist Church, or extracurriculars, the kids were with mom Carolyn, a homemaker who excelled in creating a “real close- knit family,” said Rich. “Mom is an amazingly talented woman in every way,” Cara added. “There’s really nothing she can’t do. She can cook, sew, craft, sing, play piano, and the list goes on.”

The day after Rich graduated high school, his father woke him at 5 a.m., handing him a pair of work boots; he would be spending his summer working on a survey crew for the Arkansas Highway Department, a job Carroll and his father, Thurman, had both held as young people. “After two summers of that, I decided I was never gonna work outside again, especially in Arkansas in the summertime,” Rich remembered. “The third summer, I was like, ‘Where is the coldest place in this town to work? St. Michael.’ So I applied to be an orderly.”

That summer job at the hospital may have been the catalyst for the family’s medical dynasty. Rich had the 3-11 p.m. shift, arriving home nightly to find his parents and siblings awake, waiting to hear Rich’s stories. Rich, too, was excited about his job. Ten minutes into his very first shift, having been trained in basic life support and equipped with a beeper, he was called to do chest compressions on a patient. The thrill planted an idea in his head: “Maybe I want to be a doctor.”

Upon learning of his interest in medicine, Dr. Gene Joyce, a family friend whose praises all three Payne siblings sing, connected Rich (and later Todd and Cara) with shadowing and other preprofessional opportunities. Also on the University of Arkansas Medical School board, Dr. Joyce encouraged Rich to attend Arkansas for medical schooling. “I guess you’d call him our lynchpin,” Rich said.

Rich and Todd both attended Baylor University and majored in sciences. Rich attended UAMS and then University of Kansas City to become an anesthesiologist. Todd pursued his MD at UT Southwestern (as did his wife, Christy, who is a pediatrician) and then trained as a urologist at Ohio State University. Cara attended University of Arkansas at Fayetteville for her basics, then went on to earn her BSN and Nurse Practitioner degrees from UAMS.

*^ Todd and Rich holding sister, Cara, in 1976.*

To explain his own venture into a scientific field, Todd gives credit to his teachers at Arkansas High School, who he feels equipped him with a strong math and science background. Cara cites her secondary teachers as well, but she goes on to say that the path her brothers paved was so compelling that she hardly had another option but to pursue medicine. “I had the privilege of watching my brothers get degrees in medicine, so it was all I really knew to do,” she said. “They were both so smart and driven that I had no choice but to follow in their footsteps.” Her position behind her brothers also influenced her not to pursue an MD. “I had already watched how taxing and disciplined Rich and Todd had to be in order to become MDs, and I wasn’t really wanting that for myself,” she said. “I decided to major in nursing instead of pre-med because all I really wanted in life was to be a mom and have kids like my mom did. It seemed that nursing would allow more time for that.”

The sibling bond Rich, Todd, and Cara have flourishes through their common vocations. The siblings often treat the same patients, and they love sending messages through their patients. “We send patients to ding each other all the time,” Todd said. “I always tell my patients to let me know if one of my brothers isn’t treating them right, and I’ll personally beat them up for them,” Cara laughed.

The trio also enjoys serving together on medical mission trips to Guatemala. Even their spouses and adult children come along, working in all facets. “My best memory of this is operating with Rich’s son, Jackson, while my son, Davis, helped my brother with anesthesia,” Todd said. (Jackson is a BSN and may one day pursue a CRNA; Davis is at medical school at UT San Antonio.)

While medicine is an important commonality for the Payne siblings, their relationships thrive outside of shop talk. Rich and Todd are pilots and own a plane, cleverly named “Streams and Dreams”; the family loves using the plane to visit the various children, nieces, and nephews, who are planted at universities across the South. Rich and his wife, Allison, have three children: Jackson (24), Meredith (21) and Mabrey (18); Todd and wife, Christy, have two children: Davis (22) and Cathryn (19); Cara and her husband, David, have two children: Caroline (12) and Payne (9). Todd and Cara sing praise and worship together at church. Family gatherings are largely dominated by the Payne family’s recreational activity of choice: dominoes.

It’s sure that Rich, Todd, and Cara would be close regardless of their chosen professions, bound together by idyllic childhood memories and a shared faith system. Still, it’s interesting to imagine what the Texarkana medical scene would look like in the absence of the Payne sibling dynamics. As Rich likes to put it, “I had to toe the line, my brother stepped over the line, and my sister said, ‘What line?’” While the proverbial “line” Rich speaks of has to do with causing their parents grief as they grew up, the line metaphor could also describe the leadership each sibling showed and benefited from. As the first to pursue medicine, Rich’s approach to the line cut the trail, allowing Todd to make the trek. When it was Cara’s turn, she saw no path but the one her brothers had paved for her. And now, their collective seven children see even fewer barriers to achieving their dreams, be them dreams of medicine, education, parenthood, or anything else.

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