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ome patients leave an indelible mark on a physician. Juan Carlos Mendoza ’09 still recalls the little girl carrying a box with air holes who arrived in his office decades ago, complaining of stomach pains. The 7-year-old held a note from her family with a stark description of unemployment and poverty. Cash payment for the treatment of her appendicitis was clearly out of the question. The contents of the box would have to do.

Mendoza cared for the child and sent her home. Later, he opened the box to find four puppies.

“That’s how it is back home,” says Mendoza, formerly a surgeon who had both a private practice and an appointment with the Ecuadorean Institute of Social Security in the regional hospital of Guayaquil, Ecuador. Even in Ecuador’s most populous city, payment in chickens and rabbits was frequent enough that the former surgeon still winces at the thought of a patient bearing a box with holes.

Mendoza, a father of four, was hardly reassured as he witnessed these and other effects of his country’s boom-and-bust cycles through the late ı980s. By ı987, unemployment stood at 50 percent, and although government measures slowed the economic decline, inflation was still 55 percent in ı992. Only 87 percent of university faculty held graduate degrees, and public secondary schools were significantly overcrowded.

Deeply concerned that their three daughters and son would never have the educational and job opportunities they deserved, Mendoza and his wife made the painful decision to leave their homeland in 1995 and move to the city of Binghamton. This spring, he graduated from the Decker School of Nursing’s Baccalaureate Accelerated program, the culmination of the family’s hard-won, ı4-year struggle to recast their futures in the United States.

After the family arrived in Binghamton, Mendoza spent more than a decade working nights as a nurse’s aide while his daughters studied at Binghamton University and his son earned a bachelor’s degree at Notre Dame. In June 2007, one month after daughters Gabriela ’02, MA ’04, PhD ’07, and Liliana ’05, MA ’07, earned their graduate degrees, Mendoza enrolled to pursue his own dreams.

His goal: deploy the features of medicine he had most enjoyed in his native country (caring for the whole patient) — but without paying dearly in time and money to repeat the board examinations and residency required for qualification as a U.S. surgeon.

Then calamity struck. Halfway through that first fall semester, Maria, his wife of 35 years, took a turn for the worse in a battle with cancer. Mendoza put his prospects on hold to focus on her needs. After her death in June 2008, he returned to the classroom, where his perspective as father, Ecuadoran physician and widower of a cancer patient gave him a unique view of the role of nurses in the U.S. health-care system.

“I like the one-to-one experience with a patient — that’s what I had in Ecuador,” says the 58-year-old, noting how in many respects, the role of U.S. nurses has much in common with that of physicians in Ecuador. “You look beyond, to the family, the environment — it’s the humanity aspect. You render service and extend your arm a little more. You have more impact and show your concern and care.”

On this late April morning, clinical instructor Meg White has gathered the ı4 students in her Practice in Nursing clinical course to make their final presentations. Beginning at 7 a.m., as they have all semester on the hospital wards, each student presents a case study based on a patient encountered in clinical assignments.

When his turn comes, Mendoza — clad in white slacks, orthopedic shoes and a green V-necked scrub top — stands to lead the discussion. He presents a seemingly straightforward case of a middle-aged woman who visited the emergency department for pain in her upper abdomen and back. Admitted and treated with laparoscopic surgery, her two-day inpatient convalescence sparks little discussion until Mendoza reveals a final detail: After discharge, the patient waited nearly five hours at the hospital exit for a sibling to retrieve her.

As he gives more details about the patient’s life at home, the possibility emerges that the woman’s sister, with whom she shares the family farmhouse, is emotionally and perhaps physically abusive. “We’re advocates for the patient,” says Mendoza, acknowledging that facts about the woman’s home life surfaced only after her release, which could absolve a nurse of legal or moral obligations to intervene.

“Do we do something for this patient? When do we stop being a nurse?” Mendoza’s classmates grapple with the question: Does the woman think of herself as abused? Is the situation abusive, or just uncomfortable to think about?

Mendoza steers the discussion toward solutions: “What resources are available?” he asks the class, and the conversation picks up steam. “You could organize a post-op home health-care visit,” suggests one woman. Another recommends providing the phone numbers for local hotlines or support groups. Others continue struggling with the question of what constitutes abuse and how to interpret a nurse’s role.

Mendoza has brought a vital perspective throughout the clinical course, White says. In debriefing following the students’ 7 a.m. to 3 p.m. rounds during the semester, the former surgeon was a resource on clinical questions and offered insightful cross-cultural observations. In his final presentation, Mendoza took a unique approach. “Juan has significant life experiences… and he asks broader questions,” White notes. “I liked the question of when do you start — and when do you stop — protecting someone or being involved as a nurse. Does it stop when they leave the building? When they’re healthy? Until they die?”

In Ecuador, Mendoza’s answers to those kinds of questions involved providing pro bono medical care in the impoverished, rural communities surrounding Guayaquil. In ı99ı, he and a half-dozen other physicians set up a faith-based medical foundation to provide access to health-care, generic pharmaceuticals and surgery.

But perhaps Mendoza’s greatest demonstration of advocacy was making the sacrifice to move to the United States so that his children would have the chance in life he believed Ecuador could not provide.

Mendoza had a clear idea of what he believed his children would find in the United States. From the ages of 7 to ı5, he had lived in Teaneck, N.J., a town he recalls as the quintessential American suburb. It was the early ı960s, and families ate dinner together every night. Neighborhood children took care of the widow down the street, tending her lawn and shoveling her drive; in turn, she hosted Bible studies replete with cookies and hot chocolate. Later, before his medical training, Mendoza worked for a shipping company based in the World Trade Center.

A lover of languages, Mendoza met his wife at an international institute in Ecuador, where he briefly studied Chinese. He has also taught foreign languages — English in Ecuador, Spanish at Broome Community College. To boost his children’s chances, he enrolled them in bilingual schools in Ecuador; after their move to Binghamton, the family spoke only Spanish at home so the children would remain fluent. “I always thought that the more languages you have, the more chances you have,” he says.

His wife, Maria Mendoza, shared his interest in other cultures, but she had reservations about moving to the United States. She believed the suburban idyll her husband had known as a boy had evaporated, and she was skeptical of permissive attitudes she feared her children would encounter.

A month-long visit during the winter of ı992 to Mendoza’s sister, Wilson Memorial Hospital trauma surgeon Liliana Lofaso, paved the way for Maria’s agreement to emigrate. Three years later, the whole family moved, even though Gabriela, Mendoza’s oldest child, had already enrolled in college in Ecuador.

“Being ı8 in Ecuador is not the same as here,” says the 32-year-old about moving with her family. “In South America, it is very family oriented. Whether you’re ı8, 35, 80, there’s always the head of the family. Although your opinion counts, keeping the family together is what matters. There, you only leave your family when you marry.”

Her younger sisters, Paulina ’02 and Liliana, finished degrees at Binghamton University and enrolled at the Lake Erie College of Osteopathic Medicine in Bradenton, Fla. Today, Paulina works as a medical resident in Reading, Pa., while Liliana completes her studies in Florida. Juan Carlito, the 23-year-old youngest of the brood, returned to Binghamton after his mother’s death. This spring, he will earn his first Binghamton University degree, a master’s in accounting.

As both father and son travel to interviews for jobs around the country, Mendoza dreams of one day working in the medical practices of his daughters. Gabriela and her siblings aspire to live on the same street one day: “We’re ridiculously close,” she says. “It’s from coming here as a group — it makes your bonds stronger.”

Mendoza knows their mother would be proud. At a family dinner recently, he found himself sitting with his sons-in-law. His four children were clustered together at the other end of the table. “What caught my attention was their spontaneous desire to be together,” he says. “That was Maria’s work.”

In their decades together, he and his wife didn’t always agree. “It was 50-50 who would give in,” Mendoza says. But both spouses loved their children fiercely and shared a vision for them that included educational opportunities and service, he says: “When it came to the kids, we usually agreed.”