Tuesday, May 18, 2010

Another Speech I Never Gave

Back from another commencement, where I heard a great speech on neglected tropical diseases and the possible impact that doctors who treat them could have on child health, world poverty , and thereby war and other ills. As inspiring as that was, I wish I could have shared a very different experience with the graduates.

A couple of weeks ago, I evaluated a refugee applying for asylum. He was an accomplished professional who had been persecuted and harassed for decades in his home country, because of his activities against corruption and mistreatment of others. Before he finally fled, leaving his wife and children in very perilous circumstances, he was detained and tortured. Upon coming to this country, he was detained again, in stressful and humiliating conditions.

He recounted his entire history with little affect, breaking down only once, as he talked about losing his family and his country because of his beliefs. As part of my evaluation, almost by rote, I asked about his medical history. Since coming to the US, he had had to make a visit to an emergency room. Although the hospital knew he was destitute, they were still dunning him for the bill. This bothered him terribly—-not as much as being tortured, of course, but it was by no means a trivial stress.

He mentioned that the hospital had found him to be hypertensive but did nothing about it. Though not part of my usual protocol, I put on a cuff and found that his blood pressure was indeed way up. At the end of the interview, I spent a few minutes scouring the internet and calling around, and was able to get him a follow up appointment in a free clinic. After I completed my affidavit for his attorney, I received a message: “He was very pleased about the appointment for his blood pressure.”

This comment really struck home. My simple act of medical care, freely given, was something a first year student could have done. Yet it seemed to redress in some small measure the injustice and the tragedy inflicted on this man by his countrymen, and by the moneychangers in our own temple. I wanted the students, now doctors, to reflect on the profound impact that they will have on others, even if they don’t cure thousands of children of parasites, or never perform lifesaving surgery, or make a million dollars. Moments of grace occur in every field of medicine, in the most unexpected ways. Recognizing them and, occasionally, sharing them with others, is a feeling like no other.

That’s what I would like to have said to the class of 2010.

13 comments:

  1. Very well put.

    Moments of grace should be a topic to touch on in the comment thread. You got me thinking. I'm just a pathologist, with little patient interaction, so I don't have anything as profound to share.

    I was followed, and confronted, in the parking lot of my grocery store the other day. I was a little scared.

    "Hey, are you a doctor?"

    I replied affirmatively.

    "I knew it! You did my FNA (fine needle aspiration biopsy). I was so terrified, and you were really great. See my surgery scar? Everything went really well. I'm doing just fine. Felt like I needed to tell you that, how much I appreciated you. Hope I didn't bother you."

    He was a young guy, and had a benign neck lesion removed after my diagnosis (which was confirmed on the surgical). It felt good to hear follow-up from the patient. We pathologists don't get that often (ever?).

    One of my partners is in her late 40's, and can't wait to retire and start free clinics in her native country. She wants to go back and train in primary care, after a twenty-plus year career in pathology, to serve people. I admire her goal tremendously, and although I am only at the beginning of my career, her dreams make me think of all the possibility I have in my future. Choosing a specialty doesn't have to limit us for our entire lives, and you have just showed that in your own patient interaction.

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  2. Wow, thanks (to both of you) for sharing. I'm a first year (well, almost 2nd year) and it is so great to hear stories like this. You see so many physicians who seem bitter and jaded, and hearing people's moments of grace is beautiful and inspiring.

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  3. Great post. I'm just finishing my first year, and the best part about med school so far is volunteering at the free clinic, because it puts things in such a great perspective- people are (most of the time) SO grateful just to have someone listen to them.

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  4. What a beautiful post. It may not have felt like much, but just making those calls and getting him an appointment was a wonderful act of caring that lifted both of you up, and in the long term, probably saved his life.

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  5. So true! Those little moments of grace and gratitude are what buoy you through the rest of the day/week/month! I am a 3rd year medical student (almost 4th!) and am beginning to realize how important those moments are!

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  6. These moments of grace are the real payoff for insurance disputes and disability paperwork and other administrative hassles. I got a birth announcement for the son of my patient today. He arrived on his father's 5 year anniversary of being cancer free. On the back was "thanks for a lifetime of moments like this"

    SDN

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  7. These moments of grace are the real payoff for insurance disputes and disability paperwork and other administrative hassles. I got a birth announcement for the son of my patient today. He arrived on his father's 5 year anniversary of being cancer free. On the back was "thanks for a lifetime of moments like this"

    SDN

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  8. Maybe you didn't get to say it to the class of 2010, but you just said it to one of the class of 2013. I saved it to my folder for things I need to remember when I get annoyed and am feeling jaded. :) Thanks for reminding me why I left my job to return to school!

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  9. What a great statement.

    I graduate from medical school (+ PhD = long road) this Friday. What you write really hits me tonight.

    Thank you.

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  10. This brought tears to my eyes. Thank you so much. I sat next to a medical student at a convention this weekend who is the daughter of two physicians. She told me she isn't a fan of the "welfare state" and doesn't have any ideas on what to do about it, but it has to go.

    My husband teaches Haitian immigrant children at his public school, and they are stunted from malnutrition. Some of the only food they eat is provided by the "welfare state", and that is only at school via free and reduced lunch, since their undocumented parents don't qualify for the food stamps she thinks go to cigarettes instead of hungry children.

    Thanks for reminding me there is still a lot of empathy in medicine.

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  11. Thank you for your post. That was wonderful. This is one of the most satisfying things about primary care.

    Yesterday I saw an almost 2 y/o boy for hearing problems. Mom brought him in concerned about how sensitive he was to noises. We discussed that this was part of his probable diagnosis of autistic spectrum disorder. Mom had heard that I'm leaving (I'm relocating in 2 months) and was just so disappointed to see me go, and told me how much I had helped her son through his medical problems, and that they thought the world of me. It was really heartwarming, and the chance to form relationships like that with patients is the exact reason I went into primary care.

    BTW, I fully plan to go back to school and do an MPH and then go into public health... But for the meantime, I'm enjoying taking care of patients and families. :)

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  12. " Moments of grace occur in every field of medicine, in the most unexpected ways. Recognizing them and, occasionally, sharing them with others, is a feeling like no other. "

    Beautifully said!

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  13. Thanks for this post. I'm in my first year out of residency and working in primary care at a clinic for the underserved. It has been the most challenging year of my life in so many ways. Most days I feel under appreciated and like giving it up. I've made many sacrifices in my life to be this point and I question whether it has been worthwhile. Knowing that there may be some people who appreciate what I'm doing, makes it more worthwhile.

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