Struggle

Trying to eat vegetables out here and feeling like this (#theStruggleIsReal):

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Fellowship Essay

(I got rejected, but I love this essay)

I decided to become a doctor because I want to defend the right of every soul that crosses my path to live healthily and happily. When I was honest with my abilities, interests and achievements at that pivotal moment in my life when I chose this profession, medicine made the most sense and the path into it was clear. As a student doctor, I have made a great effort to ensure that my focus was not solely on the human body, but also the humanity which animates it. The human existence is the marriage of a myriad of disciplines and experiences and I never want to forget that.

I believe that my studies thus far in the humanities, social justice, and the health sciences will help to contribute to a vibrant conversation about conscious medical practice, identifying bias in both negative and positive contexts, and the next ethical step in the evolution of medicine, should I be deemed worthy to receive this Fellowship.

It is my sincere belief that this fellowship will help me continue my education in a subject that is a necessary component of modern medicine: ethics. For me, the Holocaust is one of many appropriate beginnings for my continued enrichment in the history of ethics for personal reasons as well as practical ones.

My practical reason is related to my career choice in medicine. The research and evidence demonstrating the existence of the social determinants of health now is astounding. The social determinants of health speaks to an understanding that one’s wellbeing is not just intrinsic to the individual but also contingent on the milieu by which they are surrounded and the sphere they occupy in their society. Race, gender, sexuality, religion, immigration status, socioeconomic status and many other things can affect the severity of the same disease in two individuals with different backgrounds. It has been very well demonstrated that those belonging to marginalized groups tend to have poorer health outcomes for most diseases. We as current and future clinicians tend to focus more on the avoidable, downstream manifestations of these social determinants, an expected consequence of how we are instructed and trained. We’re more likely to treat an anxiety and depression complaint with a medication than take a step back and realize that the anxiety and depression of our patient is a function of a poor, single mother with job and food insecurity, almost no social support and poor literacy skills being denied necessary aid from the government because she filled out her forms incorrectly as English is her second language.

And often, even if we are aware of all of that, our power to help such an individual may be limited to that prescription.  However, we’re uniquely poised in the present climate of medicine to start addressing those identifiable upstream social determinants of health, at the societal level.

The role of the doctor is changing and has been changing for some time. There are a plethora of medical complaints that no longer directly need a physician to be addressed. While I will still defend to the death the need for primary care providers, this role that was once just filled by physicians is now being filled by capable and diverse teams of specialized providers.

As the presence of clinicians is less necessary in the clinical settings, I believe that doctors need to practice medicine in the macro scale: no longer one patient at a time, but in the public health and health policy arenas, where the health of entire demographics can be effected for the better by our meticulous clinical training and problem solving skills. This is important because now we as clinicians, the traditional harbingers of health, can work actively to address those social determinants of health that contribute to the frightening health disparities in the United States and worldwide and unnecessarily burden healthcare systems. What is more, often, the populations with greatest health disparities are those with histories wrought with dark times of humanity that many would like to forget: exploitation, legal and social discrimination, bloodshed, war and deliberate wrongdoing; wounds that have long needed dressing.

As someone who wants to defend the right of every soul that crosses my path to live healthily and happily, how can I not address the social determinants of health that I take so much time educating myself about? The answer is that I cannot and still expect to achieve that goal. Therefore, addressing the social determinants of health and health disparities, learning the history that contributed to them, and the practices that maintain them is a matter of medical ethics.

The Holocaust blatantly demonstrates what I still find to be true in many subtler ways today: the illness that is killing people is a function of a society that is sick. All atrocities committed in the name of supposedly advancing science must not be forgotten and the medical ethics which evolved in response to should be a pillar in the education of all future physicians. The Holocaust changed Medicine forever. The unspeakable human experimentation carried out by doctors can serve as both a cautionary tale and a lesson of the importance of practicing medicine methodically but also with a conscious.

Ignoring the past and not addressing the wounds that it left behind on the present would be irresponsible.  We deem ourselves healers. That being said, if we are silent then we are complicit in the sickness that afflicts our society and we betray our oaths and divine calling of medicine. I hope contribute to the field of medical ethics and medicine in the future, addressing health disparities and continuing the work of exposing all wrongs committed under the guise of advancing the field of Medicine. Whether in Auschwitz, on Indian Reservations or in the underserved rural south town of Tuskegee, Alabama, there is much learning and atonement to be done.

Through these hard lessons, we can better heal the gaping wounds that still mar us.

Threatened Independence – Conversation with an Elderly Veteran

Right now, I’m here.  I don’t want to go down.  Like down, a hole in the ground, in a grave.  I’m almost 90. Most people my age are vegetables.  But I do alright by myself.  I do what I want, go where I want, take care of myself and I have my own finances, no romance, I’m too old for that.  But I don’t want to be a burden.  I got a good family. I live with my son, but we don’t hardly see each other.  My youngest son comes sometimes, and he cooks for me, when I don’t feel like doing it myself.  I’m independent, I’m satisfied.  But now, I’ve fainted and they’re trying to figure out what’s wrong and I want to stay where I am, avoid the decline.

 

Maybe you’ll find it hard to understand, you’re a young lady.  You’ve got a good education, good job and your whole life to live.  Me, I worked the same job for more than 30 years after the navy.  They respected me.  I didn’t complain, knew my job, they called me ‘Old man H’.  There hasn’t been anything I haven’t been able to provide for my family, anything they wanted.  I’ve been halfway around the world, now I just want to do what I want.  My son sometimes acts like he’s the boss, but he ain’t.  I’m the kingpin.

 

If you done been through what I’ve been through, seen what I’ve seen and know what I knew…  I do what I want now.  They’re talking about sending me to a rehab, but I got things to do, I got to the to the bank, I got places I need to be.  I take care of myself.

 

I’ve had hemorrhoids; I got them cut out.  I have a hernia.  I’ve had diphtheria.  People would die from that; put a big black cross on the front door and say, don’t go in there, ‘so and so’ died.  There wasn’t one on my door then; there ain’t one on my door now.  I don’t need that. At my age, I’m satisfied.  I do what I want, I take care of myself.  I’m satisfied.  You probably think I’m nuts (sidenote: I didn’t and I told him so).

Thoughts on Global Aid/Health

So I read a few articles for an elective class that I’m taking and I had to write a reflection about what I read… This is the bulk of it, I had a few other thoughts, but they were kind of random, but most of this stuff fit together.  I don’t think you need to read the pieces to appreciate the points that I make on them, hence my sharing.  I hope you enjoy reading it as much I enjoyed writing it!
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  One of the most striking thing that I found about most of Grim’s writings is her frequent use of the word “disaster”, “chaos” or some other word or phrase that conveyed pandemonium and disarray.  Its use highlighted a great sense of disillusionment that she must have experienced when she realized what the realities of giving medical treatment in a 3rd world or war torn country meant:  a feeling that many untouched by such things in life must experience the moment they step outside of themselves or stop viewing things as a tourist or transient presence, destined to return to the sterile aesthetic of the Western/1st world.  At one point in “How to Vaccinate Children in a War Zone”, she does explicitly question whether or not she’s making a difference..

.             At this point in my life, I’m not quite sure that I understand what making a difference is supposed to mean or look like.  I want to share an experience of mine to illustrate:.

.            This past February, I was selected as an Ambassador to a CARE-Nepal project sponsored by the company that I left to begin medical school.  Everyone expected me to have some life altering experience by being sent to Nepal for ten days to kick start the mission (our project funded programs promoting maternal and neonate infant health in rural and urban Nepal where death rates due to child birth were the highest).  But it didn’t change my life.  I appreciated the trip, I loved that I was selected out of hundreds of applicants to receive the privilege of being sent to Nepal, but I’ve been in the 3rd world many times before: it looks the same.  My family is from the poorest country in the Western Hemisphere.  The poor there are poorer than the most poverty stricken Americans.  They all die from lack of access to the same basic needs that we take for granted here.  I took it in silently, wondering what possible difference I could make with this one trip as an entry level employee at my company whose job description did not babyprepare me for anything I was doing out there, meeting with local government officials of a country whose infrastructure I knew little about and whose culture was novice to me and I couldn’t readily identify with.  I had applied on a whim and hadn’t expected to be selected and a month later, I was there.  I took it all in pensively, learning and drawing parallels to examples that were a bit closer to heart and home, trying not to drown in the futility of my being there.  What could I possibly do?  I was the youngest, least experienced and one of the only non medically trained Ambassadors… Well, the CFO wasn’t medically trained either.  But she had the company’s checkbook on hand, a powerful tool that she could and that she had waved about at her discretion..

.             I learned so much about CARE, their operations and their attempt at sustainable models of community education that I hope to apply to my career as a physician, but my life was not changed.  That’s just the honest truth.  Which seemed to annoy our CFO, the big boss on the trip.  And her annoyance bothered me.  I couldn’t say it out loud, but I was more annoyed by the Corporate Vice President/CFO’s Savior complex than anything else, as if she was doing the people of Nepal a favor by being there, waving about that figurative checkbook.  But she couldn’t humble herself enough to put herself in their shoes for a moment and squat over the traditional Nepali toilet (a simple hole in the ground… it’s an experience).  No, we had to go on a several hour journey to find traditional Western styled toilets for her to use in a tourist hotel.  And she had the nerve to chastise me publicly for my pensive silence and not following in her extrovert model of leadership, as if that was the only way to set an example and make that elusive difference..

.             I happened to have crashed last week’s mandatory event for the Global Health Track.  I couldn’t bring myself to spend an hour studying.  It takes an hour just to get ready to study sometimes; I’m incredibly inefficient.  Anyway, I have a terrible memory and wrote nothing down, so I can’t honestly tell you anything about the lecture beyond the day I attended it.  But at some point, before the speaker started talking about some of the work his NGO was doing in East Africa, he shared this Camus quote:  “The evil that is in the world almost always comes of ignorance, and good intentions may do as much harm as malevolence if they lack understanding.”  There was a lot of self-congratulating going on in my trip to Nepal by someone who I don’t think understood the amount of effort it had taken and it would take to make real change in the maternal and infant death rates due to childbirth in Nepal.  Sometimes, looking at the facts and figures presented, the obstacles to the task at hand seemed insurmountable.  You can’t just change things immediately when some of the biggest issues were deeply ingrained in superstition and culture (like the erroneous belief that eating leafy greens would make Mum and baby sick, so women were often discouraged from eating them).  Note the difference of approach:  trying to understand what is feasible (what I was attempting to do) vs. giving yourself credit for doing “good” that may not be that good in the long run, assuming that you even retrospectively analyze the implication of your actions (the CFO’s plan of attack).  But to the CFO, she was making a world of difference and couldn’t have been prouder of herself and our company and I was left writhing in my own insecurities of potential uselessness.  Sometimes, I wish I was wasn’t beyond that level of delusion, if for nothing else then for the undeserved boost of self-esteem..

.            Action and self-education can occur simultaneously: they don’t have to be mutually exclusive events, but I find too often they are.  If I saw more people were taking a moment to educate themselves and understand the way things operate in a world that is not their own, I think I would be more in support of Global Health Initiatives/service trips and less ambivalent and critical.  “Dying of a Treatable Disease” brought up the point that while drugs for the treatment of HIV being introduced into Africa is essential, it’s not enough.  Without a fundamental understanding of what else is needed, one may think that simply providing them with drugs as sufficient.  But, as Keirns points out, there is a “serious shortage of staff to administer them, leading to overwork, guilt and burnout among dedicated medical staff members.”  So a simple intervention of providing necessary drugs may lead to losing essential medical staff and an already understaffed, under-resourced 3rd world country, which would further impact how many people get vital medical care (and it would ultimately lead to waste, because if you lose the medical staff needed to administer the drugs, then the drugs will inevitably go to waste).  An example of the evil that ignorance may breed Camus highlighted in his quote:  It’s a simple, well intentioned act, but the consequences are potentially more devastating than the current reality..

.           Which is the lesser of two evils: introducing temporary interventions that may leave the natives and recipients of Global Aid worse off when funding and supplies run out or doing nothing at all?  A small Band-Aid on a gaping wound or the uncertainty of letting the wound heal (or fester) on its own? (I really like the way I wrote that, so I’m gonna use this phrase over again, haha…  Stealing from myself is not wrong.)

I don’t know if I’m in a position to say.