Metaphors and Medicine (Year I): Chapter 11

“Do you want to be a health and social advocate for your patients?” A local physician asked us during a presentation on racial disparaties and equity. 

                My mind began spinning to moments, small snippets which I believe have led to this moment. I recalled my first time working in an inner city hospital while I was a pre-med student. I was working with different physicians in the internal medicine outpatient clinic when a patient arrived who appeared a little disheveled. She appeared happy to see the physician, and immediately began catching him up on where her life was. However, she had missed a few previous appointments, and she began giving a variety of explanations: trouble finding transportation, her son was supposed to bring her but didn’t bring her, she had work and could not leave her shift. The physician was sympathetic and made a light-hearted comment about his happiness that she was able to find time to come in to care for herself.

                I did not think much of this encounter until it became repetitive, feeling like déjà vu each time. It was not only with that physician, but with many others. Sometimes they were non-English speaking patients. Their ages varied, their occupations were not the same, and they did not fit a “standard” profile of patient. This persisted when I worked in a smaller city Emergency Department as a scribe when patients gave similar reasons for not being able to see their primary care provider before their issue became emergent, their pain forcing them to put themselves first. The worst of this was when the problem became terminal and the “what if they had come sooner” thoughts set in.

                The truth is advocacy is a huge part of medicine. Most of us are called to medicine for our will and drive to hold someone’s tender life in our hands, hold it gently but firmly, and do our best to release their life intact, safe, and whole. We hope that the impressions from our hands will leave some kind of lasting impact on their life, one that will leave them prioritizing their health because they love and care for their own well-being as much as they do someone else’s. We want to teach all patients to understand why coming in is important and help them foster a desire to be compliant with their treatment plans.

                This question was important, but I was left with a feeling of uncertainty about our preparedness. Personally, I am frequently critiqued for my “idealist” perspective of medicine. I hope, dream, aspire, and desire all these “perfect” outcomes for every one of my future patients. What the journey to medical school has taught me though is this field is far from idealistic, and I often try to change my language to something more concrete and tangible, as tangible as those lives that will be in the palms of my hands.    

                I believe that the key to being an advocate is realizing that there is so much to learn. Always. I think back to my time on a medical mission trip in the West Bank, how I believed that living there had equipped me to understand these patients and their lives. The truth is that just because I could speak their language did not enable me to understand the intricate language of their lives. Did I find commonalities that I could build a foundation from? Of course. 

    However, there were greater barriers that I found between us that I did not expect, and I believe that my confidence regarding my preparedness led to many moments that humbled me and showed me exactly how much remained out of my scope of understanding. It was as though I thought I had built a stable bridge, and yet I noticed as I made it halfway across this bridge that the other half was incomplete. There was much more work to do, and the effort had to come from my experiences with anyone I could encounter while seeking cultural awareness.

               The physician waited patiently as the quiet room became even quieter. I could hear the ticking of my classmate’s brains as we all looked internally to catch hold of that desire to be patient advocates. However, I remained held by these “what ifs”, the incomplete bridge, and the missed appointments. Our desire to be patient advocates was just that: a desire. An idea. A perfect line to add to an essay, to say in an interview. So let’s make this tangible. The truth is that most medical students come from some kind of privilege, and I do not only mean financially. We are living in a bubble of education. We have had the opportunity to choose the communities we invest our time in and what people we are exposed to. For many of us, perhaps we sought the underserved communities. However, at the end of the day, we each retreated back to our worlds buried in readings, exams, and the sheltered walls of our institutions. Surely, these experiences drove our passions and shaped us into the individuals we are today who seek to hold a life in their hands, but we remain students with this opportunity to be receiving this education.

                Every patient interaction in the communities will contribute to our formulation of a narrative regarding the patients and issues we will face in our future. They remain small snippets that will help form a grander narrative and will make these issues far more real to us. Despite our own experiences that we have brought along with us into this field, there remains another narrative we do not know well enough because we did not live it. May we all seek exposure to the stories that will change our idea of human stories, force us to shift our perspectives, and most importantly, enable us to be empathetic care providers capable of holding someone’s tender life in our hands and do our best to release their life intact, safe, and whole.