Category Archives: Society

Tropical Paradise Has Challenges Too

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“I didn’t have power for 4 months. My daughter got lice because we couldn’t bathe properly; with my long hair, I got them too when I picked them out for her. We washed our clothes by hand. During those months, some areas started to get power and I was able to bring my big items (like bedding) to a laundromat. I lived in a place where I wasn’t allowed to have a generator. But even the rich people with generators didn’t have power because you need gas to run generators and we didn’t have that. I couldn’t keep food all that time because my fridge didn’t work. It was hard… So, I think we all have a little PTSD when it comes to hurricane season,” a Puerto Rican said, recalling her experience during Hurricane Maria. She’d just given me a tour of San Juan’s primary hospital campus, including pointing out the street where they used to have shipping containers lined up to hold corpses during Hurricane Maria because they couldn’t identify them fast enough.

“It was bad. Help didn’t come or it was delayed,” she said. I remembered this; it was all over the news. Hurricane Maria hit Puerto Rico in 2017. You might remember the politics of the US then; there was a lot of news about the hurricane’s effects and how the US government delayed or didn’t send aid. Perhaps 3,000 Puerto Ricans died, but we’re not exactly sure of the true number. Many more lost their homes.

I remember someone asking me if Puerto Rico had been rebuilt since Hurricane Maria when I left for Puerto Rico. At the time, I found the question odd because it’s been 6 years since that hurricane struck. But I have an answer now and have come to realize that it was a good question. The answer is: yes and no. If you visited Puerto Rico today, your first impression would be that it’s a tropical paradise and you might fall in love with the place. There’s a reason why Puerto Ricans are so proud of their home. As a tourist you’ll enjoy both friendly hosts and living accommodations equivalent to those in the continental US. But if you dig deeper than the average tourist experience, you’ll discover that the island has challenges. Despite the beauty of the island and its strong identity people are leaving Puerto Rico. This Washington Post article describes the situation of Puerto Rican’s leaving their home (and people leaving other US territories too).

If you explore beyond San Juan (Puerto Rico’s capital and biggest city), you will see shadows of Puerto Rico’s complicated situation. In the town where I’m staying (and all throughout the island), you find deserted houses on most blocks. A coworker explained that sometimes people just leave their homes and move, often to the continental US. The pay here is lower than in the continental US (often in general) but especially in industries of interest to me such as healthcare. Infrastructure throughout the island, like healthcare, is much like in rural regions of the continental US, which is to say that many people don’t have easy access to the healthcare they need.

My husband and I visited a small island just off Puerto Rico’s coast called Vieques. It’s where the brightest of the 3 bioluminescent bays in Puerto Rico is and that’s why we visited. Being me, I had us walk the 5ish miles from the ferry to the town in which we were staying. Again, being me, I googled to see if there was a hospital on Vieques and the number of beds it has (as I do everywhere I go) just in case I wanted to move there and work. I learned that Vieques doesn’t have a hospital because it wasn’t rebuilt after being destroyed in Hurricane Maria. I also noticed signs demanding that the hospital be rebuilt on a chain-link fence as we walked across the island. On our walk back to the ferry from our Airbnb, a local stopped to offer us a ride because it was hot. We accepted. I can’t remember if I asked about the hospital or if it came up naturally in conversation, but the local explained that the hospital hadn’t been rebuilt and it was a point of political tension. Further, in 2020, a teenage girl died because there wasn’t available transport to San Juan when she needed it and Vieques didn’t have a ventilator to help her breathe. According to the local, even the family of the girl helped manually give her breaths (with a bag-mouth mask which is what EMTs use on ambulances until they get to the hospital), but she died anyway.  

From these conversations, I’ve learned that Puerto Rico has a complexity that can be overlooked as a tourist. Living here a few weeks has not made me an expert (or even a novice) in Puerto Rican anything…except maybe dengue because I’m doing an internship about it and fruit juices because they are delicious. But my time here has allowed me to see that beyond the beautiful beaches, blended frozen beverages, and seafood Puerto Rico has a historical, political, and economic reality. Puerto Rico reminded me of the confusion I had while living in DC: It is odd to me that there are territories that are part of the US where the inhabitants aren’t granted the right to vote and to have congressional representation because it seems rather undemocratic. I don’t know if it would change anything in Puerto Rico if they were represented in US congress or participated in US presidential elections. I also I don’t know if that is something Puerto Ricans want. But, at the very least, I’ve come to see that I have a lot to learn about Puerto Rico’s history, its current governance, and its relationship with the US before I can fully unpack my experience living here.

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The Ocean

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I’ve never lived by a sea or ocean before. But for a few weeks this winter I am. And not just any salty expanse but the Caribbean Sea and Atlantic Ocean around Puerto Rico. It’s not hurricane season so, in the few days I’ve been here so far, the waves have crashed with careful, well-mannered regularity. Right now, I’m on the Atlantic Ocean coast. The water is warm and blue. Walking along the beach I find myself covered with a salt film both from the lapping waves and the salt in the air. The temperature has been perfect and the sun a beautiful gold. Proximal to the sand and rocks that meet the water are coconut trees, marking where the beach ends and the rest of the island begins.

As I walk along the rocky bits of the shore crabs scuttle so quickly that they’re hard to see – their shell patterns match the sea plants and the design the sunlight creates as it dances with the waves. Pelicans hover above the water, make a diving plummet with a smack as they break the water’s surface, rest on the ocean’s surface to swallow the fish they caught, and then take flight to follow the wind off the water to only scoop around like a boomerang and head back out to fish again.

People sit on the beach and hangout in the water. They listen to their loud music, dig holes in the sand, throw rocks, and drink alcohol (mostly beer). I walk along the junction between the water and the sand – sometimes more on the side of the sand and other times more on the side of the saltwater. The waves fill the gap between me and the seemingly infinite ocean. Sometimes I’m taken by surprise when a large wave barrels to shore and splashes up against my legs and catches my shirt in its spray.

Where there are tidal pools, I look down at the ruby red sea urchins with deep crimson spikes – their colors remind me of the colors of fresh and dried blood or, perhaps more appealing, the colors of red I’d expect royalty to wear. There are little fish that dart around in the tidal pools; they’re the color and pattern of sand. There are sea plants that look like little green balloons. There are shells hiding live creatures whose names I don’t know. Some of the bigger pools have sea anemones. I peer into each tidal pool, eager to see what it keeps in its mini-sea haven.

I love the sound of the waves and the smell of the salt water against the sand. It’s new to see coconuts. But, in this serene backdrop I can’t help but notice the broken glass and plastic bits, bottles of all varieties, cans, and all the other trash humans on the beach have failed to pick up…or humans elsewhere tossed in such a way that their trash found its way to the beaches where I wander now. I walk barefoot in the sand, but it’s almost a bad idea because so many people have broken their beer bottles.

The creatures and features of the ocean are no less beautiful with the trash present, but I imagine how it would be paradise without the plastic bottles there as a reminder that so many places I love are being filled with trash. Will this beach be swimmable when my grandchildren are alive? There must be a better way. There must be a way to keep this beach with its crabs and sea urchins for the generations to come.

As I turn up the road between where I’m staying and the ocean I see heaps of bottles, cans, Styrofoam, plastic bags, and other discarded single use items on the side of the road. They create a scattering of litter among the snake plants, palm trees, mango trees, papaya trees, pothos vines, and other plants of the tropics. Is there another way or is it already too late to return our natural spaces to paradise?

The Moments We Have Together

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I would think of her often after we met as I hurried down the hospital walls. I always hurry down the hospital halls…rarely because I needed to hurry, usually just because it’s nice to stretch my legs. Sometimes the memory of her bright eyes would shoot across my mind as I opened the electronic health record system to work on different patients.

She had come to the hospital with a stroke. I followed her during the few weeks after she was diagnosed, during her acute recovery in the hospital. I met her on the medicine floor and then wandered the hospital until I found the rehabilitation center wing where she was moved one night.

After the first day when I conducted a thorough history and assessment of the patient, my visits were just “social visits” – the term for checking in with a patient or their family for the singular purpose of offering support rather than providing a medical update. She hated the hospital and visiting hours started late in the morning. I’d visit her before her family could be with her to help pass some time until they came.

Strokes cause a range of outcomes. Her outcome was good; long-term she was a little weak and a little off balance but still sharp as a tack. Strokes are injuries to the brain. In the first week I followed her, she was very depressed. Strokes can do that. I sat with her in the morning as she described her terrible dreams. Flashbacks to her childhood. She had been a Jewish child in Nazi territory. She described hard times. Her husband had also been in that situation – he had lost his whole family in the concentration camps.

As our days together continued, the patient talked less about WWII and more about her family in the US. She talked about how wonderful her children were. How hard it was now that she was old and her friends were dying. When you get old and people start dying, she told me through her stories, there are fewer people who remember your life experiences. Fewer people who truly know the world you knew.

We chatted about the hospital food. The boredom of sitting in a hospital bed. How playing cards with her children was nice, but barely passed the time. As I got up to go, she’d say, “Come back tomorrow.”

I went back until my school schedule sent me to clinics rather than the hospital. Medicine and the hospital are busy. Healthcare is frustrating and terrible sometimes, even often. When I find myself falling into the pit of work that is any job but especially a job that involves dealing with people and clunky systems all day, I push myself to pause and remember why I went into medicine. The weeks this patient was in the hospital she was my light. I like to think I also helped take the edge off her hospital stay. Seeing patients through sickness is the highlight of medicine in my opinion. Not all stories end as well as hers, but all hospital stays can be made better by our shared moments.   

The Night Chef

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Overnight, the hospital halls are quiet; all the administrative areas are closed. There seems to be endless dark ends of corridors where no one is. There is the constant beeping of heart monitors and other hospital machines. The night shift’s laugher periodically fills the space – the nurses and others making sure patients get what they need overnight. Of course, if you’re a patient and trying to sleep it seems loud and it’s annoying because you’re woken frequently for vital signs checks and other things.

Some folks chose night shift. Some folks like the autonomy that a less full hospital affords. Some do nights so they can be with their kids during the day. Some do it for the higher pay. Others are just night owls. I do night shift out of necessity – either when the budget requires it or there’s no way out of it. And that is how I found myself in the hospital when I met the night chef. I was on a rotation that had a week of night shifts.

The night chef is the man who runs the grill of the only cafeteria open overnight at the hospital where I train. When your shift is overnight there’s not much to be done but have lunch at midnight. If you’re like me and prefer to be asleep well before midnight, midnight lunch is daunting. On my first night of nights, one of the residents I was working with reassured me that the night chef was one of the best things about night shift. I was curious what she meant.

The night chef can make anything. He’s gregarious and happy despite working at odd hours of the morning. When I met him, I could not understand why he was working in the cafeteria. He is one of those people who could sell anything. You know, one of those lively talkers who connects with anyone. Why had he chosen to be a hospital chef at night?

He welcomed me and the resident I was with when we entered the cafeteria. He listed the delicacies he had imagined that evening. And despite the terrible hour of day, I found myself smiling and feeling only a little guilty for turning down the pizza with gobs of meat he gloated about for a different option.

During my first week of nights, it became routine to visit the night chef at some point. I never bought his most creative dishes, but I did enjoy his cheer.

Eventually my stretch of nights ended. On my last night, I stopped by the cafeteria on my way home. “Will I see you again tomorrow?” the night chef asked.

“No, I’m going back to days.”

“Ugh, too bad,” he said. “But… I understand.”

I went on my merry way wondering if I’d see him again. And, of course, I did soon thereafter because I started my day shift before his night shift ended. He was jolly as ever, even at 6 in the morning after having cooked all night. “Where have you been?” he said the first time I saw him again. “Nice to see you.”

“Nice to see you again too!” I said. I meant it. It doesn’t take much to make someone’s day and his happy greeting made mine that day. The night chef is a master at brightening his customers’ shifts. Perhaps that is why he had chosen to be the hospital night chef. Night shift at the hospital needs him most.

Burnt

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Her hands had become so numb she could no longer administer the eyedrops that kept the pressure in her eyes from getting too high. If her eye pressure got too high, she’d go blind. So, her eye doctor said she needed surgery if she couldn’t use the eye drops. There were two surgical options. One surgery would take an hour and she’d leave the operating room able to see. One would take 3 hours and she’d leave the operating room blind, requiring 4-6 weeks of recovery before her vision would return. She was lucky because she had family who already helped her a ton because her other health conditions had made independent living hard for her. For some reason, the insurance would only cover the 3-hour surgery that would leave her blind for over a month. The holidays were coming up. The family members that took care of her had kids. She refused to make them care for her while she was blind over the holidays. She postponed the surgery. Would she go blind before she could get her surgery? Is this the healthcare system we want?

~

The patient wasn’t COVID vaccinated. “What will you do to treat me if I get COVID?” she asked. I thought about the patient a resident had told me about. That patient had been dependent on family for care. His family didn’t vaccinate him. He got COVID. He came to the emergency room with trouble breathing and then went to the intensive care unit. He lived on the intensive care unit for a year. Eventually, his healthcare team cut a hole in his neck to put a breathing tube in because he needed it. They did everything they could to keep him alive. The resident said when the patient first came to the emergency room, he was a happy, funny soul. The patient lost his happiness slowly during the year he fought to breath. After a year of an entire hospital trying keep him alive, he died. When exactly did avoiding sickness fall out of favor? Do you ask what firefighters will do if you set fire to your house or do you make a concerted effort to not catch your house on fire knowing that firefighters will do their best to stop a fire if it occurs but are limited because fires are destructive and destroy houses and the people who try to stop them?

~

The patient asked, “Why are so many doctors retiring?” I wondered how he didn’t know the answer to that question already. It seems so obvious. Then, I realized he was not a medical student. Being a medical student is to have a front row seat for observing the current state of healthcare. What had I seen? Why did it seem perfectly logical to me that so many people were retiring from healthcare even as I was striving to make it my career?

Not just doctors and nurses, but everyone in healthcare seems to be retiring…

We report our COVID cases. Our COVID test rates. Our COVID survival rates after hospital admission. Our COVID deaths. Who was there to perform those tests, to care for those people when they came to the hospital, and to close the curtain when the ventilator wasn’t needed anymore? Healthcare workers. But, they were also there for all the other things too. The heart attacks. The stomach pain. The broken bones. The cancer. The normal healthcare screenings. They were there when people looked for help with their depression and their anxiety. Healthcare workers’ hours increased. They worked the job of two, three, four, and five people because the hospital was short-staffed before the pandemic hit. Again, healthcare workers were already working long hours and doing the work of several workers before COVID came. Then healthcare workers got sick. And the ones left standing worked for their sick colleagues, worked for themselves, and worked for the staff who were missing before the pandemic came. Wages stayed the same.

Housing and food got expensive for everyone, including healthcare workers. Healthcare workers missed the same performances, social events, and restaurants that everyone else was missing. Life got more expensive because everything including industry was disrupted by COVID. Healthcare wages stayed the same. Healthcare workers got sick. Sick leave was used up. Shifts were harder because healthcare was short staffed and there were more patients than before. And the patients were dying. And insurance didn’t want to pay for the treatments that patients needed, not that that was new, but it remained disheartening. And there was the need to wear masks at work. And to put on goggles and gowns and for healthcare workers to take extra time to protect themselves from infection. There was the risk of bringing COVID home after working in healthcare. Wages stayed the same.

People got sick. And healthcare workers got tired. Wages stayed the same. Hours were long. Vacations couldn’t be taken like they used to be taken. And just like their patients, healthcare workers got sick, tired, depressed, and anxious. Staff shortages increased in the hospitals and clinics.

People denied that COVID was real. People invented vaccines that helped prevent COVID infection. People refused to get vaccinated. People complained about wearing masks. People got tired of social distancing. People got sick. The intensive care unit was full. The psychiatric ward was full. The cardiac ward was full. Alcohol use disorder, diabetes, high blood pressure, and all the other medical conditions that always exist marched on because they don’t stop during a pandemic. Healthcare workers shouldered the workload of several workers each because some of their colleagues had left, some had died, and some were sick. Wages stayed the same.

In such an avalanche, how long would you have waited to change careers? For many, the answer was between 1 and 2 years.

~

There is always hope and healthcare has been grounded in hope since the beginning. But as a student so excited to become a physician I know that change must happen if hope is to materialize into lives saved. And for my sake and all the people who might need the hospital or a clinic in the coming years, let’s not make it take a healthcare collapse before we seriously consider how we might improve and restructure our healthcare system. I’d very much like some seasoned healthcare workers who are not completed burnt at my side when I start practicing as an independent physician because experience is gold in medicine. I’d also really like to have enough staff to care for patients without having to burn myself and burn my colleagues with the weight of too many lives in each of our two hands.

A Cup of Coffee

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I saw the physician I was working with return from the cafeteria with her normal cup of coffee and a second small coffee. She walked by our computer station and into the patient’s room.

The patient had been plagued by a headache that morning when I saw them, not long before the physician arrived with a cup of coffee. The patient had requested coffee because it usually helped with their headaches. Of course, they would get coffee with their breakfast tray later, but that could take hours.

The patient had had a rough year. They’d been in the intensive care unit several times after trying to kill themselves, the first time almost not surviving. They’d lost a child to overdose. Their life had other stress-causing features. The patient was calm when they were under our care, but they’d attacked their nursing staff earlier on during their hospital stay.  

When the physician returned to our computer station, I thanked her for getting the patient a cup of coffee. Little acts of kindness like that are not as common as you’d like them to be. The hospital is full of burnt-out thoughtful people (also known as staff). It’s also full of people with all kinds of diseases. The diseases of the brain can be quite tough. When a psychiatric illness sends people to the hospital, there’s the suffering of the patient and there’s the challenges that they sometimes pose for medical staff. The brain is a powerful organ and when it gets sick it can do all kinds of things. As such, when healthcare staff are overworked (which is always these days) and when the hospital is full (which is most of the time), patients with brain diseases do not always receive the kindness that they deserve from their care teams. But, on that morning, this patient did.

I thought about that cup of coffee. It brightened the patient’s morning. It can be hard to remember the little things we can do to help others. But, on this occasion, the physician I was working with reminded me by setting an example.  

One Example of Sexism in the Operating Room

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Often enough to be considered a pattern, the men in the operating room chose to discuss the annoyance of the hospital’s anti-harassment yearly training videos and anti-harassment policies when I was the only female in the operating room with them or when it was just an older female nurse, them, and me. And while I also find the hospital’s anti-harassment training videos frustrating (for entirely different reasons than my male counterparts), I did not appreciate when a surgeon said he could get tips from the scenarios in the video. I did not appreciate his comment (despite his humorous tone) because the truth is that harassment doesn’t just occur in training videos. It occurs all the time and in all settings of women’s lives.

And I found it interesting that these men were complaining when most of them are fathers of daughters, and many are fathers of young daughters. And if the risks weren’t so high for me, I would have asked them the questions I pose now, “How old do you think your daughter will be when she first gets cat-called so badly she feels unsafe? How long riding public transportation will it take before she has a set of rules she follows because of the physical and verbal harassment she experienced from male passengers?” The use of “when” and not “if” is intentional.

You see, women close to me have been strangled and shoved into walls. I’ve sat by as a younger woman asked for advice from an older woman about what to do because her husband raped her every night. I’ve been called by friends in tears because they were cat-called so badly they were shaken. I’ve sat with women as they hid behind dark glasses waiting to get photos of their bruises to use in court. On my first day of one of my first jobs, my preceptor told me how to use the printer and warned me to be careful of our male boss. He left the company before I had to worry about exactly how careful I had to be. By the time I’d worked in healthcare two years, two of my female friends had been groped by male patients. I’ve only been training in the hospital as a medical student for six months and already two female physicians have taken time out of their busy schedules to have lengthy conversations about how to keep my head up and build my career despite disrespect from male colleagues and male patients.

And the reason I would ask the fathers of young daughters the questions above is because I know they love their daughters. And I know they can’t fathom that they are being exactly the type of men who will get in their daughters’ way as they reach for their dreams. And I would ask the fathers of young daughters these questions to remind them that they cannot protect their daughters from the future. And, truth be told, they will likely never know the harassment episodes of their daughters’ life. And I would ask these questions to recommend that they learn how to respect women so that they can set an example for their daughters of what it’s like to be respected. That way, when their daughters do experience disrespect, they know it is not their shortcomings but the shortcomings of the disrespectful one. In other words, it’s worse to be a daughter of a father who doesn’t know how to respect women because he sets a poor example of the male gender. And the behavior of these men in the operating room made it clear that they still had much to learn about respect despite surgeons being among the most highly educated people around. What an unsettling reality to have so many years of education and still lack competency in a basic principle like respecting all humans.

You can look up the statistics in the US for harassment and rape of women (and other demographics) if you’re curious. It’s an easy Google and the numbers are almost as bad as the news that makes the front page of the newspaper. If you want to get really dark, look up statistics related to intimate partner violence. The numbers are horrific. And the numbers always surprise me because all women are daughters and perhaps sisters, mothers, and partners. Fathers and mothers see the statistics and are inclined to tell their daughters to be careful. To not drink too much. To not wear too revealing clothing. To never set down their drink. To not walk alone at night. To not live on the first floor. To lock their windows and doors. To always go out with friends….the list goes on. But the question I always wonder when I hear these statements of warning is why don’t parents just tell and teach their sons that “no” means “no,” “stop” means “stop,” respect applies to all people regardless of genitalia, and that drunk or not you are responsible for your actions? Because all men are sons, and many are brothers, fathers, and partners. It would seem more helpful to prevent the problem of people harassing others, than react to the problem by telling the victims to avoid harassment.

I also find parents’ lectures of caution stifling because they do not address so many of the manifestations of sexism their daughters will experiences. Yes, there is the risk of rape and physical abuse. But for those women going into competitive or historically male professions many of the troubles we face as women are more subtle and persistent than acts of violence. The times we’re told we’re mean or bossy when a male counterpart with the same behavior is considered strong. The times we’re ignored, spoken over, interrupted, and discredited despite consistently being correct. The times (like in the operating room when men decided to complain about harassment protection for women) when we’re othered and made to feel like demanding respect isn’t a right, but a burden we place on our male counterparts. The times we’re underpromoted, underpaid, and passed over simply because we are women. The times we must dig deeper than our male counterparts not because of shortcomings but because our parents taught their daughter to be cautious and taught their sons to be bold.

And as these fathers of daughters discussed sexual harassment policies as an annoying restraint placed on them, I thought about their daughters. I knew when they’d be cat-called. I knew how long it would take on public transportation before they developed their safety rules. And I hoped for those daughters’ sake that they would have men that set an example of what it’s like to be mutually respected. It had made such a difference for me to coexist with many men who looked at me as a person and not some different creature. You see, it’s helpful to know respect is possible because at times it seems like a fictional concept. I thought about those young daughters one day standing where I was. I sent them strength. As much as I hoped the world would change in the years between us, I wasn’t sure it would because these men I stood with in the operating room would still be here. And their sons who had them as role models would be here too.

And I was once again weary, not so much because of the long hours I was spending studying or the fact that I was scoring equal or better to many of my male counterparts in medical school while also getting cat-called and navigating colleague and patient sexism, but I was weary because these men in the operating room, like so many others, stood in the way of my father’s daughter. They stood in my way because they made things more difficult for me than my brothers simply because of my genitalia. None of this was new or surprising, but it did make the hours in the operating room seem especially long. And if the operating room had been a safer place for me, I would have told these fathers the reason I didn’t like the hospital’s anti-harassment videos was because they were triggering for those of us who have been sexually harassed and spoke of a justice system that I have not found anywhere I’ve worked. And I’ve worked in many places.

Rainy Days

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The rain fell. It fell hard. It was a mate drinking kind of day. It was a flood-warning day. And the rain reflected my mood. I’d seen a rainbow just before the rain started. With the rain comes rainbows, but on this rainy day I was feeling the grayness more than the light reflected off the raindrops.

And I thought about a text I’d gotten from a friend not many days before the storm hit my town. She’s a good friend and checks in when the world is in shambles and I’m ignoring the news – which is to say, she checks in whenever something happens in the world I should know about because I almost always ignore the news these days. Despite my efforts at ignorant bliss, I’d heard about some of what she said already. And I felt the same as she: what we were doing seemed pointless when so many people were suffering. And yet, it seemed school would give us skills to better help the world. However, the future is hard to predict.

On this rainy day, I thought about allies and who we can trust. I’d recently seen a patient riddled with cancer. It doesn’t require one moment of school to recognize a dying person. This patient was the picture of death. Their eyes were dull, their movements slow, and their skin ashen. The patient couldn’t eat, yet begged for food, and now their cancer had spread so much that it was making connections between their organs. Their pain was barely controlled. They didn’t desire surgery or treatment; they wanted the pain to stop. They wanted to eat. On one hand, the patient and their healthcare team knew exactly when the pain would stop – the word wasn’t mentioned. The family of the patient, on the other hand, pushed for treatment. Treatment in this case meant prolonging life but not ending the pain and not preventing the eventual end we already knew.

Medicine can’t change fate, nothing can. The family had convinced the patient to continue with treatment, and yet the patient wavered. The patient didn’t want to disappoint their family, but they were so tired. I reflected on their family’s choice to push the patient to continue fighting. I realized that I hope that the folks I call allies are there when I need them, when the going gets tough. And I hope that in the tough moments of my battles they think about what’s best for me, even if it’s not their preference.

I wondered if the betrayal of a family wasn’t so different from the betrayal of a country. In this case, though, the patient wasn’t allowed to pursue their end in peace. The news of Afghanistan was quite the opposite. We’d left so many allies to die perhaps avoidable deaths. And I thought back to the day the Twin Towers fell. I was in 6th grade and now I was in medical school. Seeing images of babies handed to strangers on planes in a hope they’d have a better life didn’t seem like much progress from the smoke and rubble that filled New York City when the towers fell. Politics are complicated, but I wondered about the definition of “progress”; was it simply a fiction invented to instill hope? I wondered about trust; which allies are ones we can trust? I wondered what could have been done differently.

On this rainy day, I thought about the good of the individual and the good of the whole. I’d seen a young patient recently walk away from treatment. It would have been a simple procedure with an 80% chance of completely curing their disease without them even needing to stay in the hospital. Declining treatment is a right. But by saying “no” this patient had most likely condemned themselves to metastatic cancer in under a decade. They’d decided to die of cancer well before they turned 50 because their cancer wasn’t curable once it spread. When they declined treatment, the cancer hadn’t spread yet and we most likely could have cured it.

I weighed my feelings about this patient’s decision against my feelings about people declining COVID vaccines. They were both examples of people making health decisions. It is our right to decide what happens to our bodies. But, choosing to die of cancer compared to choosing to put others at risk of infection feels starkly different. You see, the thing about cancer is you can’t pass it to others. The thing about viruses is that they spread. While you might be just fine after catching COVID; others may die when they’re infected. And it could be you who infects them.

The rain fell and I thought about the nature of the world. I had an exam looming and I wanted to ignore everything else. Like rain drops on a rainy day you don’t have to look that far for sad things in life. It’s also true that with rain comes rainbows. And while I’m certain I like rainbows, I’m not certain they make up for whole rainy days.  And it seems that some of us get more moments with rainbows than others. There’s something about the angle between the sun and the water drops. Not everyone has the same angle.

The False Limitations We Put on Despair and Happiness

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The pit of despair and the pool of happiness are bottomless. Which means you and I can both suffer and revel in glee to any degree without limiting the pain and joy of others.  

My partner works in the emergency department (ED) and I used to work there too (that’s where we met). From time to time, our non-healthcare friends will ask, “So if I have to go to the ED, what should I say so my wait is shorter?” When this classic question is asked, my partner and I glance at each other and smirk. Anyone who has worked in the ED can tell you that you don’t want to be the first person to go back to a room from the waiting room…because the people who don’t have a wait are the people most likely to never walk out of the hospital.

No one wants to go to the hospital. It is miserable to be there as a patient. But, let’s say you go to the ED because you broke your arm skiing. Your arm is painful. The friend who accompanied you to the hospital is desperately trying to help you stay calm while also struggling to maintain their own composure because the odd angle of your arm makes them sick to their stomach. While you and your friend wait in the ED, there are others who have been in the hospital for days and there are some who have been there moments; in each of these groups of patients there are people who will die during their hospital stay. I tell you this not to diminish the suffering of your broken arm. I tell you simply to say that we don’t suffer alone. Your broken arm is not made less painful by the heart attack and death of Mr. Doe that occurred while you waited in the ED, but his death might remind you that we do not all suffer to the same degree during a particular patch of time.

The same goes for happiness. Some of the joys of this COVID era are the baby announcements, the engagements, the house improvements finally complete, the adopted fuzzy friends, and the fitness goals achieved. My social media feeds are full of cute kittens, puppies, and shiny rings. One of the things I love about all these great landmarks in my friends’ lives is that the engagement of one friend does not detract from the puppy adoption of another. It turns out that my friend with a fiancé can be dreamy about their forever while my other friend can melt with love for their new puppy.

I think the infinity of the pit of despair and the pool of happiness are important to keep in mind. You can take as much as humanly possible from both or either and there will still be a limitless amount for the next person. Not many things in life are that way.

Since the COVID pandemic started and the death of George Floyd there has been arguing among individuals and over the news about the validity and gravity of the pain and inequity experienced by different groups in America. The argument goes some like, “I’ve also had a hard life. I’ve suffered from injustice. So, I don’t see why their hardship and the inequity they face is special.”

The suffering you’ve faced does not neutralize the suffering of others. The suffering you’ve experienced does not lessen the burden of suffering for the rest of humanity. Suffering and happiness have no bounds. The argument for equity is not that your suffering does not matter. Your suffering does matter. The argument for equity is that the systems we’ve developed so far to organize our government, personal lives, education, and work make it harder for certain people to access the pool of happiness while at the same time making the pit of despair easier to fall into. The underpinning of equity is simply that there should be no gatekeeper to happiness and no funnel to despair and, therefore, where they exist they should be eliminated.

Betrayal

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I didn’t cry but my heart was heavy in November 2016 when I carefully folded up the American flag I’d always hung in my room and placed it safely in a box, making sure it never touched the ground. I folded it the way my father had taught me, which was the way his father (WWII and Korean war veteran) had taught him. As I folded the flag, I looked for tatters suggesting it needed a proper retirement—it didn’t. I swore that I would not hang the flag again until my country made me proud. Until my country no longer betrayed the promises on which it was founded.

The election in 2016 felt different than the others I’d experienced. There was a pit in my stomach about the future after November 2016 even though as a dreamer I am always hopeful about the future. It was uncharacteristic of me to care much about politics. I felt heavy. I told myself to wait and see how things unfolded. I told myself that US institutions were strong so it was unlikely that much would really change.

I was raised to believe the reality of the American dream. I took it as actuality that you could do anything and be anyone if you tried hard enough. However, as I grew older, I came to wonder if that was actually true.

My skepticism of the American dream increased as I worked through college. We all have our own challenges, but it’s hard not to notice how easy it is for rich kids to do unpaid internships and lead organizations that set them up for great success after graduation while poor kids work and try to fit in the internships and organization memberships they know are key to getting their dream job. That’s if the poor kids were lucky enough to go to college at all.

This year I no longer question the American dream because the beat of the American dream fell silent as a heart monitor goes flat when a heart stops forever. What took the place of my old belief that in America hard work is rewarded and anyone can pull themselves up by their bootstraps was a bitter taste. The bitterness was a truth I’d always known but refused to look in the eye: the American dream is an illusion. We don’t all have an equal crack at reaching our dreams. Some of us can climb, but the journey is largely about luck. Hard work pays, but being born the privileged sex and gender, class, and color pays more.

In the past 4 years I’ve seen America steal children from their families and put them in cages and call it justice. I’ve seen men supported and allowed to take positions of power despite overwhelming evidence that they had sexually abused women. I’ve seen the armed forces deployed against citizens, and I’ve seen military members accept that deployment.

I’ve seen so many people of color jailed and killed in the name of justice we could erect a memorial like that to the Vietnam War on the National Mall with their names and it would be more impressive than any war memorial. Just like for the soldiers who died in Vietnam, the people who were killed for their skin would have their names written on panels of black stone. Roses and notes would rest at the panels’ base, a tribute to the years the humans named there weren’t allowed to live and to the loved ones who miss them. When I lived in DC I visited the National Mall and Arlington Cemetery often. I visited these war memorials because it seemed the worst fate was to die and be forgotten. To have your name unspoken and your life discredited.

I’ve seen open fire on people in schools, places of prayer, and movie theaters. I’ve seen cities stopped by a pandemic, a virus that continues to kill and, yet, Americans would rather endanger grandmothers and grandfathers (possibly murder them with their breath) before wearing a mask.

I’ve seen taking part in global organizations and dialogue, environment protection, and offering refuge from persecution declared as no longer American.

Every time I’m bold enough to open the news I see more evidence that the American dream is not only dead but was never alive. Have we always been so cruel and hateful toward people different from us?

And I am angry. I know anger accomplishes nothing. Yet, as it becomes clearer how far America is from a country whose flag I’d proudly wave, I am angry and weary. I’m angry because so many of the horrors we’re seeing unfold today have always been there unaddressed. I’m angry because those in the highest places of power are clinging to the status quo which is one where only a select few are favored. I’m angry because the institutions I thought I could trust are weak.

Somehow, in the middle of a pandemic that has killed many globally and protests demanding equity long overdue, we must continue to live our lives. To love, work, study, and play. In some ways it is so easy to continue as if life were normal, even though 2020 has exposed many things that need our attention. Despite the desire and freedom to ignore what has been exposed this year, it would be an error to pretend that everything is okay. Should we choose to punt addressing our problems to a distant future, then it is not just the American dream but also America that has died. America is a place where all people have the right to life, liberty, and the pursuit of happiness and our country isn’t there yet.

I can’t help but reflect on how my life in a rural town is so different from that of someone living in NYC were people died in droves from COVID-19 and more people than the population of my hometown marched the streets to protest violence and inequity these past months. And just the tranquility of my life this year compared to many of the lives led by NYC dwellers illustrates how far we have to go to ensure that we all have a crack at life, liberty, and happiness.

As I slide closer to my second year of medical school, I continue to wonder what more I can do and what my role is in making America a place I’m proud to call home. When I think of action I am less angry, still weary, and very determined that though it will be a long journey, I might fly my country’s flag again. And while I don’t think I’ll live to see the American dream feel real again, I hope that we will lift ourselves closer to a society where every person is judged more for their work and kindness and less by factors present at birth such as the wealth of their parents and the color of their skin. I think if we can move forward, change, then we might call ourselves Americans with the meaning the American dream implied.