“I will remember that I remain a member of society, with special obligations to all my fellow human beings” – Hippocratic Oath, Modern Version
Physicians-in-training are granted a privilege unparalleled in society. Human beings generously donate their bodies for our learning. They lay naked, exposed on cold stainless steel tables while strangers, who will never know their name, study them intimately. Like a grandfather telling stories to the next generation, their organs reveal to us a story of life.
We spend years immersed in science — an opportunity most of the world will never have access to. Countless hours are spent with principal experts in medicine, progressive researchers who are changing the world at an unimaginable pace. Exploring the human genome and curing diseases that once were considered incurable. We care for patients who confide in us their secrets, truths so vulnerable they may never share with those closest to them.
As aspiring physicians we are entrusted with the knowledge that gender and sexuality are not as black and white as the world would have us believe. Gray becomes more suitable as our training progresses. We know that of the four million children born annually in United States, four to eight thousand will have Klinefelter syndrome. Their sex genes will not be XX (female) or XY (male); instead they will have an extra sex chromosome, XXY. Because they have both male and female sex genes, their bodies develop uniquely. They have both male and female characteristics. Do they identify as male? As female? Neither? This becomes their journey, one frequently burdened by confusion and rejection.
5-alpha reductase deficiency is another gray area, though much less common than Klinefelter syndrome. Children are born with an enzyme deficiency that should normally convert sex hormones to their proper form (namely testosterone to dihydrotestosterone). Most are genetically XY (male), however because their cells do not receive the appropriate stimulation they develop externally as female, while still lacking a uterus and ovaries. Some of these individuals are raised as females and typically identify as so throughout their prepubescent years. However, once puberty is reached, their secondary sex characteristics can flourish as male. In the about half of cases, they will inevitably identify as male in adulthood, demonstrating the amazing plasticity of the human brain.
Society places enormous stress on those that are perceived as different. Consequently those with unique chromosomes or different sexual orientation experience higher rates of depression and suicide. Gay, lesbian and bisexual individuals are marginalized by the definitions of what is “socially or morally acceptable.” It should not be surprising then that these youth experience a four to six-fold increased rate of suicide compared to peers identifying as heterosexual. Adults are also at an increased risk of suicide attempts if they identify as gay or bisexual.
Civilization will continue to raise its voice in the dispute over morality, striving for a definition of right and wrong. As the future of medicine, we cannot sacrifice our sacred obligation in the midst of this quarrel. While caring for patients we cannot be “pro-life” or “pro-choice,” “pro-gay” or “pro-straight,” “pro-god” or “pro-atheism.” These are aspects of our personal lives, our opinions, religious beliefs and political affiliations. No one denies that we are entitled to these. However, the second we step into our clinical role we must remain, always, “pro-patient.”
“I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug” – Hippocratic Oath, Modern Version
We are the future of medicine and the advocates for those who need us. Warmth, sympathy and understanding must also outweigh society’s opinion, political priorities and the persistent fear and rejection of that which we do not understand. In this way, our training is exemplified both by intelligence and a profound love for our fellow human beings.
Our privilege is incredible. Our words will be persuasive. But it is our acceptance of others that can influence the world for the better.