On Thursday, many of you will gather round a dinner table with your loved ones and give gratitude for your friends, family and good fortune. Many of you will think of the meal associated with the inception of this holiday, be filled with warm fuzzy feelings and gloss over the real history surrounding the relationship between those who supposedly attended the first “Thanksgiving” dinner. After eating a second helping of Grandma’s famous pie, few will be concerned about the side of historical oppression or racist colonization offered with this dinner because well, that isn’t so palatable.
As a fourth-year medical student, I enjoy introducing myself to patients as the “extra eyes and ears of the team, so feel free to tell me anything you forgot or would like to address, even if you think it’s irrelevant or burdensome. I will be your advocate.” As I establish rapport with them, the walls come down, and they often provide important information that helps my team provide the best care for them.
During my last visit home, my mother waited less than an hour before showing me her medical records. She offered them up the way I’d once presented my middle-school report cards, steering the papers across our kitchen table between bowls of peppercorn chicken and eggplant until they slid to a stop in front of me. Looking at them made my head spin, as they were written almost entirely in Chinese.
It’s been a hard week. Hard, of course, because this election has caused an unprecedented wave of fear across our nation. Hard because those whose lives have been invalidated by our newest president elect are already exhausted by the daily struggle of living in a hostile country. And — not to be discounted — hard because bad days in medical school seem to hunt in packs and pounce all at once.
“Here is what I would like you to know,” writes Ta-Nehisi Coates to his son in his New York Times bestselling book Between the World and Me. “In America, it is tradition to destroy the black body — it is heritage.” Drawing on recent events, Coates shines a bright light on the very tangible obstacles African-Americans face in our country. Unfortunately, this is a reality that has largely been swept under the rug by the rest of America, including its health care providers.It is time that healthcare providers, and in particular primary care providers, confront this reality.
In medical school nowadays, there is a heavy emphasis on perfecting a physician’s demeanor when interacting with patients. Classes on essential patient care focus upon the social constructs of medicine, allowing permeable medical minds to ponder over various patient-care scenarios and determine the perfect method of one’s bedside manner. I used to believe such classes were ludicrous.
The history of the HIV/AIDS epidemic is marked by devastating losses and a disease burden that persists to this day. Though slow to emerge, both government policy and pharmaceutical research began to address the epidemic, and the resulting combinations of antiretroviral cocktails and outreach programs have helped make HIV infection a manageable, if inconvenient, chronic condition. In 2012, however, the FDA approved a drug that had the potential to shift both the American and global strategies regarding HIV and AIDS.
Ana and I sat at that table for a few hours, enjoying each other’s company and stories told in choppy combinations of Spanish and English, some laughs of word-finding frustration spattered throughout. We talked about her daughter and grandson who lived with her, the colorful birds that were caged in her open-air courtyard, and the fact that I had come to Antigua from North Dakota to work with the God’s Child Project. As fond as I am of this memory, now that eight years have passed, I look back on my time in Guatemala with some degree of uncertainty about my intentions. I was what many would call a ‘voluntourist.’
It is a muggy Tuesday evening. Because it is Florida and it is summer, the impending storm promises no relief from the sticky heaviness that infuses the air. A line winds through the parking lot of a nondescript building. Children play under tents that offer paltry shade to their exhausted parents as they give their names to the students manning the reception table.
I was on a plane heading towards Santiago, the capital of the Dominican Republic. From there, I would take a two-hour bus ride to Mao Vallerde, where we would be working at for most of the week. I was going on a global health trip through Jose’s Hands, an organization that sponsors medical students interested in going on mission trips. For this particular trip, they had partnered with One to the Other Ministries, a Tulsa-based ministry that has been doing mission trips, both medical and non-medical, since 1986. This being my first global health trip, I had no idea what to expect other than the usual warnings of tropical diseases endemic to the area.
The interpersonal ease needed to establish trust between patient and provider might come easily to some, but is only the first barrier. As physicians and physicians-in-training, we ask patients to disclose uncomfortably thorough social and sexual histories which often go beyond the limits of our own experiences. Then we critique them, offering suggestions for risk reduction based on our medical expertise. In order to do this effectively, we are asked to know a lot about communities to which many of us are not members.
Last week marked my first week as a doctor. Like thousands of my colleagues, I began intern year with a combination of enthusiasm and dread. On my first day of clinic, I woke well before dawn, full of nervous energy. I collected my precious intern paraphernalia — my stethoscope, my Pocket Medicine guide, and my crisp long white coat. I filled the pockets of my new uniform, smoothed the hems, and, as a finishing touch, began applying the pins I wore throughout medical school to the collar.