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MVPed

Published by Kayla Privitt

Going into my third year of medical school, my goals were simple: survive and figure out what I wanted to do with my life. My first clerkship was surgery, and what a chaotic start it was. I often felt like a burden on my team. I knew nothing and asked the exhausted, busy residents a lot of questions. I was a walking ball of anxiety those first four weeks: How many questions was too many? How many questions was not enough? I wanted them to think that I was interested – because I was. I was so, so interested. But the MS4’s warned me not to annoy the residents, and I was trying my best. So I sat back and observed for the most part, keeping a running list of topics in my mind to read about later.

When you start medical school they tell you that it’s like drinking water from a firehose, or eating a huge stack of pancakes every day or whatever analogy your medical school likes to say to represent the enormous amount of information we learn every day. I hadn’t felt that feeling since I was a MS1. But on my surgical rotation, that feeling came to me once again. Except this time, it wasn’t like drinking from a firehose at all. My trauma surgery experience was like drinking from Niagara Falls and getting that infamous brain-eating amoeba.

Those four weeks I spent on trauma taught me a lot about medicine, but more importantly, about myself. The fast-paced environment left little room for debate, and helped me become more confident in my knowledge. And once I discovered that being in the operating room (OR) at 2 a.m. was exhilarating, I realized that surgery was the specialty for me.

Between all the exciting level-one traumas and ex-laps, real people were going through the worst day of their lives. There are many patients that haunt me still – like the little boy shot in a drive-by shooting, the older woman in a car accident who didn’t make it and the 6-week-old baby who was abused to the point of a subdural hematoma. Even worse, the patients who weren’t with us long enough to even know their story. I cried for them, mourned them. It was the children that affected me the most and made me swear off pediatrics forever.

But the patient that I’ll tell you about was fine. At least, from a medical perspective.

It was a quiet night, about 10 p.m., and I was sitting in the pit doing practice questions. Music was playing quietly, a sweet indie love song that made me feel relaxed. But then the pagers came to life, breaking through the calm atmosphere with grating beeps. “Level two, MVped,” the resident said.

I jumped up and headed to the bay, my trauma shears in hand. MV vs. ped, meaning motor vehicle vs pedestrian. Someone got hit by a car. These usually weren’t that bad, but I’d learned to temper my expectations before the patient arrived.

EMS rolled him in and we transferred him to the bed. While the resident ran through the ABC’s, I cut his clothes off and felt extremity pulses, 2+ throughout. Now assured he wasn’t actively dying, we were ready to hear the story.

EMS told us he was homeless and wandering around on the street when he got hit by a car. His vitals had been stable and there was not much else to say about him. He was here because his leg was broken. We got x-rays, a CT scan and consulted ortho.

Once he was put into one of the rooms for safekeeping, someone grumbled something about him probably being drunk, and others agreed. My mouth opened to protest that he seemed pretty sober to me, but the thought died on my tongue. It wasn’t really my place to say anything. Or maybe it was, but as a newly minted MS3, I didn’t have the confidence.

Things slowed down after that. So I gathered all my supplies to clean his wounds and went to him, a gentle knock on the door to let him know I was there. I took my place beside him and introduced myself, which was barely acknowledged by him with only a grunt. He was a little short with me as I requested his permission to dress his wounds, but I didn’t blame him for it. I’d be grumpy too if I had been hit by a car.

Several minutes passed with neither of us talking. Only the sound of the monitor beeping and his groans filled the silence.
“How’s your pain?” I finally said, using wet gauze to free the pieces of gravel and rock from his flesh.

“I’m fine,” he grumbled. His eyes were closed tightly, his face curled up in a grimace.

“Really,” I said, my voice gentle. “If you’re in pain, we can give you more medicine. No need to be a hero.”

“I don’t need it,” he said, more firmly this time. I nodded and decided not to press the issue anymore, despite his heart rate being high and the way he jerked as I scrubbed away at his wounds.

A few more minutes passed and I finally finished my torture, applied the antibiotic cream and wrapped his intact leg carefully in a bandage. Orthopedic surgery still needed to tend to his broken leg, so I left that one alone.

Something in me hesitated to leave, but I had no reason to stay. I stood there for a second with unused rolls of gauze gathered in my arms, trying to figure out what I was forgetting. I shifted my weight and a few of them fell to the ground. As I gathered them up again, it hit me — the comments earlier bothered me, about how he was probably drunk. In the chaos of the trauma bay, no one had the time to ask him if he was truly “wandering around on the street” or if it was something else.

I took a seat back down next to him. He was lying with his eyes closed, wrapped up in a blanket. He looked so comfortable since I had stopped scrubbing his wounds. I couldn’t help but wonder how long it had been since he’d laid in an actual bed.

“So what happened?” I asked.

He looked at me, his eyebrows raised in surprise. He was silent for a moment, considering his words.

“I was crossing the street and some idiot on their phone hit me,” he grumbled.

“That’s terrible.”

“Yeah,” he said, “They drove off before I could really see anything. Didn’t get their license plate, nothing.”

A hit and run. Anger surged through my body, turning my blood to ice. I couldn’t believe there were people like that, who would just hit a person with their car and drive away. Everyday I spent on the trauma service, the more I believed that good people were hard to come by.

“That’s terrible,” I repeated, like an idiot. My stomach dropped in embarrassment. I’m not good at comforting words.

He didn’t seem to notice or care that I was giving myself an F in bedside manner. He just huffed in response.

“Maybe there are cameras,” I said, a meager offering of a solution.

“Doesn’t matter,” he said. “The police won’t do anything.”

I hummed and nodded my head. I didn’t know that for certain, but who was I to question this man, who has been through so much more than me? He said it like it was a fact, like it had happened a million times before. I was inclined to believe him.

“Well, I’m sorry this happened to you. We’re going to take good care of you,” I said with a smile and a pat on his shoulder. He smiled back at me and muttered a quiet thanks. I left him alone and went back to the pit, his words weighing heavily on my heart.

In the checkout that morning, the patient was cleared for discharge home, pending social work consultation. But can we even say discharge home, when he has no home to go to? No doctor would comfortably say sure, discharge them to the street, but it happens. Unfortunately, doctors, particularly in the emergency department, often lack the time to set up the perfect discharge plan for everyone. So we delegate this task and rely on social workers to work their magic. Despite the existence of excellent outreach organizations, there’s a significant community need to address the care of this vulnerable patient population.

As for this patient, I never saw him again, but I think about him often. He taught me to always talk to your patients, even if the story seems cut and dry. Through healthcare’s game of telephone, some facts may get lost somewhere along the way.

I wish we could’ve done more for him besides cleaning his wounds and splinting his leg, like getting him a home. But we’re doctors, not miracle workers, and we’re reminded of that reality every day.

I just hope that he’s okay. 

Image Credit: “F.R.E.I.” (CC BY-NC-ND 2.0) by gato-gato-gato

The Shadow

Published by Rachel Siretskiy

I never understood the appeal of people who liked to be “low key” or exist under the radar. As a lifelong social butterfly, the spotlight was always a more natural setting for me. I thrived in environments where I was visible, putting my skills on open display and receiving opportunities to grow, whether through praise and encouragement or constructive feedback. 

However, there were, at times, circumstances where I had finite say in my visibility. My innate ability to deafen an audience with my singing meant that playing the lead role in my sixth grade production of Grease was not in the cards. Despite my best efforts to strain my vocal cords into the correct pitch, I was relegated to the role of Marty. While this role did have a musical number, the number did not involve singing. For the first time, I struggled with the inability to use what I felt to be my greatest asset. Until this point, I had perceived my voice as a tool that helped me reach my goals, not a limiting factor. I was not used to remaining silent, nor was I used to playing a secondary role. Needless to say, I was not a fan of either one. 

I wanted to minimize how often I encountered this feeling, so I did my best to immerse myself in settings where I knew I had ample opportunities to be a vocal and visible leader. This led me to appreciate medicine, as I saw the way a physician’s role was like the quarterback of a football team: leading a coordinated effort to carry out the playbook of care, anticipating unforeseen circumstances and facilitating a recovery when the outcomes seem bleak. As a natural extrovert, my loquacious nature inclined me toward the idea of a career built on talking to people all day. My relentless determination and outgoing nature made my career choice easy. I knew that becoming a physician would give me the platform to grow into the leader that I aspired to be.

My understanding of the reality of pursuing a career as a physician was shattered when I started my third year of medical school. When I entered the double doors of the hospital, I was no longer the main character of my day. Instead, my attending’s patients became the highest priority and feedback transitioned to how I could improve to better serve them. Further, as the person with the least training in the room, my presence was frequently less relevant to the delivery of care. I was there as a physician’s shadow: observing, absorbing and documenting behind the scenes. At times, I even followed them a little too closely – without thought – straight into the bathroom. I had spent the last two years thriving in the light of didactic education, but now I was subjected to the exact thing that I had worked all these years to avoid: working in the shadows.

This disquieting feeling was particularly exaggerated on my surgery rotation. Entering the operating room felt like what I imagine babies feel as they acclimate to the newness of the world. I was awed by the bright light, overwhelmed by the rules and etiquette of the space and scared but simultaneously enthralled by the new opportunities I was getting. If I had felt that I was in the shadows on the wards, working in the OR felt as though I was existing in the dark.

The last time I had been in the OR was as a patient rather than a member of the medical team.  I had to undergo surgery during the height of the COVID-19 pandemic. At the time, patients’ family members or loved ones could not sit with them until they were being wheeled into surgery. On the morning of my surgery, I was dropped off at the hospital doors to navigate the uncertainty and fear on my own. With how busy everyone seemed and my own desire to not be a burden, I kept these feelings to myself. I tried my best to remain stoic despite my overwhelming stress manifesting as stress eczema, or “streszema” as I like to call it. I was rolled back, woken up and wheeled out of the hospital alone.

Now armed with the perspective of both patient and medical staff, I was more cognizant of the non-verbal communication that patients made with their eyes and gestures as they were laid on the operating table. I was particularly attuned to these cues on my pediatric surgery rotation, where some of my littlest patients openly expressed their fears through cries and others concealed them with stiffened bodies and silence. I could hear the echoes of their thoughts through their watering eyes and grimaces saying “I’m scared,” “I wish my mom was here” and “what is happening right now?”

With the luxury of experience on my side, I saw an opportunity to step into the role of a person that I needed when I was the one on the operating table. Instead of settling into the role of a passive bystander there to learn by way of observation, I volunteered to be a more active player on the team. I asked about their lives and hobbies to distract them, played a Bluey or Baby Shark video while they were getting acclimated and held their hand as they were induced and extubated. I hoped that these actions communicated sentiments like “everything is okay,” “we care for you” and “you are not alone” to our patients, while silently communicating to my team “I am happy to help however I can.” 

In my initial months as a shadow while on rotations, I felt stripped of my power when my voice did not have a place or carry weight in my environment. What I did not realize is that this abrupt change forced me into a position that broadened and honed my skills of observation, advocacy and non-verbal communication. My perspective shifted from seeing my voice as the only way to share my thoughts to understanding that a thoughtful gesture can hold the same power to communicate, comfort and support.

For me, being a shadow is no longer a limitation but a superpower.

 

 

Image credit:
“In the shadows” (CC BY-NC-ND 2.0) by Salfaro94

Loving My Dirty Skin

Published by Hannah Korah

It started at the age of five. Fair and Lovely — India’s favorite skin-lightening and beautifying cream. I owe this regimen my first memorable medical concern; a rash that angered the skin on my face to scar over redden, burn and peel. I hid indoors for two days, embarrassed for others to see me in public. When the reaction subsided, I remained embarrassed of what stayed — the same ugly dirty brown skin.

When I turned 13, my cousin came to stay with us. The neighbors named her “velutha penne’” or “white girl” in my native tongue Malayalam, an endearing compliment to signify how beautiful she is, blessed with the skin of the after-pictures in the ads I saw for Fair and Lovely.

When I was 20, I learned about matrimonial sites for Knanayas, my endogamous ethnic South-Indian community, where a criteria for choosing a bride to filter by is “complexion.” Oh, what I would do to be “wheat” skinned!

What would I do? “Scrape off the inside of ripe banana peels and rub it on your face.” “Wasps’ nests should be mixed with water to form a clay-like facemask paste.” “Stop running outside for exercise, the sun has clearly clouded your skin.” “Lather your body, head to toe, in turmeric before showering once a week.” “Drink more milk and yoghurt water; if your insides are white, your outsides will be, too.”

Need I go on?

When I was 24, I learned about the power of melanin. It was my first dermatology lecture in medical school. The dark pigment rooted in my hair, skin and eyes. What protects me from cancer, gives me eyesight, what adapts to the weather around me and keeps my hair youthful from graying. My skin was redefined. I embraced this protection passed on to me from my ancestors. I learned to love my dirty brown skin — my espresso latte, sun-loving, beautiful chocolate skin!

Today, at 27, I received my headshots, edited to appear “more professional” and “cleaned up.”  My melanin erased. I am reminded again of the before and after pictures of the Fair and Lovely ads. Perhaps I should have felt anger, discriminated against or unseen. Instead, I remembered hate. The five-year-old hiding in the house, hating my dirty brown skin.

In the art of healing, a wound stretches and scars,
from the naked eye, we see only the blemish that mars;
The bruises may linger, beneath the surface, far below,
in hues of purple, blues and black, healing ebbs and flows.

We weave through life, our actions vast,
unaware of the shadows they have cast;
An innocent drizzle turned to a hurricane,
unphased wiping out a whole terrain.

Hurt and healing as I may be,
every being carries a scar, never on their sleeve;
So I too tread gently in my actions vast,
unaware of the shadows they cast.

 

The Science of Knowing

Published by Eliza Broadbent

When I told my aunt I was going to medical school, she looked me up and down and said, “So you’re going to be a know-it-all.” This comment took me aback at the time but I now realize it was in fact a revelation that could be pronounced upon anyone embarking on this mystifying snarl of a career path. 

You learn quickly in the first year of medical school that facts can be traded for respect — a  professor’s nod or a grudging “they’re so smart” muttered from one peer to another. Acronyms, lab tests and Latin names become intellectual capital, the more obsolete the better.  

So each day you open your skull flap and shove in as much knowledge as you can, all the while hoping you’ll be able to zip it back up. You begin to feel like an overfilled suitcase, constantly debating whether you can manage more easily without the last pair of underwear or your favorite socks. 

And yet, there are moments that make you pause in your packing. That set you back on your heels and let cool wind whirl just beneath the curve of your forehead.  

Like when I lifted a cadaver’s arm to study the complex arrangement of tendon and muscle and saw she was wearing nail polish. The color, a florescent pink with tiny orange flowers, barely chipped, brought me back to a walk on the beach and white wings against blue.  

Or when we had a patient panel of parents and their children born with a life-threatening  congenital defect, and one six-year-old girl with a cloud of white-blond hair spent the whole hour running up the lecture hall stairs and swinging upside down from the railing. Her irrepressible energy spoke more eloquently to childhood amidst illness than any of the words. 

Or the day I learned that my heart was so difficult to find on ultrasound because it is located not on the left side of my chest but squarely behind my sternum. A fact that would, my instructor offered brightly, make chest compressions that much easier should I ever need them.  

But most of all, when I shadowed at a pediatric clinic and listened to a mother explain how her baby, a toe-sucking buddha in a onesie the shade of a melted Creamsicle, would not drink her breast milk. Her doctor recommended testing, which revealed high lipase. 

“Then I went home and tried it,” the mother said, her omission to drinking her own breast milk so casual that, at first, I thought I must have misunderstood. “It was foul,” she said, “Poor guy. No wonder he wasn’t drinking.” 

As she explains how she now blends her breast milk with bananas to feed to her baby, the ultimate natural smoothie, a wind is again whirling in my head, stirring up new thoughts. 

That I am an adult woman who has never considered that breast milk would vary from woman to woman, in taste and composition. That it would not be uniform like the half gallons lining the grocery store fridge, expiration date stamped in block letters.  

That mothers are strange and wild beings whose actions at times are so mundane you forget their true fierceness.  

That there are many types of knowing. Telling someone their milk is high in lipase is an example of one type, the kind where poor infant feeding is translated into lab values and decimals.  

But — and often I forget — that is not the only kind of knowing.  

There is the knowing of this mother. A caregiver who needed to find out what high lipase tastes like in order to feed her child. Who drinks her own breast milk. Who learns to add bananas.

The kind of knowing that reminds me that each patient is not a lab value, and every problem is not solved with procedures or medication. That shows me the best physicians are not overfilled suitcases or unquestioned savants. And that the best sort of knowing, like the best sort of science, leaves room for discovery and for awe.

Image Credit: “box of medical textbooks” (CC BY-SA 2.0) by pmccormi

 

Donning and Doffing

Published by Olivia Veira

As you search your closet
For your scrub cap,
Stethoscope,
And pants,
Search the depths of your closet
And find your old tools.

I know you have them there, somewhere.

Don the eyes of your 18-year-old self
Watching mentors carry love in their oversized pockets,
Healing at solemn bedsides,
And wanting to carry love in your pockets, too.

Don the spirit that was moved to action,
By the haunting realization that, here,
Too often
Without pay,
there is no receiving treatment.

Don the mind that understands
You are working with neighbors, and friends, and siblings,
Not bodies and chief complaints.

Find the heart of the student
Who believed in impossible cures
And transforming health care systems
And don that, too.

While you’re there,
Take the time and
Doff those test-taking shoulders,
Formed from hours of solitude
And reading stereotyped vignettes.
Let them rest.

Doff the anxiety
Of not knowing the answers.
Sometimes you will not know the answers.

But knowing is not enough,
For healing,
Anyway.

So, doff those things.
You won’t need them where you’re going.

I know you are in a rush.
But I ask you,
Please.

Take this time.

Don these old tools,
And remember who you are.

Don these old tools,
And you are already ready.

Image credit: “Surgery Room” (CC BY-NC-ND 2.0) by nodigio

Poetry Thursdays is an initiative that highlights poems by medical students. If you are interested in contributing or would like to learn more, please contact our editors.

The Moments That Go Unnoticed

Published by Melanie Molina

When you begin clinical rotations in medical school, people encourage you to be as involved as possible in patient care. They tell you to take initiative, to challenge yourself. They also tell you that there will be times when it is most appropriate to stand back and observe. It is in some of these moments that the most valuable lessons are learned.

You are in your second rotation — obstetrics and gynecology. You walk into the resident’s room as you do every morning before meeting with the attendings. As the team discusses the patients on the service, the nurse calls regarding one of them. You head to the patient’s room with the attending and the resident on call. On the way, the resident explains that this patient came in overnight because of bleeding, with workup indicating intrauterine fetal demise.

You walk into the patient’s room. This is not the same as the countless other times you have walked into the rooms on this floor. There are no feelings of nervousness and excitement, there are no carefully pre-packed hospital bags and decorations. The sadness in the air feels almost palpable as you see a young woman your age experiencing what may be the worst day of her life. You had not even learned about cervical entrapment before this moment.

It feels impossible to process what you are witnessing. You see this tiny, perfect baby in the process of being delivered breech. You can count its fingers and toes. You observe as the attending assesses the patient and tries to explain that she is not yet dilated enough for the baby’s head to pass. You notice her partner, teary-eyed, holding her hand. This patient is well into her second trimester; you wonder if she followed the general rule of thumb to wait to tell others until after the first trimester, when it is “safer” to announce a pregnancy. You wonder if she had a gender reveal celebration or if she had the baby’s name picked out.

Does anyone else notice when the resident looks at you and mouths, “You okay?” Does anyone notice when the attending lowers her voice to speak in your direction, asking about another way to phrase the medical explanations in Spanish because the patient is not processing her words? Is anyone else noticing the young boy, presumably the patient’s brother, sleeping on the couch in the corner of the room? You think about how the patient’s mother must have been woken up in the middle of the night and had no time to arrange child care, meaning she had to bring the patient’s little brother with her to the hospital in order to be physically and emotionally present for her daughter. You wonder if he will remember this day when he gets older. 

The team leaves to give the patient a moment of space after administering the medication to increase dilation for the delivery to complete. You notice the white wreath on the patient’s door, a signal to staff to avoid unnecessarily going into their room due to the circumstances. You wonder if any other patients have noticed the white wreath and have presumed what it signifies. Or have they walked past it, blissfully unaware?

In this moment, the resident again checks in on you. She tells you that she feels no one ever checks in on the medical students, not realizing that it may be their first time experiencing moments like these. She tells you to feel free to go into the residents’ room for as long as you need if you ever need time to yourself. Before you know it, the nurse calls the team to head back.

Back in the room, it is eerily quiet. There are no more cries for help to finish the delivery as quickly as possible. All you hear are silent sniffles as the patient and her family hold back tears. The resident shows you the placenta and begins to explain to the patient that it appears she had a placental abruption, going into detail about what that means. After a few moments of silence, the resident asks the patient if she knows why she is explaining this to her. She tells the patient, “This is not your fault. There is nothing you did to cause this.” Those few words, as simple as they may seem, hold so much weight. This is when you learn that those were the questions the patient was asking when she was being evaluated at the labor and delivery triage in the middle of the night.

You notice the resident’s eyes begin to well with tears as she continues to reassure the patient that there was nothing she could have done to prevent this. You step out together and both begin to cry, finally accepting all that you have just witnessed. She suggests retreating to the residents’ room and you follow behind her.

You enter the room and see the intern you worked with last week, her very first week of residency. Her back towards you, she hears the door open and begins to ask a question about the EMR before she turns and notices you and the resident are both teary-eyed. She is one of your favorite interns you have worked with. You remember just last week when you were in a delivery with her — the nurse needed to grab something, so you took over counting to ten in Spanish as the patient pushed. Did the patient then notice the intern, who only speaks English, doing her best to count in Spanish with you?

Once you collect yourselves, you exit the residents’ room. As you walk out, the resident greets one of the attendings you have met previously with a smile. You wonder if the attending heard about the patient that you just spent the morning with. You follow the resident and think about how no one around you knows the sadness you just witnessed. They don’t notice that the resident was able to give her all to that patient and yet moves forward to continue helping others. You wonder if anyone even notices she is here past when she was supposed to get off shift. Have her patients noticed she has stayed with them through their entire labor, made possible by her moving her work schedule to see them through their deliveries without violating her maximum work hours?

You go home that day and begin crying when your mom asks you how your day was.

A few months later, you are back at that same hospital. Now, you are in your surgery rotation, and you are rotating through your cardiothoracic surgery elective. The resident you are working with tells you to wait outside the doctors’ lounge for a minute as she quickly grabs a coffee. As she walks into the lounge, the OB/GYN intern walks out. You make eye contact, and she recognizes you as the medical student who was with her those very first few weeks of her internship. You think of how when you first met her, you were offering to show her the way to the pre-operative area on her very first day of internship. You think of how much more comfortable she must be now.

As you catch up, the resident you had seen the stillbirth with passes by and begins talking to the intern. Seeing them both makes you remember that day and all the moments that came with it. Anyone walking past these three people in surgical scrubs would never notice how much it means to you to see these two doctors again and how you still wonder every now and then how that patient is doing. And just like that, as quickly as it began it was over — another moment that goes unnoticed.

Image credit: “heavens” (CC BY-NC-ND 2.0) by andrealeev

Jumping: From Between Two Worlds

Published by Rakan Alshaibi

I am moving, yet I am going nowhere. I am going nowhere, yet I have come a long way. I do not count how many go by, but each spin demands that I keep moving. With every rotation, I take another step, another leap, one jump on this Earth. These cycles fly by, so much so that I can almost hear them as they whoosh over my head in an instant, making seconds go slow. For those willing to take the step, this full-circle reality becomes shared. The constant rhythm hums a ceaseless tune, paying no mind to its patrons’ attempts to engineer different songs of the same note. I like the sound I have made though, so I keep my feet moving to this hip-hop beat.

This thread of time orbits me in a series of identical waves, but I remain free to move. The way I land on my feet is unique for every step. The part of my soles that push the ground, the pressure I apply and the direction I go craft my own reality and the creative journey that unfolds. They say time is longer than rope because you will never find the end of its line, but I have a grip of mine, and in fact, I have two handles of time. In a two-by-two square, I am holding on tight, spinning this rope 360 degrees around, with one goal in mind: just keep jumping.

So jump I did, and jump I’ve done. July 2023 marks 12 months since I got a hold of a jump rope and first set it in motion.

Two weeks prior to my first day in medical school, I recall reading a narrative on the “arrival fallacy,” tailored to students like myself. The arrival fallacy is the expectation that happiness comes only after accomplishment. It speaks to the self-fulfilling illusion that once you have accomplished the lofty goal in mind, then, and only then, will you be rewarded with fulfillment and happiness. Time flies, however, and success visits suddenly; alluring aspirations halt as they become tangible realities. The instant adrenaline and lingering dopamine buoy you only momentarily, but eventually, the next tide comes, and the fulfillment ends. The once-alluring tidings transform into yesterday’s stories, leaving you adrift in a sea of confusion. You followed the map, obeyed its directions and endured the arduous path to the ‘X’ in the sand. But no matter how deep you dug, there was no treasure chest to be found. Staring at an abyss, you are faced with the empty reality that the wellspring of fulfillment has run dry and now awaits your desperate chase to fill it once more.

When I first donned my white coat, that narrative came to life.

My white coat ceremony concluded and quickly became a blurry part of my past. I found myself still, just a frozen mold stuck in time with the empty thought: “What now?” I now know this painful sentiment to be a shared reality among many students, especially in the medical field. We are in a ceaseless state of progression, always preparing for the next level. The beauty of these feelings is that they reflect the intrinsic qualities of the medical field they represent, which is in an endless pursuit of discovery and innovation. The shared reality among scores of medical students across the world is that our profession is ever moving. Medicine both demands and depends on change. Our collective body of medicine is only able to stand with one foot in the future. As honorable individuals, who took an oath to maintain the noble traditions of this profession and abide by standards to advance medical knowledge, we all find ourselves standing with the same ensuing stance. The fact of the matter is, for as long as we hold this oath sacred, we will never catch up to our front foot. This shared reality is naturally not conducive with “being present” because living in the moment is impossible when we are always focused on the next one. Our minds are one step ahead of our bodies, and when we come to this realization, we feel as though we have left ourselves behind because tomorrow never comes.

As a budding medical student, however, I yearned for a way to regain my natural stance. I made it a priority to be present, find a balance in time and get my two feet back under me. I dedicated myself to reclaiming a spot entirely within the moment. I closed the gap between my feet which were in two different eras of time and re-aligned myself for movement in a different direction. Stepping into the cadence of a twirling tempo offered me a whisper of control. My mood for the week directed my shoulders and wrists to generate a certain revolutions per minute that my tiring legs and feet could match before the rope would snap and the rhythm ended. In a systematic trance, like a descending wave, my body became one. I was hooked, and what was once just a childish exercise became cemented in my weekly routine. The minimal time, space and equipment required for this sport made it the perfect fit for a busy student in the bustling city of Miami. The built-in opportunities to learn new tricks and transition them into sequences with a jump rope was the creative release my inundated brain craved. The mental baggage in the form of forelooking, ruminations and current anxieties gracefully lifted as one thought dominated my mind: just keep jumping.

When my colleagues learn I like to jump rope, they are mostly surprised at my out-of-proportion enthusiasm for such a specific form of exercise. The conversation will lead to a discussion of what the specific physical appeal is for this activity. In honesty, my initiation into the world of jump rope was not driven by its physical rewards; those revelations only unveiled themselves months later, unexpected and serendipitous. Instead, I sought a personal sanctuary, an escape uniquely mine, set in motion by the long-neglected jump rope resting in my garage that beckoned me. The stagnation I faced after achieving a lifelong goal set in motion a desire for movement. I found my antidote to the “arrival fallacy” lay in the movement towards goals themselves — not to harvest joy solely from their attainment but rather from the enriching nature of their pursuit and the growth it has in store for me. This sport is a culmination of single steps that require individualized attention and meaningful presence, and this rope underscored the significance of each of these steps for any movement to continue. In its pure essence, my happiness found its roots in the motion itself, transcending destination or direction. Simply, what made me happy was that I was moving and not that I was going anywhere.

The feelings I had in my early medical career instilled a justified doubt about setting any more goals. I worried that the efforts required to reach them would be futile if the achievement did not provide me with the happiness I was looking for. However, we should not forsake our intellectual capacity to set goals merely out of fear that achieving them will not bring satisfaction. Frankly, it is a taxing practice to live in a perpetual state of the present time and not an optimal solution to sustainable satisfaction. I am still a firm believer in having an eye on the prize. Without a destination in mind, there is no intrinsically meaningful reason to take a step forward. Nevertheless, in our respective journeys forward, we must routinely acknowledge the place where we stand. It took a simple rope for me to momentarily escape the fixation I had on arriving, and finally appreciate the stationary place where I planted my feet. Strangely enough, this repetitive motion finally allowed me to stop. Only then could I remember and admire the reason for the movement itself. So yes, I am moving, but I am not going anywhere, and in that I have come a long way.

I am not promoting a single approach nor desire to praise any single activity as a sure-fire vessel for success. Rather, I hope to encourage others with reflections from an activity I have come to call my own. I only implore us to relish the present ground upon which we sit, stand or run. To immerse ourselves in the pull of our body’s presence. No matter how you choose to achieve this personal space, no matter where you are or how you feel in this present state, with both feet grounded between the worlds of what was and what will soon to be: just keep jumping.

Image credit: Pexels.com (CC BY-ND 2.0)

Poetry Thursdays is an initiative that highlights poems by medical students. If you are interested in contributing or would like to learn more, please contact our editors.

Everyone Remembers Their First

Published by Samantha Barkan

Fluorescent lighting, lemon-scented cleaner and recently mopped tile floors. The sights and smells of a hospital floor were slowly becoming familiar to me as I wound my way around corner after corner bright and early at 6:15 a.m. on a Thursday morning. While for everyone else, it was an average Thursday, for me, it was my first Thursday of my third year of medical school. 

“Female in her early to mid twenties, having seizures in the ED” was all I was told by the tired ARNP whom I had been working with for the past week. I had yet to see a patient with seizures in my whopping three days of my neurology rotation. Excitedly, I began to look through her chart with the fervor that only someone new to the process could muster. Given the 30 minutes, I had to review my heavy caseload of one single patient, I scrolled back to the very beginning. 

Yes, she was having seizures, not from epilepsy, but rather due to brain metastasis from her stage IV breast cancer. Two weeks prior, she had been taken off all medications and sent home to be comfortable. Diving deeper, I learned that she had been diagnosed at 18, right when she was about to start college with aspirations of being a pre-med major and attending medical school. The parallels to myself were apparent. In another world, she could have been one of my classmates, a partner in a small group, maybe even a friend. Based on the most recent note written by the emergency room physician, she has had many seizures in the past, suffering from one of the most feared neurological pathologies: status epilepticus. She was questionably responsive.

Recognizing that I had never seen a consult in the emergency room by myself and was unsure of how to even get to the emergency room, I asked for help. I found myself sweating through my new scrubs and still freshly dry-cleaned white coat as we wound our way through the twists and turns of the hospital to the first floor and finally to the emergency room. I was ready to take a history and do a complete neurological exam just as I had practiced religiously in the past two years. I would walk into the room, cheerily introduce myself, wash my hands and begin asking questions. 

Only this time, when I walked into the room, there was not a patient pretending to be in pain as they had in every standardized patient exam. There was beeping. Tremendous amounts of asynchronous beeping correlating to every machine she was hooked up to. The only indication that she was there were wires pouring out of blankets; so small and frail that I could barely see her under the warm blankets placed over her. Her teary-eyed and exhausted family sitting in the corner after a night of watching her suffer through seizure after seizure while waiting for EMS to arrive. 

I would love to say that I had all the right words for the situation. But I did not. In fact, I had no words. I froze. It did not matter that I knew the details of the patient’s chart better than anyone else on the team, had the ability to give a high quality and succinct patient presentation, and had researched the mechanism of action of her prior chemotherapy medications. I froze, not because I was not taught how to deal with emotional scenarios or because I did not have empathy for her situation, but because there is nothing that prepares you for the first time you are overcome with emotions. 

When reflecting on how I felt walking into that room, I now know there is a word to describe it: impotence. 

No, not as in erectile dysfunction. I mean the inability to take effective action or the feeling of helplessness. 

While this was the first time I felt this way, I am sure it will not be the last. The only thing I can do is work on how I deal with this feeling when it arises. As medical students, we often feel inadequate when we do not immediately have the right answer; we are used to being on a timer. However, once we step out of the classroom, we are no longer alone staring at a multiple-choice question with our fingers crossed, hoping that the hours of studying help us pick the right answer. We are now surrounded by a hospital full of people that we can discuss difficult cases with. Asking for help is not a sign of weakness, instead I see this collaboration daily when physicians place consults and discuss complex treatment plans casually at lunch. As a student, I watch these conversations in awe realizing the teamwork involved in each patient’s care. 

Fortunately, before going down to the emergency room, I leaned on my team and brought someone with the experience necessary to carefully navigate the difficult situation. I watched her comfort the family with the kindness and empathy that I strive to emulate. Hopefully next time I am in this scenario, I can pull on the skills I have learned both in the classroom and through newfound experiences in difficult situations to be the physician that my patients both need and deserve. 

Image credit: “Blanket” (CC BY-SA 2.0) by matsuyuki

Echoes of Grief

Published by Ashley Newsholme

“We have reason to believe that your daughter is brain dead.” The silence was deafening.

We had ushered the family into a room labeled “Conference Room” for this conversation. From the outdated décor, it was evident that this room was reserved for serious discussions, not conference calls. Various-sized couches and chairs lined the small room’s walls, and a box of tissues sat on a side table in the corner just out of reach. The family members filed onto the couches while the resident and I sat on the opposite side of the room. We already felt too far away, but I was scared to close the gap between us.

The patient’s family members included her mother and two female relatives. At this point, their faces were expressionless, as if the resident had not said anything at all. He continued, “Since she was admitted, she has not had any of the basic reflexes: the corneal reflex, the gag reflex and the cough reflex. Additionally, she has a Babinski reflex. Because of this, she likely has no brain activity and is brain dead”.

The words hung suspended, like unanswered questions in the room. They hadn’t understood a word he said.

I wanted to step in and explain things more compassionately, to break the uncomfortable tension in the air. The patient was admitted following a car accident. A driver, intoxicated on heroin and meth, drove the wrong way onto an on-ramp and hit four cars; the patient’s car was one of them. The perpetrator was also a patient on the ICU floor, just a few beds down.

Recognizing that he had to reiterate the statement, the resident tried again: “You see, we all have reflexes. When I touch your eyelashes, your eyelid should naturally move; that would be the corneal reflex. The gag and cough reflexes are others that we all normally have.” The family nodded in unison; they were following. “When someone is brain dead, they lose all of these reflexes.”

“Since she was admitted, we have been unable to see any of these reflexes in her, making us suspect that she has no brain activity. To confirm our suspicions, we have to do a test that will tell us whether or not there is blood flow to her brain. If there is no flow, then she will be confirmed brain dead.” Every time he said “brain dead” the words rattled around in my head with no place to settle. At this point, tears filled their eyes; none of them uttered a word. Grief fell over them like a thick veil.

Then the avalanche of questions came. “Do we have to do the test now? How long will we have? I thought you did a test the other day. What are our options? How can you be so sure that she’s gone when you haven’t done the test yet? What if we don’t want to do the test?” 

The resident took a deep breath and explained that he was not asking the family for consent; rather, he was informing them of what would happen. During rounds a few hours before, the attending told my resident that he would have to break the news to the family, suggesting that he emphasize how strong our suspicion of brain death is to spare them the cruelty of false hope. In trying to crush the family’s hope of life, the exhausted resident was cruel in other ways, offering them no tissues for their tears or empathy for their anguish.

The reality was that everyone on the ICU floor had known that the patient was brain dead except for her family, who had clung to the glimmer of hope that she would be okay. To medical professionals, it had been clear as day from the moment she arrived. Now, the patient had sat in her ICU bed for three days. There was no more time to give.

“If the test shows no blood flow to the brain, then we will have to withdraw life support within 24 hours.” All three women, with their heads turned down and their arms crossed, nodded silently. The resident and I left the room.

As we walked out, the nurse at the front desk complained, “You left them in there by themselves? They’ll never leave!”

There was not an ounce of compassion spared for these women. My heart was breaking for the family. 

The next day was my last day in the Trauma ICU. By the end of the day, I was drained and ready to go home, but at 6 p.m., the test results were in.

Gathering the family, the resident and I entered the patient’s room. The patient lay there motionless, connected to the ventilator and countless lines. The resident walked to the computer and pulled up the patient’s scan.

“The blood shows up as black on this scan. You can see the blood here in the blood vessels of her neck, but here…” He was pointing to her brain. It was whiter than snow. She was officially brain-dead. Time of death: 18:00.

Then a sound followed that I had never heard before: the intense cry of someone experiencing profound loss. The wails of the family members that filled the room were gut-wrenching and primal in nature. We stood there in silence, letting their grief fill the room.

Tears filled my eyes. I was not going to cry in this room. I would not make this moment about me, the most insignificant person in the room. After a few minutes, the patient’s mother, possibly the strongest woman I have ever seen, looked up with tears running down her face and said, “I know you said 24 hours, but can we have more time?”

The resident bumbled through an explanation about how, by law and hospital policy, that would not be possible.

One of her aunts spoke up, “She has three children. They couldn’t even say goodbye. How do we tell them that their mother is dead?”  The cries still pierced the air; family members were on the floor, clinging to one another.

Eventually, the resident and I left the room, but the whole ICU floor continued to hear their cries. As we walked through the halls that now echoed with the sounds of loss, I looked to the nurses who had cared for this patient tirelessly. They exchanged worried and tired looks, revealing a collective yearning to ease this family’s pain but we were all stuck; frozen in place. As the resident slumped into his chair, he sighed and looked at me with eyes weighed down by exhaustion. He turned his attention to the computer and said “Well, you did good today, you can go now.” It was as if he had not just announced the official end of that woman’s life. As if he had not just launched her family into an abyss of grief. 

I left the hospital that day with a pit in my stomach. From the moment that patient entered the hospital, we had failed her and her family. As doctors, we were expected to be there for our patients in life and in death, ensuring that no one traveled in this life or to the next alone. I knew that the resident, who completed a 24-hour shift the day before, had no more emotional currency to spare. He was a shell of a human being, and he simply could not afford to offer any empathy. 

To this day I am disappointed in everyone including myself. I think about those women every day. I wonder what would have happened if I had allowed myself to cry with them in that small hospital room. What could it have meant for them if I had offered a hug or a tissue? If I had even stopped to acknowledge the loss of life; a loss that they will never forget. What if I had allowed myself to be human at that moment and mourn the loss of another life? A single act of vulnerability could have provided the family some solace in those initial moments of grief.

Image credit: “tissue” (CC BY-NC-ND 2.0) by tamaki

The Anatomy of Healing

Published by Austin Guerrina

On September 29, 2021, my world started to unravel. My first anatomy lab as a medical student had just begun. I stepped foot in the cadaver lab where the pungent odor of formaldehyde clung to the air, and I was overflowing with eagerness.  It was about 3 p.m., and I noticed a call ringing through on my cell. I didn’t think much of it, and I hit “decline,” choosing, instead, to focus on the anatomy material I had to learn. But then, the phone rang again. Reluctantly, I answered this time and the lady on the other line was from a hospital in Sanford, Florida. She proceeded to inform me that my father was in the hospital, the victim of an accidental overdose.

My body went numb. The same room that I was so excited to be in just minutes prior, now felt cold and dark. I stared blankly at the cadavers before me, knowing that my life had just changed forever.

That night, in Miami, about a four-hour drive from Sanford, I anxiously waited for updates from the hospital. As my parents had separated when I was very young, I was the oldest child and health care surrogate for my father. Twenty-three years old at the time and barely a month into my medical school training, I felt hopeless and scared.

The next day came, and I continued to attend classes while receiving brief updates from the hospital every few hours. These interactions were cold and clinical. I longed for understanding and compassion from the healthcare providers on the other end of the phone, but my interactions were limited to fleeting exchanges.  I was only met with stark facts and difficult decisions.

By Friday night, my father had been on life support for nearly 48 hours. There were no signs of life. It was time for me to make the heart-wrenching decision I had dreaded each second for the past two days.

On Saturday morning, I stood at the hospital, surrounded by a crowd of extended family. Only my sister and I were allowed past the sliding entrance doors due to COVID-19 protocols. I was escorted to the hospital chapel, where I had been told that I was going to meet with the treatment team. The small room, with walls covered in stained glass and dim lighting, was symbolic of my feelings. From within, a relentless unease gripped me, a profound fear that left my body frozen with anxiety. I still visualize that room and exactly where I sat, awaiting answers.

Finally, the critical care doctor working with my father entered the room to meet with me. His demeanor was impenetrable. He first said that he was sorry and that they had done the absolute best they could for Dad. He said that they had run “all the tests,” and at this point it would be best to take him off life support when I was ready. He asked if I had any questions, offered his condolences once more, and exited the room.

I was angry. I was angry at him, I was angry at the situation I faced, and angry at the world. The critical care doctor never sat down, and that bothered me. The room was lined with benches. He could have sat anywhere he wanted. I yearned for a deeper connection, a shared understanding of the horror I was living.

I lost hope in Medicine. I had never felt so alone and isolated. If this was how doctors treated patients and their families, I wanted out. I had only been in school for a month, I could turn my back on medicine, and I wanted to.

This nightmare became a turning point in my medical training. I was determined to demand more from myself. Life as a physician will be stressful. It will be challenging, and many days will break me down. Regardless of the circumstance, patients and their families deserve empathy. They deserve raw emotion and the gift of time.

No matter where this journey in medicine takes me, I am always guided by this experience and await the time when I will be on the other side. It is my hope that I can make these impossibly difficult moments therapeutic for patients and their families, but also for myself.

As one light is lost, another is ignited. In the same hospital that I was brought into this world, my father left this world. Each day, I carry his memory with me, fueling my purpose to make a difference in the lives I touch.

Image credit: “DSC_0250” (CC BY-NC-ND 2.0) by aagelaki

Speaking of Stigma

Published by Sudharshini Prasanna

The pea-sized lumps in my neck were insignificant until the day I received a call from the public health department. The voice of the nurse on the phone was muffled, but my mother’s expression said it all. Bad news.

A knot formed in my stomach hearing the word “tuberculosis.” The chest x-ray revealed that the bacteria were absent in my lungs, which meant I was not contagious. The news was a relief, since isolation was not a part of the treatment plan. Instead I was scheduled for a strict daily seven-month antibiotic treatment, the norm for patients with extrapulmonary TB. I understood the dangers of antibiotic resistance and untimely medication. Still, every pill I swallow must be in the physical or online presence of a certified health professional.

The district health care nurse arrived in a truck with a huge display of the public health department’s name. I glanced around at the houses in my neighborhood. The common stigma of public health workers and contagious diseases weighed on my shoulders. I stepped back into my house in embarrassment.

I placed the first pill on my tongue, opened my mouth so the nurse could see, closed my mouth, swallowed the pill, and opened my mouth again so the nurse could confirm that I had swallowed it. I had to repeat this for nine more tablets and this drill continued for seven days a week and for seven more months of the treatment.

The challenge to this drill came during after school events. At 5 p.m. sharp, my peers watched me place my violin down and leave for the hallway, staring down at my shoes. I would rush to my car and log onto a treatment app to video record myself taking the pills.

“Just a lymph node problem,” I would tell my classmates. Telling them I had TB felt like I would be seen as an unclean, infectious person.

I was only at my third monthly doctor’s visit when her words helped me view my own situation differently.

“There’s nothing to be embarrassed of,” she said, and I was surprised she brought it up herself.

“I too was treated for TB, and I’m aware of everything you’re going through.”

A brief conversation with her helped me realize that addressing infectious diseases among other conditions is not just about treating the disease, it is about holistically addressing the person with it. Stigma surrounding conditions like HIV and AIDS, tuberculosis and obesity continues to exist as a pandemic in the healthcare system. With so much taboo surrounding contagious and disfiguring conditions, empathy is key. Empathy comes with awareness.

Suddenly, being a TB patient did not feel like something to hang my head low for. Perhaps there is a positive in experiencing health-related stigma first-hand. Without having to learn about it in a medical ethics course, I realized that this stigma was real and widespread.

Around a year later, I accompanied a general physician in and out of patient examination rooms. I took vitals and entered patient records. Each day, I was exposed to people with different conditions, tackling their stigmatized illnesses in different ways. I recollect the amiable middle-aged man with a stringent diabetes management plan. He laughed about a blood sugar spike during his vacation cruise and joked that every family member, even his caveman ancestors, had diabetes.

The case of a middle-aged woman resonated with me the most. I greeted her as usual in the waiting room. Crinkles grew at the sides of her eyes, telling me she was smiling from behind her mask. She didn’t utter a word as she trailed behind me to the examination room, tugging at her receding full sleeves. Her loose hair curtained the sides of her face while she gave me one-word answers in the softest voice possible. It took me back to the months when not a day would go by desperately trying to conceal the small lumps in my neck using my long hair.

I held a short conversation with her, joking about the summer heat and asking her about her job as a designer. Reading out each medication name in a list of over twenty zipped me back to the time when I would swallow a handful of pills each day. She reluctantly extended her arm for me to wrap the blood pressure cuff. I understood her reluctance when I saw the pink scaly rash on her skin.

“Psoriasis?” I asked. She nodded. I took care not to hurt the area, encouraging her to wrap the cuff around her arm herself.

The doctor boomed in with a smile. Her shoulders seemed to drop at the sight of the doctor, the same way relief used to engulf me when my TB physician entered the room, bringing with her a knowing smile and a deep understanding of everything I was going through.

Sweeping away the hair on her forehead, the doctor analyzed the red, scaly psoriatic rash. The woman’s eyes darted to me, but I gave her an acknowledging smile which I hoped read as: I am not judging you and there is nothing to be embarrassed about.

She mentioned to the doctor about the itching of her palms affecting her hands-on work, and that certain fabrics irritated her skin. I could relate to her frustration when something out of control, psoriasis in her case, interferes with daily living.

The rashes on her forearm were widespread but the doctor commented with positivity that they had improved since her last visit. Her eyes seemed to light at his statement. Hope, like when my doctors had told me treatment could end two months earlier.

At the end of my shift, the doctor had a special message for me. The woman had told him that she was glad to have me greet her and take her vitals without gloves.

There are so many other stigmatized conditions that do not require personal experience in order to convey empathy. In fact, it is not necessary to experience stigma first-hand to offer care. Being in a similar situation can channelize empathy, but awareness of stigma is crucial in navigating through societal prejudices with sensitivity and understanding.

My steps were sure and steady as I walked out of the clinic and into the now-softer setting sun. I once thought that my TB chapter had to be forgotten, but I did not realize that the awareness I had gained would remain with me during every patient interaction, creating a space of comfort in a world of taboo.

Image courtesy of the author Sudharshini Prasanna.

When Advocating Becomes Difficult: Health Care Professionals and War

Published by Haad Arif

Health care providers, whether they be nurses, paramedics, or physicians, typically enter the medical field for one core reason: to alleviate the suffering and ailments of those around them. However, one of the most important roles that health care professionals play is that of patient advocate. We see whoever walks through the hospital doors, irrespective of who they may be, thanks to the emphasis on mitigating bias, improving cultural sensitivity and enhancing impartial decision-making during our medical training. We even go so far as to elevate their voices to ensure that everyone under our service receives the care they need. Now, with the increased attention to global health initiatives, a physician’s role in advocacy is no longer limited to their home country. However, the paralleled increase in social media has significantly facilitated the spread of both information and misinformation that fosters prejudice in consumers. Physicians are not immune to this phenomenon and must work diligently to ensure that the advocacy and care they deliver are not influenced by implicit and explicit biases.

The current humanitarian crisis unfolding in Gaza is on an unprecedented scale due to our unique ability to form para-social relationships with its victims. The occasionally conflicting information coming out of Palestine and Israel has caused people to form strong opinions regarding the violence in the region. Nevertheless, physicians have a moral and ethical duty to remain impartial in this crisis and to advocate for the safety of all non-combatants. The escalation of violence on October 7, 2023 preceded a significant rise in both Islamophobic and anti-Semitic sentiment in the United States. In the two weeks following October 7, there have been nearly 800 calls for help and reports of Islamophobia as well as over 300 incidents of anti-Semitism, a rise of nearly 200% and 400% respectively. The violence abroad has direct effects here at home as physicians and allied health professionals can expect to face the aftermath of increasing hate crimes.

Recently, the term “genocide” has been used to describe both the actions of the Israeli government and military as well as those of Hamas. Although there has been an overwhelming condemnation of the Israel Defense Forces’ actions by national organizations, such as the United Nations, World Health Organization, and Doctors Without Borders, many remain steadfast in their belief that there has been a justified and equivocal Israeli response in Gaza. Overall, physicians should condemn all forms of violence, regardless of the perpetrator and alleged justification. The destruction and siege of Gazan hospitals, regardless of the reason or legality, must be condemned in the strongest of fashion. Whether these calamities are from an Israeli airstrike or a misguided Hamas rocket should be of less importance to health care professionals compared to mustering an overwhelming call to action in sending medical aid to the victims of these horrid attacks. Indeed, the Geneva Conventions dictate that “the standard of care of the wounded and sick must be the same for one’s own and the enemy’s personnel.”

As health care professionals, we know all too well the importance of patient and provider safety during a health care visit — countless checks and balances are set to ensure that “do no harm” is implemented as best as possible and that our basic principles of health care are observed. Yet surgeons in Gaza are functioning without the necessary supplies and facilities, forced to operate without appropriate sterility or anesthetic. At the time of writing, nearly 200 physicians and nurses, and over 300 medics and allied health staff have been killed while treating patients as a result of hospital bombardments. 2024 began with the near-total destruction of Gaza’s hospital network, with the most recent attacks focused on Nasser Hospital, the last functioning hospital in Gaza, and killing over 20 civilians. Moreover, emergency response personnel have been decimated leaving behind a mere sum of six ambulances to service the totality of the Gazan refugee population. America has seen its share of atrocities that have taken place in what are typically deemed safe places — schools, places of worship and hospitals. Just as news of these attacks shook the foundation of Americans across the country, the videos and experiences of those in Gazan hospitals should instill a sense of discomfort and urgency.

The debate of whether this is a war against Hamas, a genocide or an ethnic cleansing has persisted over the past 120 days, but regardless of the answer, it is the non-combatant population who is suffering. While South Africa, with the support of countries across the globe, has brought forth claims of genocide against Israel to the International Court of Justice in the Hague, it could be weeks to years before any action takes place to achieve justice for the innocent victims in the region. As such, all health care professionals must join one another in calling for an immediate end to the hostilities in Palestine and the sending of immediate medical and humanitarian aid to the victims, patients and health systems of Gaza.

The purpose of this piece is not to assign blame, nor is it to debate the inciting event for the current state of the people in Gaza. Instead, I hope to inspire you, the reader, to set aside any political differences and to lean into your role as both a human and patient advocate. I urge you to speak up in support of our colleagues overseas, who are treating and operating under the threat of death; for history will not judge our silence kindly.

Image credit: “Rabbis opposed to Zionism, Boston 2002” (CC BY-NC-ND 2.0) by Louis George 2011