The first thing I notice are his boots. He’s still in his street clothes, having just been admitted. He looks thin, emaciated — his clothes hang off him, shirt collar drooping down from his neck like peeling paint. His boots, however, seem to fit him properly. They look warm, well-worn but sturdy, like they have weathered a hundred bitter winters and could withstand a hundred more. For some reason, this comforts me.
In this episode we interview Dr. Tait Shanafelt. Dr. Shanafelt is a Jeanie and Stewart Ritchie Professor of Medicine, Chief Wellness Officer, and associate dean at Stanford University School of Medicine.
My medical school career was complicated by more than just complex cardiac physiology or biochemical pathways. Little did I know that at the end of my second year I would go from knocking on a patient’s door during a clinical session, to sitting in an exam room myself.
Upon arriving at the room, we learn that the nurse continued trying to speak to this patient in English despite the patient’s evident inability to speak the language. Following her half-hearted attempt at “patient education,” she proceeded to lift the patient’s gown and attempts to strap on the monitors. As a result, the woman is frightened by her nurse because she is unaware of what this foreign nurse is doing to her and her unborn child. One week out from detention. She is scared. Imagine.
When the start of M3 year came along, I was ready: ready to put my First Aid book to rest, ready to be involved with patient care, ready to observe physicians in their realm of expertise and ready to find my place in the broad field of medicine. Now, halfway through the twelve months of clerkships, I ask myself, was it all I imagined it would be as an inexperienced first-year student?
This feeling of loss and subsequent reflection revealed to me something fundamental about how I experience time in my own life. As I depart the anatomy lab, I stand on the shores of time’s river and gaze into the clear water’s surface. In it, I see a reflection of growth and of internal transformation — a reflection not of who I was but of who I have become. I emerge not only learned in anatomy but also with insight into the impact that individuals can have on one another.
I was patiently sitting in the lobby at Quest Diagnostics, waiting for the staff to slowly let people inside in adherence with the new social distancing guidelines. I waited for about ten minutes before a man in his mid-50s called my name and led me into a patient room.
In this episode, we interview Dr. Edward Barksdale. He is the newly elected American Pediatric Surgery Association president. He is also the division chief of pediatric general surgery and thoracic surgery at UH Rainbow Babies and Children’s Hospital.
“We are taking him to rehab,” she said. I could hear a faint sigh of relief and happiness permeating her voice, which had been distinctly absent for the last few months. I could also hear wind whooshing in the background and a distant trail of her voice, which meant they were already on the road.
I am sitting in school / but I am also thinking of you. / Yes, I do / wonder how consciousness / wraps round and round / this hunk of meat, / how chunks of flesh / sustain your metaphysical feat.
if we can just cling / and weather this weather, / we can make some things / much better and better.
As physicians, we must work to lift patients up when they are struggling, rather than shaming them into well-being. As Dr. Donald Berwick once noted, it is not always patients’ diagnoses, but their helplessness that kills them. Indeed, the helplessness we instill through our focus on individualism and molecular pathology in the clinical setting will ensure that this epidemic kills millions prematurely and costs billions of dollars. If obesity is a disease caused by society — its inequities, trauma, and expectations — then the solution for obesity should address more than just the patient sitting in front of us.