I recently worked a shift at one of the free, student run clinics here in Palo Alto. Compared to a previous shift a while back, today was quite calm with a manageable flow of patients. In fact, the number of volunteer hands far outnumbered the number of patients so I wondered if my services were even necessary.
Should I duck out early to go work on one of the four problem sets that I have due this week? Now that my time is strained, I must be a bit more selfish to keep everything streamlined and maximally efficient. So this is a waste of time, right? I should be focusing on my studies and come back another day when I can really get my hands dirty and get some clinical experience under my belt. These were some of the thoughts flowing through my mind as I sat idly for the first hour waiting to see my first patient.
Of course, as I notice upon reflection, all of my thoughts revolve around me, myself, and I. This is my precious Sunday and I have work that must be finished and I could be outside enjoying the day and … the list inevitably grows longer with each passing second. But who is to blame? It took a whole heap of self-centeredness to get to this position and to have this opportunity in the first place. Everything involved in the preparation for medical school is necessarily a total preoccupation with oneself—my school work, my time, my goals, my future. So this is different. I feel a bit uncomfortable and anxious. But in reality, this is life so I had better adjust and embrace it.
We have switched roles. I am used to controlling my own time, but now time is in the driver’s seat. And this is not my time. This time belongs to the patient in the waiting room who is both anxious and hopeful for my arrival. And his time grips me forcefully, commanding me to obey. For I am now at his service and at the service of anyone who takes the brave step of coming into a free clinic in what is often a desperate search for care, compassion, and attention. How could my time possibly trump that of the patient. It would be a negation of the intrinsic morals of the profession to which I am now devoting myself.
And then, chart in hand with white coat buttoned, a step into the waiting room and make eye contact with the patient. Before I even have a chance to introduce myself, this temporary tug of war ceases; the patient wins and I helplessly submit as soon as I let go of my self-righteousness. Over the course of our exchange, a change of perspective to the patient’s point of view makes everything clearer. I imagine myself … in an unfamiliar setting, simultaneously ashamed and stressed by my loss of health insurance, in desperate need of a refill for my diabetes medication. I have nowhere to turn and no one to turn to for help. My wife does not speak English, yet she has come with me to this new world in hopes of a better life. And what do I give her in return? Nothing! I am unemployed and unable to provide for her and my two young sons. Up until the recession, I was successfully employed as a building contractor. Demand was high with the expansion of the tech companies here in Silicon Valley. I was in the driver’s seat, but now, three years later, I am on the ropes of financial ruin. I am ashamed, but I am fearful that if I do not seek help my condition will worsen. I am committed to caring for my health, but the financial stress of every day put health on the backburner. And now I am here, against my will, but seeking your help and guidance.
As these thoughts flash by—one by one in a jumbled order—I forget about myself. My time and energy meshes seamlessly with that of the patient. I am eagerly entangled in his story, full of want to know more and to understand how this condition came to be and how it affects his daily life. For a man who was in near perfect health for most of his life, a diagnosis of diabetes three years past was terrifying and upsetting. Not only is this a chronic condition that requires daily attention and management, but this is the evil culprit that broke his streak of good health. In a sense, this was a challenge to his independence and self-worth—a chink in the armor that exposes vulnerability. He does not want to be one of the 824,000 Californians or one of the more than 7 million Americans ages 45-64 with diabetes mellitus. Moreover, the pain of vulnerability is been exacerbated by the shame of unemployment and the inability to procure health insurance for him and his family. This idea of taking medicine seems almost unmanly. After years of contracting with pharmaceutical companies, he distrusts their motives and views the drugs they sell as profiteering scams. He refuses to become dependent on industrialized drugs, and has experimented with alternatives such as cinnamon to regulate blood sugar and garlic to lessen his blood pressure. But his stress levels remain high as his blood pressure affirms. Blood glucose levels are elevated, so despite his attempts at denial, he has made the hard first step of seeking care. I commend him.
Although he eventually acknowledges the necessity of a refill of metformin and Cozaar, we enter into a fruitful discussion of lifestyle. He expresses a desire to be more physically active and we determine that a first step would be walking and playing with his two sons in the nearby park during the week. He explains how he has become more conscious of what he eats and focuses on eating smaller portions with everything in moderation. We talk about some healthy lower carb options and possible substitutes for some of the foods that he is already eating. Although the medications are critical at this stage, we both agree that lifestyle changes will be critical in the long run. In fact, his aversion to medicine may be a powerful weapon in his fight against diabetes because to save himself, he must commit to lifestyle change. He seems willing and excited to have guidance and encouragement. I am excited that I actually have knowledge and experience to bring to this situation. We feed off of each other’s positive energy as if we had been friends for years. As the visit closes, he is visibly elated and encouraged. In fact, we both are because we are both invested in his health.
In merely speaking with this patient, I remember why exactly I am traversing down this rocky road called medical school. Moments like these make it all worth it. I must remember this next time I am feeling stressed by my own to-dos and frustrated when time escapes my control. This is life, and in comparison to most of the patients that I will encounter, my position is pretty sweet. I must never forget this and remember to give each patient my best effort and attention because each patient is worthy of my best. As I progress in my clinical training, I intend to consistently remind myself that this is what I am working towards and each moment with a patient is not only practice … it is a privilege.
Rich Joseph is a medical student who blogs at Progress Notes.
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