About 15 years ago, I spent a few weeks at a small community hospital in Zambia, helping to staff the primary care clinic and attend some of the rounds on the small inpatient units there. The inpatient pediatrics unit was full of young children suffering from malaria or measles, often both. One particularly stark evening, a young couple walked in with an infant wrapped in a scarf carried softly on her mother’s back. They stumbled into the hospital waiting room and gently unwrapped their baby who couldn’t have been more than two weeks old. They had walked for three days from a remote village when the baby first fell ill. She was burning with fever, severely dehydrated, and barely breathing. The hospital staff quickly started an IV and gave her some medication, but it was clear she was deteriorating rapidly. There was no ventilator, so we gently started to bag her while the pediatric head attending, and I began to discuss her care. With a ventilator and appropriate intensive care support, this baby would have a chance.
Here in this small village in an understaffed and under-equipped hospital, her chances were close to hopeless. I wasn’t ready to accept that and spent the night and the better part of the next day bagging her, refilling her IV fluids, and hoping for change. Her parents sat quietly at her side, stroking her cheek, and periodically holding her tiny hand. The nuns who ran the hospital spoke with me several times and finally came to me late in the day and told me this type of thing “happens all the time.” It was time to let her go. I put down the bag and placed my hand on the mother’s shoulder. She sagged with defeat and wrapped her body around her daughter while her husband stood solemnly at her side. I had never felt more defeated and helpless and went to seek comfort from my colleague and friend.
“How can we bear it?” I asked him. “This happens all the time? Why do we come here?”
He paused before he responded. “Yes, it happens all the time. But part of our job here is to bear witness to what is happening. That is important; it has meaning and significance. Someone should know.”
Years later, I helped to start a residency to train residents to care for underserved populations in low resourced settings. Their inpatient rotations were at a disproportionate share hospital with limited access to state of the art equipment, technology, and personnel in a historically oppressed and underserved community. Every year we recruited students who were committed to this type of medicine and came to us energized and passionate to implement social justice and systemic change. Inevitably, about 2-3 months into residency, every intern found themselves in my office, shaken, defeated, and hopeless. What they were witnessing were patients traditionally ignored by a broken system, suffering, and dying from illnesses that were a direct result of a lack of access to appropriate resources. Existing in a society that has the best technology and the best treatment for most illnesses but not having the option to access those resources can be unfathomably demoralizing.
In those moments, what I found myself repeating to those residents was what my friend had told me years before. “What is happening here will happen whether you are here or not. Your first job is to bear witness. That has meaning, and it has significance. We do what we can do. Take care of them, look at the system, advocate for change.”
When I first heard about medical schools fast-tracking graduation for students and shifting young residents into high need areas to fight the pandemic of COVID-19, I thought of how panicked those students and residents must feel. Asking them to step in to fight a battle we don’t know how to win, and envisioning them witnessing the suffering and death of multiple people due to lack of resources and a broken system is terrifying. Asking them to risk their own safety and that of their families due to a paucity of protective equipment is beyond the pale. My more experienced colleagues whisper to each other that we too are afraid of serving on the front lines, but inevitably someone says, “I guess this is what we signed up for.” The truth is none of us signed up for this.
As medical professionals, we do sign up for quite a bit of sacrifice. We work long hours, miss holidays and family gatherings, miss meals, and sleep while we sit with people at their most vulnerable, their most exposed. It can be an incredible honor and an incredible burden to bear. So maybe it doesn’t seem to be such a stretch to ask us to sacrifice our safety in the name of our jobs. I think what gives most of us pause is not our own safety but the risk we will then bring home to our families. How can we be asked to choose the lives of strangers over the ones that we love when their only risky choice was in choosing to love us?
In my area, we are expecting a surge of cases any day, and I have been asked to step in if needed to staff sections of the hospital. Without hesitation (well, maybe a little hesitation), I have agreed to serve in whatever capacity I can. But when residents, students, and colleagues have reached out, I have told them that there is absolutely no shame in choosing to say no. What is happening is unprecedented in our lifetime, and the lack of resources to protect our patients and ourselves is astounding and frankly, reprehensible. Our national leadership has failed us at every level, and no one could possibly fault someone for choosing not to step into the line of fire. But if they do choose to serve and undoubtedly find themselves in those moments of feeling defeated, helpless, and hopeless, I have told them to remember what I told them those first few months of residency. Our first job, when faced with the reality of our broken system, is to bear witness and to tell the story of what we have seen. There is meaning and there is significance in that. Then we do what we can, look at the system, advocate for change.
Deborah Edberg is a family physician.
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