At her Supreme Court confirmation hearing in front of the Senate Judiciary Committee, Judge Ketanji Brown Jackson recounted a story from her time as a college undergraduate. She recalled being a freshman at Harvard after having attended public school in Miami, Florida, and her transition to life at the university had been challenging, causing her to question if she belonged at the school and if she could succeed. She was walking through Harvard Yard and passed by a Black woman who she did not know but who, as Judge Brown Jackson described, “knew how she was feeling.” As they came near each other, the woman leaned towards Judge Brown Jackson and said to her just one word: persevere.
The concept of perseverance is one that applies to many facets of society and is an ideal that is often sought after but not always achieved. We are in awe of those individuals who have overcome great challenges and continued to fight the good fight. The late Senator John McCain first came to national attention after enduring 5 1/2 years of brutal life as a prisoner of war in North Vietnam; he not only survived but also went on to lead one of the great lives in public service to his country. The stories of Holocaust survivors like Elie Wiesel, who after liberation from Buchenwald devoted decades to confronting hatred and genocide and was awarded the Nobel Peace Prize in 1986, inspire us as well. One need not look only to the most extreme examples of human courage but can also see perseverance practiced in everyday life. The child who works to overcome his or her stutter, the athlete who trains hard and sets a personal best—these are also illustrations of what the human spirit can accomplish.
In medicine, health care professionals are quite familiar with the concept of perseverance as an essential aspect of maturation and growth. First, to study hard and gain acceptance to medical school, nursing school, or an allied health training program is no small feat, requiring dedication and delayed gratification, with evenings spent in the library rather than at social events. Residency and fellowship take this commitment to a whole new level, with long arduous calls, nights occupied by balancing the needs of dozens of patients, and years of practice to master discreet skills in clinical reasoning and technical procedures. Not unlike Judge Brown Jackson, many medical trainees often find themselves asking: Do I belong here? Do I have what it takes to be a competent physician? Even if I give it my all, will I fail to meet my expectations and those of my patients?
These questions have only been amplified in the face of the COVID-19 pandemic, which has pushed many of us closer to the breaking point as we confront personal and professional struggles in a time of great anguish and suffering. It is a force of will and a refusal to admit defeat that have kept many of us going even as we face these significant obstacles. In an article for the journal Academic Medicine, Belfi and colleagues eloquently describe the importance of this concept in contemporary medicine: “Grit brought faculty in academic medicine to work in the face of increased anxiety for their own personal safety and health of family members. Grit keeps faculty returning to work in the face of pandemic fatigue, diminished clinical workforce, and post-traumatic stress. Grit is the fire inside of us, the fire that keeps us, the faculty, going.” Clearly, the same can be said of countless physicians in community practice who have demonstrated a tenacity and toughness that has allowed them to continue to work even under extreme circumstances.
Yet more important than looking at ourselves in this regard is to look at the individuals who always have and continue to exemplify what it means to persevere—I am, of course, talking about our patients. I am sure that we all have many patients who come to mind when we think about overcoming great odds. For me, I have recently been thinking about one of my patients, Mrs. M, whose story is a paradigm of perseverance.
When I first met Mrs. M, she had undergone a large battery of tests to identify the cause of her persistent and progressive hand stiffness, swelling, and decreased flexibility. When I met her in the office, her hands had the unmistakable appearance of that seen in early scleroderma. Once her RNA Polymerase III antibodies returned as markedly elevated, thereby confirming the diagnosis, we initiated mycophenolate mofetil to try to curb the worsening of her skin disease, but to no avail. We added IVIG to her therapeutic regimen, and there has been some plateauing of her cutaneous disease, but she has already reached a level of skin thickening in her hands and fingers that makes it challenging for her to hold a fork or write with a pen. Despite this, she imbues each visit with an air of grace, acceptance, and even humor. In describing her interactions with her family, she chuckles in recounting how her kids tease her about not being able to give them a thumbs up when they do a good job. She notes that she tries to count her blessings and focus on the positives rather than the negatives of her situation, with the goal of seeing continued improvement in her disease so that she can return to a more normal life as a teacher, wife, and mother.
When I interact with patients like Mrs. M, I find myself in awe of such insight, grit, and perspective, though I remind myself that even the most doggedly determined of patients may be trying to put on a good show in the office and may actually be struggling more than they let on to their doctor. Indeed, patients may sometimes be afraid to admit that, despite their best efforts, they are having a tough time dealing with the hand that life has dealt them. Thus, it is incumbent upon us to simultaneously cheer on our patients as they seek to persevere in the face of hardship and to support them openly and nonjudgmentally, allowing them to express their frustrations and fears. We are lucky that, as health care professionals, we have the honor and privilege of supporting patients in their time of need and, if all goes well, be able to help them live their lives by that all-important and beautiful refrain: We shall overcome.
Jason Liebowitz is a rheumatologist.
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