Michelle Green - A Fraction of a Physician

"Hello…good morning…how are you?" were the words that I was greeted with as I approached the general hospital in downtown St. George's. The smell of combustion loomed in the air as the bus drove past. I was struck by the architecture of the building: yellow, diminished paint hung over corridor crevasses and unshakable, dark brown, iron-rod bars covered the windows.

As the morning began, we were greeted by a man who appeared to be a patient favorite. His khaki slacks and short-sleeve button-down reminded me of physicians in Managua, Nicaguara. The unbearable heat would not allow for anything other than something short-sleeved.

"Hello students. Follow me outside for a small chat before we start the day."

As we walked through the hallway, the pungent smell of old porridge and milk greeted us amongst the smiles of men who sat aimlessly listening to the music of a television show.

"Today, I will leave you with a patient. I would like you to obtain as much of a history and perform a relative physical exam. It is important to be thorough in everything you do. It is a patient's life you are dealing with now. Not someone fake. Use your best judgment."

"It is the patient's life you are dealing with now" struck a chord and rang continuously in my ears as we entered our patient's room. The environment again reminded me of my time in Nicaragua: a lack of privacy from patient to patient, conversations with yelling, crying, anger permeated the room. In a less developed country, the lack of resources was more evident in a hospital environment than any other location. Common draping, or even privacy, in the room was sacrificed for the need to maneuver eight hospital beds into one room. In such conditions, your privacy is no longer yours.

We were greeted by an older man who sat looking at his phone as we approached the bed. With a large smile, he said hello. As we introduced ourselves, an overwhelming sense of relief graced the man's face.

"You seem as if you would like to say something," I stated.

"Yes, I hope that you all together can help me. I think with you all here and with the doctor's help, we can figure out what is going on."

One by one, as the team looked at each other, the words, "It is a patient's life you are dealing with, now" showed in our eyes with a passion to do whatever it took to help this gentleman.

The gentleman began to describe his symptoms as we eagerly took note of every detail given. Frustration and anger weighed heavily as we progressed through the interview. As I took a step back, I was reminded of the importance of going beyond the immediate needs and truly understand who this patient was.

"Can you tell us about yourself?" I interjected over one of my colleagues. "What makes you happy? What brings you joy?"

An aloof expression crossed his face as he sat back in his bed and pondered answers to those questions. In the blink of a moment, he began to describe his ultimate goals of wanting to better the lives of the people in his country. He hoped for a better tomorrow and a life that his kids could reflect on and say that they were proud of their father.

In those five minutes, it was no longer a focus of "me, the patient and my problems" but rather of others. It did not negate the importance of treating the man's symptoms, but it shifted our focus to understanding who this patient truly was, how he viewed himself and the environment he lived in. What was his role or duty to his society, even in the midst of a debilitating crisis? It reminded me of the value of being holistic in every aspect of medicine. Beyond the bedside of the hospital, our patients have lives. Some of them have desires to make an impact on the world. As a future physician, I have a duty to help them do that in any way I can.

In life's hardest moments, when the value of life is challenged by conflict, we desire to be reminded of what it means to be treated as a human. Humanism goes beyond seeing the immediate medical needs of an individual; that's just part of a whole picture. Holistic approaches to the advancement of care are vital parameters to our ever-advancing healthcare system. The conditions of the environment described above, the man who allowed students be challenged with the duty of providing continuity of care; are all fractions of the embodiment of what it means to be a physician.