In the novel “Being Mortal,” Dr. Atul Gawande introduces the idea that doctors are at war with death — a clear enemy with superpowers that we simply cannot defeat. Generation after generation, the medical field continues to expand research and develop new treatment options in hopes that death will surrender one day.
et, after caring for patients, I have found that there is much more to one’s quality of life than mere survival. As providers, we get to see how, in difficult times, our patients draw happiness from the love in their relationships, the pride in their accomplishments and the strength in their battles.
We are also witness to the untold hardships that challenge the lives of our patients. In medical school, I was introduced to the invisibility of the undocumented immigrant, the loss of control experienced by an addict, the painful struggle of hiding one’s true gender identity and the sense of defeat felt by a veteran forgotten by society.
Three years ago, I was seeing a Spanish-speaking patient at the Equal Access Clinic for her diabetes. Her significant other was there and insisted on translating and guiding the conversation despite my attempts to lead the visit in Spanish. He was uneasy when I tried to examine her and insisted that there was no need since she was healthy and only needed a medication refill. Something felt odd about their dynamic, and as I presented her case to the attending physician that evening, Dr. James Grigg, he agreed that we should speak to our patient alone. As we returned to the room, we kindly asked her partner to leave. He was furious and intent on staying, yet Dr. Grigg’s calm demeanor somehow swayed him to give us some privacy. I watched as Dr. Grigg pulled up his chair to our patient and stretched his hand out to hers. “What’s been going on?” he asked.
She was shaking as she recounted the ways her partner verbally and physically abused her and how she lived in constant worry of him outing her undocumented status. With tears streaming down her face, the woman revealed an array of bruises hidden along her body. She lived her days quietly, wanting to go unnoticed by society, all the while finding herself deeper in this dangerous relationship. Dr. Grigg nodded as he listened and gave her his undivided attention. Meanwhile, I watched as our patient, who had previously felt rejected by society, reclaimed her sense of self-worth through sharing her story. Undocumented victims of abuse and domestic violence are often isolated and silenced by the fear of deportation.
I have realized that the practice of medicine is a deeply personal and human experience. Medicine provides an intersection where people from different backgrounds meet and disclose their secrets, fears and dreams in search of a better future and improved health. How humbling it feels to be the one patients look to for help.
So yes, Dr. Gawande is right — physicians are at war with death. But I would like to amend his commentary on the role of a physician. I can no longer think of myself as just a member of the infantry shielding my patients from illness and death. I believe that I can do better than that; we all can. I propose that we are also at war with the injustices and hardships that stand in the way of our patients’ well-being and access to care.
As physicians, we have an opportunity to shape our institutions, our culture and our conversations in ways that can transform the possibilities for our patients. As leaders, our actions and opinions can transcend generations and give a voice to those who feel overlooked or neglected by the system. We can refashion the way society views our patients and help preserve dignity and purpose in their lives.
As MDs, we are advocates for our patients, a support system for one another and leaders within our communities. May we always remember to take the time to sit, listen and make our patients feel heard.