On The Time I Saved a Life

July 3, 2014

Last night one of the girls at Wema with poorly controlled asthma had an attack brought on by the latest thunderstorm. It quickly deteriorated into status asthmaticus, a life-threatening, severe asthma attack that merits immediate hospitalization in the intesive care unit. Failure to do so can result in death.I’ve never been more scared in my life.
I’m in rural Kenya and ambulances are few and far between, let alone in the torrential downpour that we were experiencing. The thunderstorms could not drown out her wheezing as her lungs were closing up and she was only at 10% breathing capacity. She was suffocating to death; her inhalers were no longer helping. My mom, a Family Medicine doctor, was with me and knew that the girl needed high dose steroids if she had a shot at living.We had come to Wema a few days earlier to give all 500 children primary care checkups and the appropriate medication. The last time I was here, I encountered allergies, GI issues, and infected cuts and scrapes. Granted my medical knowledge was limited at the time so I was blinded to the actual diagnoses of their various complaints, but I knew that they had illnesses that were beyond my capacities. I had hoped that bringing my doctor-mom, who had been practicing for over 25 years would bring some clarity to their healthcare. While I was correct, I never anticipated that we would be thrown into a situation of life and death, forced to use every medical tool in our arsenal to keep someone alive.

I could see the worried look on my mom’s face and immediately knew that we were in trouble. While she remained relatively calm, I knew that any indication of panic from a woman that was normally composed was a grave sign. Without medicine, a doctor could do little to help someone with a severe asthma attack. She felt as helpless as I did.

We convinced the director of the school to take us to the local pharmacist to see if he had the medicine the girl needed. Though teachers warned us that leaving the compound this late at night was dangerous and we could be kidnapped, we felt that we had no option. A girl’s life was on the line and only we could save her. By the time we left she had already passed out from oxygen deprivation; we were running out of time. We used dim flashlights and with only a few feet of visibility in front of us, we braved the elements and trecked through the flooded dirt road, surrounded by nothing but darkness, for one mile into the nearest town (safety be damned!).

We came upon Bukembe Village, which was still because it was so late at night, and after banging on the doors of the pharmacist’s house and saying that we were doctors and a girl was dying, he opened the shop and fortunately had the medicine we needed. We bought 100 pills of Prednisone 5 mg and 60 pills of Salbuterol (for future use because we knew that there would be more attacks). Though our spirits were lifted because we had the medicine to save her life, we weren’t in the clear yet. We hurried back to the girls’ dormitory where she was lying (fortunately conscious) on a bed, her wheezing still as bad as ever.

My mom convinced her to take the medication and within one minute her wheezing had dissipated and she could breathe; she had saved her life. And with that, we were finally able to breathe again. Had my mom not been there and had the pharmacist not had the medication, she may not have made it through the night. Call it God or fate or a coincidence, but life smiled on her last night.

After staying with the girl for a few minutes longer to make sure that she was alright, we walked out of the dormitory towards Stephen and Teresa’s house. We didn’t care that the rain was still drenching us or that we had forgotten to eat dinner. We had saved a life. I had never experienced anything like it.

This is why I’m so passionate about working in developing countries because as evident by this incident, one physician can save a life. The needs are so basic in the resource poor settings that we have the capacity to do a lot of good as doctors. Unfortunately, the reality of healthcare, or lack thereof, in the developing world is such that simple problems with known solutions are often untreated. Therein lies the tragedy because we have the capacity to treat it as doctors so it’s instant gratification, but it’s also heartbreaking because the solutions are available, just not in certain geographic regions. People are falling ill and dying for things we know how to treat. I know I can’t help everyone, but I can help some, and this is why I’m becoming a doctor.

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On the Unlucky Triad (dated August 20)

One after the other, day after day it seems, I find myself in a room where the resident is breaking the news of terminal cancer to my patients and I feel an overwhelming sadness belied by numbness. It’s only been a week and a half on Internal Medicine and I’ve already diagnosed three unsuspecting patients with cancer in the past few days.

The kind of cancer that offers little hope for remission and for which none of them had any risk factors.

Mr. X is in his 80s, Mr. Y is in his 30s, and Ms. Z is in her early 60s. Mr. X was old and frail and expected to die soon, but I came to learn he had trouble sleeping because he was anxious about his health. Mr. Y has two children under the age of 2 at home and came to the hospital because he suddenly turned yellow for five days but had no other symptoms. Ms. Z who lost her hair then most of her body weight and eventually came in seeking help for her stomach pain caused by a giant mass crushing her organs.

All of them have cancer.

It’s tough because you have to put a wall up or else you’ll be crippled by how sad these stories are; you’re right in the midst of their suffering. But some of the stories penetrate through (how can they not, after all?), and if you think about it too much, the sadness scoops out your guts and burrows in. Yes, you tell yourself that you’re doing your best to help them, to make them comfortable during their remaining days, and to even offer hope because nothing is definite and no two people are alike. But it’s been difficult to separate what I spend 13+ hours of my day doing from my personal life. I don’t know if I’m alone in feeling this. Maybe I’m a bleeding heart. Maybe I’m human.

It’s hard to convey the magnitude of the past few days, but standing there and looking into the eyes of an unsuspecting person when they are told that they have terminal cancer is something surreal. Your natural instinct is to feel what’s going on, but your body tightens up and you suppress it. You watch them, the sadness breaking through on your face but the tears staying in, and see the disbelief and shock as they try to process what you’re telling them. I haven’t seen any tears yet. People have remained calm and stoic. But imaging the tears that they’ll invariably shed and the long, lonely days in the hospital that leave them a lot of time to their thoughts is worse to me than seeing them break down and cry in person. I know their diagnosis isn’t about me, but when spending almost 80 hours a week being consumed by their illness and what we can do to help them, it begins to wear on me.

I’ve learned about their lives during our time together. And with each new piece of information, I find it harder to distance myself from their stories. I think about them when I got home, wondering how they are doing and what their lab values look like. In the back of my mind, they’re always there. I feel cowardly when I dread going to their rooms in the morning because each time I feel myself fighting the human instinct to absorb the sadness and truly feel the magnitude of their illness. I came into medicine to talk to people and to hear their stories. And yet, I’m shying away from them because seeing their faces will put a face to the declining lab values and dismal scans I’ve looked at all day. It’s shitty of me, but it’s what I’ve been doing.

I knew going into medical school that I wasn’t a fan of taking care of very ill patients but that it’d be a necessary part of my training. So I actually surprised myself by how much I’ve enjoyed this rotation and the joy that comes with being autonomous and a useful member of a medical team. I’ve learned a lot at the hospital taking care of the most ill and destitute patients that Los Angeles has to offer, but in instances like this when all of the sadness is clumped together, it’s tough to find perspective. Yes, it’s an unfortunate part of medicine. Yes, it will pass and I’ll move onto patients with Congestive Heart Failure or multiple broken bones, but in this moment, it’s pretty damn shitty.

Here’s to hoping tomorrow will be better and here’s to being grateful for what you have because my patients have taught me that it can be over in an instant. There’s no happy ending to this story or a neat message. It just is.

On Family Medicine

It’s something that stuck with me. When I went home that night while getting ready to sleep, my mind drifted to the frail, meek Indian woman. I thought of her lying in her bed, a bed in a rented out room in a foreign land, living in a house with a family that was not her’s, that would never be her’s. I thought about her processing the news she received earlier that day during her doctor’s visit. She has osteoporosis and would be on medication for an unknown amount of time. She’d have to delay her trip to Canada to move in with niece for another year. She was looking forward to leaving America in a few weeks because she had no family here. No friends to keep her company. The medication is too expensive in Canada, she’d told me dejectedly. She’d have to stay. She had no option. She was so sad when she left me.

I thought about the sorrow she felt, the fear, the hopelessness. The fact that she walked to a nearby store to buy something, anything, just so she would have something to do with her days and someone to talk to. The ache she felt in her bones and the throbbing in her shoulders. I imagined her standing in her small bedroom, desperately doing the exercises the doctor showed her to strengthen her bones.

I surprised myself when I looked in the mirror and realized that I was crying. And though I’ve seen scores of patients during other rotations that tell tales of abuse, mental illness, homelessness, and tragedy, I’ve never cried. The walls were up. My white coat guarded me. I maintained a sense of professional distance, as I was taught, so that I wouldn’t break down each time I heard the gut-wrenching stories that would invariably mark my career. It’s the only way I could survive.

Yet, this thin, old woman whose loneliness was as palpable as the sandalwood scent she carried with her managed to break through. The idea that she had no one was too much to bear. We spend our lives trying to accumulate love to insulate ourselves from loneliness. Some say we give love and receive love to live. She was truly alone.

And the floodgates broke.

And I began to think about the woman whose husband of 40 years refused to leave her side and suffocated her with his cruel words and machismo dominance. How she would wake up at 5 am to sneak out of the house to grab a cup of coffee at McDonalds just so she could feel normal. Sitting there, in a plastic booth, drinking stale coffee and dreaming of the day she could move out and live on her own. She was married for 40 years and felt isolated for 40 years. She was truly alone.

Family Medicine is a mosaic of stories. In one room and out to the other you go, leaving with a fresh epitaph to add to your arsenal. Narratives are woven into your understanding of humanity; a balanced perspective of the universe, tales of suffering intermixed with accounts of joy. Patients unload their anecdotes onto you and you unload your medicine onto them. A rich transaction, that often leaves you brooding about the lessons learned.

What makes this field unique is that the story doesn’t end with a simple snapshot and an imagined dénouement. The narrative arch is very much alive in Family Medicine. Each visit is a Polaroid, put in a box marked with each patient’s name, and eventually they begin to tell a story. The characters become more developed, the plot changes, and together with the patient, you get to guide where the narrative goes.

A meth addict with bipolar disease becomes a recovering meth addict that is responding well to lithium. An obese recently diagnosed diabetic with a BMI of 42 may transform to a slightly overweight woman who has taken up running and has lost 30 pounds. Some battles are won but most are managed. Even the small victories like helping a single mother with fatigue and migraines because of the stress of raising three teenage boys are worth it. Because you did more good than harm. Left the world better than how you found it. And in this sense Family Medicine gives me hope. The frail, Indian woman’s story doesn’t end with tragedy. It’s still developing and I get to watch how it unfolds. I can be her confidante, working to help her improve physically and mentally, and in this sense she is no longer truly alone.

Family Medicine has taught me about life and its complexities. I used to believe that medicine could fix anything. I decided to become a doctor so I’d have the capacity to treat virtually anyone in this world. This is true, but to a lesser extent now. I’ve realized that my role as a physician is to ease the pain of the body so that hopefully the individual can work to heal their mind and emotional health.

Sometimes the stories feel like a burden, weighing you down at the end of the day. They tug at your soul and force you to reflect on morality and justice. They often don’t have tidy endings and are complicated by the realities of life. You learn that things are inexplicably unfair and justice does not always prevail. They serve as reminders that life is not a fairy tale. But other times feel like successes and you become rejuvenated and revel in the small victories. For a brief moment in that room, talking to that patient, you feel a stirring of your spirit and a renewed optimism. Regardless of the experience, I’ve realized that a typical day in Family Medicine is an amalgam of good and bad, and you leave the clinic feeling like you’ve accomplished something. You’ve touched x number of lives today. And you get to do it again tomorrow.

On My Muse

defend the defenseless

Three Nigerian children, their hands clasped together, their faces covered in white soot, books lay on their laps, hope in their eyes, and hunger in their bellies. I came across this image in National Geographic my senior year of high school. I was moved by this image of inexplicable poverty, my chest tightening when reading the caption, a hard lump in my throat forming.

Images rarely affect me and I haven’t found one to date that has quite moved me like this one. Their solemn diligence, faith in the face of despair, and courage spoke volumes to me. Little did I know, but this 8×11 photograph that I ripped out of a magazine and stuck in my backpack would dictate my future path. I went home, rummaged through my desk for a sharpie, and scrawled the phrase “Defend the Defenseless” across the top of the photo. I taped it to the wall and decided in that instant that that’s exactly what I wanted to do.

It still resides above my bed today, having traveled with me to college and medical school, and reminds me of what I’m working for. While it’s currently surrounded by photos of children I’ve met in places like Honduras and Kenya, it still resounds powerfully with me.

I’ve found that when I’m faced with dejection, despair, often at the hands of a seemingly endless workload and long hours that make any hope of accomplishing my future goals look bleak, I look at the photograph and find a sense of inner strength. This image gives me the courage to keep working, to keep persevering, to keep on fighting for my dreams.

I want to rediscover what makes humanity so beautiful. I want to be apart of a movement that empowers people to take charge of their health and by extension—their lives. I want to be a traveler with a healing pack to make that wish a reality.

On Writing

There’s something about narratives, a certain inexplicable power that grabs hold of you at your core. It ignites dormant passions and evokes such strong emotions that if you took a step back, you’d realize just how vulnerable and exposed you were because of an extended string of words. That’s the power of this medium. A world created from mere characters on a page is as moving to the author composing the piece as it is to the reader.  It’s for this reason that I’ve always been drawn to narratives, particularly writing stories. It has the power to elicit emotions and feelings in me that I repress or am unable to tap into because I am so swept away by the responsibilities of daily life.

Storytelling makes me feel more in touch with my humanity than I’ve ever experienced. Few moments in life have brought me comparable joy—pure bliss that comes from the sound of my pen scratching feverishly on paper as I spill my inner thoughts and construct a universe with as much emotional relevance as this one.

Writing is simultaneously terrifying and exciting. It is an intoxicating process with unimaginably high stakes. Each pen stroke solidifies an idea, statement, or thought. It creates a world from nothing, something so fundamentally ominous, unfamiliar, and powerful it has the capacity to elevate you to a new height of joy, euphoria, and self purpose. It also has the ability to expose your darkest, most wicked thoughts.

Writing keeps me grounded in my humanity. It empowers me to pursue my goals and to realize my purpose. By keeping me grounded, human, and contemplative about the world around me, writing has given me keen insight into how to approach certain issues—particularly problems that are beyond an individual scope. To me, it’s life in its purest form.