This essay was written for the 2018-2019 HMS Dean's Report in answer to the question "What was your most formative or memorable experience in your medical education at HMS?"
The clinic was nearing closing hours, but my patient Rosa sat patiently in her chair. She wore a simple blouse framed by light embroidery. Her hands rested softly on her lap. During her visit, we spoke at length about her diabetes. Her conversation was thoughtful and timid, polite yet committed. After a lengthy discussion, I asked if there was anything she wanted to work on for next time.
She took a long pause and hesitantly stated, “I want to learn how to write my name.”
“I don’t have papers,” she said. “It is hard to explain. My family didn’t have food…”
Deciding to be a doctor can be an unquestionable certainty for some and a long, winding road for others. For me, it was somewhere in-between. By the age of 10, my family had moved from Mexico to the United States three times because of economic instability in our small Mexican town, where classrooms lacked textbooks, supplies, and often, teachers. Health services were primarily provided by a small Red Cross clinic staffed by local nurses. The nearest hospital was an hour drive away.
In the U.S., life presented different challenges because of my undocumented status. From a young age, I witnessed many injustices faced by immigrant communities: lack of access to health care, surprise raids by ICE, dangerous working conditions and truncated educational opportunities for undocumented youth. Once in college, I knew I wanted to advocate and empower communities facing unique sociopolitical disparities while continuing to explore my passion for understanding the biological mechanisms of disease. The two roads converged in one place: medicine.
As a medical student, I have learned that MD training is often as much a time of learning and failure as it is a time of reaffirmation—committing again to the things that brought us to the field. Within its realms, we find beauty and suffering, innovation and tradition. And if there’s one thing that is constant in this field, it is that it is always changing. I have often referred to my years in medical school as my chameleon years; years where I have been a pediatrician, a surgeon, a psychiatrist, a radiologist and even an otolaryngologist.
Yet, the moments that have cemented my decision to enter this field have frequently been the small, intimate encounters with patients. Moments where our conversations have spanned an array of experiences: a recent cancer diagnosis, the passing of a loved one, an unavoidable surgery with high risks, the tortured realities of homelessness, and sometimes, the shame of never having learned to write your own name.
My first summer in medical school, I spoke routinely with Rosa. She was born in Colombia and had left her children in her mother’s care while she worked in the U.S.; she had now lived in the country for seven years. The third time I met with her, I learned that she was undocumented. She disclosed it near the end of our meeting—a last minute thought before grabbing her purse.
“I don’t have papers,” she said. “It is hard to explain. My family didn’t have food and I …” her voice softened, and she began to cry.
I reached for her hand in comfort, and I continued to listen. That day I learned the real reasons for her joint pain, scars, diabetes and depression.
It is without question that violence, poverty, lack of education and government policies all come down with great vengeance on the body. What is most concerning is that these are often not our patients’ choices. However, in our medical role, we have the opportunity to act and give a voice to issues where human rights are contested, where justice is absent.
Ultimately, as doctors, we have a duty to our patients and with this duty comes responsibility. For me, it is important to know that regardless of the specialty I decide to pursue, I will continue to speak for the issues that brought me to this field and have continued to strengthen my decision to become a doctor. In this role, I will continue to educate, empower, advocate and serve my patients. From time to time, I may also trade my books for worksheets and stencils, reminding myself of the power in our own name.