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?"
“Est-ce qu’elle respire? (Is she breathing?)”
“Est-ce qu’elle pleure?” (Is she crying?)
My patient asked a barrage of questions as she tried to peer past the medical teams grouped around her newborn daughter.
Several members of the neonatal and pediatric cardiac ICU teams surrounded her baby, who was not crying or breathing. Soon, there was a burst of activity as they all promptly began resuscitative efforts.
Most of of my medical education up until that point had been in the classroom with other students, where we had poured over the physiology and pathophysiology of the human body. We explored the medical technologies, surgical interventions and pharmacological agents we would deploy on hypothetical patients.
Human suffering from disease often takes the same shape and form, but the tools we have to mitigate that suffering can be hugely different.
As our third year of medical school began and as we entered our principal clinical experience at the various Harvard-affiliated hospitals, the curtain was pulled back, so-to-speak; we began to learn the day-to-day realities and complexities of delivering care to real patients. I learned that not only are we tasked with the precious role of healing the sick, we are also called to bear witness to the most intimate and vulnerable moments of our patients’ lives.
As I held my patient’s hand in the obstetrical operating room, I couldn’t help but reflect on the journey that had brought her from her home country to Brigham and Women’s Hospital. I thought back to our first encounter and then right up to the very moment where we were praying against hope that her newborn daughter would make it.
Over my first and subsequent interactions with my patient, I learned that this was her first pregnancy and things were complicated. She had chronic hypertension that was then superimposed with preeclampsia. During initial and follow-up fetal surveys, she and her partner learned that their child had devastating anomalies and that without several early, complex and high-risk surgeries, the infant’s chances of survival beyond birth were very slim.
My patient and her husband were physicians and were well aware that the kind of postnatal care and surgical intervention required to give their unborn child a fighting chance was unavailable in their home country. And so, despite the emotional, physical and financial toll, they made the decision to travel to the United States for advanced medical care.
In my first year of medical school, I had taken a class on social medicine where we explored the idea that health outcomes could be socioeconomically, politically and geographically determined. This idea was not too foreign; my decision to pursue medicine was largely influenced by my background growing up in Zimbabwe during the HIV epidemic.
During that time, the cunning biology of the virus that caused HIV/AIDS, poverty and a new economic crisis, along with stigma and a lackluster public health response, had worked synergistically to produce a health crisis that disproportionally affected already vulnerable populations. Perhaps it was my proximity to this case, or the fact that my patient’s story exposed some personal incongruences I was grappling with, but as I helped care for this new mother and her family, the term “accidents of geography” took on a significantly different meaning.
I thought about the fact that my patient and her husband were physicians, trained in the same principles of modern medicine as any of the physicians that were handling their care. However, because of various social, political and economic forces, they couldn’t reasonably expect that their daughter would receive the lifesaving surgery she needed back in their home country—surgery they knew was within reach elsewhere.
I reflected on myself; on the fact that as a medical student from Zimbabwe training at some of the best medical institutions in the world, I was learning to deliver a gold standard care that was unavailable to many of my fellow countrymen and women back home. Indeed, the kind of level of care I was learning to deliver was often inaccessible to members of my own family.
I have had the privilege and honor of having learning experiences in Namibia, Zimbabwe, Uganda and the U.S. From these experiences, I have learned that at times, human suffering from disease often takes the same shape and form, but the tools we have to mitigate that suffering can be hugely different. And that’s an accident we need to change—an accident we cannot simply accept.
Witnessing my patient and her partner’s suffering not only reaffirmed my decision to be a physician, it set a fire in my heart to be one of a generation of doctors working to make sure that the knowledge we generate and the advances we make as a medical community reach the people who need them, regardless of their locality.
It might take generations of research and tinkering with the science of implementation, it might take a redoubling of efforts to engage political and financial stakeholders, but I absolutely want to be part of that cohort of doctors on the frontlines battling this problem.
A loud baby’s cry brought a collective sigh of relief in the obstetrical operating room that day. My patient’s husband, who had been standing watch some distance away from the medical teams that were attending to his baby, took out his phone and took a picture of her. Overcome by emotion, he walked back to his wife, tears streaming down his eyes and gently kissed her on the forehead. The journey to save their baby’s life had just begun.