As part of our new curriculum, we have an ethics class. I have been know to call it our "race class" - because that was what we talked about, A LOT. But it was really ethics as it relates to health disparities of different races, cultures, genders, classes, etc. I wish we had spent time discussing other aspects of disparities like religion, mental illness or more than the half hour we mentioned women and homosexuals. Anyway, these are my thoughts composed for my final essay:
When I was 24, I had decided I wanted to pursue medicine. One of my early formative medical experiences was shadowing Dr. W, my physician-mentor-friend at the hospice Acute Care Unit (ACU) in Arlington. I’ve related this story many times but I have seldom had reason to explain the emotional upheaval and personal revelations I had that day. Now it seems relevant.
It was a snowy February Saturday. I was so excited I was even early. Dr. W often lectured on end-of-life issues – something I was curious about ever since an 8th grade debate class in which I had to defend euthanasia. Going to see what hospice was all about was exciting in a lot of ways for me. After Dr. W and I had got settled in and the charge nurse had given her report we saw our first patient. This man was gasping for air, eyes bulging, pulling at anyone who came near him for help. I had never thought the practice of medicine could be such a visceral experience. Our next patient was a cheerful lady with COPD who had set up shop in one of the private rooms. The ACU was for acute cases obviously; it was a place where people came to actively die. But she joked with us that even though she hadn’t been expected to live this long she like it so much here so stayed for four months. I secretly hoped it would be forever.
The next patients were all in a large room with six beds. At this point I could hear what Dr. W was telling me but I wasn’t listening. I was trying very hard not to act like a blubbering idiot. We made our way through the room. I think I started finally paying attention at the fifth patient. He was unconscious, but what seemed like his entire family was at his bedside. As he taught me how to palpate his abdomen – rigid with tumor – Dr. W told me he was an artist. I watched as one of his grandsons anxiously but absently rubbed a crucifix between his fingers. I thought about my own faithlessness and wished desperately I had something that I believed in.
The sixth patient I remember vividly. He was cachectic; not an image your mind erases. His friend vigilantly stood by. I remember him distinctly too because he asked Dr. W if he could give our patient “just a little extra” morphine.
I think Dr. W could see that I would be his next patient if we didn’t take a break. I sat desperately trying not to cry while he charted and chatted with me about how many times he gets requests from loved ones to put patients out of their misery. I don’t really remember what happened the last few hours of the day until our last patient. She was brought in by ambulance from Middleburg. I remember her dry, cracked lips and how anxious I was to help but was not allowed to. She was so gracious to me as I sat beside her. I talked while the IV was started and she began to feel a little relief.
We live our lives so divided. But we all die the same. I knew all people died, but I didn’t understand what a great equalizer it was until that day. I’ve always been compassionate. My mother called it a “broken wing syndrome” and my husband tells his friends I would pick them up off the side of the road if I thought they needed a home. But compassion is not the same as acceptance. The ACU reminded me to accept people as people because we all share the human experience. Should it matter in how we treat our patients that they are black, or eastern European? Or gay, dying of AIDS? Or a wealthy white woman?
Health disparities exist for a lot of reasons. Some of them are bound by the prejudices we hold and others are not as insidious. Race, gender, religious, status have never really been much of an issue to me, and while it is hard to predict how I may deal with a future, hypothetical patient, I do know that I will treat patients the way my values and experience have taught me to treat all people – with respect. When I think about addressing health disparities as a practitioner I hope I will treat my fellow human beings as such with an open mind to their distinct challenges. But there is a huge irony here, exemplified in my day at the ACU. The only thing that was missing that day were those who don’t have the means to die in hospice. The ones who were missing are the ones we don’t know about. I don’t know what I don’t know. And I can't help who I can't see.