“To Shekinah: May I haunt your every compromise!”
These were not the traditional words of wisdom that I was expecting. “Thank you!,” I said, dumbfounded, starting down at the newly inked koan, as if the words might clarify themselves upon repeated reading. Dr. Hunter Campbell Adams, known the world over as “Patch,” had just given a rousing talk to and auditorium packed full with students. He told us that he was a clown and a doctor in equal parts, that to practice medicine was a privilege, and that we should learn to walk joyfully toward suffering. I was transfixed. Never before had I lingered after a lecture to wait for a word with the speaker. But this time, I had to stay.
I made my way to the front of the crowd, hand outstretched, and introduced myself. I was a sophomore, I wanted to practice medicine, but I had no idea how I was going to get there. My college grades in the sciences weren’t without their blemishes, but I was here, I had the drive, and I understood was he was saying. Would he sign my paper? Sign it he did, of course. While the actual slip of paper is long gone, not a year has passed where I haven’t puzzled over his words and used them as both compass and mirror. With that written riddle, he sent me off on a path of discovery that has led me to Boston, Maputo, Rwanda, New York, and right back to where I started: certain that I wanted to pursue a career in medicine.
The desire to become a doctor was deeply set, a fire started in me by the illnesses of early life and nurtured by science teachers, whose classes I loved. Open heart surgery at age seven, cancer at ages eight and 13, if not a picture of health, I was a poster child for survival. And I learned so much from my physicians, especially one oncologist who knew how to treat both the rhabdomyosarcoma and the child whose body it was inhabiting. My doctor, Brian Greffe, introduced me to the March on Cancer, an organization that aimed to raise funds and support for cancer research. Though this organization, I was able to give voice to my survivor-hood, filming a commercial with a fellow survivor, General Norman Schwarzkopf, and speaking at rally on the National Mall. Health advocacy and doctoring, I thought, what wonderful pair for a person like me who loved both science and service.
But, used to high school science classes of ten or twenty, I felt absolutely dwarfed in a university lecture hall of hundreds. I was bolstered by Dr. Adams’ reassurance, but still struggled immensely with the transition to college. As a result, I took more and more courses in Community Health, a small major with only 35 of us total. There was room for group discussions, and much more personal contact with faculty. I excelled and stuck with it, slowly moving away from the premedical curriculum. I worked in cultural competence, mental health, HIV/AIDS, and global health, and finally decided to pursue more training with a masters at Columbia University. But, I wondered, had I compromised? As much as I loved Public Health, would I eventually be haunted by my decision?
The answer was, thankfully, yes. During the second month of my masters’ internship in Mozambique, I traveled to the rural village of Gurue to work with the HIV center team to strengthen their patient outreach and home-based care. That’s where I met Dr. Nuria Munoz, and saw patients with her from before first light to whenever the line had wound itself down to nothing and the doors were closed. We would see mothers-to-be who needed medications to prevent transmission of the virus to their babies, small children who needed coaxing to take their HIV syrups, and adults who wanted to get tested and know their status. Not only did I enjoy taking a history and working with Dr. Nuria to determine the next steps in treatment and document key clinical findings, but I loved working with the patients to explain how pills were to be taken or to answer questions about HIV transmission.
During our work together, I was always full of questions, trying to fill in the clinical gaps in my public health education. How often should a CD4 count be taken, and are there clinical signs that can tell you that its dipping? What level of antiretroviral medication needs to be maintained to suppress the virus? What was the prognosis for the woman we had seen bed-ridden with Kaposi’s Sarcoma? After about a week of working together and her being accommodating of my questions, Dr. Nuria looked at me and said, “Like me, you can’t resist knowing more.” That was it exactly. I’ve loved working in Public Health, and the humanistic perspective that it has afforded. But I can’t resist the details, the very biology that underpins the practice of medicine. And here, in the middle of Mozambique, with a doctor, her patient, the suffering of illness, and the joy of treatment, I understood what I had to do.
While finishing my last semester of the masters program, I started the first semester of my post-baccalaureate premedical studies. The courses were still packed with students, but they felt smaller, somehow. Whatever had been missing at 18, I now had at 25. Perhaps a practical dedication to getting the details right, finally certain that an understanding of basic chemistry would lead to an understanding of nucleotides, which would be essential to understanding viruses, and, in its turn, helping a patient with HIV adhere to her medications.
I think that it’s about time that I write Patch a message of my own. I will tell him that I made it through my post-bac program, an older but wiser ‘pre-med,’ and at last on to medical school. I’m a third year student, and have seen the appropriate share of joy and suffering as I’ve rotated through the hospitals on my clerkships. I see the beauty in the basic sciences, the art in medicine, and will hopefully get the privilege of practicing as a physician in just a few years time. And most importantly, I will tell him that he has haunted my every compromise. And, for that, I will always be grateful.
Shekinah Elmore is a third year student at Harvard Medical School. Follow her on Twitter @premad. Contact: [email protected].