By Amy Blair
I was not sure I wanted to be a physician when I stood in front of the dark blue US mail box on the street corner of my college campus, one hand on the door handle and the other on my neatly typed applications, hesitant to let them go. I wanted an extraordinary life, but I wasn’t sure this was the right path.
The closest I felt to certainty was when I shadowed a family physician who cared for immigrants in a rural Midwest clinic. He had served as a physician to countless victims in El Salvador during the civil war in the 1980s. His past and current practices were rooted in his social justice, in the philosophy that all humans on the globe deserve the physical, mental and emotional well-being necessary to arrive at their potential. I wanted to be a part of that and I began to imagine myself as a physician…
Now, my “patient panel” are my neighbors, and within my panel there is remarkable diversity. Together we review acute concerns, chronic conditions, and preventive care. Each day is challenging and fulfilling. My mentor has described seeing me “wiggling around” in clinic, as a goldfish put back in its fishbowl. And that is how I feel- where I am supposed to be, alive and happy in my work. It is extraordinary.
Yet it is not without frustrations. The unjust barriers to care pose a threat to idealism in medicine. Even when I do my best to advocate for patients, there are powerful challenges to wellness that are both systemic and personal, and some, I have little training or knowledge regarding how to tackle. I know how to care for them when they are ill, but how else can I be their neighbor?
Living less than two miles from my own home where my own children eat, a young middle-school aged patient told me he did not have enough to eat when school was out for the summer. He is hungry.
A middle-aged patient confides in me that she has never been able to read, and that all of the discharge paperwork on how to manage her heart failure from countless inpatient hospitalizations meant nothing to her, nor does the word “sodium” or the measurements of fluids. “All I know is that I’m thirsty, doc.”
A woman tells me that she cannot fathom scheduling a mammogram for the next month, as her husband is scheduled to be deported soon, and she debated leaving her life behind to join him. They have been made to feel as strangers.
A patient with uncontrolled diabetes, premature heart disease, renal failure and depression, who used to find strength in attending church, says he has missed for months due to the inability to afford new clothes. Naked.
Many, too many, mothers and grandmothers speak of sons or brothers or husbands who are incarcerated, or who have been murdered with guns. In prison. Systemic imprisonment. Imprisoned by violence. Imprisoned by grief.
How can be I be a neighbor? As a physician, I am privileged and powerful. How can I change more than the medical illness I was trained to care for? It is clear that my clinical care contributes to only a portion of the health of my community. How can I feed, give drink, cloth and visit my neighbors? How can I welcome them?
I have never stopped feeling that life as a physician is extraordinary. As I dive deeper into these difficult questions of how to be a better neighbor, I hope each day that our work helps bring about a better world. I hold tightly to the idealism that brought me to medicine.
Amy Blair, MD, is Associate Professor of Family Medicine and Medical Education and also directs the Center for Community and Global Health at Loyola University Chicago Stritch School of Medicine