“Wow, you don’t have an accent at all!”

From Charlottesville to NFL stadiums, conversations and controversies surrounding race relations have seldom felt more heated. These events challenge each of us to consider how racial issues intersect with our daily lives, as OHSU emergency physician Esther Choo notably did in a now-viral tweetstorm about patients refusing care from providers of color.

The reverberations of these seismic disruptions in our social consciousness have, naturally, stirred discussions in our medical school’s classrooms and clinics: how we’ve felt impacted, how our patients have been affected, and how we can root out structurally-ingrained racism in our local environments. And while I can’t claim to understand or have experienced the unique challenges my black or Latino colleagues encounter, these conversations have raised common threads of reflection among my Asian-American peers about the micro-aggressions we navigate while learning medicine in the ‘buckle of the Bible Belt.’

Thankfully, the experience of being verbally confronted or having my services refused on the basis of race isn’t something I’ve had to handle—for such overt hostility, the New England Journal of Medicine has an excellent primer on “Dealing with Racist Patients.” Instead, my brushes with “lowercase-r” racism have been much more subtle, and often unintentional.

“I know a Dr. Patel; he lives in North Carolina? Do you know him?”

Funny; I know a Joe Smith in Edison, New Jersey. Do you know him?

“Where are you from?”

New Jersey.

“No, where are you really from?”

I promise, I am really really from New Jersey.

“Where are your parents or grandparents from?

[Groan.]

“Wow, you don’t have an accent at all, and your English is great!”

Well, I scored 5’s on my AP English exams and an 800 on my SAT verbal, so I’d say I’m pretty decent at English, yes.

“You moved here when you were two months old? That means you’re almost one of us!”

Thank you for letting me know that, though I’ve spent 99.3% of my life here, completed 20 years of schooling here, renounced my Indian citizenship for a U.S. one, and consider myself as deeply immersed in your sports, music, and pop culture as anyone else, that you still think of me as less entitled to the privilege of being “American” than you are.

If you’re not convinced, Buzzfeed has some delightful examples, too.

I came to Tennessee (which is 1.8% Asian) from a university ranked #1 for race-class interaction, and before that, a minority-majority hometown where our high school cafeteria resembled the United Nations. It felt entirely foreign, then, to transition to a setting where most of my patients not only didn’t look like me, but had often lived for decades in rural communities where everyone looked the same, sounded the same, prayed the same, and voted the same. It was a rare experience to feel hyper-aware that I was different, which was only heightened by my patients’ comments and curiosity questions. These bigots, these ignorant rednecks, these deplorables, I fumed internally.

With time, though, as I grew to better understand my patients, my exasperation softened to empathy. Through brief interactions at the bedside, I came to see my patients’ “political incorrectness” not as ill-intent, but inexperience. If you live in McMinnville, Tennessee, you might believe that most towns, like yours, have only one South Asian family, and intuit that these dispersed Desis find and know each other. You might only know of South Asian culture through the pop culture vignettes of Simpsons or Slumdog, so that when you encounter an Indian American medical student, your conversational instinct is to ask about accents, bindis (“dots”), the caste system, or arranged marriages. Maybe that is bias or racism, but it’s a curious naivete that’s infinitely harder to hate or look down upon than a tiki-torch mob.

Acknowledging that naivete, I no longer get frustrated or angry. Instead, I teach.

“I know a Dr. Patel; he lives in North Carolina? Do you know him?”

“No, I don’t. There are 4 million Indian Americans across the U.S., so it’s hard for all of us to keep in touch! “Patel” is also as common a last name among Indians as “Smith,” “Jones,” or “Johnson” are here. It’s like asking if you know my neighbor back in New Jersey just because he has the same last name; I’m guessing you probably haven’t met!”

“Where are you from?”

“I’m originally from New Jersey, where my family still lives.”

“No, where are you really from?”

“Well, I was born in India, but moved here when I was two months old. I’ve completed all my schooling here, gone to college here, and consider myself culturally American with Indian roots. Most people tend not to remember much from the first two months of their life, so practically, my life here is all I’ve lived and known!”

Likewise, acknowledging my limited insight into the lived experiences of the South, I learn. I ask my patients what it’s like to live in rural Tennessee or the ‘urban underserved’ areas of Nashville. I ask about the factors that promote or impair physical and mental wellbeing in their communities. I ask about their beliefs, values, and goals, realizing that their social contexts might frame these perceptions to be drastically different than my own precepts or presumptions. As I realize that I understand their lives and backgrounds as little as they do mine, it becomes harder to cast judgments or throw stones.

Of course, not everyone’s experiences might be as benign as I’ve been fortunate to have, or as amenable to resolution with casual conversation and cross-teaching. Medicine has much self-reflection and work to do regarding racial disparities—certainly, among others—in our physicians’ demographic composition, in our patients’ health outcomes, and in our interpersonal interactions in clinical practice. That’s a much larger matter, and I’ll table it for a more seasoned expert’s commentary.

But, for immigrant medical students and physicians, I offer this advice: the next time you encounter an off-putting or politically-incorrect remark, consider where it’s coming from, and the contexts and experiences which frame that person’s viewpoint. Consider the positive impact you might offer by deferring confrontation for education. And most critically, consider your own biases or presuppositions before judging or critiquing someone for theirs. Shared understanding isn’t always the solution, but it’s often a worthwhile start. Give it a try; I promise your patient interactions (and cortisol levels) will be all the more better for it.

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Chugging Along

It’s the morning after Election Day, and the world still has a sort of surreal quality to it.

I awoke this morning with a sense of fear. Fear for my own safety, and the safety of my loved ones who fall beyond ‘standard’ templates of race, faith, nationality, gender, or sexuality. Fear for the stability of public discourse and debate in the coming days and weeks. Fear for the legacy of the last 8 years—and the last 240 years, really—which today seems more vulnerable than ever.

Somehow, I got out of bed, took a shower, got dressed for school, packed a lunch, and drove to school, all the while feeling anxious to discover what a “Great Again” America would look and feel like.

And then I reached the hospital. Here, it doesn’t feel like the morning after Election Day; it’s Wednesday, November 9th, and just that. Doctors are taking care of patients. Residents are scurrying about, completing their usual errands. Patients are being seen, heard, and cared for, just like any other day.

One of medicine’s most beautiful qualities is that, whatever the turbulence beyond the hospital, the essence of the patient-provider interaction and the bedside encounter remains a familiar constant. Today, my fellow healthcare providers will head to work carrying the weights of their emotions and thoughts, but once we walk into that exam room, nothing else will seem relevant but the needs of the patient before us. Even if that patient is wearing a “Make America Great Again” cap, and even if he holds an ideology that considers my kind an outsider or a threat, we’ll look beyond that. We’ll resist the temptation to see a ‘deplorable,’ and challenge ourselves to see someone who needs our guidance, compassion, and care. A patient—nothing less, nothing more.

That’s not to suggest at all that medicine occurs in a vacuum. As physicians and physicians-in-training, we now face an uncertain future that could well profoundly affect the way we practice. Our patients will face renewed challenges to receiving accessible, affordable, equitable health services. The health and wellbeing of marginalized populations, such as women and LGBT individuals, will be more vulnerable to the whims of partisan policy than ever before. Gun violence will, once again, fail to receive its due recognition as a public health emergency.

These are important matters, and as educated experts who navigate these issues in the trenches each day, our voices will be critically important to these conversations. We cannot let our commitments to advancing the health of populations waver in the face of adversity. The path forward will be harder, and so our convictions must be even stronger. That conversation begins tomorrow.

But today, when it seems like the rest of the world is standing still, and when it feels like a future with a President Trump is too painful to even imagine, I take comfort in the assurance that ours is a profession that, despite our emotions and adversities, keeps chugging along, changing the world one patient at a time.

When Breath Becomes Air

As I write this, I’m wiping away the tears in my eyes stirred by Dr. Paul Kalanithi’s When Breath Becomes Air. Richly reflective and powerfully evocative, it’s the touching narrative of a doctor’s attempts to confront death—as a student of literature, as a neurosurgeon, and as a patient—and, through the lens of terminal illness, examine how dying gives meaning to living.

With When Breath Becomes Air, Dr. Kalanithi allows us to, in his words, “Get into these shoes, walk a bit, and say, ‘So that’s what it looks like from here … sooner or later I’ll be back here in my own shoes.'” It’s a walk that resonates particularly strongly for me as a fledgling physician.

As he reflects on his medical training, Dr. Kalanithi looks back with the perspectives of both patient and provider to offer valuable insights on what it means to be a physician: someone who translates statistics and survival curves into a patient-oriented language of values, identities, and capabilities; someone who is relentless in the pursuit of operative excellence, but understands that a surgeon is more than an expert technician; someone who aspires to perfection, but ultimately accepts his fallibility.

For any avid reader of medical non-fiction, these reflections will sound familiar, the stuff of Better and Being Mortal. And yet, When Breath Becomes Air feels different, because it explores medicine’s virtues, values, and flaws from the perspective of a patient, someone who is both an insider and outsider to medicine. As Dr. Kalanithi writes, “As a doctor, you have a sense of what it’s like to be sick, but until you’ve gone through it yourself, you don’t really know.” His perspectives on what makes a good doctor are informed by an intimate understanding of what patients feel, what patients think, and what patients want that most of us, as providers, can only infer and intuit from our interactions with illness in the third person.

At its heart, When Breath Becomes Air is about more than how we ought to provide care; it’s a contemplation of how we ought to live. The life of a physician-in-training often feels like a life of anticipation, of potential, of surviving the present to reach the rewards of the future. We spend a third of our lives studying, sacrificing sleep, accumulating loans, and watching our friends build lives that are less exhaustive and more lucrative, all of which we accept for the eventual promise of a career that offers an unparalleled balance of intellectual engagement, moral fulfillment, and socioeconomic comfort.

I ask myself, then: if faced with a terminal illness tomorrow, would I feel that I’d achieved anything more in 23 years besides a pursuit of a life still yet to come? For Dr. Kalanithi, the prospect of dying gives the present an immensely deeper significance, a more imminent urgency. As I read his detailed recollection of his last day as a physician, a heartfelt recall of each interaction, each sensation, each incision, I felt uncomfortably reminded of what I’ve seen and done over the last week, and how it felt so unremarkably routine. I’d been present, but I hadn’t been truly present.

Reading When Breath Becomes Air, I felt called to attention, awoken from autopilot to embrace the quiet miracles and subtle wonders that transpire around us each day in the hospital. If we practiced medicine each day as if it were our last, what might that look like? What could it do for our connections with patients, for our interactions with our colleagues, for our thirst for meaning and fulfillment in our daily lives? This, I think, is Dr. Kalanithi’s strongest parting advice for us. And as cliche as “live as each day is the last” sounds, that we so rarely do it makes it advice worth hearing.

When Breath Becomes Air is an easy read that raises difficult questions, a short book that invites lengthy pauses for thought. Whether you’re in medicine or not, you’ll invariably someday find yourself pondering the matter of mortality and the meaning it imparts to the closing days of life—and therefore, you’ll invariably find this book to be both moving and meaningful.

Thanks, Dr. Kalanithi.

MedX|Ed: Fast Four

Medicine X is an event that’s one part performance art, two parts academic conference, and three parts social movement. The last 24 hours have been a whirlwind of awe and inspiration that’s left me speechless—sorry, tweet-less.

First and foremost, I have to applaud Medicine X for its unique approach to medical education. Traditionally, medical education meetings are where deans, program directors, and educators meet to prescribe a top-down vision of what’s best for medical learners. MedX|Ed—and naturally, MedX is anything but traditional—takes the opposite approach. It begins with the end users, learners and patients. Next, it identifies these users’ needs in an evolving healthcare system and dynamic social-technological climate, and imagines how academic medical ecosystems might be re-engineered to better support them.

What a wild idea: that medical students might actually have a vested interest in crafting their ideal learning modalities, and that patients might actually have a vested interest in shaping their ideal provider’s skill set. Imagine that.

As the MedX webcast and tweet-stream illustrate, when students, patients, providers, and educators converge, the discussions are delightful, and the ideas are incredible. If you’re not keen on combing through 6,500+ tweets of lofty ideation, raw emotion, and heated disruption, here’s a “fast four” of take-always to ponder.

Reimagining pre-med. Creative destruction of medical practice starts with creative destruction of medical training, which starts with creative destruction of medical admissions and selection. If we want scholars, innovators, and humanists, why do we, as Nisha Pradhan critiqued, put physician-hopefuls through a meat grinder of memorization and multiple-choice assessments? As a medical student, I never solve Diels-Alder reactions or draw Krebs cycle intermediates. I frequently search for the subtexts in dialogues and make perceptual assessments of subjective situations—you know, fluencies I built from my humanities coursework. How might we rethink pre-medical prerequisites to actually hold relevance to the practice of medicine?

Reimagining med ed. Anki, Picmonic, Firecracker, Pathoma, Goljean, DIT, UWorld: the last decade has seen an explosion of digital study tools, tutorials, and Q-banks in medical education, and it’s all driven by the increasing centrality of standardized testing in residency selection. Have dreams of derm? Better splurge for that $500 test prep resource. Now consider that this ‘Step 1 economy’ exists in addition to a medical education that costs $30-60,000 per year. Medical students today are dually enrolled in the study of patient care and the study of Step 1. Why is that? If our tests are so detached from the curricula they evaluate, shouldn’t we aim to close the gap? How might we redesign assessments to capture a holistic excellence in clinical practice, rather than an acute ability in factual recall?

Reimagining patient ed. It’s no coincidence that the word ‘doctor’ derives from the Latin word ‘docere’: to teach. At its core, to be a physician is to be an educator. In today’s volume-driven healthcare system, though, that teaching interaction is often confined to a brief moment at the close of a patient visit. As more physicians become content creators and digital connectivity becomes ubiquitous, might we extend patient education beyond the clinic? It’s easy to imagine a near future where a patient’s ‘presenting complaint’ triggers an email with curated educational content, like an Evans Health Lab video, ahead of a visit. Such ‘flips’ would allow more time for the clinic visit to focus on hands-on teaching or addressing questions. How might we use digital media, informatics, and educational theory to inform a ‘flipped classroom’ for tomorrow’s patients?

Reimagining educators. Traditionally, teaching moves down the hierarchy: attending physicians teach residents and fellows, who teach medical students, who sit at the bottom of the totem pole and try not to mess up. As we continually extend the competencies and fluencies expected of providers in an age of accountable care and networked medicine, perhaps the best educators aren’t solely physicians. Maybe the best educator on empathy, bedside dialogue, and the patient experience is, as Dave DeBronkart and Emily Kramer Golinkoff proposed, a patient. And maybe not even just learning from a patient lecturer, but from a patient’s chronological illness narrative on social media,or from a patient who brings their ‘Google biopsy’ results to an appointment. How might we create structure opportunities for trainees to connect to and learn from non-conventional teachers?

Clearly, we have much to think about, and even more to still accomplish. Again, a huge kudos to MedX for extending the vision of ‘nothing about me, without me’ from the clinic to the classroom. And a final note for healthcare students: now that we’ve been given the opportunity to participate and speak, we’re charged with the responsibility to co-lead and actively shape our learning ecosystems. Let’s get to work.

Closing question: what are your “how might we’s” from MedX|Ed, and how do you envision implementing them by MedX|Ed 2016?

Well, Here Goes Nothing

It’s finally here.

After 13 years of K-12 schools, four years of college, and one year of pre-clinical medicine, I’m finally doing the unthinkable: stepping beyond the classroom, trading chalkboards for charts, swapping study guides for stethoscopes, and putting 18 years of learning into application at the bedside.

Well, sort of–there’s still grand rounds, morning report, and core didactics. And I’m far from done with textbooks or tests. But it’s hands-on, and it’s dynamic, and it’s the closest I’ve ever felt to actually doing anything tangible, applicable, or useful, so I’ll seize the opportunity for a little ‘hooray!’

Just one thing: I’m scared to death–tense, timid, terrified, and (D) all of the above.

In the days to come, I anticipate carefully budgeting my umms, uhhs, and I don’t knows. I expect to know all the right answers–that is, about five minutes after the question’s been asked and the resident’s moved on. I plan to stockpile the responses that are valid for almost any question; I’m told ‘cytokines’ and ‘idiopathic’ are reasonably reliable. The unshakable conviction that I’m only here because of an admissions office clerical error is back, right on cue from this time last year.

Here’s the wild part, though: even though all that’s true, and sleeping in is about to mean 8:00am, and a two-day weekend is about to be a vaguely fond memory of days past, I’m still really, really amped for this.

These next few months, there’s no telling what might happen. I might get to introduce a life into this world. I might get to reboot a heart that’s stopped beating. I might get to offer someone a word of comfort in their waning days. Even the most simple of things sound like opportunities–I might draw upon 19 years of lessons and lectures to decipher what’s making someone feel crummy, then find a way to make them feel less crummy.

It’s going to be petrifying, but profound. Terrifying, but terrific. Wild, but wonderful.

As I embark on this next chapter, then, these are my promises to myself. In the months to come, I hope to revisit these promises, to measure my personal growth against them, and to hold onto them as my compass, my ‘true north,’ of moral and intellectual character.

Start humble; stay humble. This one’s easy, especially when you don’t have the expertise or credibility to be anything but humble. As I grow in this clinical life, though, I hope to retain what it feels like to not have the answers, to speak from a place of low hierarchy. and minimal confidence.

Remember that everyone’s an educator. Even while learning to think like a doctor and do as doctors do, I hope to bear in mind that there are many things to be even better learned from my other colleagues and collaborators: from nursing, compassion and advocacy; from social work, resourcefulness and relationship-building; from environmental services, perseverance and ‘can-do’ willingness.

Seize every moment like it’s once-in-a-lifetime. This year, I’ll rotate through 100 specialties, and 99 of them won’t be my future profession. In other words, for anything I do this year, it could be the first day of the rest of my life, or the last time I ever deliver a baby or close a surgical incision. I’ll inevitably be tempted many times this year to skip a learning opportunity or cursorily participate in an educational experience–”I’m never going to need this skill.” When that happens, I hope to catch myself, to cherish everything as potentially unique, and to stay open to the moments that might unexpectedly captivate me.

Resist a reductionist view of the patient. Toward the end of first year, I knew I was overdue for a summer break when I’d catch myself tuning out of the ‘irrelevant’ parts of the patient narrative, feeling impatient with the details that weren’t pertinent to a diagnosis. As the medical student, I have the gift of being ‘non-essential’; my histories and physicals are, most likely, just educational exercises. In that context, I hope to remember that it may occasionally be more impactful to defer the review of systems to allow a patient space to reflect. I hope to remember that there’s more to patient care than a detailed differential.

Exist beyond medicineFor better or worse, medicine isn’t my all-consuming identity, my sole purpose. I’d like to think I exist beyond the hospital, in the form of values, leisurely pursuits, and relationships. Naturally, this won’t be the year I chase my dreams of seeing the world, or the year I take a step back to focus on my relationship. The hours of clerkships and the drive to study more, to know more, to perform better will be demanding, and these will come first. I hope, for my sake and for the sake of those dear to me, that this medical apprenticeship doesn’t become everything–the only thing–that I’m about.

So there it is–the manifesto of who I am now, and who I hope to become (or not become) by the conclusion of this whirlwind of a year. Preachy? A bit. Sappy? Definitely. Over-ambitious and doe-eyed? Sure, probably. Still, I know the odds are against me, and chances are high that I’ll end this year more jaded, more skeptical, and less empathetic. And maybe, just maybe, if I set my goals to an aspirational degree of virtue, goodness, and empathy .. then I’ll land somewhere in the middle, and fare just okay.

Well, here goes nothing.

Beyond Protcols

EMTs learn, train, and practice by protocols. But some situations challenge us to operate beyond the guidelines.

Technicians, not diagnosticians.

Here’s a fact that, despite my best efforts, eluded the students who knocked on my dorm room door at 2:00 A.M. asking me to diagnose their stomach-ache or to differentiate a possible sprain from a potential fracture: emergency medical technicians are not diagnosticians.

It’s a fact that’s drilled into us during our training. We do not paint portraits of diagnostic clarity, but form foggy sketches of clinical approximations. Indeed, every emergency medical provider is well-trained in the art of cookbook medicine. We identify plausible signs and note visible symptoms, determine which protocol best fits the patient’s condition, then systematically implement a recipe of mandates and instructions.

There’s a protocol for chest pain. Check the ABCs—airway, breathing, and circulation. Start high-flow oxygen. Administer aspirin, 320mg. Check vital signs. Blood pressure over 110 mm Hg? Start an IV, run fluid, and give nitroglycerin, 0.4mg. Repeat dose if … …

There’s a protocol—quite a few, to be precise, for difficulty breathing. Sudden onset shortness of breath? Urticaria? Swelling? B/P depression? Treat for allergic reaction. Noisy, wheezy breathing? Accessory muscle use on inspiration? Peripheral edema? See the checklist for COPD exacerbation.

While all these protocols truly underscore the ‘technician’ in ’emergency medical technician,’ where EMTs define themselves is not in these cycles of recognition and execution, but in the moments beyond the lines—those aberrations and anomalies for which no protocol exists.

Call it in; patient DOS.

“Medic 86, you are responding to an unresponsive patient. 916 River Falls Drive,” the dispatch tones blared, the lackluster monotone of the programmed voice an ironic contrast from the emotional tragedies and urgent crises it often signaled.

I stumbled out of bed and into my medic boots, groggy and irked. 5:17 A.M. … Yechhh. We moved with a requisite urgency, but our optimism muted; at this hour, it was almost invariably a panicked caller who’d awoken to find a rigid, lifeless relative in the bed across from them. To hope for more was, as I’d come to learn, to invite frustration and failure.

On scene, our skepticism was soon enough confirmed. The patient—or what had until recently been one—lay eerily still as stone in bed, her eyes locked in an inhumanly blank gaze, mouth locked grotesquely open as if to convey horror and shock, limbs woven into the unmistakable contortions of rigor mortis and imbued with the hues of lividity.

“Call it in: patient DOS,” the supervising paramedic instructed matter-of-factly.

Our anxious pulses eased, our breaths calmed, our emotions sank; there would be no opportunity to resuscitate a life here. The darkened tints of my goggles masked fresh tears. Experience and exposure aside, even the most seasoned EMTs are rarely up to the task of remaining stoic in the face of death. Sensing the mounting tensions between my external restraint and my internal distress, I withdrew to the kitchen to collect myself. EMTs, after all, are collected.

There is no protocol for human compassion and empathy.

As I stood over the kitchen sink, the warm water reinstating a sense of calm and cohesion, I heard a nearby sniffling that was not my own. I turned to see, tucked away in the shadows of a recliner chair in the living room, the patient’s son. Unlike mine, his face showed little emotion or pain; instead, his solemn countenance and still expression inspired in me both admiration and wonder.

“I’m sorry for your loss,” I whispered to the man. The words felt stale even as I said them; they were the trite recitations of someone who didn’t know how to properly express compassion or consolation. “Is there anything I can do for you?”

“She’s gone, right?” the son asked, his composure again taking me by surprise.

“ … Uhm, well … Uhh, yes. Yes, I’m sorry to say so. Sometimes, we can try to start their heart again, but here, it doesn’t seem like there’s anything we can do. I’m sorry.”

“Actually, I don’t think that’s true,” he responded, motioning to the foot stool beside him. “If you could spare a moment, would you sit down?”

Now as confused as I was curious, I obliged. The son paused for a moment, taking a pronounced gulp and wiping his eyes for the first time.  “Please,” he said, “Would you pray with me?”

I drew back, stunned by this request. Religion, to me, was going to the temple once a year because my grandparents said so. Religion was when we would skip prayers at Diwali to swap brightly-wrapped gifts and eat rich sweets. It had no bearing on my moral compass, much less my practice as a healthcare provider. I was an EMT, not a priest or chaplain. What place did I have to engage in prayer?

For the first time in my medical career, I was at a loss for words or actions. In my EMS training, I could triage a mass-casualty incident. I could intubate a patient and breathe for her. I could stabilize a fracture of any size, location, or orientation. But I could not respond when asked to share in a gesture of faith and spirituality.

There was no protocol for human compassion and empathy.

There, caught at the intersection of reason and emotion, challenged by intuition and expression, I deferred thought to instinct. I met the son’s gaze, sat down, and put my palm in his. At that moment, there was no sense of protocols or directions, rules or expectations; there was only the circumstance before me, and what felt like the right thing to do. The man closed his eyes and wept in silence. After several minutes, he cleared his throat, loosened his grip, and nodded to me with a brief, “Thank you.”

A reflection.

When I’m asked what my most memorable call in EMS has been, people expect the multi-vehicle collision or the successful resuscitation. But there’s more to EMS than running lights and sirens, and there’s more that we can do than fulfilling checklists. That night, I wasn’t confronted by a matter of faith, but a matter of understanding and responding to a person’s needs as he navigated one of the most difficult chapters of his life. In that moment, the best care that I could offer that patient was to be emotionally present for her son.

In a discipline where it’s easy to feel the frustrations of merely checking off boxes or meeting the medical-legal obligations of cover-your-ass medicine, it’s important we remind ourselves that our most profound abilities lie not in our procedural dexterity or acute observations. As EMTs, we instead define ourselves by the moments when we go beyond the guidelines or transcend the limitations of protocol-based medicine to provide for our patients’ needs—biomedical and beyond.

In this patient encounter, names, events, and details have been altered and fictionalized to protect patient anonymity.