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.

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White Coats for Black Lives? Prove It.

When it comes to advocacy on matters of race and social justice, medicine’s C.V. is, at best, mediocre. 19th century medical students learned their craft by dissecting the grave-robbed cadavers of African Americans, immigrants, and the poor—the bodies that wouldn’t be missed or spark protest. Decades of translational research relies on an immortal cell line extracted, without consent, from African-American Henrietta Lacks in the 1950s. And, of course, there was that clinical experiment for “bad blood.”

Which makes it all the more fascinating, then, how medical students nationwide responded to the recent controversies surrounding the deaths of Michael Brown and Eric Garner:

On one level, it’s incredible to see medical students taking a stand, making ripples nationwide, and letting all our patients know that we stand with them. The white coat—even a short one—lends reputation and gravitas, and #WhiteCoats4BlackLives proves that if we stand (or die-in) together, people listen. As tomorrow’s doctors, we should be inspired from these events to capture that attention and guide public discourse on society’s leading issues: access to care, women’s health, medical errors, gun control … the opportunities are immense.

And yet, on another level, it feels somewhat hollow to die-in together, to call our campuses to attention with powerful gestures, to feel the pride of a national movement … only to return to clinic or class an hour later, ready to resume our usual routines. We have the public’s attention, but now I’m tempted to follow up with a question I encountered too often as an Indian-American liberal arts major: “What are you going to do with that?” If social media is any indication, we grabbed the microphone for a moment, dropped it, and walked off the stage. That’s not social advocacy; it’s feel-good activism.

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In the days to come, we have to remember that raising awareness is a means to an end, but not an end in itself. It’s imperative that our objective is continuity, not complacency. We’re entering a discipline where our black and white patients’ life expectancies differ by five years. Where blacks have the highest rates of cancer, but the lowest rates of clinical trial enrollment. Where six percent of our colleagues are black. Where 70% of the applicants for NIH funding are white, and 1.4% are black. If we want to take action—to not just “raise awareness” of problems, but solve them—the social agenda practically writes itself.

As medical students, we chose this profession to help others—to make a difference. So let’s challenge ourselves to go beyond the “social activism” of fighting a disease by wearing pink, pouring ice water on ourselves, or sprawling out on a sidewalk. Let’s challenge ourselves to identify matters of race and social inequality within our communities, in our medical institutions, and at the bedside of each patient we meet. Let’s challenge ourselves to not simply “raise awareness” of the issues that are already trending in the media, but to take real, directly measurable actions to make these social inequalities artifacts of history.