The man in scrubs stands in the middle of the room. He has a blood-filled syringe in one hand and hand-written lab notes on the back of an envelope in another. He scans the room, looking for someone or something. I follow his gaze. A young man is curled up in a ball on the floor, rocking himself back and forth while groaning in pain (gangrenous wound on leg). A man is throwing all his weight on his wife and yelling in pain (renal colic). A woman is holding a piece of red, soaked gauze tightly on the hand of her screaming 7-year-old son (amputated finger). An older woman in a wheelchair is drooling from one side of her mouth and has a drooping shoulder (stroke). A young man, handcuffed to a police officer, has circular marks around his neck and blood dripping from his mouth (suicide attempt with hanging and ingesting barbed wire). A young woman sits limply in a wheelchair, eyes rolled back, and blood on her clothes between her legs (severe anemia – abortion days prior). In this room no bigger than my mother’s walk-in closet, the suffering is palpable and audible, but the man in scrubs does not find what he is looking for, and begins to walk out. Before he reaches the door, an unconscious man is carried in to the room (antifreeze ingestion). Without missing a step, he reaches over and gives the man a rough sternal rub to wake him up, to no avail. He exits the room.
The man in scrubs is the sole medical resident in charge of the stabilization and triage of incoming patients at this Emergency Department situated in a Low and Middle Income country. As a visiting medical student, I am wearing a white coat, and although I should fit in, my general ignorance about the majority of relevant things makes me feel like an imposter. I shouldn’t be here. I shouldn’t be wearing this white coat.
‘You! You can help me!’ exclaims a woman in a wheelchair as she reaches towards me. Her face is covered, but somehow I know that she is in pain. Reluctantly, and with as much grace as a fish on land, I walk towards her. I walk towards her knowing that the only care I can provide is a hug, a tear, or a smile; the only prescription I can write is a kind word, and the only order I can put in is a prayer to the heavens.
I came to medical school to gain the skills that I need to better care for my neighbors, to share moments of humanity, of suffering and healing with my neighbors, to be meaningfully curious – to ask and answer questions that benefit my neighbors and our community, and to use medicine as a platform to implement meaningful social change. The irony is, I see none of that now; all I can do is stand defeated as I watch my neighbors suffer. I watch because I don’t have the money to cover the 15 pounds admission fee for every patient that is turned away at the door of the ED. I watch because I don’t know whether that comatose child who was just intubated is in trouble because his stomach is inflating instead of his lungs. I watch because I don’t know if that medical student just injured that woman’s radial nerve while trying to get an arterial blood sample.
With tears in my eyes, I fumble out of my white coat and head for the exit. I’m done watching, I tell myself. I’m done watching and I’m ready to learn. I’m ready to learn how to care for the suffering. I’m ready to be a part of the change I want to see in the world. As the door of the ED closed behind me, I managed to catch a final peek of the chaotic scene, as if to tell myself, ‘I will return when I’m ready.’
Looking back, I wish I had kept my white coat on, even if just to care with a tear, heal with a kind word, and pray for the well-being of my neighbors.
Photo Credit: Alex Proimos
