I am at the point in medical school that I can forget how strange a place the hospital is. Most days, I pre-round around 5am and I leave as the pink and gold of sunset reflects in the windows of the inpatient tower. I no longer smell the antiseptic that pervades the air. I write my notes oblivious to the announcements of “code blue” or “stroke team activation” playing over the intercom. When I walk through the hallways, there is purpose in my strides. The core clinical rotations that every medical student undergoes (family medicine, surgery, pediatrics, etc.) are a time for exploration and the forging of identity. We learn: This is how doctors act and react.
Read moreCostumes: What a Plague Doctor Wears to Deliver Care by family physician Carla Barkman →
This past Halloween, I rewatched The Rocky Horror Picture Show and thought about costumes. Who here is truly in disguise? Is it Frank-N-Furter with his heavy eye makeup, corset and garter, or Janet and Brad with their buttoned-up blouses, white doll shoes and matching purse, who come alive only after they are stripped to their underclothes and made up, for the final performance, in drag? Sometimes we dress up as monsters, but perhaps more often we hide our quirky selves beneath bland cloaks of conformity, afraid of the attention an unusual performance might attract.
Read more“A Line Blurring Joy and Grief”: Empathizing from a Distance, by Daniel Ginsburg
How do clinicians carry on their vital work without bearing the grief of patients and their families, yet still comfort them?
Read moreOn “When Suicide Speaks Arabic”: A Deeply-felt Call for Cultural Representation in Medicine by Sunidhi Ramesh
A suicide attempt. A Syrian teenager. A team of American psychiatrists whose training suggests he is out of the woods. But, to Dr. Ibrahim Sablaban, something does not sit right. The son of Arab refugees, Dr. Sablaban sees hidden red flags in the teenager’s story.
“When Suicide Speaks Arabic” (Fall 2020 Intima: A Journal of Narrative Medicine) is a story of quiet compassion. It is a story of intuition born from upbringing—of a physician who sees a slice of himself in a patient who is in need of understanding.
It is also, at its core, a story about cultural representation. Dr. Sablaban instantly connects with his young patient by speaking in Arabic (citing that he had “already heard [the] story in English, and from [his] experience, it could be a distant language”). He is able to parse out the boy’s feelings of shame and sinfulness by referring to his own understanding of the Islamic faith. This was not at all the patient he had heard of earlier during rounds; this “was a tragedy waiting to happen.”
Dr. Sablaban’s story of connecting with and ultimately facilitating better treatment for this young Syrian boy can be viewed as a stroke of luck—a happy encounter and a happy ending. But he ends his piece with a striking sentence: “I can’t help but feel like it was more a story about failure than success.”
And it could be made out to be that way. Many knowledgeable and experienced physicians spoke to the patient before Dr. Sablaban did. Yet, it was his cultural knowledge, not his medical knowledge, that ultimately helped this boy.
Some sobering statistics: 0.4% of US medical doctors are Hispanic, while Hispanic individuals make up 17% of the American population.1 4% of US medical doctors are African American, while African American individuals make up 13% of the American population.1 Similar statistics hold for the majority of minority groups throughout the country. This lack of racial representation in medicine is widely cited, and efforts (albeit small ones) are underway to address it.2
Dr. Sablaban’s story, however, is about more than racial representation. Race is not equivalent to a language. Or a culture. Or religion. Race is not at all encompassing, and racial representation would not have been enough to fully address this teenager’s needs. Perhaps, then, there must be an adjustment to the discussion about diversity in medicine—about the need for physicians who “look” (i.e., race and gender) more like the population they are serving.
Perhaps the need is for physicians who simply are more like the populations they serve—who speak the languages, practice the religions, and have had the experiences that their patients face every day.
References
1. Sullivan, Louis W. Missing persons: minorities in the health professions, a report of the Sullivan Commission on Diversity in the Healthcare Workforce. 2004.
2. Cohen, Jordan J., Barbara A. Gabriel, and Charles Terrell. "The case for diversity in the health care workforce." Health affairs 21.5 (2002): 90-102.
Sunidhi Ramesh is an MD Candidate at Sidney Kimmel Medical College at Thomas Jefferson University. She graduated Phi Beta Kappa from Emory University in 2018 with degrees in sociology and neuroscience and is the managing editor of "The Neuroethics Blog." She has also served as the education co-director for the Philadelphia Human Rights Clinic. Ramesh’s writing has been featured in Stroke and Vascular Neurology, Retina Today, and the American Journal of Neuroradiology. She authored the Winning Essay in the 2019 International Neuroethics Society Essay Competition and has written chapters on neuroethics and neurotechnology in various textbooks. Ramesh works on research spanning neurology and neurosurgery, particularly focused on perceptions of invasive brain surgery, intra-arterial chemotherapy, and the implementation of tele-stroke protocols in hospital emergency rooms. Her non-fiction essay “3:43 AM” appears in the Fall 2020 Intima. @sunidhiramesh
A Physician's Response in an Emergency: Humility Complements Competence by Rachel Fleishman
Watching a medical emergency as a physician who is not functioning as a leader or caretaker unearths discomfort, a mingling of denied identity with humility. And it is from this vantage that we can harness the power of narrative medicine to create space for reflection, to make sense of medicine and how it unfolds.
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