To the Naysayers

“Why would you ever want to be a doctor?” That’s a question I often get when expressing my career aspirations. In light of the recent health care debacle, I can’t say I blame them. The new reforms are expected to cut salaries and increase patient volume, all together submerging physicians deeper in politics and bureaucracy. Still, though, I stand firm with my decision, and here is why:

Burnt dust kicked up behind the motorcycle as we lurched through hills and valleys. Hoards of people gathered along the side of the road, shouting interchangeably “Muzungu (White person)! Jesus!” Our destination was Kayanga, a rural village located on the outskirts of Rwanda’s capital, where we would be conducting home visits for a local health center program. The first one – a thatched-roof, clay-brick shack – was no bigger than my dorm room, yet it housed eight individuals from at least four generations. Cautious stares followed me into the house. The only thing breaking the silence was the mother’s footsteps. Careful not to wake the child strapped to her back, she rested her hand on my own. The sight of her mangled, infected wrist revealed the source of a putrid smell. The contrast was striking – Black and white, wise and naïve, sick and healthy. Indeed, my skin color had become a proxy for my healing abilities, of which I had none. Never before had I felt more powerless. Without an able body, how was this woman to support her family? How could she manage an income if she couldn’t even bring her harvest to the market? How could an ambulance ever navigate its way up here, never mind finding the home? Putting a face to global health inequities was as much a sobering experience as it was a call to action.

Three years earlier, my story was on a quite a different trajectory. Nothing about my upbringing was remarkable – I hailed from a prototypical New England town, was raised by loving, middle-class parents, and enjoyed the typical trappings of American adolescence. On top of this, I was deeply insecure about straying from conformity. It was comforting to be in the mainstream, inside the proverbial “box.” The way I saw it, risk aversion was the most certain way to succeed. Deferring to structure, however, left me with little cause to think about who I was as a person. When questions about careers popped up, the medical field appealed most, not because of sense of calling, but because the road to becoming a doctor was already well-established. If I could simply run through a checklist of requirements, in ten year’s time people would be calling me Dr. Brewster.

This is not to say that my thinking was completely misguided. Something that has always driven my interest in medicine is the challenge of connecting the small, isolated constituent to its larger context. To truly grasp a scientific concept requires a deep understanding of the elementary components from which it was derived. And, the synchrony of these parts, from the atom through the organism, is what gives rise to the universe and its occupants. Unpackaged from all its hypotheses and experiments and data, I’ve been convinced that science is merely the framework to discover the wonder behind the mundane the profound behind the phenotype. The human body is no exception. We see it as sacred and immutable when in fact it represents the product of billions of years of tinkering. Even in its current iteration, it is in a constant state of dynamic equilibrium. Doctors have the privilege of engaging this miracle, and ensure that it continues to be just that.

What I failed to realize, though, was that the big picture meant more than just managing a network of biochemical reactions. The medical practice is unique in that it is both a science and a service. It should seem obvious that preserving health can be both subject to and a determinant of an individual’s political, social, and economic agency. Access to medical care has been declared a fundamentally human right whose realization is inseparable from a person’s capacity to thrive. Yet, it took working with the most vulnerable populations for me to finally connect health to its social justice imperative.

“!José está sufriendo una parada cardíaca!” were the first words I had to translate as a Spanish-English medical interpreter. “He’s having a heart attack!,” I quickly relayed to the doctor, a retired family physician volunteering with the Open Door Clinic. The patient was one of the 1,5000 Mexican migrant workers in Vermont. Without legal documentation, they endure highly restricted living conditions and are oftentimes deprived of their most basic needs. José had effectively waived his right to health in the name of productivity. His estatus illegal had rendered him nothing more than a commodity. And as a commodity, he was disposable. So, when his condition had prevented him from working for three weeks, regardless of the clinic’s treatment, the farm owner had no recourse but to dismiss him. As I learned that subsequent summer in Rwanda, José’s story was a microcosm of the gross inequities in health care delivery around the world.

For someone whose initial motives for a medical career centered on self-interest, seeing health disparity firsthand went beyond a reality check. It was humbling to know that I had benefitted from a global system that has caused the suffering of billions. It was, in other words, that sense of calling. I realized that I had an obligation to serve those most in need, to guarantee health as a human right where it did not exist. Doctors, unlike laws, are not answerable to rules or politics; instead, they are answerable to whether a given intervention is in the best interest of the patient. The German biomedical scientist Rudolph Virchow once described physicians as the “natural attorneys of the poor.” From the farms of Middlebury to the hills of Rwanda, one’s physical well-being necessarily governs social and economic rights.  Thus, doctors can leverage medicine to promote a more socially-driven agenda. I want to be such a voice because I believe empowering communities through health can begin to right the deep inequalities between rich and poor. I want to be such a voice because I believe that where there is health, there is opportunity. Being idealistic and utopian is one thing, but I am reassured by that simple fascination of mine – Everything starts with an atom.

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