"Son, I shot her in the face."
Most people probably can't pinpoint the moment they chose their career. I can, though. It was the moment - in a quiet, sunny courtyard on a July - that I heard an old man utter those seven words to me. He probably didn't realize it, but it changed my life forever.
Let me start at the beginning.
My personal statement for my American Medical College Application Service (AMCAS) application was adequate. It talked about passion for medical school in three dimensions - academics, research, and service. I had a nice story about a personal experience with mental illness in my family, examples of my dedication to service work in the community free clinic, and a short but detailed description of my basic science research in neurosciences. All in all, I think it was pretty good. And more importantly, it served its purpose!
But not much of that was the real reason I was coming to medical school. I had the experiences that truly defined my interest in the profession, but I was too young to understand their impact on me. I now realize that the real reason I am studying/pursuing a career in medicine is because patients are people. How did I come to this realization?
The summer before my junior year in college, I had the opportunity to work as a Patient Safety Aide (PSA) in a local hospital. For those of you who don't know, a PSA is wonderful thing. We exist to serve. Our technical description is essentially to replace restraints. My unit was filled with rather sick geriatric patients, and as you may know, they sometimes get confused and try to get out of bed, take out their IVs, and generally cause a fuss. Instead of using restraints, the hospital put aspiring students in various units to move from bed to bed, check on patients, keep them company, and occasionally play some games with them. I also spent a lot of my time with the nurses, and I really was eager to help (when I wasn't reading novels, anyway - I think that was a Harry Potter summer for me). I would help clean up rooms, get things that nurses needed, and I wasn't really aware of much going on around me. You may think that I really got to connect with the patients, because I was spending so much time with them, but this is entirely untrue. Unfortunately, most of the patients weren't too communicative, and many of them were rather confused about where they were.
All in all, it was a very pleasant atmosphere and a nice summer. But it didn't particularly make me want to go into medicine. Actually, what I saw was pretty discouraging. Patients looked like bags of meat with all kinds of tubes sticking in them. Really, that's what I saw - near lifeless sacks of flesh that seemed to be entities of suffering far more than of living.
One sunny, July day, I engaged myself in one of our additional duties. Some thoughtful clinician had realized that patients don't really like to be cooped up in their rooms all day. I gathered the patient up into a wheelchair to take them outside.
It was a gorgeous day outside, the kind of sunny day that just feels great in scrubs that you've only been in for a couple of hours. I wheeled the patient to the garden and breathed in deeply, enjoying the flowers and bathing in the relaxation of the moment. It was just me and this garden, and it was rather peaceful. "This was a pretty good summer," I thought. "This'll look great on my med school app and I can probably write about some meaningful experience I basically make up about how I saw a doctor really connect with a patient and ... what was that noise?"
The patient had started talking. It wasn't too clear, and I had to walk around in front of the wheelchair and kneel down. I got a better look at him. He looked like he was 80, beaten badly from the inside out, with the bruises showing through his skin, but I knew he was in his early 60s. And he was talking to me.
"Sir? I can't really understand you."
A little coughing. The coughing had actually gotten quite a bit better, it seemed like.
"I was in the war."
"Sir? The war?"
"I was about your age. I was with my boys ... a little girl was walking up to us. It was disgusting there. She was maybe 6 years old. She was pretty. So pretty. Beautiful face. Adorable. She was one of them, wearing rags and looking tired and confused, but she was a beautiful little girl."
"Sir? A girl?"
What was this guy going on about? Maybe I should be worried - maybe he is becoming delirious or something. Maybe this is why they have me here, for when this happens and he starts to think he is back in the war, what if he tries to stand up and fight me or something. He probably thinks I'm the enemy!
"Son, I shot her in the face."
"... Excuse me?"
"She was carrying a grenade. They had sent her to us with a live grenade. I shot her in the face to save my men. She was so beautiful ... "
That is when it happened. Patients became people. That was the moment, crystal clear in front of my eyes to this day and forever. This man looked like hell and lived with incredible amounts of suffering, but he did not live the life I saw. He lived a life of profound regret for that one moment in his life that happened when he was as old as I was. He possessed a profound clarity despite the chocking fog of his illness, and he was not delirious or demented. And he was a person.
I think I told that story in an interview at my medical school, with a student. I don't know why I started to tell it, because I really didn't think it was a good story to tell at an interview. I told that story, and I barely understood it or its impact on me. Three years later, with some more maturity and a bit more experience with patients, the meaning of that story is only beginning to set in. Those suffering patients in that hospital were not sickened, lifeless, unanimated meat. They were human beings in the most deep and spiritual sense of the word, and they lived those ultimately human experiences. Love. Pain. Regret. The question of whether or not they did the right thing.
I would be lucky to be that human, ever. And that is the real reason why I want to be a doctor. Because patients are people.
- Lakshman Swamy, MD/MBA Candidate, 2013, Boonshoft School of Medicine at Wright State
Originally posted on August 15, 2011