The following letter that Professor N. Benjamin Frederick, a family physician at Penn State/Hershey Medical Center, wrote to Penn State medical students, begins a new series on the Coastal Research Group website on primary care physicians and other health personnel, who contribute their time in service to those in need.
On Presence and Courage: A letter to medical students:N. Benjamin Fredrick, MD; Associate Professor, Department of Family and Community Medicine and Director, Global Health Center; Penn State University/Hershey Medical Center; Hershey, Pennsylvania.
Dear medical student,
On my first trip to Haiti I remember walking through a tuberculosis ward in Haiti with a short nun who absolutely lit up the room by her presence. She stopped at each man lying on his cot, took his head in her hands, moved her smiling face very close to his, and gave each one a morning greeting. They beamed right back at her. I walked along behind her and they reached out their hands to me, pushing their frail bodies up off the beds, and happily thanked me for “the sacrifice” I had made in visiting them. They were quite sincere. These were dying men. They had no options available to them.
Do you see how the nun was choosing to be present in that setting? I do not think we can overstate the importance of being present for our patients. I mean being truly present. What I’m saying is: you can wear the White Coat and still not be present with a patient while standing in her room. This is a choice we must make.
By being present we are being compassionate. You will see this in the examination room and in the waiting room and in the ER and on the floors of the hospital. The opportunities are all around us but we must take them. We must choose them. Choosing to be present with your White Coat–as a medical student and as a physician–is very important for our patients. Our presence in the midst of providing competent care is ultimately what our patients expect of us.
Several years ago my wife and I hosted some children from Haiti for heart surgery, performed at my medical center. We had no idea how that decision would change our lives. Since that point I have been traveling to a rural part of Haiti called Pestel, a very poor area on the same level of poverty as Sub-Saharan Africa. It is where Nelson lives, one of the boys we hosted for heart surgery. When Nelson arrived at our house in 2007 he was extremely thin and wasted.
I saw him in June of this year and he has grown to be almost as tall as I am. His mitral valve had been destroyed by untreated streptococcal bacteria that likely began with pharyngitis. Nelson did not have access to penicillin, and this is such a sad example of where a few pennies would have prevented a great deal of suffering and resources. In these situations we do not lack the knowledge to solve or prevent these sorts of problems. Something more is needed.
When I first visited Pestel I was struck by the great needs in the villages. I left the impoverished area faced with a choice of how I would respond to the needs that I saw before me. Were these people now somehow part of my responsibility? I also found, however, that I was immediately presented with an opportunity, one that could mean making a big difference for many very poor people.
The question was there: Would I respond to the needs that I saw, and if so, what might that mean? I decided at least in some small part to enter into their suffering and into their difficulties. In short, I decided that I was willing to be present with them.
If we walk away from something that might be our responsibility we may also be walking away from an opportunity to use our White Coats to make a difference, to make a positive change.
Let me explain: In Haiti some of the hardest times have occurred when I have had to stand by a person in great need and felt helpless. I could not help a 20-year-old girl who laid limp on her matt-bed. Having hemorrhaged for the prior two weeks since her miscarriage, she was going to die. She was a very pale young black woman, pale with a very thin, fast pulse. I felt incredibly helpless.
For those brief moments I was present with her and her family.
As I left this situation I came away indignant. I have encountered many similar haunting or maddening experiences during my trips to Haiti. I am not content or satisfied with the existing answers of why things are the way they are. I am beginning to see these issues as opportunities to make a difference. I am motivated to help improve the situation.
Now I must be honest: While I had a compassion for these poor people in Pestel, I lacked something. I lacked courage. This was not an easy decision for me. I am not a world-class traveler, I don’t enjoy high adventures or sky-diving. I prefer to sit at home, read my books, be with my wife and kids, and drink tea.
There will be times when we will need an extra bit of courage to put our compassion into action. You already have a level of compassion which is why you have chosen this path of becoming a physician. However, there will be times when you need more than compassion.
With the White Coat comes the expectation that we will always seek to do what is best for our patients. Fortunately for us, the White Coat is rich with a history of heroes and role models who have worn the coat before us.
The White Coat can provide us with that courage to be present, a confidence bolstered by a sense of duty to our patients.
Now this need for courage can take many forms. You may need courage for example to step into a difficult family situation—perhaps there is conflict between siblings over a parent’s end-of-life wishes. These are difficult situations. Or you may need courage to stand up for your patient when the system isn’t working for them—we typically view these as hassles or extra work.
In these cases you will be asked the same question: Will you be present with the patient, even if it’s difficult, or will you walk away?
The White Coat provides you the opportunity and it can give you that extra kick of confidence and courage. But you must still choose.
For me it meant choosing to fly to a remote part of Haiti and being willing to speak up for those who did not have a voice. I can tell you that it is not easy work, but it is incredibly gratifying work. Now, to my great surprise, I have found myself putting on my White Coat for a role that I did not expect: to seek an end to the suffering in Pestel, Haiti because I am convinced that the solutions are out there.
In return, I have been overwhelmed by the responses of individuals and groups interested in helping, organizations like Variety International, Heifer International, Water Missions International, Vitamin Angels, and most recently UNICEF. Together we are starting to make important differences for these folks. There is tremendous joy in receiving a million doses of free iron tablets for the Anemia Campaign now underway. There is joy in knowing that the parents in Pestel are thrilled with the results of the de-worming campaign. One family counted 106 worms from one child. We’re providing medical records to each child for the first time. We’re collecting data on cell phones instead of on paper, which is an exciting step forward. We’re reaching some of the farthest kids in the hardest to reach villages with medications.
All of this is part of my joy. The White Coat has given me both an incredible and life-changing opportunity and the responsibility that goes with it.
I urge you to consider using your White Coat to join with those in need. The White Coat can give you courage to put your compassion into action. We are truly very fortunate people with incredible opportunity. Many of these opportunities only come, however, when we choose to be present with those in need.
My hope for you, then, is that as you continue on your journey you will find great joy and satisfaction because by your presence you can make a difference.