My Patients Help Me Belong

IMG_9498Shohinee Sarma
McMaster University
Class of 2016

One Kashmiri morning in the early spring of 1915, my grandfather Aadam Aziz hit his nose against a frost-hardened tussock of earth while attempting to pray. Three drops of blood plopped out of his left nostril, hardened instantly in the brittle air and lay before his eyes on the prayer-mat, transformed into rubies. Lurching back until he knelt with his head once more upright, he found that the tears which had sprung to his eyes had solidified, too; and at that moment, as he brushed diamonds contemptuously from his lashes, he resolved never again to kiss earth for any god or man. This decision, however, made a hole in him, a vacancy in a vital inner chamber, leaving him vulnerable to women and history. Unaware of this at first, despite his recently completed medical training, he stood up, rolled the prayer-mat into a thick cheroot, and holding it under his right arm surveyed the valley through clear, diamond-free eyes. (Salman Rushdie, Midnight’s Children)

I wish I could write like Salman Rushdie. I have always found the above passage beautiful and every time I read those lines, they somehow strike a chord. In a few powerfully packed sentences, Rushdie portrayed a young medical student’s conflicts of identity. Dr. Aadam Aziz returns home to Kashmir, India after completing his medical training in Germany. His worldview is changed, he is changed, but his homeland in his perception remains unchanged.

Identity, culture, migration, transitions are such complex topics. Moving back to Canada to start my medical school training seemed like a wise choice to make. I had been warned about the difficulties of medical school: the endless studying, the physically demanding hours, and the emotionally draining patient encounters. Living at home with the guidance and support of my parents would ease these transitions. But the journey back home along with the transition into medicine has not been easy.

In some ways, Canada is my home. I have lived here for thirteen years, experienced the highs and lows of a North American education here. Those formative adolescent years were instrumental in defining my adult identity, yet I retained vivid associations with my Indian childhood. I attribute my childhood in India as being greatly responsible for my interest in medicine. Growing up near rural and urban public hospitals made me realize that I wanted to work with complex indigent populations one day.

The past few years have been spent traveling and gaining new experiences in other countries. We are all a product of our personal experiences, and the people I met, the conversations I had, and the decisions I took, all lend themselves toward the type of medical student I am today.

The most important thing I have learned from these experiences is this: that each person is a set of unique narratives that cannot be encapsulated within a single framework of identity. We all have our stories to share. It is these stories that distinguish people - not age, ethnicity, or geographical status, or even a medical diagnosis.

I have tried to approach my initial months of medical training with this mindset. My patient histories have often been less focused and more rambling. I have struggled with getting the appropriate answers because one question leads to another and I get caught up with a patient’s story. The stories are often fascinating, some disturbing, some lead me to better understand why the patient presents with a particular ailment, but many times they do not. I still let the patient talk.

I know that eventually my medical training will require me to interrupt a story, to ask more focused questions, to tease out the most relevant patient information. I know that this approach is more beneficial to the patient in the end. But in these initial months of training, I want to hear the human experience beyond the scientific pathology. I want to know why one patient with obesity-related chest pain exercises more than two hours in the bitter cold everyday, whereas another similar patient has given up. I want to better understand what drives one patient with shortness of breath and chronic cough to quit smoking, yet a similar patient continues smoking immediately upon discharge. Perhaps the answers to these questions are not relevant, but I strongly feel that hearing these stories will make me a more informed physician one day.

Perhaps part of it also stems from needing a sense of belonging to a community of patients that does not feel like home. Hearing the stories of people growing up in this community is one way of creating a dialogue with the community itself. Perhaps if I continue to listen, to care, to ask – perhaps one day I can bridge this gap and feel at home once again.

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