2011 Humanism in Medicine Essay Contest
2011; Lippincott Williams & Wilkins; Volume: 86; Issue: 11 Linguagem: Inglês
10.1097/acm.0b013e3182323b17
ISSN1938-808X
Autores Tópico(s)Empathy and Medical Education
Resumo“Tienen un año.” “Lloran, lloran cada minuto.” “Twins, infant males aged 12 months; incessant crying,” I scribbled on the chart, in an attempt to sound doctor-like on paper. I looked up at the mother. Maybe it was the way that she held them—so closely, protectively, as though hers was the only protection they would ever need. Or the way that she smiled at their beautiful faces, with a love that hinted an edge of steel; one that should have suggested to me there was more at stake than what I could see. But I was naïve then, a new college student looking to explore tropical medicine in the beautiful Honduran Bay Islands while practicing my Spanish. The mother did not say another word, and I did not think to ask. Instead I referred to the steps on my printed-out pocket protocol, which instructed me to take the kids' temperatures, measure their head circumferences with my paper ruler, and weigh them on the scale in the back of the makeshift clinic. The children were terribly uncooperative, and their mother's coaxing could not get them to sit still on the scale. I gave one of them a stuffed animal to hold onto as I adjusted his position, but he threw it back in my face and resumed his crying. I glared at the boy, and he started shrieking. I panicked. Dr. L walked into the room just then, calm and unfazed by the sounds coming from the baby boy on the weighing scale. Dr. L approached him, took his tiny hands into his own and gave them a tight squeeze. The crying stopped. Dr. L then proceeded to weigh the boy, listen to his heart and lungs, and check for obvious problems. There did not seem to be any. He gently lifted up the boy, to see whether he would make any effort to stand up, but his tiny legs crumpled beneath him. Dr. L appeared concerned, but not terribly so—until he asked for the twins' charts. After seeing my handwritten notes, his face became grim, and he said to me in a quiet voice, “These boys are much too small to be a year old.” I did not know what that meant, exactly, or what we could do about it. Had I written down something incorrectly? Had the mother lied? Dr. L was quiet, purposeful, as he walked toward the cabinet and selected a box of Enfamil formula milk. He made up a warm batch right there in clinic, filled a small plastic bottle and handed it to one of the infants before going back to fill another for his brother. Meanwhile their mother's expression was a rather strange one: There was an anxiety in her brows, but also unmistakable relief. She wiped a tear from her eyes and looked down at her shoes. I looked at the infants. Their eyes were wide and searching; their bottles were already empty. They began clawing at one another and at their bottles, trying to extract more milk. And this time it was the mother—not the babies—who began to cry. It was a simple case of starvation. But a difficult case of pride. Beneath her nice-looking clothes and her leather handbag was a woman who had done everything she could to hide the poverty that left her children hungry each night. She worked all day at one of the restaurants where tourists would dine during their cruise ship stops on the island. The children's father had left her when she was three months pregnant, and since then she had been living with the twins in her parents' two-room apartment in Coxen Hole. She was accustomed to starving herself if it meant money to buy formula milk for her kids, but even then, it was impossible to ensure a permanent source of nourishment. She had stopped breastfeeding months ago, and she was getting by. She would not accept charity. She was a respectable woman, and that is how she wanted her children to see her. She was a good mother. And Dr. L had seen it. I simply saw a mother and her two children; Dr. L saw hints of depression, betrayal, resignation, and deep sadness. He saw pride, strength, and courage. In one of my first attempts at taking a history, I had focused on what I could immediately see and hear. He searched for the story behind the history, and found it with a warm, plastic bottle of milk. More remarkable still was how he dealt with the delicate situation of how to treat these children. Their mother had come in with a simple request: a medicine to make them stop crying all the time. Having carefully identified the underlying problem, and in a way that did not insult the children's mother, Dr. L had managed to save the children without slashing her dignity in the process. He turned toward the cabinet again, this time for a different kind of formula, one of lasting change. He removed all of the remaining boxes of Enfamil and placed them on the table in front of him. One by one, he packed them into a large plastic bag. He then jotted something down on a piece of paper and handed it to the woman: a note with the address of a women's shelter on the island, phone numbers of a financial counselor, and the phone number of a day care center for low-income working parents. Only then did he hand her the bag of milk. Anticipating that she would not freely accept charity, he placed a condition on the gift: “Take this milk as an investment. Nourish yourself and your children today, turn your life around, and reap the rewards of a happy, healthy family in the future. Don't hesitate to ask for help. And when both you and your children have become strong and healthy again, repay the gift by helping someone else in need.” With tears of gratitude, the mother thanked Dr. L and accepted the bag of milk. She lifted up her two children into her arms. After two full bottles of milk each, they had both fallen asleep. They looked beautiful—angelic, even. And for the first time in months, they were smiling. “Gracias por las sonrisas.” “Thank you for bringing back their smiles.” The Arnold P. Gold Foundation Humanism in Medicine Essay Contest The Arnold P. Gold Foundation is a not-for-profit organization founded in 1988 to nurture and sustain the time-honored tradition of the compassionate physician. Today, students, residents, and faculty at over 93% of medical schools in the United States and at medical schools abroad participate in at least one Gold Foundation program. These programs and projects are derived from the beliefs that compassion and respect are essential to the practice of medicine and enhance the healing process; the habits of humanistic care can and should be taught; and role-model practitioners who embody humanistic values deserve support and recognition. The Gold Foundation instituted the annual Humanism in Medicine Essay Contest as a way to encourage medical students to reflect on their experiences in writing. Since the contest's beginning in 1999, the foundation has received close to 2,000 essays from students at more than 125 schools of allopathic and osteopathic medicine. Contestants for the 2011 Humanism in Medicine Essay Contest were asked to ponder the following quote by author and social change activist Parker Palmer: “‘Good teaching cannot be reduced to technique; good teaching comes from the identity and integrity of the teacher.’ Write about your experience of how a role model taught or influenced the way you practice/intend to practice medicine (use personal experiences or observations where possible).” Winning essays and honorable mentions were selected by a distinguished panel of judges. For the tenth year in a row, Academic Medicine is pleased to publish the winning essays. These essays can also be found on the Gold Foundation's Web site at www.humanism-in-medicine.org/essaywinners2011. For further information, please call The Arnold P. Gold Foundation at (201) 567-7999 or e-mail: [email protected].
Referência(s)