This thing you’re gonna do – almost no one’s gonna get it. Why are you going abroad? Why are you exposing yourself to TB? HIV? Living in a house that has water sometimes? Going to a country you don’t understand the language or heritage of? Aren’t there enough poor people in America for you? These things I expected. This I’ve encountered my whole life – I’ve been brushed off as an idealist, patronized as a person early in my career who would “grow out” of my foolish notions and settle into a more practical, picket fence version of life once the benefits of the society I was born into permeated my silly, young skull.
What I didn’t expect was to return and feel like a stranger in my own home. This thing you’re gonna do – it’s going to change you forever. It’s going to change who you are as a doctor – but it’s also going to change who you are as a friend, mother, father, sister, neighbor, patient, consumer, employer – it’s going to change everything if you let it. If you live in that place and not just on it. You will be haunted by both your actions and your inactions. You will bear that weight of what “physician” really means for the first time – bear it in a way that most of your colleagues won’t understand because they have always had a safety net, they have always had more each other. You will celebrate with your kids in complete joy when, against all odds, they defeat illness ... and you will cry in humble defeat at the feet of deceased children you thought you could save. You will learn to trust your judgments.
You will change – you will evolve from someone whose seen a handful of kids die to someone who understands the reality that there are only so many resources, only so much time you have that can be spent in this hospital day in and day out, and you will triage your hospital ward into acceptable and unacceptable losses. You will fear to speak this reality out loud because something about it feels like the betrayal of unspoken American ideals - never give up the fight, there are no acceptable losses. Something about it feels threatening to your humanity – but this is the reality of the present even if you are striving towards a different future. You will come to see loss differently and understand that death is not always an enemy – that there is grace and beauty in dying well, in the courage it takes to love your baby enough to sing him a lullaby and rock him in the hours before his heart stops instead of shoving tubes and lines into him. You will be frustrated by your limitations both personally and logistically. You will be angry that children are dying of things we’ve been curing or preventing for at least half a century. You will find fulfillment in the knowledge that what you have done today is important, that you did a job no one else could do, that you fought the injustice of children dying from pneumonia, malnutrition, diarrhea... You will experience self-doubt wondering if a history, physical and educated guess were really ever taking you in the right direction – if one of those people, one of those people who chose not to show up here, could’ve done it better. You will bear the burden of speaking dark truths into reality, watching people’s world shift beneath them and try to help them re-equilibrate. You will have the privilege of watching them thrive and flourish in adversity and you will cry with them in the moments neither of you can see past the obstacle ahead; and then you will look forward and try to find where to go next. You will see that you alone are not and cannot save anyone, but we are saving each other moving one small step at a time in a better direction.
You learn that to love people you also have to love yourself – that you cry with them and then somehow have to come home and keep living your life and that that doesn’t cheapen their loss. For most people, when someone dies the whole world changes – but you must learn to honor the change in the world, to recognize the life – but also to accept that your life continues and that your happiness on a day of tragedy does not tarnish your soul. You embrace the reality that all of life is this mingling of bitter and sweet, loss and joy, life and death, healing and suffering, living and dying well, loving and mourning... and somehow living in the raw reality of both mourning and rejoicing well makes life intensely vibrant, worth living and worth fighting for. Worth every moment in the best, worst days you always never want to live every day again. Every day again.
-Jennifer Werdenberg, M.D.