Resident Physician Contributing Writer
McMaster University Faculty of Health Sciences
Kevin Dueck is a Family Medicine resident at McMaster University’s Brampton site. His interests in the health humanities include medical narratives of illness and care, exploration of medical culture, and the history of medicine. Kevin is the author of the blog Aboot Medicine and co-founder of the undergraduate medical student wellness project Western Vitals (http://westernvitals.ca/).
“Daddy, time to wake up! It is morning time!” I open my eyes to our four-year-old daughter at the foot of the bed smiling, her hair meticulously braided. I get up and wake her younger brother from his crib and carry him downstairs. The baby is still sleeping.
“Bunny!” my mom shouted from the foot of the steps, hurrying me out of bed the morning after my medical school graduation. She used the childhood nickname that came from my brother who was unable to pronounce “Dominic” as a toddler, a name that had stuck well into adulthood.
The word “gestalt” is thrown around constantly during medical school, residency, and beyond. Although never specifically taught, we all develop an idea of what gestalt means — impression, clinical intuition, gut feeling, something we are meant to develop over time.
I knew what was coming before it happened. She was looking up at the ring of white coats encircling her hospital bed, eyes darting from side to side to follow the sequence of their voices when suddenly, her lower lip began to quiver. And with her quivering lip, her breaths came faster and she sucked in deep gulps of air between her pleading questions. But soon the pack was headed on to the next patient on rounds. She was left alone, and the tears rolled freely.
I was one of only eight African-American students in my medical school class of 214, and now I am a part of the less than four percent of African-American physicians in this country. My personal and professional experiences have further invigorated my passionate interest in public health and to explore effective strategies to reduce health disparities for minority populations in the United States.
As we discharge another patient from the intensive care unit, we celebrate a job well done. “Can you believe how far she’s come in the past few weeks?” or “I didn’t think he would be able to go home so soon.” With the use of modern technological advancements, we are able to bypass the heart and lungs of patients, and push the limits of life to as early as 22 weeks gestation.
She was talking to another attending when I recognized her voice from around the corner. As a third-year medical student, I wanted to look busy, so I moved briskly, avoiding eye contact, trying to make it seem as if I were headed somewhere important.
One of the most poignant and gut-wrenching examples I’ve witnessed of the interplay between the social determinants of health and clinical practice arises in a particular patient population: those who suffer from addiction.
Ana sits on the exam table in front of me explaining how, in three short weeks, her mother will evict her from her childhood home. She is eight months pregnant and is studying night courses to become a paralegal. As her prenatal provider and primary care physician, I have been sending referrals to numerous community agencies in hopes of securing housing at the local YWCA.
Health and wellness are more than a simple product of access and initiative, as such a simplified formula is only enjoyed by a very small minority. The equation becomes more complicated as new factors enter, such as unemployment or housing insecurity. Despite their importance as determinants of health, such elements are seldom addressed in the medical interaction between patient and physician, and are thus discarded in the interest of a perceived efficiency.
As a child of immigrant parents, I had limited exposure to the American military. Ironically, my sole memory of the American military exists outside of America — in Japan. I spent part of my childhood in Tokyo and fondly recall the excitement that came from visiting the American Naval Base in Yokosuka to buy “American groceries,” specifically Eggo waffles.
The below poem was written during a weekend away in Indianapolis. I watched an apparently homeless older gentleman sitting outside a coffee shop for several minutes while I read. It was a generous reminder that our patients should be seen in their environment and not only in our own, with fluorescent lights and temperature control. We all have different backgrounds and life circumstances and drastically effect our behaviors and choices.
Resident Physician Contributing Writer
Medical College of Wisconsin
I'm originally a Mountaineer from the hills of West Virginia. I love football, animals, reading, running, and exploring with my husband and daughter.
