Attending

I just finished reading Attending by Ronald Epstein. In this book Dr. Epstein talks a lot about having presence as a physician. Presence here being more than physical, but emotional, intellectual, and “spiritual” as well.

As I’ve mention in a previous post, I received this book from a mentor and friend of mine who I met through Doctors Without Walls. When I started volunteering with the organization, I really knew nothing about street medicine or people experiencing homelessness. As the story goes, after a few weeks I fell in love with the organization and the people I met through it, patients and volunteers a like. For a long time I wondered what it was about those first few clinic days that made such an impression on me and inspired me further to go into medicine. I feel like I always had an idea and this experience is something I have written and talked about numerous times in applications and interviews, but it was always kind of vague. I would talk about how I was inspired by the team of volunteers and was motivated by compassion towards the patients, but this book has given me new language to talk talk about this experience more specifically.

What impressed me most all those years ago was the presence of the volunteers. Working in street medicine, not only benefits from, but in fact requires you to see a patient as a whole person. If you plan to have any level of success in treating someone on the streets, you have to know their whole story; where their from, where they sleep, what they do during the day, who they hangout with, what they know, what they don’t know, how they get around, where they get money, what resources they utilize (or don’t utilize), etc.

One could argue these are all things that should be a requirement for working with any patient, but I think when working in clinics or in specific environments, a lot of these factors can be taken for granted or are deemed socially inappropriate to talk about. And why I think it was hard for me to articulate all of this before is because when my senior volunteers were present with patients, it felt so seamless and natural that it didn’t feel like anything special was happening, which is ultimately what made those interactions so special, it was just a conversation.

This is the exactly presence that I think Dr. Epstein is talking about and that which he proposes we bring into all settings as healthcare providers, as physicians (who are stereotypically lacking in this area, at least in recent history), and just as people.

I feel extremely fortunate to have had such amazing examples of this presence prior to starting medical school, one of whom passed away this past week. So this goes out to you Fr. Jon, a beacon of compassion and a truly unforgettable presence.