Op-(m)ed ran the “Primary Care” contest in March 2018. We are excited to announce this piece as an honorable mention.
My very earliest memory is my dad beating my infant sister with a wooden spoon. I knew I should be in bed, but instead I crawled quietly along the dark, carpeted hallway towards the kitchen. There, under the weird fluorescent lighting, my mom sobbed and begged him to stop. I couldn’t understand why she didn’t seem to be doing anything. Why didn’t she stop him? My sister screamed, her face purple with the intensity of her shrieks. I crawled back to her room and hid under her crib, waiting for her to come back.
For the first five years of my life, I would often wake from horrible nightmares, screaming in fear.
Thankfully, my mom left with my sister and I when we were five and three. We ended up living in severe poverty, but my nightmares stopped and I was generally happy. I remember my mom borrowing my allowance to buy food. I remember eating a lot of pancakes for supper because that’s all we could afford. I remember waiting in line for our charity turkey at Thanksgiving.
My mom remarried when I was six and we moved into a paradise compared to “the old apartment” (what my sister and I called our first home after leaving my dad, where we would see blood outside when we got up in the morning and broken windows from late-night fights). Our new home was in a good, honest, working class neighborhood full of painters and plumbers and cleaning ladies and daycare workers. Our house had golden-hued solid wood floors that shone in the sunlight from the patio door, which we never had to worry would be broken when we got up in the morning.
Shortly after the move, while playing in my mom’s basement, I found the court documents containing our full medical records and I realized that our doctor’s office had known exactly what was going on at home. The nurse’s tidy printing mostly made sense but I couldn’t read the scrawling handwriting of the doctors. I didn’t need to read the words, though; I sat stunned, staring at the photographs stapled into our charts. Photographs I don’t remember being taken. Photographs of my sister and I wearing nothing but underwear, covered with bruises.
In the backseat of the car driving home from seeing our new pediatrician, I told my mom that I wanted to be a nurse when I grew up. She replied, “Well, you could be a doctor.” I thought about that. The doctor knows what’s really going on in people’s lives and can help. And a doctor can support her family and never find herself in the situation my mom was in. I decided right then that I would be a doctor. And from the beginning, being “a doctor” meant “being a doctor who cares for the family and gets to know them on a deep enough level to be there for each family member.”
I decided that to be a doctor, I needed to learn as much as possible about as many things as possible. Our doctors always seemed to live in a different world from us so I needed to be a doctor who understood everyone’s worlds. Anytime I had an opportunity to try something new, join people in their own world, I took it. It was such a habit that when I was 18 and my boyfriend mentioned that he was going to a truck stop to see an old friend of his grandpa’s who was driving through, I insisted on coming along because I’d never met a cross country truck driver or seen how they live. My boyfriend’s family friend had a great time showing me how he stored his belongings and discussing the loneliness of the highway life and the difficulty he had in managing his blood pressure on a truck stop diet and no exercise. It was conversations like these over the years that taught me that if someone’s medical problem isn’t controlled, the two critical steps are making sure the patient truly understands their condition and making sure that I truly understand the patient.
I was able to go to a good private university on full scholarship for undergrad and felt horribly out of place. I studied hard for my MCATs, told this same story in my personal statement, and received an invitation to an interview at the only school where I applied. I had never owned a suit in my life or personally known anyone who wore them except the elderly professors in the stodgier departments at my university. I wore a button down shirt and slacks to my med school interview and was so embarrassed to be dressed differently than the other applicants that I wouldn’t take off my coat, which was at least black wool and fairly respectable. But I got my acceptance letter and finally knew for sure that I would be a physician, something I had been working towards since that car-ride conversation when I was six.
I loved every rotation, from surgery to psychiatry. When people asked me why I was going into Family Medicine, I’d just say that I enjoyed everything, so I guessed I’d just have to go into Family Medicine so that I could keep doing a little of everything. Which is true enough. But this story is the real reason I went into primary care and it is the reason that I am passionate about my call to know the truth about my patients and care for each of them on a deeper level. Primary care is profoundly intimate care of the whole person and the whole family.
The author is a female family physician working with an underserved urban community in Colorado.