Essays

This piece is inspired by my work in women’s health as a medical assistant, working closely with patients and hearing their stories.

If compassion is a tree, then human dignity is the roots, self-awareness is the branches, and empathy is the leaves.

Of a tree, human dignity is the roots. Respect for human dignity must run deep throughout clinical practice, as roots run deep in soil. Without roots, a tree topples over; likewise, without respect for human dignity, clinical interactions sit precariously at the surface level. Without the respect for human dignity, one cannot recognize the gravity of clinical work. One cannot recognize that medicine, a means to address and improve health and well-being, is necessary because of the inherent value of life. Respect for human dignity deepens the interaction, bringing it beyond the surface to a level that acknowledges the intertwining moral, ethical, systematic, and social aspects of medicine. Compassion is rooted in the respect for human dignity.

Self-awareness is the branches. Just as branches grow because of the roots, self-awareness builds on the respect for human dignity by recognizing the provider’s role in the physician-patient interaction. Providers must practice self-awareness to acknowledge what they know and do not know. Physicians are not omnipresent, all-knowing beings. But, if physicians know what they do not know, they can collaborate with colleagues in their healthcare team who do know.

Furthermore, self-awareness should also be also cultural awareness. It means that providers recognize what identities they have and what they have experienced in their own lives; but more than that, providers must practice self-awareness to recognize what identities and experiences they do not have so that they can learn, listen, and appreciate all experiences and identities, especially those unlike their own. In this way, self-awareness leads to empathy, as branches lead to leaves.

Empathy is the leaves. Like leaves, empathy is the most visible part of the provider-patient encounter. It is what is felt. And emotions endure. Without empathy, words have meaning but not emotion. Empathy is not feeling for a patient, but is feeling with the patient. Commonly, leaves are often used to identify species of trees; leaves display the species of tree. Similarly, compassion is displayed through empathy to make patients feel recognized, seen and understood.

May we all have a deep respect for human dignity, a strong sense of self-awareness, and impressive empathy; may we all grow trees with deep roots, strong branches, and impressive leaves.

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ALICE TREUTH is a clinical research coordinator with the University of Arizona College of Medicine –Phoenix with hopes of going to medical school.

I wrote this piece about the summer I spent shadowing an OB/GYN who specialized in family planning, specifically in late-term pregnancy termination for fetal anomalies. My experience had a life-changing impact on my career goals and perspective on medicine. Some names and patient details have been changed in order to protect privacy.

“Is this much blood loss normal for this procedure?” The anesthesiologist’s tone was concerned as he turned to Dr. Tanya Jones, the OB/GYN I was shadowing. Dr. Jones frowned and shook her head, efficiently placing more and more gauze pads into the patient in an attempt to staunch the flow of blood. Adrenaline coursed through my veins as I watched a seemingly infinite sea of red surge past the gauze, pouring onto the pristine ground and covering the tips of my plastic-coated shoes. Frustrated, Dr. Jones asked for someone to call down to the obstetrics floor immediately for better equipment. In the past, she had always been able to operate on the floor dedicated to her specialty, where nurses, OR technicians, and anesthesiologists were intimately familiar with gynecology and support was ready at her fingertips. However, the third floor had been growing increasingly busy, and Dr. Jones specialized in late-term pregnancy terminations — procedures which many deemed low priority for valuable space in the proper obstetrics setting. As a result, Dr. Jones had been relegated to operating on the seventh floor, which typically housed orthopedic surgeries. I watched in awe as Dr. Jones remained cool and confident, calmly instructing the various members of the surgical team until they were able to control the hemorrhage and complete the procedure.

That day was my first in an operating room, and the terrifying image of blood spilling onto the floor is one that will be seared into my memory forever. However, tied to it is a recognition of the weight of the decisions made by doctors in quick, irrevocable moments, and the heavy responsibility those decisions carry.

Throughout the next several weeks, I continued to shadow Dr. Jones, following her not only through the operating room but to clinic appointments, Morbidity and Mortality reviews, and even to resident trainings. One afternoon, I accompanied her to a pre-op appointment for a young woman around my age.

“I can’t believe I let this happen,” the woman rolled her eyes and laughed self-deprecatingly, tucking her hair behind her ear. She spoke casually about college and sex, and exuded a poised self-assurance despite the potentially uncomfortable circumstances. Heavily talkative, she reviewed her medical history as Dr. Jones prepared a speculum, and I sensed a shift in her tone as her words became more heated. “Y’know, I went to someone else about this before I came to you. This doctor was an old man, nice and all, but very traditional.” She proceeded to explain how he had spent upwards of an hour shaming her for her choice to end her pregnancy, bringing her lifestyle and values into question and eventually refusing to perform the procedure. Dr. Jones responded with overwhelming kindness, taking the woman’s hand before, apologizing that she’d had to go through such a traumatic experience to get here. Continuing to speak warmly, she reaffirmed that this choice had no bearing on the woman’s personal character, and that she had every right to make a decision that she thought was best for her future. To my surprise, the woman began to cry, a grateful smile visible behind her tears. “Thank you. I had no idea doctors could be so nice.” Her words shook me to my core; I was aware that lack of access to safe abortions was a huge issue worldwide and had heard many horror stories of similarly prejudiced doctors, but I always imagined them taking place somewhere far removed from myself and my bubble of likeminded friends and family. This interaction induced a radical shift in my understanding of medicine — the need for compassion and genuine human connection was just as, if not more important than knowledge of physiology or chemistry.

This lesson was further mirrored in every patient I observed Dr. Jones interact with. While some patients were electing to undergo this procedure, for many others, this situation was agonizing. I was heartbroken for the 40-year-old woman whose IVF had finally succeeded, only for her baby to be diagnosed with a fatal brain condition, resulting in a recommended D&C. My chest ached for the woman who had traveled across the southern border to the US in order to receive better prenatal care, only to find that her twins had died in the womb. Every week, I was faced with unimaginable devastation, wrought upon a diverse array of patients each with a unique and deeply personal story. However, as I saw these women week after week — first for their pre-op appointment, then for their procedure, and later for their post-op follow-up — I noticed a near-miraculous trend. In their pre-op appointments, the patients were at some of their lowest moments, carrying heavy burdens visible in the droop of their shoulders or the crease of their brows. But at their post-op appointments two weeks later, while those weights were never completely gone, their load was always considerably lighter. The one thing these distinct patients all had in common was that, without fail, they returned with brighter eyes and bolder steps. I was blown away by the extraordinary strength of every woman who walked through the door, and the resilience they demonstrated in the face of unfathomable circumstances. Above all, I was struck by the compassion exhibited by doctors, the necessity of setting personal beliefs aside in order to preserve patient autonomy, and the deep impact of being able to share in one of the most intensely personal decisions of a person’s life. My experience that summer simultaneously challenged and inspired me every day, and I am forever grateful for and humbled by the chance to further develop my understanding of the beautifully complicated nature of medicine, the impossible, intimate reality of decision-making, and the absolutely crucial right to choose.

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BLAKE FELDMAR is a first-year medical student at the University of Arizona College of Medicine – Phoenix, where she serves as a co-leader of Medical Students for Choice. Born and raised in Los Angeles, she graduated from UC Berkeley with a degree in bioengineering in 2020. In her free time, she enjoys travel, scuba diving, musical theater, and spending time with friends and family.

I wrote this piece about a patient I encountered at my Community Clinical Experience during my first semester of medical school. When faced with a very emotional situation, I simultaneously struggled with my desire to provide support, my feelings of inadequacy as a junior member of the health care team, and the necessity of remaining reserved and neutral when my natural reaction was an overwhelming urge to cry. I explored this experience in the following piece.

“There is no heartbeat.”

There’s an old riddle that asks, ‘What is the only thing so fragile that you break it simply by speaking its name?’

I am tempted to say it out loud now, “silence.”

To sound out the S and the I and the L and let the two syllables roll off my tongue.

But right now silence doesn’t feel fragile. It feels heavy, like a thick weighted blanket. It is covering the room, sucking the air out and leaving no oxygen left to breathe as it presses down on four and a half pairs of shoulders and lungs and ears.

“The baby is dead. You are miscarrying.”

The woman blinks once, twice, again. Her eyebrows furrow in confusion as she looks at the ultrasound screen, where her fetus is still visible.

The silence feels like a balm then, wrapping her in its tender embrace, persuading her to let it soothe her just a little longer, just a little longer —

The silence does not break gently. It shatters with a wail, with hysterical sobs. The doctor and the nurse are now free of its shackles and they murmur quiet apologies, give embraces, repeat platitudes.

The silence does not leave me, though. I catch it as it flees, grab onto its tail feathers and latch on tight as it attempts to fly away. I keep it wrapped around me even as it flutters, struggling to break free from my iron grip. I keep holding it even as we leave the room, as the doctor discusses the next patient, as we move on to the next appointment.

She is my new companion, and she is louder than any noise I’ve ever heard.

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BLAKE FELDMAR is a first-year medical student at the University of Arizona College of Medicine – Phoenix. Born and raised in Los Angeles, she graduated UC Berkeley with a degree in bioengineering in 2020. In her free time, she enjoys travel, scuba diving, musical theater, and spending time with friends and family.