This I Believe
I first learned about Doctors Without Borders, or Medecins Sans Frontiers, nine years ago when I was attending a trauma surgery conference in Canada. An Emergency Medicine doctor gave a lecture about his experiences providing healthcare in the mountains of Afghanistan during the war with the Soviet Union. I was finishing my residency training in General Surgery, soon to begin a fellowship in trauma surgery and intensive care medicine. His descriptions captivated me—the exotic locale, the life-saving procedures done with the barest of supplies in austere circumstances. I couldn’t imagine anything more interesting than operating under such conditions. I was just beginning of my career and the gore, blood and guts of surgery thrilled me.
I now practice both trauma surgery as well as what we refer to as “bread and butter” surgery—fixing hernias, removing gall bladders and appendices, operating on tumors of the breast and colon and thyroid gland. I’ve seen my share of shot up gang- bangers, bodies mangled in car wrecks, intestines perforated by tumors or infections. There have been days, and more commonly nights, in which I’ve had to throw away my blood-soaked shoes or slept with my hands under my pillow because I can’t wash off the scent of gangrenous tissue. I’ve celebrated with some patients and families, argued or cried with others. For the longest time, I thought I loved surgery because it was technically fun and intellectually challenging. I believed it was the act of doing surgery that fulfilled me and gave meaning to my life.
Last summer I was finally able to go on a mission with Doctors Without Borders. The context and location of the mission aren’t terribly relevant. Suffice it to say that I went to one of the many places on this earth where people don’t have access to the very basics of health care. As in most of these places, this is a result of conflict, greed and poverty. The population was just beginning to learn that it is reasonable to go to a doctor when they are sick. Many have never lived during a time in which they had access to a functional healthcare system.
Our team consisted of two surgeons, a medical anesthetist and nurse anesthetist—we came from around the globe: United States, England, Japan, France, Iraq, Austria, and Switzerland. We came and went like cogs in a wheel, carrying out the goal of the mission as best as we could: providing high quality surgical care to any one who needed it. We weren’t helping thousands at a time, like a vaccination program or clean water at a refugee camp might do. We treated patients one by one–people with bleeding ulcers, strangulated hernias, ruptured wombs and burned skin. Some of them we saved, others we couldn’t. I enjoyed improvising in the operating room, making diagnoses with minimal information, learning from the local staff how to manage problems I’d never encountered in my regular practice. The excitement and technical challenges were unending, and I thought I knew better than ever what I loved about surgery.
It was near the end of my mission that I had what one might refer to as a paradigm shift. It had the most unlikely beginning…
The anesthesiologist and I were walking back to the hospital after lunch. Picture the scene—a muddy street, chicken pecking in the dirt, overloaded, half-wrecked taxis speeding past, smiling children eager to say “hello” to the funny-looking foreign doctors… As we walked, he spoke about climbing a mountain in Switzerland. His description reminded me of the first time I had seen that mountain. We held out our arms simultaneously to show one another our goose bumps, present despite the oppressive heat, and tears came to our eyes. We acknowledged the power of those “perfect moments” in our lives—those instances in which everything seems right in our world. For some, it is at the summit of a mountain, for others, surfing a warm Pacific wave. Maybe it is as simple as finishing a race we’ve entered, or sharing a meaningful conversation with a loved one, a meal with a group of friends, or a soccer game on a makeshift field in West Africa. Perhaps it is as profound as giving birth to a child, easing a patient’s pain or helping someone die with dignity.
I haven’t been able to get the importance of those perfect moments out of my mind. I realized that sometimes I have them in the operating room—times when my hands do just what I need them to do and when the patient responds, moments when time seems to stand still and healing occurs. More important than what I experience in the operating room, however, is what I am helping to create—the chance for the patient to have another perfect moment. It’s not about the excitement, the technical challenges of sewing blood vessels or removing tumors; it’s about giving a fellow human being another opportunity to have goose bumps of his or her own.
This I believe.
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