Damari Croswell finds the power to fight for disadvantaged patients by listening
This essay was written for the 2018-2019 HMS Dean’s Report in answer to the question "What was your most formative or memorable experience in your medical education at HMS?"
Growing up in an impoverished Chicago neighborhood taught me what it means to appreciate good health. I survived a childhood exposed to shootings, absent a proper education and plagued by sporadic food availability. Those experiences continuously reminded me of the fragility of personal health—and how powerful a gift it is to be able to fight to protect the health of those most at risk of having it shattered.
I entered medical school confident of my passion to advocate for impoverished patients, and my experiences since have constantly reinforced my goals.
It was thought that she relapsed on a four-year history of IV heroin use after a nine-month period of sobriety, during which she was also pregnant.
Like many other medical students, I was exposed to a number of disadvantaged patients during my clinical year and while taking subsequent electives. Also like others, I have continuously weighed how I can balance my interest in medicine and my desire to make the strongest contribution, with my wish to vindicate my passion on a daily, monthly and yearly basis.
As a medical student, it is easy to question, at times painfully, one’s value to a team and, more importantly, to a patient’s health. There are times when each day’s reach for impact feels further than the last. But I have found that, in many ways, we are able to make a significant impact on patients’ lives and on their health in ways that sometimes others cannot.
One particular patient stands out in my memory in this respect. During my medicine rotation I followed a patient who was admitted to the hospital for infectious endocarditis and for several other complications.
It was thought that she relapsed on a four-year history of IV heroin use after a nine-month period of sobriety, during which she was also pregnant. As many might be, she was highly defensive regarding the cause of her symptoms—so defensive that she almost never listened following the medical team’s first interactions with her and she threatened to leave the hospital despite being in poor condition.
During a break in the day, I had an opportunity to visit her room to update her on her case. Just after hearing my footsteps, but before seeing my face, she began swearing that she did not use IV drugs. Nervous and at a loss for words, I sat next to her bed quietly and listened to her tirade. When she finished talking, I apologized about the team’s earlier interactions with her and shared a story of a family member who had used drugs in the past but who had successfully remained sober for years following.
I told her, that despite all the evidence in the world, he was always accused of using drugs when he showed up late to anything, and how he ultimately found that his own knowledge in the truth was enough for him; that other’s accusations were irrelevant as long as they did not affect his health. Before I knew it, she and I were smiling, and we finished our discussion of her medical plan.
I do not know that I had any meaningful influence on the actual medical care for this patient; the choice of antibiotics, imaging and various other tests would ultimately have been the same whether I was there or not. But it is at times like these that I am thankful for my ability to empathize with disadvantaged patients. I have seen—and felt—what it was like to have the agency of your life stripped from you, leaving you at the mercy of your own environment. I believed then, as I do now, that those of us who are given the privilege of surviving hardship may be the ones most perfectly suited to fight for others so that one day they may be able to fight for themselves.
Every day I question my choice to go into a health profession. I constantly re-evaluate and re-examine whether I am finding a way to make an impact that is best suited to my stage in training. I have come to believe that this is what will determine my self-satisfaction as a future physician.
I truly feel that the sacrifices that were made to lift me out of my childhood environment mandate that I no longer simply act as an advocate of change for those who are vulnerable—but as an agent of change. For those reasons, I entered medical school promising myself that I would become a fierce physician.
I am now coming to understand what this means in the context of my story because poverty and its vices will always be a part of my past. Once I grew up as a victim of them. Now, I am becoming a fighter.