Hamza is a 3-year-old male from Gambia who presents in clinic today with a congenital heart defect, a Ventricular Septal Defect, resulting in a Left to Right shunt. He is currently on Capoten, an ACE inhibitor, and Fusid, a loop diuretic. His general appearance is well, and he appears to be in no apparent distress. Physical exam shows lungs are clear to auscultation, and displays systolic murmur in the lower left sternal border in the tricuspid area.
In clinic, this is how he looks to me.
On June 3rd, 2016, I took the last exam of my first year of medical school. Countless college-ruled papers, binders, keyboard clicks, and catecholamines later, I found my way to the “Submit Exam” button. With the push of my finger, with the touch of my mouse, these past ten months would be over, a written chapter finished, a milestone carved. Sudden relief nudged me forward, my second digit slowly pressing down, the green submission screen displaying, and just like that– I was one-fourth a doctor.
Now isn’t that an incredibly scary, responsibility laden thought.
To describe in one word, one sentence, even one blog post, what this year was is almost as challenging as it was reaching its end. I was stretched to my margins, to then be pushed through previously drawn borders, to then only demarcate new capacities, new outlines to stretch towards. But if I must make the description finite, I’ll say this– it was full. Full in every sense, full in every dimension. Full of inspiration, sometimes compromised by defeat, sometimes infected by self-doubt. Full of tired yawns, full of bitten nails. Full of empty, plastic Starbucks cups, full of late night Jimmy Johns deliveries. Full of mind-clearing runs, full of deep, relaxing breaths. Full of wonderful new friends and full of incredibly understanding old ones. Full of laughter, at times out of study delirium, at times to follow a few necessary tears. Full of knowledge, full of vision. Full of fear that reached every orifice, every vessel, every tissue. Full of sympathetic driven, pupil dilating, systolic contracting excitement.
All this to say that when June 3rd arrived, I was full.
But in some ways, I was empty. I knew so many things to be true. I knew I loved medicine, I knew it was exactly where I was meant to be. I knew I was incredibly grateful to be at a school that valued me as a person, not just as a student. I knew I had done well. I knew I had succeeded. I knew there was so much ahead of me. But I was tired. I had long ago snoozed my body’s alarm for sleep. I had long ago exceeded my upper limit of awake hours.
I knew all these things to be true. But I wanted to feel them again. I wanted to feel my passion, not just know it. I wanted to feel my dream, not just envision it. My year was truly remarkable, but I was tired. So incredibly tired. I felt as though I had little glucose left. I was building up lactate. I was running on second-grade energy. I was fueling on short-term storage.
So a few weeks later, I was on Delta Flight 466 to Ben Gurion Airport in Tel Aviv, Israel, en-route to the Holy Land to participate in Save a Child’s Heart’s (SACH) Medical Internship. At some point along the journey, a few hundred miles East, a few thousand feet elevated, I remember looking out the small, oval window to my left at a sight I had never seen before. Night was surrendering– its intensity subsiding, relinquishing its hold on the sky, letting Day claim its space in time, its place in space. I could see where Night became Day. I could see where dark became light. It was a remarkable sight, and in seeing this, I somehow hoped, in a perhaps slightly overdramatic way, that this was a small metaphor for the next two weeks. That light, that energy, would raise me back within my normal limits. That my spiritual lab results would return free from errant, red arrows.
And to my relief, Save a Child’s Heart has done that and so much more.
Remember Hamza, the little 3-year-old boy who opened this blog? I’ll tell you a little more about him, about Sanusey, about Iqra. I’ll tell you about Kaddijatouh, about Salma.
I lived with Hamza, and over sixty other people in the SACH house in Holon, Israel. When the Gett Taxi dropped me off at 16 Haviva Reik, I was greeted by over thirty children running and playing, buzzing and laughing. I was hugged by girls who did not know me. I was welcomed by boys who had never seen me before. As one of them grabbed my suitcase to roll in, a bag that was double his weight and twice his size, I giggled and eventually took over the handle. I walked up the ramp, and in front were hued panels sending red and yellow and green reflections unto the adjacent white columns. Instantly, I felt lighter. There was a simplicity in the air. There was a levity to the energy.
The SACH house is a once in a lifetime opportunity. I was a sleep away camp girl for the majority of my life. I lived in a sorority house filled with over 40 pledge sisters. I attended many overseas trips with close living quarters. But nothing has really compared to this–but really, what could? My roommates were not girls who I had known since age seven. My housemates were not Jewish friends with similar upbringings. They were not my classmates. They were not my age, my race, or my nationality. They did not know my home state. They did not know my mother tongue. And I, not theirs. I did not speak Swahili, I did not speak Amharic. I was not from their city, their country, their continent. I was not from their village. I did not cook their food. I did not dress their dress. I was just as unfamiliar to them as they were to me.
And yet, I smiled their smile. They laughed my laugh. Jambo was hello. Bed-time was kulala-time.
It’s a truly, beautiful intersection of communication, where language becomes secondary, where patience becomes paramount, where understanding becomes respect. I had to learn to communicate through gestures, through expressions. Or at times, I had to be okay with not communicating, with not understanding. With simply realizing she wouldn’t understand my words, that I couldn’t grasp theirs. I had to sit with just presence. To enjoy company in stillness. It was a remarkable thing.
We had to navigate around one laundry machine for sixty people. We had to schedule around few skillets for many hungry tummies. But no shirt went uncleaned, no stomach went empty. It all worked. We all managed.
Living in the house was incredibly unique, and the lessons extended beyond the blend of identity differences. I realized immediately how unique it was to live with “my” patients, to live with their training nurses, to reside with their doctors. In clinical practice, we see patients at scheduled times, we round wards at routine intervals, and our face to face contact with the people we care for ends there. I once heard someone ask, “But what about the care between the care?” What happens between doctors appointments, after working hours, after clock out? Where does the responsibility to our patients start, and where does our duty end? At the SACH house, we have the unique opportunity to not just observe and participate in the “care between the care”, but we have the incredibly special opportunity to know these children for who they are, not just what they’re admitted for.
So yes, I know that Hamza is a 3-year-old male who received open-heart surgery for a Ventricular Septal Defect. But this is who he is as a patient, this is not who he is as a person, as a child. It doesn’t take an internship to realize this, to understand that ailments and medical histories and surgical notes offer minimal insight into the depths of the humans we treat. But admittedly, we can get lost in facts. Science can blur us. Logic can narrow our philosophical insight.
But at SACH, I know Hamza loves to take the lead at clean up time, that he loves running around with a pink baby stroller up and down the ramp, up and down the front stairs. Even at a young age, he likes order and structure– he’ll be a stickler for rules.
I know that Muqadam has the sweetest energy, that amidst his failing eyes, that despite his harsh stridor, he loves to rest his head on your shoulder. He loves to eat his Bamba. I know that he loves apple juice. I know that every time he breathes in pain, that every time he whimpers, my heart aches a little.
I know that Kaddijatou struggled post surgery. I first met her in the pediatric ward, her thinned frame weak under the limp white sheet, her arms wrapped around her torso as she sat still in pain. I felt helpless, as I’d search for something to make her time easier. I helped her sip water in hopes for some small miracle that’d calm her body’s fight within her. When she was released and back at the SACH house, she’d sit alone. Reserved. Solemn. Her eyes would stare into a distance far away, into thoughts and memories and ideas I would never know, into realities I would never understand. But eventually she started smiling, just a little bit, but smiling nevertheless. She started doing math problems, adding and subtracting, multiplying and dividing. Before I left, she’d said a few words, she’d mumbled a few sentences. I hope she finds calm. I hope she’ll feel happiness.
I know that Iqra loves to do hair, that she loves running her fingers through my curls. I know that she loves to dance, laughing and giggling when we would wiggle to Justin Bieber. It is Iqra who made me wish most that I could speak their language. She was a growing girl, and I wanted to speak to her about growing up, about feeling empowered.
And then there’s Samira—the queen bee despite her young age, despite her two-foot frame. I know that Samira has a personality of fire, a strong energy that demands attention, that commands power. She’ll be confident. She’ll be brave. I know that she laughs when I dance, that she cries if Mama Samira is out of eyesight. I know that she’s sassy, I know that she’s a diva.
I know that Sanusay has the face of an angel, an energy you can’t help but fall in love with as soon as he smiles at you. I know that he loves playing with Muhammed and Hamza– that the three are a trio. I know that he loves playing with my stethoscope. I know that he loves talking to every nurse, every doctor. He’s a ball of laughter, but when he’s not feeling well, I know that he gets quiet and loses focus. When he came to the hospital for a catheterization and brought into the lab, I had to leave the room. I struggled seeing him cry into the unknown.
And then there’s Sadam. I know that Sadam loves listening to music, that he loves singing along to the tunes from his home country. I know that this calms him, that this eases his anxiety. Sadam is older than the others, older than the little ones. Sadam understands what’s happening to him. Sadam knows the gravity of broken hearts. I know he’s scared. I feel an unease to him. I see the maturity in his gaze. I see the unknown in his eyes. I know he fears dying. I know he’s fears life.
The SACH home is more than a cohabitation space, more than a transient shelter for boys and girls, moms and nurses, volunteers and interns, perfusionists and doctors. It’s an incredible intersection of culture and age, person and patient, healthcare professional and everyday human. We leave our scrubs behind. We put our stethoscopes away. I’m no longer a medical student. I’m no longer a student of science. I’m a friend. I’m an observer. It’s a beautiful reminder that our patients walk out of hospital halls, step out beyond office walls, into a world undivided by organ systems, into a world undefined by ailment. There is fullness to their lives. There is wholeness to who we are.