I walked to work one day last week, something I fantasize about doing regularly in the future. I walked behind a little boy and his grandmother. He was probably 5, maybe a tall 4. She was probably 40, maybe a young looking 45. He had a superman cape on and those shoes that light up when you stomp. He clutched some nondescript glazed pastry in one hand, the kind you can get for 1.99 at the check out counter of 7-11. His other hand was holding onto grandma. Grandma was holding him tight in one hand, and swinging his batman backpack in her other hand. They weren't rushing, but walked steadily, with purpose. I walked behind them for about 5 blocks until they reached his school and we parted ways. She let go at one point and told him to run ahead and get his energy out before school started. Off he darted, happy to have some freedom. Her newly unoccupied hand reached for a cigarette which she enjoyed over the next few blocks, still swinging batman with her other hand. She caught up to him, put out her cigarette and dropped him off at school. His batman backpack looked huge on his wirey frame, but he darted happily inside the brick building. You could tell life wasn't perfect, but grandma loved him and he loved batman.
It was only about 7 minutes in total, but it reminded me of how valuable it is for me to be present and to live life in the same geographical and social space as my patients (another life long fantasy). There's more information to be gotten from that morning observation than from 10 minutes of diligent question asking in an exam room.
I thought about that kiddo the rest of the day. I wondered if he was hungry after the sugar rush wore off? I wondered if he had asthma, and grandma's smoking made it worse? I wondered what his home life was like? I wondered what he learned in school, and what was inside that big batman backpack? I wondered if he would get mislabeled as ADHD, or if stomping his feet to make his shoes light up filled him with feelings of security and magic powers, like batman, to face an imperfect world every morning. Kids are resilient, people say. But are they? Really? Look how many people grow up to have physical, mental, relational difficulties because of their childhood. That's not resilience, it's incubation.
A few miles away from that morning walk, and two years ago, I remember sitting in my hospital's lobby. This time, I was a patient, waiting for lab work. I had decided I'd go to doctors and deliver my baby at the hospital in which I worked. On the one hand, it was convenient. I was an intern with no time, and proximity and inside connections were gold. On the other hand, I knew all too well the flaws and messiness of my hospital. Sitting there in the lobby, it was pretty clear I wasn't the typical patient.
Similar to being a neighbor in the neighborhood where I work, being a patient in my own healthcare system was probably the best medical education I ever got. I learned about long wait times, frustrating insurance, chaotic offices, an overwhelmed hospital, and being surrounded by people who didn't look much like me. I pushed a baby out in a hospital room that was less than luxurious, yet had everything I needed. I faced my own sense of entitlement that things should work better for me!
But it isn't the humble environment or semi-chaotic atmosphere that I remember. It's is the deeper joy and importance of having my vocational, social, health, and geographical worlds collide. It is the deeper meaning behind having my baby delivered by a Nigerian, washed by an Ethiopian, and handed to me by a Korean. There's a peace that comes with being fully present- it overcomes awkwardness and social or cultural barriers. I've since delivered a few other babies in that same room, and each time had heightened meaning because of my own relationship with that space.
Live where you live, I've learned. Work where you live. Be where you live. Don't just see patients, be one. Don't just treat patients, live with them. It makes me a better doctor, to be sure, but also a better neighbor. We're all just neighbors in the end, aren't we?