As the train whistle pierced the air of the high Andean plateau, the herd of grazing alpacas wheeled away toward the jagged peaks off to the north. The great diesel engines roared to life, and I wandered back up the tracks, passing the crowd of first-class passengers haggling out final deals with the local merchants. Pausing to consider the global forces that brought such an unlikely mix together at this desolate 12,000-foot pass—wealthy and bejeweled tourists paying next to nothing for handmade alpaca goods, indigenous herders whose livelihood depended on that train's daily passing—I was torn from my musings by a sudden cry of panic. I spun around as one of the tourists, in a rush to return to her first-class seat, came tumbling down the steep embankment above the tracks, landing hard in a cloud of dust.
I pushed through the crowd to see the woman's bloodied face, and stepped in to assist as conductors whisked her onto a stretcher. Holding her neck stable, I soon found myself giving directions in Spanish as we lifted her up to the dining car. Here I was, a second-year medical student with limited EMT experience, the most medically qualified person on the train. Clicking into my best cool-but-adrenaline-charged emergency manner, I ran through the list in my head: airway, breathing, pulse, check the head wound, any other trauma? Level of consciousness? Señora, cómo se llama? Dónde estamos ahora? Y que día es? Sabe que pasó? She strained to answer through tears of fright, eyes darting from face to face in shock. As the train lurched forward, my stomach lurched with it to realize we were a half-day's journey from any semblance of a hospital.
Detecting no gross evidence of fracture or major bleeding—gracias a Dios¡—I turned back to the woman and was surprised by the terrified helplessness in her eyes. So as I'd learned years before, watching my father with his patients, I stopped and took her trembling hand in mine. I looked her in the eye and told her, slowly and calmly, that she had fallen but would be all right, todo estará bien, that I was there to help. As I wiped the blood from her face and cleaned the abrasions, her sobs began to subside, her breathing relaxed a bit. But she never let go of my hand.
After sitting with Marcia long enough to be confident she'd suffered no serious injury, I went back to haul my pack from coach class up to our first-class “infirmary.” My paciente was conversing softly with her Brazilian companions, who switched from Portuguese to Spanish and invited me to join them for a gourmet luncheon. Not about to turn down the best meal I'd had in weeks, I sat down to eat stuffed chicken and chat with the three women from São Paolo. They were embarrassingly grateful for what I'd done, insisting I stay for mousse and cappuccino—a far cry from my road regimen of nuts and instant cocoa! When they learned I was traveling alone, I found myself with three new Brazilian mothers, determined to spoil me all the way to Bolivia.
Hours later, a much-recovered Marcia called me to her side and told me she needed to give me something. I protested that she'd given more than enough, that I was just glad to see her healthy. But she was adamant, insisting that I had been there for her in a moment of great crisis. Removing from a chain around her neck a small golden pendant, she told me that it was her santo, her protective saint. Against my renewed objections, she pressed it into my palm and told me it was now mine, to wear on my own journey. By it, she said, I should remember the gran corazón de suramérica—the “great heart of South America”—and the undeniable goodness of people in a dark world. She read me the inscription—Fiat Pax in Virtute Tua, “Let Peace Come of Your Virtue”—and told me she herself had received the santo from her grandmother 40 years before. Stunned and speechless, I blinked back tears and stammered out a humbled gracias.
I looked back down the shining tracks to the setting sun, the glaciated summits burning in hues of crimson and gold. Awed by more than the view, I found myself wondering at the transcendent power of medicine, at the privileged trust given the healer. Just holding a hand could slice through barriers of class and culture and race, could tap into something fundamental and human.
Standing there in the dying light, I thought about the instinct to heal in my own family, from my father's quiet confidence as family physician to all those hands my mother had held as parish priest, and back to the enterprising spirit of the grandfather I'd barely known, who'd hopped freight trains west so long ago, an immigrant youth determined to study medicine in California. I remembered then the words my dad had written on a card he presented with my first stethoscope, marking my entrance into medical school:
“May you be guided by an ancient truth of medicine: To cure sometimes, to relieve often, to comfort always.”
And now I understood that quote for the first time. The pendant hanging around my neck, where that stethoscope would hang in a few short months, had not been given for my emerging clinical aptitude or my cool under pressure. What mattered to Marcia was not that I “cured” her condition—in fact, had it been more serious, I might not have been in a place even to “relieve” it. What mattered to Marcia, what moved her so, was that I brought some human warmth to her moment of broken vulnerability. What mattered was that I comforted her. I had no cure to give, and limited skill to offer, but I could hold her hand. And that, for her and for me, was healing.
The Francis A. Velay Humanism in Medicine Essay Contest Presented by the Arnold P. Gold Foundation
The Arnold P. Gold Foundation is a not-for-profit organization founded in 1988 to nurture and sustain the time-honored tradition of the compassionate physician. Today, students, residents, and faculty participate in at least one Gold Foundation program at 93% of our nation's medical schools and at schools abroad. Its programs and projects are derived from the beliefs that compassion and respect are essential to the practice of medicine and enhance the healing process; the habits of humanistic care can and should be taught; and medical role-model and mentor practitioners who embody humanistic values deserve support and recognition.
In 1999, the Gold Foundation instituted the annual Humanism in Medicine Essay Contest as a way to encourage medical students to reflect on their experiences in writing. Since the contest's beginning, the Foundation has received close to 2,000 essays from more than 110 schools of medicine and osteopathy.
Contestants for the 2006 Humanism in Medicine Essay Contest were asked to respond to the following quote from Hippocrates: “To cure often, to relieve sometimes, to comfort always.” Winning essays and honorable mentions were selected by a distinguished panel of judges. For the sixth year in a row, Academic Medicine is pleased to publish the winning essays from the contest. Although their essays will not appear in the journal, the Gold Foundation would like to recognize third-place winners Kelly Doran and Kate Nyquist. This year, three essays share the second-place honor; Benjamin Howard's appears here, and the other two second-place essays can be found on pages 1112 and 1114 of this issue. The first-place essay will appear in the December 2007 issue of Academic Medicine.
Winning essays are also published on the Foundation's Web site: (www.humanism-in-medicine.org) and in the Foundation's DOC newsletter. For further information, please call the Arnold P. Gold Foundation at (201) 567-7999, or e-mail: (firstname.lastname@example.org).