A clean shaven face! He will be caned for sure, I thought. Men always grew their beards and women always covered their faces in public—that was the Taliban law in my village and throughout Afghanistan. How could this man ignore the Taliban and escape the ever present gaze of the morality police who walked around with long sticks and lashed at citizens for the slightest infraction? This man, dressed in traditional peran and tumbon (shirt and pants) clothing, walked with an unassuming gait. The villagers called him kharijee (outsider). I came to know him as the good doctor from America doing volunteer work with landmine victims. We worked together for a British nongovernmental organization; I assisted him with patients and translation. The organization was one of a handful still operating in Afghanistan; most others were harassed out of or banned from the country.
He was an orthopedic surgeon, a middle-aged man with slightly graying hair. Fit and trim, he looked younger than his age. He spoke with a soft voice full of confidence yet humble to a fault. Always polite, he exuded compassion through his still blue eyes. He left a busy practice in the States, traveling to this remote village long forgotten by the world to mend broken bones and, as it turns out, a broken soul.
During the Soviet occupation of Afghanistan, 1979–1989, many roads and villages were mined. Once placed, antipersonnel mines can last up to 50 years. Long after the Soviet conflict ended, the danger of mines persisted. One particular mine, descriptively called the butterfly because of its shape and size, caused the most killing and maiming among children. They mistook it for a toy. Millions of mines were scattered by helicopter gunships and infantry soldiers like a plague of locusts upon the land.
Not long after the doctor’s arrival, a villager showed up to the clinic carrying the flaccid body of his young daughter, who had picked up a butterfly mine. She was pure white, almost angelic, her soft skin broken by the intense red splashes of blood, her breathing shallow and agonal, her right hand blown off, her forearm a distorted jumble of flesh and bone as if dipped in red paint. There was urgency in the doctor’s voice as the young girl was brought in. He stabilized her and transportation was arranged to the city hospital for emergent surgery.
The operation was long, over 12 hours. The radius and ulna were shattered beyond repair. There were too many bone fragments and too little time to knit them all together. He amputated the distal humerus. Intraoperatively, the young girl developed coagulopathy with profuse bleeding. She was given PRBC, FFP, cryo, platelets, and DDAVP, and still she bled. The hospital blood bank was running out of products. Then without warning the bleeding stopped. The young girl made it through the operation.
As the weeks and months passed her stump healed, physical therapy strengthened her muscles, and soon she was fitted with a prosthetic arm. Whenever the young girl came to the clinic for follow-up visits the doctor became overjoyed. There was, however, a hint of melancholy in his eyes, as if he too had lost a part of himself in some remote past. I wondered if the doctor saw himself in the young girl, an innocence lost? That somehow her healing was connected to his healing. I wondered why he shaved his beard knowing that he could be caned. Was he, subconsciously, seeking atonement through punishment? What secret was he hiding, tucked away so deep, that no light could illuminate? Soon, my questions were answered.
It was a warm summer afternoon as we sat in the clinic garden under the shade of the mulberry tree. We were enjoying chai and naan (tea and bread) as the wind gently rustled through the leaves. I asked him why he left the comfort of his home and family for this dusty windswept village. He paused for a moment and uttered the words “to be of service to others.” While we were grateful for his help, I asked him, “Were you not serving people in America?” He paused again for a longer moment and started to tell me his tale. He had a humble beginning, working in a small town for a small practice. He honed his skills and developed a surgical technique that significantly reduced postop recovery time. Quickly, word got out and everyone wanted to see him. He moved to the big city, joined a famous practice, and was booked a year in advance. Slowly, his ego started to take over. He was, after all, famous now and he brought in the big money. He had fights with his colleagues and the office staff over trivial matters. He became distant from his wife, an absentee father to his kids. He lost everyone’s respect. He even lost his compassion, his empathy for his patients. His practice became a mere assembly line. He was rich, he was successful, he was famous, yet he was hollow on the inside. In short, he lost his humanity. One day he saw news footage on television about children maimed by landmines. Something stirred inside him; it woke him from the stupor he had fallen into. Thus, he came to my village in Afghanistan to be of service, to give of his time and skills, to be humble, to show compassion, to mend broken bones and in the process to mend his broken soul. When he finished telling me his tale, he took a deep sigh of relief as if an Albatross had been lifted from around his neck. In a soft voice he asked me, “Am I a good doctor?”
The next day, the young girl came to the clinic. She brought the doctor a sketch she made with her prosthetic arm. She was very proud of it. Drawn in crayon, in vibrant primary colors, it showed the doctor bandaging her arm. It was a simple token of her thanks.
The Arnold P. Gold Foundation Humanism in Medicine Essay Contest
The Arnold P. Gold Foundation was founded in 1988 with the mission of maintaining the balance between medical science and human needs by ensuring that doctors value and provide patient-centered care that is both compassionate and cutting edge. The Gold Foundation’s annual Humanism in Medicine Essay Contest was launched in 1999 in order to allow medical students to reflect on their experiences through writing.
In 2013, to mark the 13th year of the Essay Contest students were given the pair of prompts that were used in the inaugural Essay Contest: “What do you think are the barriers to humanism in medicine today?” and “Who is the ‘good’ doctor?” More than 300 students submitted essays which were reviewed by a distinguished panel of judges ranging from esteemed medical professionals to authors in the field of humanistic medical care.
The top 3 essays were selected along with 10 honorable mentions. Winning essays were published on the Arnold P. Gold Foundation Web site (www.humanism-in-medicine.org) and will be published in consecutive fall issues of Academic Medicine.