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Desai, J.S. MPH

doi: 10.1097/ACM.0000000000001693
Teaching and Learning Moments
AM Rounds Blog Post

J.S. Desai is a Fulbright English Teaching Assistant; e-mail: He begins medical school in the fall.

Author’s Note: The name and identifying information in this essay have been changed to protect the identity of the individual described.

An Academic Medicine Podcast episode featuring this article is available through iTunes.

My brother Raj killed our father, but he is no murderer.

The sounds woke me up. I went downstairs to find my father’s skull battered. And I saw my brother, present in body but far, far away otherwise, standing over him. I restrained Raj, and I waited with him in my arms until the police arrived and threw us to the ground. I waited as they searched our home and I yelled into the grass that my father was still alive. I waited in a barren room in the local police station for my prayers to be answered and my father’s life to be spared. I waited an entire year before I spoke to Raj again.

A judge decided that Raj was not guilty by reason of insanity, and he qualified for a progressive release program at a local mental health center. Eventually, I too decided he was innocent.

My mother and I share the responsibility of taking care of Raj. The center provides therapy, medication, supervision, and the basic provisions essential for survival. But it is largely devoid of love and healthy interpersonal interactions. Raj gets three calls a day. During my undergraduate years, I often struggled with these phone calls. He was a poor listener and a selfish partner in our conversations. During visits, my mother and I would bring a lunch of his choice. We would also bring a box of supplies, such as soap, food, and music CDs, in an attempt to honor his desires and improve his quality of life. My mother has had nightmares about these boxes. And more than once, I have ignored his calls. I would remind my mother and myself to think of Raj as our patient. When frustrated, disappointed, or overwhelmed, I would remind myself that he needed us. Over the years, I have come to learn that I also need him.

Raj fights every day to manage his bipolar disorder, general anxiety disorder, OCD, schizophrenia, and ADHD in an effort to appreciate life and those he loves. He tells me that I matter more to him than life itself. That my happiness is his happiness. That if I do not want to talk to him or visit him, it is okay, as long as I am at peace. This past year, Raj asked me, “Do you still look up to me?”

Yes, Raj, I still look up to you. I think of the experiences, accomplishments, awards, and friendships I have accumulated in the years since Dad died. And I see how foolish it was to think that my successes made me better than you. The truth is that I could not have done it without you. I am sorry if I ever held the misfortune of your illnesses against you or forgot to be grateful for your love. You may be my first patient, but you will always be my big brother. You have both softened my judgment and made it keener.

Often, we judge one another without taking time to consider the complexity of each person’s narrative. We reduce people to what we know about them and deny them the opportunity to show us their pain. In building relationships with patients, I intend to be generous and resilient, for every clinical encounter involves not one but two healers.

I love a person whose hands bear my father’s blood. And I intend to bring this love to classrooms, clinics, and communities in the years ahead.

J.S. Desai, MPH

J.S. Desai is a Fulbright English Teaching Assistant; e-mail: He begins medical school in the fall.

© 2017 by the Association of American Medical Colleges