I am in the back of a van again. They let me sit here so I can unfurl my six-and-a-half-foot body down the aisle between the rows of seats. The dirt road is full of ruts and bumps, and a cloud of red dust whips up behind us as the driver navigates without a single road sign in sight. In Uganda, you either know where are you are, or you are lost. The health care providers around me gossip as we race the setting sun to our compound for dinner and some much-needed sleep.
We take turns telling stories from our past. Each gets raunchier by the mile, and we compete to see who can get the biggest laugh. Only five days earlier we met awkwardly at the airport, with only a few of us knowing any of the other members on our team. Now we discuss experiences from our lives that we rarely share with anyone else.
As one member of our team finishes chronicling her exploits across Europe with a heavy metal band, it occurs to me what an amazing experience we are having at that very moment. I interrupt the laughter to ask, “What do you think we would be doing right now if we had internet access?” The obvious answer is that this incredible bonding experience would be lost in a digital quagmire. The lush, green African landscape would be overlooked for the nonurgent, web-based dreck that has infiltrated our regular lives. The baboons leaping into the jungle and the children running out of huts to wave as our vans go by would be missed in Twitter rantings. Being forced to participate in the most basic human activity—talking with other humans—does not feel forced. It feels wonderful.
One of my objectives for this trip was to create personal bonds with great people who share a common vision for helping others, as I noted in a previous column. (http://bit.ly/EMN-Match.) This seems like an easy goal to achieve, but it can take years to really learn about the people around you at work. In many cases, it never happens. Hospital hierarchies can be more rigid than they seem, and time to really get to know non-physicians is often elusive.
But in the middle of a strange country with language barriers that limit our communication with most locals, our group members become fast friends. Breaking bread, long van rides to and from tiny villages, witnessing desperate poverty, setting up and breaking down clinics, and getting really dirty on a daily basis force everyone to go beyond exchanging pleasantries with the person next to him. We need to know everyone in the group because building trust within this ad hoc community is the only way to achieve the goals of our mission. With this trust comes personal stories, intimacy, and lots of laughs. It is the best thing our species has to offer. Our lives collide, and we overcome.
Residents in Arms
Many examples of similar group behavior can be found in sports, charity, community, faith, or even coming together for a few hours during disasters. Humans just drop the pretense and wonderfully coexist. Even more fascinating is that the greater the external pressure, the greater the bond. The term “brothers in arms” comes from soldiers connecting with each other under trying circumstances. Former warriors can burst into tears when they see each other for the first time in decades from the pure, unfettered emotion of their bonds.
Residency training is a similar experience. I watch a new class meet for the first time each July. They are always awkward and cautious, but I know that in 36 months they will have deep affection for each other. They will know each other's families, likes, dislikes, and political opinions. They will know each other in a way that no one else does because they have persevered together through one of the most formulating experiences of their lives.
But residency ends. Then what? Each graduate will move on, but subsequent professional experiences will never be the same. Eventually the excitement of the first days as an attending wears off, and days become routine. Like a romantic relationship, the intensity in the beginning can be intoxicating, but no one stays drunk forever. You have to find other aspects of that relationship to keep it meaningful, and this analogy will extend to your career as well. How will you find meaning in what you do to keep going for decades?
For me, it is going global. Stepping off a plane in a country for the first time is scary but exciting. Conquering those anxieties with a group of similarly minded folks intensifies the experience exponentially. I know international travel cannot be the passion of every EM graduate, but I do challenge all of my residents from their first day of training to think about what they will do in their career to maintain long-term professional satisfaction and to find others with the same interests to join them.
Dr. Cook traveled to Uganda with OneWorld Health. Find out about volunteering athttp://oneworldhealth.com.
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