Heart of a Doctor
Wednesday, June 26, 2013
This column is supposed to be about various topics in public health. I’m going to brazenly disobey that order today and tell you about the moment I knew, without a shred of doubt, that I was created to be a doctor. It happened in Zimbabwe in 2000, in a tiny mission hospital.
I showed up with nothing more than a backpack and good intentions. It was 1999, and the AIDS epidemic was ravishing southern Africa. My time there would be spent living among the Shona tribe and shadowing the hospital’s (only) doctor: delivering babies, doing surgeries, and caring for patients. I was honest and naïve, quietly hoping that my pull towards medicine would be confirmed.
By Courtesy Photo
Today in Zimbabwe, they have medications and allow for testing and treatment of HIV/AIDS. But at that time, though I didn’t know it, an estimated 26% of Zimbabwe’s population was infected with HIV (an underestimate, I suspect), and 3,000 people were dying per week of AIDS. Robert Mugabe, Zimbabwe’s corrupt dictator-president, was unwilling to acknowledge this crisis. On my first day at the hospital, I was pulled aside and emphatically told to never say the words HIV or AIDS. They used code words instead. Government thugs had shown up at other facilities for much lesser offenses than openly testing for HIV, so I took the warning very seriously.
Without HIV medications and with limited supplies of antibiotics, the situation was dire. The doctor would decide which patients were beyond salvage and send them home to die. Around 80% of our patients had “the disease,” many of them children. Some had been infected during pregnancy, but some were infected through rape.
Every time I watched a child die, it felt like an emotional grenade had exploded inside me. Death from AIDS is the most horrible, gruesome death I have ever seen. Their little bodies were ravaged with tuberculosis and parasites. I watched as they coughed up blood and chunks of lung tissue, slowly suffocating as their own blood filled their lungs. Helpless to ease the intensity of suffering, we would pray that God would take them quickly, that the end would mercifully come soon. But often, it did not.
My one respite from the heartbreak was rocking a little baby outside the tuberculosis ward. She and her mother had traveled many miles to reach the hospital, only to be told that they both carried “the disease” and would probably die of AIDS and tuberculosis very soon. Although the baby was one year old, she was barely the size of a newborn and her skin was thinly draped over the protruding skeleton beneath. All day and all night, she whimpered – a soft little cry that echoed through the halls. I loved holding this little baby and walking with her through the open passageways of the hospital in the warm African air. Her mother was dying, and as the baby was passed between women, I discovered I had a special gift in comforting her. We would sit, and rock, and sing, and stare at each other with big questioning eyes. She, too, was dying.
After months of living at the hospital and following the Shona doctor around the operating room and patient wards, and witnessing few victories over AIDS and tuberculosis, I had answered my own question. I wasn’t cut out to be a doctor. It was exhausting, physically and emotionally, and felt hopeless. Instead, I would choose a softer, gentler path, one where my heart wasn’t crushed every day.
I knew the day would come when the little baby would be taken home to her village, along with her mother, to die. Even so, the sight of her relatives loading the shoddy wood wagon left a sick feeling in the pit of my stomach. I held her as long as I could that morning, lingering over my goodbyes, then watched them roll away down the dirt road. Sadness filled me.
I wandered back to her hospital bed, and was suddenly drawn to the paper medical chart nearby. With shock, I realized I’d never known the baby’s name. Overtaken by a sense of urgency, I frantically scanned her chart – and then froze. I couldn’t believe my eyes. “Baby Charity,” it said. Her name was Charity.
Unable to move, I felt a tingling warmth sweep through my body from head to feet. Hot tears began to stream down my face. Had Charity always been her name? Or did her mother name her after me? I would never know. But in that instant, I did know – down to my tingling toes – that I was created to be a doctor. If I chose to follow it, this was my path.
My tears that day weren’t just for Baby Charity, but for myself. For my own emotional rawness, surprisingly not numbed by the countless children I had watched die, but intensified. If I chose medicine, an agonizingly hard road lay ahead, promising only more witness to suffering. Could I handle it? I wasn’t sure.
Baby Charity is buried in a tiny grave somewhere in rural Zimbabwe that I will never be able to visit, because I don’t know where it is. But I’ve visited her a thousand times in my heart, to pour out gratitude for the gift she gave me.
The seemingly enormous coincidence of that little baby’s name forever altered my life’s direction. It was a signpost. I have come to believe that my life path is not the by-product of random, disconnected events but rather the result of interconnected signposts along the way that I choose to follow. They usually appear in the humblest, most unassuming of circumstances, and are easily missed if I’m too hurried to notice them.
As I carry on the daily work of public health, where most of my patients have been touched by disease and poverty, my prayer is that my spirit stay as soft as it was that day in Zimbabwe. That I never cope with my patient’s suffering by averting my eyes. And, above all, that I watch for the little signposts on this brave, wild path of life.
Charity Thoman, MD, MPH oversees the HIV and Tuberculosis clinics at the Santa Barbara County Public Health Department.