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IDEA OF FRIENDSHIP DAY ESSAY

He also began to eat a few morsels of food, just for the taste of it, and that made Sharon feel better about the decision. Read classic New Yorker stories, curated by our archivists and editors. Creed got down on her knees in front of him. And he pressed the button. Dave Galloway died one week later—at home, at peace, and surrounded by family.

A week after that, Lee Cox died, too. But, as if to show just how resistant to formula human lives are, Cox had never reconciled herself to the incurability of her illnesses. So when her family found her in cardiac arrest one morning they followed her wishes and called instead of the hospice service. The emergency medical technicians and firefighters and police rushed in.

They pulled off her clothes and pumped her chest, put a tube in her airway and forced oxygen into her lungs, and tried to see if they could shock her heart back. But such efforts rarely succeed with terminal patients, and they did not succeed with her. Hospice has tried to offer a new ideal for how we die. Although not everyone has embraced its rituals, those who have are helping to negotiate an ars moriendi for our age. But doing so represents a struggle—not only against suffering but also against the seemingly unstoppable momentum of medical treatment.

Marcoux to discuss the options she had left. By this point, Sara had undergone three rounds of chemotherapy with limited, if any, effect. Perhaps Marcoux could have discussed what she most wanted as death neared and how best to achieve those wishes. But the signal he got from Sara and her family was that they wished to talk only about the next treatment options. They did not want to talk about dying. Sara knew that her disease was incurable, they pointed out.

She had told her family on several occasions that she did not want to die in the hospital. She wanted to spend her final moments peacefully at home. Her father, Gary, and her twin sister, Emily, still held out hope for a cure. We were young. And this was so shocking and so odd. We never discussed stopping treatment. Marcoux took the measure of the room. With almost two decades of experience treating lung cancer, he had been through many of these conversations. He tries to be scientific about decisions.

The data show that, after failure of second-line chemotherapy, lung-cancer patients rarely get any added survival time from further treatments and often suffer significant side effects. But he, too, has his hopes. But, he went on, there were also experimental therapies.

He told them about several that were under trial. Sara and her family instantly pinned their hopes on it. The drug was only in a Phase I trial—that is, a trial designed to determine the toxicity of a range of doses, not whether the drug worked. Furthermore, a test of the drug against her cancer cells in a petri dish showed no effect. The critical problem was that the rules of the trial excluded Sara because of the pulmonary embolism she had developed that summer.

To enroll, she would need to wait two months, in order to get far enough past the episode. In the meantime, he suggested trying another conventional chemotherapy, called Navelbine. Sara began the treatment the Monday after Thanksgiving.

Step by step, Sara ended up on a fourth round of chemotherapy, one with a minuscule likelihood of altering the course of her disease and a great likelihood of causing debilitating side effects. An opportunity to prepare for the inevitable was forgone. And it all happened because of an assuredly normal circumstance: a patient and family unready to confront the reality of her disease.

I asked Marcoux what he hopes to accomplish for terminal lung-cancer patients when they first come to see him. For me, the long tail for a patient like her is three to four years. You hear that time and time again. First, our own views may be unrealistic.

A study led by the Harvard researcher Nicholas Christakis asked the doctors of almost five hundred terminally ill patients to estimate how long they thought their patient would survive, and then followed the patients. Sixty-three per cent of doctors overestimated survival time. Just seventeen per cent underestimated it. The average estimate was five hundred and thirty per cent too high.

And, the better the doctors knew their patients, the more likely they were to err. Second, we often avoid voicing even these sentiments. Studies find that although doctors usually tell patients when a cancer is not curable, most are reluctant to give a specific prognosis, even when pressed. More than forty per cent of oncologists report offering treatments that they believe are unlikely to work. You worry far more about being overly pessimistic than you do about being overly optimistic.

And talking about dying is enormously fraught. When you have a patient like Sara Monopoli, the last thing you want to do is grapple with the truth. I was, too. Earlier that summer, a PET scan had revealed that, in addition to her lung cancer, she also had thyroid cancer, which had spread to the lymph nodes of her neck, and I was called in to decide whether to operate.

This second, unrelated cancer was in fact operable. But thyroid cancers take years to become lethal. Her lung cancer would almost certainly end her life long before her thyroid cancer caused any trouble. Given the extent of the surgery that would have been required, and the potential complications, the best course was to do nothing.

But explaining my reasoning to Sara meant confronting the mortality of her lung cancer, something that I felt ill prepared to do. Sitting in my clinic, Sara did not seem discouraged by the discovery of this second cancer. She seemed determined. So she was geared up, eager to discuss when to operate. And I found myself swept along by her optimism. Suppose I was wrong, I wondered, and she proved to be that miracle patient who survived metastatic lung cancer?

My solution was to avoid the subject altogether. I told Sara that the thyroid cancer was slow-growing and treatable. The priority was her lung cancer, I said. We could monitor the thyroid cancer and plan surgery in a few months. I saw her every six weeks, and noted her physical decline from one visit to the next. Yet, even in a wheelchair, Sara would always arrive smiling, makeup on and bangs bobby-pinned out of her eyes.

She was ready to try anything, and I found myself focussing on the news about experimental therapies for her lung cancer. After one of her chemotherapies seemed to shrink the thyroid cancer slightly, I even raised with her the possibility that an experimental therapy could work against both her cancers, which was sheer fantasy. Discussing a fantasy was easier—less emotional, less explosive, less prone to misunderstanding—than discussing what was happening before my eyes. Between the lung cancer and the chemo, Sara became steadily sicker.

She slept most of the time and could do little out of the house. Clinic notes from December describe shortness of breath, dry heaves, coughing up blood, severe fatigue. In addition to the drainage tubes in her chest, she required needle-drainage procedures in her abdomen every week or two to relieve the severe pressure from the litres of fluid that the cancer was producing there. A CT scan in December showed that the lung cancer was spreading through her spine, liver, and lungs.

When we met in January, she could move only slowly and uncomfortably. Her lower body had become swollen. By the first week of February, she needed oxygen at home to breathe. She just needed one more set of scans for clearance. These revealed that the cancer had spread to her brain, with at least nine metastatic growths across both hemispheres. The experimental drug was not designed to cross the blood-brain barrier.

PF was not going to work. And still Sara, her family, and her medical team remained in battle mode. Within twenty-four hours, Sara was scheduled to see a radiation oncologist for whole-brain radiation to try to reduce the metastases. On February 12th, she completed five days of radiation treatment, which left her immeasurably fatigued, barely able get out of bed. She ate almost nothing.

She weighed twenty-five pounds less than she had in the fall. She confessed to Rich that, for the past two months, she had experienced double vision and was unable to feel her hands. She was given two weeks to recover her strength after the radiation. Then she would be put on another experimental drug from a small biotech company. She was scheduled to start on February 25th. Her chances were rapidly dwindling. But who was to say they were zero? He went to a medical library when he got the diagnosis and pulled out the latest scientific articles on the disease.

The news was devastating. But then he began looking at the graphs of the patient-survival curves. What the naturalist saw was remarkable variation. The patients were not clustered around the median survival but, instead, fanned out in both directions. Moreover, the curve was skewed to the right, with a long tail, however slender, of patients who lived many years longer than the eight-month median. This is where he found solace.

He could imagine himself surviving far out in that long tail. And he did. Following surgery and experimental chemotherapy, he lived twenty more years before dying, in , at the age of sixty, from a lung cancer that was unrelated to his original disease. For most situations, however, I prefer the more martial view that death is the ultimate enemy—and I find nothing reproachable in those who rage mightily against the dying of the light.

I think of Gould and his essay every time I have a patient with a terminal illness. There is almost always a long tail of possibility, however thin. Hope is not a plan, but hope is our plan. For Sara, there would be no miraculous recovery, and, when the end approached, neither she nor her family was prepared.

On the morning of Friday, February 22nd, three days before she was to start her new round of chemo, Rich awoke to find his wife sitting upright beside him, pitched forward on her arms, eyes wide, struggling for air. She was gray, breathing fast, her body heaving with each open-mouthed gasp.

She looked as if she were drowning. He tried turning up the oxygen in her nasal tubing, but she got no better. He had no emergency kit in the refrigerator. No hospice nurse to call. And how was he to know whether this new development was fixable? When he asked if they should drive, she shook her head, so he called , and told her mother, Dawn, who was in the next room, what was going on.

A few minutes later, firemen swarmed up the stairs to her bedroom, sirens wailing outside. As they lifted Sara into the ambulance on a stretcher, Dawn came out in tears. This was just another trip to the hospital, he said to himself.

The doctors would figure this out. At the hospital, Sara was diagnosed with pneumonia. In another way, the diagnosis of pneumonia was reassuring, because it was just an infection. It could be treated. The medical team started Sara on intravenous antibiotics and high-flow oxygen through a mask. The family gathered at her bedside, hoping for the antibiotics to work. This could be reversible, they told one another. But that night and the next morning her breathing only grew more labored. Only later did the family realize that those were the last words they would ever hear from her.

After that, she began to drift in and out of consciousness. The medical team had only one option left: to put her on a ventilator. Sara was a fighter, right? And the next step for fighters was to escalate to intensive care. This is a modern tragedy, replayed millions of times over. When there is no way of knowing exactly how long our skeins will run—and when we imagine ourselves to have much more time than we do—our every impulse is to fight, to die with chemo in our veins or a tube in our throats or fresh sutures in our flesh.

The fact that we may be shortening or worsening the time we have left hardly seems to register. We imagine that we can wait until the doctors tell us that there is nothing more they can do. But rarely is there nothing more that doctors can do. We want these choices. Instead, most often, we make no choice at all. We fall back on the default, and the default is: Do Something.

Is there any way out of this? In late , executives at Aetna, the insurance company, started an experiment. They knew that only a small percentage of the terminally ill ever halted efforts at curative treatment and enrolled in hospice, and that, when they did, it was usually not until the very end. So Aetna decided to let a group of policyholders with a life expectancy of less than a year receive hospice services without forgoing other treatments.

A patient like Sara Monopoli could continue to try chemotherapy and radiation, and go to the hospital when she wished—but also have a hospice team at home focussing on what she needed for the best possible life now and for that morning when she might wake up unable to breathe. The surprising result was that they did give up things.

They visited the emergency room almost half as often as the control patients did. Their use of hospitals and I. Over-all costs fell by almost a quarter. Aetna ran a more modest concurrent-care program for a broader group of terminally ill patients. For these patients, the traditional hospice rules applied—in order to qualify for home hospice, they had to give up attempts at curative treatment. But, either way, they received phone calls from palliative-care nurses who offered to check in regularly and help them find services for anything from pain control to making out a living will.

For these patients, too, hospice enrollment jumped to seventy per cent, and their use of hospital services dropped sharply. Among elderly patients, use of intensive-care units fell by more than eighty-five per cent. Satisfaction scores went way up. What was going on here? And somehow that was enough—just talking.

The explanation strains credibility, but evidence for it has grown in recent years. Two-thirds of the terminal-cancer patients in the Coping with Cancer study reported having had no discussion with their doctors about their goals for end-of-life care, despite being, on average, just four months from death. But the third who did were far less likely to undergo cardiopulmonary resuscitation or be put on a ventilator or end up in an intensive-care unit.

Two-thirds enrolled in hospice. These patients suffered less, were physically more capable, and were better able, for a longer period, to interact with others. Moreover, six months after the patients died their family members were much less likely to experience persistent major depression. In other words, people who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die at peace and in control of their situation, and to spare their family anguish.

Can mere discussions really do so much? Consider the case of La Crosse, Wisconsin. Its elderly residents have unusually low end-of-life hospital costs. Despite average rates of obesity and smoking, their life expectancy outpaces the national mean by a year.

I spoke to Dr. In most respects, the patients were like those found in any I. There was a young woman with multiple organ failure from a devastating case of pneumonia, a man in his mid-sixties with a ruptured colon that had caused a rampaging infection and a heart attack.

Yet these patients were completely different from those in other I. To understand La Crosse, Thompson said, you had to go back to , when local medical leaders headed a systematic campaign to get physicians and patients to discuss end-of-life wishes. Within a few years, it became routine for all patients admitted to a hospital, nursing home, or assisted-living facility to complete a multiple-choice form that boiled down to four crucial questions. At this moment in your life, the form asked:.

By , eighty-five per cent of La Crosse residents who died had written advanced directives, up from fifteen per cent, and doctors almost always knew of and followed the instructions. Having this system in place, Thompson said, has made his job vastly easier. It was that simple—and that complicated. One Saturday morning last winter, I met with a woman I had operated on the night before. She had been undergoing a procedure for the removal of an ovarian cyst when the gynecologist who was operating on her discovered that she had metastatic colon cancer.

I was summoned, as a general surgeon, to see what could be done. I removed a section of her colon that had a large cancerous mass, but the cancer had already spread widely. I had not been able to get it all. Now I introduced myself. She said a resident had told her that a tumor was found and part of her colon had been excised.

Yes, I said. So when she asked me to tell her more about the cancer, I explained that it had spread not only to her ovaries but also to her lymph nodes. I said that it had not been possible to remove all the disease. She absorbed the news in silence, looking down at the blankets drawn over her mutinous body. Then she looked up at me. A few days later, I tried again. She has done well. So far, the cancer is in check. Once, I asked her and her husband about our initial conversations.

Susan Block, a palliative-care specialist at my hospital who has had thousands of these difficult conversations and is a nationally recognized pioneer in training doctors and others in managing end-of-life issues with patients and their families. One basic mistake is conceptual. For doctors, the primary purpose of a discussion about terminal illness is to determine what people want—whether they want chemo or not, whether they want to be resuscitated or not, whether they want hospice or not.

They focus on laying out the facts and the options. There is no single way to take people with terminal illness through the process, but, according to Block, there are some rules. You sit down. You make time. This requires as much listening as talking. The words you use matter. It can sound like pity. Ten years ago, her seventy-four-year-old father, Jack Block, a professor emeritus of psychology at the University of California at Berkeley, was admitted to a San Francisco hospital with symptoms from what proved to be a mass growing in the spinal cord of his neck.

She flew out to see him. The neurosurgeon said that the procedure to remove the mass carried a twenty-per-cent chance of leaving him quadriplegic, paralyzed from the neck down. But without it he had a hundred-per-cent chance of becoming quadriplegic. The evening before surgery, father and daughter chatted about friends and family, trying to keep their minds off what was to come, and then she left for the night. So she turned the car around. It made no difference that she was an expert in end-of-life discussions.

The surgeons told her that, in order to save his life, they would need to go back in. But he had already become nearly quadriplegic and would remain severely disabled for many months and possibly forever. What did she want to do? Yes, they said. She gave the O. And I would have beaten myself up. Did I let him go too soon? During the next two years, he regained the ability to walk short distances. He required caregivers to bathe and dress him. He had difficulty swallowing and eating.

But his mind was intact and he had partial use of his hands—enough to write two books and more than a dozen scientific articles. He lived for ten years after the operation. This past year, however, his difficulties with swallowing advanced to the point where he could not eat without aspirating food particles, and he cycled between hospital and rehabilitation facilities with the pneumonias that resulted.

And it became evident that the battle for the dwindling chance of a miraculous recovery was going to leave him unable ever to go home again. So, this past January, he decided to stop the battle and go home. Eventually, he stopped eating and drinking.

He died about five days later. Susan Block and her father had the conversation that we all need to have when the chemotherapy stops working, when we start needing oxygen at home, when we face high-risk surgery, when the liver failure keeps progressing, when we become unable to dress ourselves. Few people have this discussion, and there is good reason for anyone to dread these conversations.

They can unleash difficult emotions. People can become angry or overwhelmed. Handled well, they can take real time. I spoke to an oncologist who told me about a twenty-nine-year-old patient she had recently cared for who had an inoperable brain tumor that continued to grow through second-line chemotherapy. The patient elected not to attempt any further chemotherapy, but getting to that decision required hours of discussion—for this was not the decision he had expected to make.

First, the oncologist said, she had a discussion with him alone. She was frank. She told him that in her entire career she had never seen third-line chemotherapy produce a significant response in his type of brain tumor. She had looked for experimental therapies, and none were truly promising.

And, although she was willing to proceed with chemotherapy, she told him how much strength and time the treatment would take away from him and his family. He did not shut down or rebel. His questions went on for an hour. He asked about this therapy and that therapy. The oncologist next met with the young man together with his family. It was the same with his mother, who was a nurse.

Meanwhile, his father sat quietly and said nothing the entire time. A few days later, the patient returned to talk to the oncologist. His father had shown him reports of cures on the Internet. He confided how badly his father was taking the news. I feel I have a unique experience from which to draw as I embark on my medical school journey, experiences that can be applied both here and abroad. I hope to conduct research in the field of health care infrastructure and work with government agencies and legislators to find creative solutions to improving access to emergency facilities in currently underserved areas of the United States, with an aim towards providing comprehensive policy reports and recommendations on how the US can once again be the world leader in health outcomes.

While the problems inherent in our health care system are not one-dimensional and require a dynamic approach, one of the solutions as I see it is to think less in terms of state-of-the-art facilities and more in terms of access to primary care. Much of the care that I provide as a first responder and volunteer is extremely effective and also relatively cheap. More money is always helpful when facing a complex social and political problem, but we must think of solutions above and beyond more money and more taxes.

Of course, my policy interests do not replace my passion for helping others and delivering emergency medicine. As a doctor, I hope to continue serving in areas of the country that, for one reason or another, are lagging behind in basic health care infrastructure. Eventually, I would also like to take my knowledge and talents abroad and serve in the Peace Corps or Doctors Without Borders.

In short, I see the role of physicians in society as multifunctional: they are not only doctors who heal, they are also leaders, innovators, social scientists, and patriots. Although my path to medical school has not always been the most direct, my varied and circuitous journey has given me a set of skills and experiences that many otherwise qualified applicants lack. I have no doubt that the next ten years will be similarly unpredictable, but I can assure you that no matter what obstacles I face, my goal will remain the same.

I sincerely hope to begin the next phase of my journey at Brown University. Thank you for your kind attention. The roots of my desire to become a physician are, thankfully, not around the bedside of a sick family member or in a hospital, but rather on a acre plot of land outside of a small town in Northwest Arkansas.

I loved raising and exhibiting cattle, so every morning before the bus arrived at 7 a. I was in the barn feeding, checking cattle for any health issues and washing the show heifers. These early mornings and my experiences on a farm not only taught me the value of hard work, but ignited my interest in the body, albeit bovine at the time. It was by a working chute that I learned the functions of reproductive hormones as we utilized them for assisted reproduction and artificial insemination; it was by giving vaccinations to prevent infection that I learned about bacteria and the germ theory of disease; it was beside a stillborn calf before the sun had risen that I was exposed to the frailty of life.

Facing the realities of disease and death daily from an early age, I developed a strong sense of pragmatism out of necessity. Witnessing the sometimes harsh realities of life on a farm did not instill within me an attitude of jaded inevitability of death. Instead, it germinated a responsibility to protect life to the best of my abilities, cure what ailments I can and alleviate as much suffering as possible while recognizing that sometimes nothing can be done.

I first approached human health at the age of nine through beef nutrition and food safety. Learning the roles of nutrients such as zinc, iron, protein and B-vitamins in the human body as well as the dangers of food-borne illness through the Beef Ambassador program shifted my interest in the body to a new species. Talking with consumers about every facet of the origins of food, I realized that the topics that most interested me were those that pertained to human health.

In college, while I connected with people over samples of beef and answered their questions, I also realized that it is not enough simply to have adequate knowledge. Ultimately knowledge is of little use if it is not digestible to those who receive it.

So my goal as a future clinical physician is not only to illuminate the source of an affliction and provide treatment for patients, but take care to ensure the need for understanding by both patient and family is met. I saw this combination of care and understanding while volunteering in an emergency room, where I was also exposed to other aspects and players in the medical field.

Medicine is a team sport, and coordinating the efforts of each of these players is crucial for the successful execution of patient care. It is my goal to serve as the leader of this healthcare unit and unify a team of professionals to provide the highest quality care for patients.

Perhaps most importantly my time at the VA showed me the power a smile and an open ear can have with people. On the long walk to radiology, talking with patients about their military service and families always seemed to take their mind off the reason for their visit, if only for a few minutes. Growing up in a small town, I never held aspirations of world travel when I was young. But my time abroad revealed to me the state of healthcare in developing countries and fostered a previously unknown interest in global health.

In the rural north of the country near the Sahara, the options for healthcare were limited; he told me how our professor was forced to bribe employees to bypass long lines and even recounted how doctors took a bag of saline off the line of another patient to give to him. During a service trip to a rural community in Nicaragua, I encountered patients with preventable and easily treatable diseases that, due to poverty and lack of access, were left untreated for months or years at a time.

I was discouraged by the state of healthcare in these countries and wondered what could be done to help. I plan to continue to help provide access to healthcare in rural parts of developing countries, and hopefully as a physician with an agricultural background I can approach public health and food security issues in a multifaceted and holistic manner.

My time on a cattle farm taught me how to work hard to pursue my interests, but also fueled my appetite for knowledge about the body and instilled within me a firm sense of practicality. Whether in a clinic, operating room or pursuing public and global health projects, I plan to bring this work ethic and pragmatism to all of my endeavors. My agricultural upbringing has produced a foundation of skills and values that I am confident will readily transplant into my chosen career.

Farming is my early passion, but medicine is my future. I am a white, cisgender, and heterosexual female who has been afforded many privileges: I was raised by parents with significant financial resources, I have traveled the world, and I received top-quality high school and college educations. I do not wish to be addressed or recognized in any special way; all I ask is to be treated with respect. As for my geographic origin, I was born and raised in the rural state of Maine.

Since graduating from college, I have been living in my home state, working and giving back to the community that has given me so much. I could not be happier here; I love the down-to-earth people, the unhurried pace of life, and the easy access to the outdoors. While I am certainly excited to move elsewhere in the country for medical school and continue to explore new places, I will always self-identify as a Mainer as being from Maine is something I take great pride in.

From the rocky coastline and rugged ski mountains to the locally-grown food and great restaurants, it is no wonder Maine is nicknamed, "Vacationland. The state is dotted with wonderful communities in which to live, communities like the one where I grew up. Perhaps not surprisingly, I plan to return to Maine after residency. I want to raise a family and establish my medical practice here.

We certainly could use more doctors! Even though Maine is a terrific place to live, the state is facing a significant doctor shortage. Today, we are meeting less than half of our need for primary care providers. To make matters worse, many of our physicians are close to retirement age. Undoubtedly, Maine is in need of young doctors who are committed to working long term in underserved areas.

As my primary career goal is to return to my much adored home state and do my part to help fill this need, I have a vested interest in learning more about rural medicine during medical school. I was raised in Cumberland, Maine, a coastal town of 7, just north of Portland. With its single stoplight and general store where it would be unusual to visit without running into someone you know , Cumberland is the epitome of a small New England town. It truly was the perfect place to grow up. Recently rated Maine's safest town, Cumberland is the type of place where you allow your kindergartener to bike alone to school, leave your house unlocked while at work, and bring home-cooked food to your sick neighbors and their children.

Growing up in such a safe, close-knit, and supportive community instilled in me the core values of compassion, trustworthiness, and citizenship. These three values guide me every day and will continue to guide me through medical school and my career in medicine. As a medical student and eventual physician, my compassion will guide me to become a provider who cares for more than just the physical well-being of my patients.

By also demonstrating my trustworthiness during every encounter, I will develop strong interpersonal relationships with those whom I serve. My citizenship will guide me to serve my community and to encourage my classmates and colleagues to do the same. We will be taught in medical school to be healers, scientists, and educators. I believe that, in addition, as students and as physicians, we have the responsibility to use our medical knowledge, research skills, and teaching abilities to benefit more than just our patients.

We must also commit ourselves to improving the health and wellness of those living in our communities by participating in public events i. As a medical student and eventual physician, my compassion, trustworthiness, and citizenship will drive me to improve the lives of as many individuals as I can.

Cumberland instilled in me important core values and afforded me a wonderful childhood. However, I recognize that my hometown is not perfect. For one, the population is shockingly homogenous, at least as far as demographics go. As of the census, Only 4. Essentially everybody who identified with a religion identified as some denomination of Christian. My family was one of maybe five Jewish families in the town. Efforts to attract diverse families to Cumberland is one improvement that I believe would make the community a better place in which to live.

Diversity in background and in thought is desirable in any community as living, learning, and working alongside diverse individuals helps us develop new perspectives, enhances our social development, provides us with a larger frame of reference, and improves our understanding of our place in society.

Surprised, I briefly explained the influenza vaccine and its purpose for protection. My connection to children and their health extends to medical offices, clinics and communities where I have gained experience and insight into medicine, confirming my goal of becoming a physician. My motivation to pursue a career in medicine developed when my mother, who was diagnosed with Lupus, underwent a kidney transplant surgery and suffered multiple complications.

I recall the fear and anxiety I felt as a child because I misunderstood her chronic disease. This prompted me to learn more about the science of medicine. In high school, I observed patients plagued with acute and chronic kidney disease while briefly exploring various fields of medicine through a Mentorship in Medicine summer program at my local hospital.

In addition to shadowing nephrologists in a hospital and clinical setting, I scrubbed into the operating room, viewed the radiology department, celebrated the miracle of birth in the delivery room, and quietly observed a partial autopsy in pathology. I saw many patients confused about their diagnoses. I was impressed by the compassion of the physicians and the time they took to reassure and educate their patients.

Further experiences in medicine throughout and after college shaped a desire to practice in underserved areas. While coloring and reading with children in the patient area at a Family Health Center, I witnessed family medicine physicians diligently serve patients from low-income communities. At one impoverished village, I held a malnourished two-year old boy suffering from cerebral palsy and cardiorespiratory disease.

His family could not afford to take him to the nearest pediatrician, a few hours away by car, for treatment. Overwhelmed, I cried as we left the village. Many people were suffering through pain and disease due to limited access to medicine. One physician may not be able to change the status of underserved communities, however, one can alleviate some of the suffering. X, my mentor and supervisor, taught me that the practice of medicine is both a science and an art. As a medical assistant in a pediatric office, I am learning about the patient-physician relationship and the meaningful connection with people that medicine provides.

I interact with patients and their families daily. Newborn twins were one of the first patients I helped, and I look forward to seeing their development at successive visits. A young boy who endured a major cardiac surgery was another patient I connected with, seeing his smiling face in the office often as he transitioned from the hospital to his home.

I also helped many excited, college-bound teenagers with requests for medical records in order to matriculate.

Sara Thomas Monopoli was pregnant with her first child when her doctors learned that she was going to die.

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