When We Needed His Wisdom More Than Ever.

Abstract

Sir William Osler once told his students, “Listen to your patients—they’re telling you the diagnosis.” He emphasized that good doctors should focus on their patients. The patient is not only an individual who needs to be healed but also part of a complex world that a good listener needs to understand. Mr. Ramirez was in tears after seeing his brother, Alejandro, having a seizure. Alejandro, just 39 years old, had been diagnosed with AIDS a few days prior. He had a nonresectable cerebral tumor that was causing him to hallucinate and he could barely recognize his family members. As he was crying, Mr. Ramirez held our hands and spoke from his heart. He was tired after enduring a 20-hour bus trip to get to the hospital and then seeing his brother in such a poor condition. He is a resident of Tabasco, Mexico—one of the poorest regions of an incredible country that has recently been struggling in a deep ocean of poverty, crime, and inequality. Having less than $2 in his pocket, he was also struggling with something that can sometimes be harder than his brother’s illness: poverty. Poverty is a simple word that can be hard to understand if one has had the privilege of being far from it. It can be smelled and felt, like a sword embedded in the heart or ashes brushing one’s face. These ashes caught fire as the tearful doctor explained that Alejandro’s prognosis is bad; the rural hospital does not have the resources to offer better treatment options; and the other possibilities for treatment he could have are now limited, as the major hospitals in the area have collapsed because of one of the worst pandemics the world has ever faced: COVID-19. What can a good doctor say to a patient when his hands are tied by the poverty of his country, an inadequate health system, and a global pandemic? A good doctor must then approach medicine as an art—an imperfect art full of beauty but also mysterious and sometimes faulty. Medicine is a beautiful skill used to correct an imperfect body, or in this case, an imperfect world and society. A good doctor should always teach others how to love this art and how to use it the best way possible. Sometimes that means choosing the least bad option. If I could share my experience with Mr. Ramirez with someone, I would choose Sir William Osler. I wish he could explain to my interns and me the best way to deal with illness, poverty, and a pandemic at the same time—a reality that has not been covered in even the best medical books. Students should understand the society they are living in before approaching an individual patient. Patients are just individual examples of different shades of gray in society. Good doctors should always see their patients as a whole world but treat them as a unique piece of art. They should use their creativity and think outside the box to help their patients using limited material resources. Just as Osler transmitted his wisdom to his students, I will strive to teach my interns the best way to deal with difficult situations, to approach them with critical thinking and an open mind, and to always offer their patients the best option. We need to listen to our patients. They might not tell us the diagnosis this time, but they will give us courage to continue trying to help them the best way we can, and we might create new answers along the way. Acknowledgments: The author would like to thank all those people who have remained standing and have courage, even when it is difficult to find answers to their problems. He would also like to thank his medical interns, for whom one has to continue fighting for answers in a world where there are only doubts.