Surgery in North Philadelphia
By Howard Ross, MD
What I want my children to know, and maybe what everyone should know, is that there is both intense beauty and a powerfully sad reality of medical practice in a safety net hospital.
The privilege of providing cutting-edge care to people regardless of their ability to pay strikes me as the soul of medicine. The gratitude of patients who understand how you fought for them is not a feeling that can be purchased with money or experienced on social media. There is not a more meaningful career than medicine and I am still humbled daily. The concern families have before an operation starts is almost visible, like a thick fog wrapping and covering them in a grey, damp blanket. And the relief families express after an operation ends is like the first breath you take after swimming upward from deep underwater. I never expected to gain so much.
The sadness and unfairness of poverty and its impact on health is too real and too frequent. Try arranging chemotherapy for a homeless mentally ill gentleman who survived emergent colon cancer surgery. Reliable safe housing and constant access to food are not givens in Philadelphia. Patients ignoring problems that should have been addressed long ago is heartbreaking. People who do not have means can convince themselves there is nothing wrong, despite pain, weakness, weight loss and bleeding. The suffering that lack of access and education causes is profound. I speak of what I see with my kids at dinner. I hope they understand how fortunate we are and how there is so much work to do.
When I accepted my offer to work at Temple University Hospital, a colleague asked me why I wanted to work “up there.” Insulting and ignorant. There are so many things I treasure about being a surgeon at Temple. The common mission we share gives meaning to my every day. “Team” is something we stress a lot in surgery. When we speak of team at Temple, we include everyone who plays any role in our patients’ experience. Our team includes transporters who smile and speak to patients as they travel through the alien world of a hospital on a stretcher; the men and women in the cafeteria who wish us a blessed day; the greeters at the hospital entrances who say “welcome doc” to me and guide worried patients to their destination. We have nurses and doctors and students and translators; secretaries and radiology technicians and administrators. I think “Team” as we experience it at Temple actually means family.
Some older physicians I have met lament, “American medicine is dying. The best and brightest will follow the money and go into finance.” That is far from what I view every day. Temple’s students continuously inspire me. Temple is abuzz with the yearning and energy of trainees in nursing, physical therapy, pharmacy, dentistry, podiatry and every form of medical and surgical residency that exists. Millennials are driven, compassionate, accepting and smart. (They can also do anything with a phone or computer). Temple students sit with patients, listen, and feel. We are in good hands.
I went into medicine largely because of my father and his early death. He used to tell me, “you can be whatever you want…but if you are a doctor you will always be able to feed your family and do something good for society.” He died when I was in high school and I never explored any other calling. I believe my father was correct; however, my career at Temple has graced me with far more than a stable income and a hypothetical worthy purpose. Surgery in North Philadelphia has taught me the overwhelming value of caring for each other and the oneness we all share. I am eternally grateful.
Michael Vitez, winner of the 1997 Pulitzer Prize for Explanatory Journalism at The Philadelphia Inquirer, is the director of narrative medicine at the Lewis Katz School of Medicine at Temple University. Michael.firstname.lastname@example.org