Letter 1.

Dear Mr. Sofamiliar,

Before you walked into my exam room, the medical assistant handed me a piece of paper with a last name and booking number but, this black man, looking at me through the glass window that separates me from the inmates, distracted me.  I looked out towards him while trying not to make eye contact because I was uncomfortable.  Then he got up to drink from the water fountain that sits right outside my door, while he continued to stare at me.  I was new to the jail and because of what I had heard during orientation I was uncertain of my safety, but I really didn’t want to be afraid.  As the man drank his water, I made sure I knew that the deputy was in eyesight.  I asked the medical assistant to call the patient named on the paper.  The man who was still staring at me suddenly walked in and sat in front of me.  It was you. 

I am writing to tell you how I experienced our encounter. 

There was something very familiar about you.  I went through my normal spiel that I go through with every patient, “my job is to go over any medical complaints you have, review your medical history, do an exam, and then decide your next steps.”  I do this because it is so important for me to clearly state my role, but to be honest, I am not sure if it even helps. Nonetheless, you nodded, kept things rather simple and had no complaints.  I assumed that much like the other inmates, you had gone through this before and you just wanted to get out of holding and into housing.  I asked you about your past medical history and you mentioned the same things that other 33-year-olds mention— as a child you were diagnosed with asthma and attention deficit disorder because “you know that’s how my momma got extra benefits.”  I guess the medical assistant was listening to our conversation when she interrupted and asked you “where you from?” Your answer surprised me.  You grew up in a city that neighbored where I grew up, so I looked at you again to figure out where our paths had crossed.  For a second I thought that since we were the same age, maybe I saw you at a high school football game or at the mall.  As my mind wandered, we continued our conversation and then you described your surgical history.  You pointed to a gunshot wound that you got in your groin about seven years ago, and suddenly a memory of my past flashed through my mind.   When I asked you where the surgery happened, I already knew the answer.  Immediately after your response I asked if you remembered me; I hoped that the memory was as engrained in you as it was for me.  I was the medical student on the surgical team that cared for you.    

When we met seven years ago, I was a lost third-year medical student on a trauma rotation in a busy safety net hospital.  You were one of the first patients assigned to me and I didn’t know what I was doing.  When I knew my knowledge of medicine was failing me, I did what I knew best— I tried to show compassion to people who were suffering all around me—the patients, environmental services staff, secretaries, nurses, anyone and everyone.  Being the same age, I remember asking you how you got to this place and I may have tried to encourage you to do better with this second chance you had been given.  You told me about your gang bangin’ but didn’t share the details about why you got shot.  After our alone sessions during the very early pre-rounding times of 5am, I would return to your bedside with the team at 6:30am and talk about your case.  Being a part of a team speaking medical jargon, I would look over to you to see if you had a reaction or if you even understood what was going on and often you didn’t.  Before we left, we would change your wound dressings with the materials that I carried in my pockets (because that was my job on the team), and I would hold your hand as you cried in pain.  This went on for over a week.  On the day of your discharge, I made sure to return to your room and say goodbye to you and your family.  A week later, by happenstance I got to see you in trauma follow-up clinic with your mom—you still had a long recovery in front of you but you continued to promise that things were going to change.  I believed you but I wonder if you believed you. 

There were probably many stories from that year and many more that accumulated throughout my training that I stored away.  I had not thought about yours until you sat in front of me in the jail.  I wondered how you remembered me. I will never forget the moment you recalled my face and said, “Oh shit, and you are the full on doctor now?… Congratulations!”  My heart sunk. I whispered, “yeah, but you are here” not because I was disappointed in your inability to keep your promise to change but, I was devastated by how our life circumstances started in the same neighborhood but culminated with a dramatically different outcome. 

To be honest, what I felt was a tremendous amount of guilt.  Our circumstances have been the sole reason why I went into medicine so that I could be a part of a health system that could prevent your outcome.  In fact, since we met seven years ago, I have been working on how to assess and address the positive and negative factors that influence health and well-being (they have this fancy term for it—social determinants of health).  The sum of our encounters, from the neighborhood we grew up in, to the hospital where your gunshot wound was cared for, and now to the jail exemplifies what I have been trying to explain to the people in this “system” of healthcare so they can help improve your outcome.  In fact, everything about you was an example of how your social determinants of health had everything to do with the structural inequalities that exist in our world.  From how hard it was for you and your family after your trauma to get you back on your feet, to how post-recovery you were on the straight and narrow.  But because you lived in the same neighborhood where you grew up with the same friends that you gang banged with, you were now in jail.  Your eyes lit up when you talked about your three-year old daughter and it made me smile, but I wondered how her circumstances would dictate her path. 

While I appreciated your pride in my success, I still wonder what was so different about my journey.  What did I do to that was so special to lead me to where I am?  My privileges should be equally yours and until that is so, I will use my power to amplify voices like yours.  I just want you to know that I am thankful that our lives intersected twice. 

You fuel my fire. 

Thoughtfully,

Dr. A