Bravery

The sun is as warm as I remember it. I’d never minded that hot ball of heat, even when it beat down on me during many a long summer, as I worked outside with my hands.

My hands. I look down at them now, my fingers giving the illusion they’re gripping the little knobs on the handrests of my power wheelchair, but I recall the occupational therapist placing them there back in the rehabilitation facility’s rec hall an hour ago.

Recently, I attended a funeral gathering for my long-time friend, Flo, who’d  been an RN for over four decades. She’d been a loving wife, mother and grandmother. But I also remember several pivotal times in her life that Flo had shown courage and faced physical and emotional risks.

A few days ago, I received an Orwellian email about my National Institute of Health (NIH) biosketch from the director of an NIH-funded research center at my institution. We are submitting an application for renewal of our funding, and all mentions of health disparities, health inequities, low-income patients, and safety-net hospitals were highlighted on my biosketch with a request that I delete them.

I responded to my colleague’s e-mail, “Sure, I’ll do it (with some  reluctance, horrible to have to do this).” I didn’t want to jeopardize my institution’s (and my) funding, so I edited out the undesirable language where I could. But I couldn’t change the titles of my publications dating back to 1995, such as  “Health Disparities in the US and Canada: Results of a Cross-National Population-Based Survey.” I’m now feeling complicit, perhaps even compromised. Am I a coward for whitewashing my NIH biosketch?

As a family doctor, I see acts of bravery every day. Not big, showy, public acts, but individual, ordinary acts. Acts by people who, in the face of adversity, choose to live and to believe in a future.

“You are the only exception . . .”

Every time I hear these lyrics by the rock band Paramore, I think of Xan, a patient I met a few years back while working as residential advisor at a mental health rehabilitation facility. There, we served patients diagnosed with treatment-resistant mental illness—people who had tried every pill and every therapy and had still been hospitalized again and again. Our program was a sort of last-ditch effort to get people back on their meds, back in their community, back to living lives that they found meaningful.

The patient dug her fingers into my palms, her grip so tight, yet slippery from the sweat. Tears streamed down her face. I could see her pain, from a place I couldn’t fathom.

She’d come to us in the second trimester of her pregnancy. When we examined her, there was no sign of life inside her womb. The fetus had not passed spontaneously, so we performed a procedure called Dilation and Evacuation, or D&E.

The unspoken question looms. I might ask first, dropping a bomb that disrupts the medical visit. Or the patient asks at the appointment’s conclusion, when I query, “Anything else today?” Patient concerns brought up when their visit has ostensibly ended are dubbed “doorknob questions.” Previously, these were predictably about Viagra or vaginas. Since the November 2024 election results, my patients voice their terror that access to gender-affirming medical care will cease to exist.

It often begins subtly, almost sweetly. The extra attention feels like a warm embrace that draws you in, making you feel cherished and unique. You revel in the connection, in the moments where the world fades away, and it’s just you two. Their genuine interest in your thoughts and dreams ignites a sense of belonging.

But then, in an unexpected flash, the first inappropriate touch shatters that comforting illusion, leaving you frozen in confusion. The initial hope lingers, whispering that perhaps it was just a momentary lapse. You cling to the belief that you can still retain that special bond and navigate this new terrain unscathed.

My aunt was a one-of-a-kind lady. Her laugh was infectious, and she gave the warmest hugs. I miss that laugh. And those hugs.

Every holiday was special. She made sure every one of her nieces and nephews had the perfect gift and spent the same on each of us, I mean to the cent! We all felt her love and knew she was proud of every single one of us. The saying, “to know her, was to love her,” could not be more fitting.

When she was diagnosed with cancer, she put on a brave face and acted as if she had something minor, like a hangnail. Being a healthcare professional, I knew better.

In February 1979, new regulations went into effect that were designed to protect women and ensure appropriate consent prior to sterilization of patients receiving federal funds. The waiting period was extended to thirty days for giving permission in advance of the procedure and could not be obtained while in labor. It fairly quickly was adopted as a standard, including where I was a student and resident.

Medicine presents many opportunities for bravery. Years ago, I was at a medical imaging facility, where a  child was getting a CAT scan. The mom said to her offspring, “Be brave.” Sometimes, bravery is going into a burning building to save a kid, and sometimes bravery is a kid going into a small tunnel of a CAT scanner.

I wake up to a miracle.

Snow, in Texas: real snow, not merely a listless splatter of ice and sleet. There must be two inches now, at the least.

Normally, I would be meeting patients, straining to hear narrowed valves and weakened lungs through the prim aluminum of my stethoscope. First, I would make a painless remark to help smooth the shift to the paper-lined examination table; something about the weather, probably. There’s always something to say about the weather.