Courage

In medicine, we live between two spheres: a small one of safety and control, and a larger one of risk, courage, and purpose. Most of us move between them unconsciously—retreating to the small one when we’re afraid, stepping into the larger one when we feel brave. Over time, though, we learn that we can choose.

The larger sphere is where purpose resides. It contains risk—the possibility of failure, exposure, uncertainty—but it also contains energy, compassion, light, life, and grace. In that sphere, we find that by making ourselves vulnerable, we become indomitable. The act of stepping forward, undefended, becomes its own kind of strength.

I see this clearly whenever I teach clinical skills to fourth-year medical students.

My third summer, I was 30 months old, sitting with my older brother on a warm brick stoop. Mother brought us an ice pop. Two wooden sticks, two sides to the treat, broken in half—one half for my brother, one half for me. Sticky orange or red melted on our hands and faces. Then, one day, for an unknown celebration, two halves for each of us!

Here’s what happens when your insides twist and lock. The key? Well, there might not be one.

At first, your innards are just tender. Maybe it’s only the havoc of your upcoming vacation. What the hell, you think. It will go away on its own, right, like a pimple or a hangover.

“How do you do it?” my dear friend asks me. A marriage and family therapist, she finds it hard to hear about the physical ailments of my senior patients—all of them over sixty-five, all homebound due to mobility impairment from a serious illness or injury. “I could never do it,” she says. “With my patients, I help them create new beginnings. For yours, there are none.”

John was sitting up in bed as I approached his room. “Come on in, Sister. Father has just left.”

Somewhat hesitant, I entered the room aware that his wife and daughter were in tears. I asked John if there was anything I could do for him. “Sing for me” he replied, and I began singing the words to YOU ARE MY SUNSHINE. John immediately bellowed out the song, and his wife and daughter joined in. Through their tears they gave me the courage to enjoy a heartwarming visit with John.

Few individuals are called upon to be heroes like Ukrainian president Volodymyr Zelenskyy who, in choosing to stay and fight a massive, invading army, faces a real possibility of imprisonment and death. This is true courage.

Within the medical profession, there are also wars to be fought that require true courage. One thinks of the late Dr. Paul Farmer, who worked tirelessly throughout his career to bring high-quality health care to Haiti, Rwanda, and other resource-poor nations around the world.

My senior year in college, I took a course called Women and Radicalism. It was an exciting class. We studied radical movements on the left and right, with a focus on women’s participation. The course featured a weekend retreat with women activists. For two days, women took the stage to describe their causes and advocacy roles. I attended many sessions, in awe of these phenomenal women who were making a difference in the world. I noted that most of them had been thrust into their cause by a personal adverse event, such as gun violence or an environmental catastrophe.

Rosie is in the hospital, alone. She is alone because she has survived the deaths of a child, two husbands, and five siblings. “They left me behind,” she laments. “All I have are flimsy memories and yellowed obituaries.” She plucks several photos from a bedside table and stares at them, as if in pilgrimage.

Sara looked me up and down when I walked into the exam room. Her diabetes and hypertension were uncontrolled, and her PCP had asked me to counsel her.

I introduced myself as an RN and asked Sara to tell me about herself. She launched into her medical history, but I stopped her. “Tell me about Sara,” I said, “and what she likes.”

She looked startled. “Well, I’m a proud grandmother of a four-year-old,” she said. “Her name is Amy.”

In the early 1980s, I considered everyone at Thomas Jefferson Hospital in Philadelphia to be my friend. As a volunteer and a vestry member at the nearby Episcopal church, I would often arrive at the ER with a homeless person who had come to the church for help after being badly injured. I was so impressed with how the doctors and nurses treated these patients that I developed a real affinity for the hospital.

Harper Lee taught me so much in To Kill a Mockingbird, including the definition of real courage: “It’s when you know you’re licked before you begin but you begin anyway and you see it through no matter what.” Through caregiving, I found that I am a woman of such courage.