In her book, Braiding Sweetgrass, Robin Wall Kimmerer describes her lifelong struggle to reconcile scientific and indigenous knowledge. For a time, she describes “teetering along, one foot in each world,” careful to avoid cross-pollination, before realizing that there were not two worlds, but one in which we live, and that having both ways of seeing and knowing is superior to either on its own. These different bodies of knowledge inform and enrich the other, she discovered, like the strands that create a braid of sweetgrass. As she states, “all flourishing is mutual.”
Kimmerer’s quandary mirrors my own: each day of this medical training, I stumble, trying to reconcile my own healing and the ways of knowing I have cultivated through that journey and my lived experiences with what is taught to me in the glass-walled classrooms of our modern medical school that was designed to resemble an operating room and the sterile, sunless rooms of the hospitals I train in. I have been considering the ways the physical environment of these training settings reflects the teachings and interactions that occur within them; this demands control, often manifested as either/or thinking, or “One Right Way”.
These decontextualized learning strategies seek to isolate and transmit the critically important teachings from the vast ocean of scientific knowledge into our preclinical brains. However, I think they succeed in highlighting the separation and delineation: of organ systems, laboratory abnormalities, manifestations of disease, and protocols with which to treat each aspect, at the expense of considering the whole, and the influence of the ways that the body before us has behaved, interacted, and existed in the world before arriving in this hospital bed. Instead of identifying the source of the problem through integration of the whole, the isolation approach only succeeds in narrowly, quantifiably, defining it. Randomized controlled trials focused on a single variable are often the source of data which physicians are most confident in applying to their patients, yet no patient presents with a single variable awry, and often are not adequately represented in the study participants.
In order to meet the needs of people seeking health and healing in our world today, a holistic, generalist perspective to sustainably, longitudinally treat (and ideally prevent) disease is needed. I believe that these solutions to chronic disease - the vast majority of the disease we attempt to tame in western medical institutions - lies not in more tightly controlled clinical trials of novel pharmaceuticals or additional years of rigorous training, but rather in thoughtfully considering the origins of the preventable chronic diseases plaguing the people in our modern world. From depression to hypertension to metabolic syndrome, I see the origins of disease in our daily habits and patterns: overwork, loneliness, undersleep, constant rushing, overeating, and under exercising. Fundamentally, there is a lack of balance. Our society has progressed at a pace that outruns our bodies and brains, and we have unfortunately seen those advances as a challenge to outsmart our own bodies’ rhythms and needs, trying to find ways to extract more energy and productivity out of ourselves than human beings were ever meant to do, while failing to address our spiritual, physical, and emotional needs. On a daily basis I am told that nutrition, exercise, and sleep are not important factors to inquire about when obtaining an HPI; I am shown directly through the behaviors of healthcare workers around me that caring for the basic needs of the human body is unimportant and irrelevant. Even as the attendings audibly fantasize about taking naps on the floor of the operating room in my presence, they deny the need for structural changes to their schedule to permit them the hours they need for rest and relaxation.
The more steeped in the medical world I become, the more confused and alienated I feel, for what I find here is the polar opposite of what motivated me to enter a profession of healing. I have learned to stop asking open ended reflective questions about how the system could be different, and how it could serve them better when the attendings and residents around me comment that although they love what they do, they wish they had more time with their loved ones, or just one day to sleep in. I have learned to stop asking, because in response, I receive fear in the form of anger and condescension - that I could not possibly understand the Very Good reasons for why this system is the way it is.
I dream of guiding whole people, for their whole lives, towards wellness and balance. As a soon-to-be broadly trained family physician focused on integrative and preventive medicine and well versed in emergency medicine and behavioral health, I know I will eventually fulfill my dreams of becoming a healer on my own terms, able to provide what my patients need. But in the interim, I struggle: do I step into this western training wholeheartedly, attempt to forget all the other ways of knowing that I know to be true, and valid, for the sake of being accepted and to set down gut-wrenching feelings of bewilderment and betrayal? Or do I continue to try to speak out, knowing that I run the risk of being told, like Robin Wall Kimmerer was by her own academic advisor, that the questions and ideas I have are not those that physicians should concern themselves with? (“But not to worry, they can be trained out of you.”)
Each day I wake, I make my choice again, and in just my third year of medical school I have chosen what I know to be the braver option. I choose to heal myself from my training while steeped in it. I refuse to sacrifice the pieces of my life that make me feel alive and well, not out of denial of the responsibility that comes with being a physician, but out of acknowledgement that this responsibility means I must care for myself with the same intention, slowness, and thoughtfulness as I expect my future patients to care for themselves. I create and repeat affirmations that allow me to continue to advocate for myself and my ideas, recognizing that the medical system in which I work is incredibly flawed and broken. I know that it no longer exists to serve the patients in its hospital beds nor the physicians who care for them.
