I woke up, confused, staring at the ceiling of my middle school gym. My spine ached and the world seemed to spin worse than it had from the concussion I had a week earlier. I spent the next five years jumping between specialists and recovering from two back-to-back concussions and a spinal cord injury. Concurrently, my sister recovered from two brain injuries, my mom battled hemipelegic migraines, and my grandma slowly succumbed to stage IV glioblastoma. We spent our days working with robust teams of physicians who ensured our care was intentionally coordinated and all aspects of our conditions were addressed. Whether guiding us through the healing process or towards a comfortable death, our physicians graced us with kindness while utilizing groundbreaking science and life changing treatments. I was enthralled with the miracles of medicine, but I did not yet understand the power of patient-centered care, personal narratives, and advocacy that now inform my plans for my medical career.

 

In high school, I began to explore my interest in the science behind medicine through a summer

shadowing neurologists at Boston Children’s Hospital. Here I began to truly grasp the power of

humanity and empathy in medicine that, unknown to me at the time, made a positive impact on my recovery. Amidst the brilliant science, each physician, with their own flair, found a way to comfort families by breaking complex medical jargon into simple terms, cracking a well-timed joke, or reminding patients that each test got them closer to finding the brain’s problem and a potential solution. On rounds with the residents, a girl about my age insisted I test her plantar reflexes so I could see hyperreflexia and clonus in action. “Cool, isn’t it?” she said with a smile plastered across her face while her foot rapidly pushed into my palm. We shared a brief laugh, while I internalized the importance of heartfelt, patient-centered connection, for the purposes of morale, healing, and peace.

 

One night, while scribing in an emergency room in early college, ‘Jon’ arrived after an accidental

overdose. The department head and I entered the room to find a young woman. “Sorry, I have the wrong patient. I’m looking for Jon,” said Dr. P. The patient sighed. Her frustrated and defeated expression, one I have made many times myself as a transgender and gender diverse (TGD) individual, told me we had the right patient. “I’m ‘Mary’ now. I’m a woman,” she said proudly. “Okay, Jon,” said Dr. P sharply. In stark contrast to my prior care and observed provider-patient interactions, he ran through the motions of the exam in near silence. Mary stared blankly into the distance, clearly detached from the supposed safety of the emergency room. As a young, closeted scribe, I did not have the agency to speak up on her behalf or express my sorrow for the denial of her identity, but I used her proper identifiers in the patient documentation with the hopes she would feel affirmed by my writing. Recognizing that this is not an uncommon experience among marginalized communities, I now plan to create environments where patients are able to come to me with all aspects of their identities and will know their provider is knowledgeable and mindful of how social determinants of health–such as age,

race, ethnicity, sexuality, gender identity, and financial status–may inform their care.

 

Through college, I engaged in bench science research such as genetics and water purification. As time passed, I found myself applying these scientific inquiry skills to research and advocacy that center LGBTQ+ voices and address social determinants of health in medical care. In my current role as a research assistant at Brigham and Women’s Hospital in TGD Health Research, I co-develop and implement community-based participatory health and epidemiology related research created by and intended for TGD people. In a study evaluating TGD service delivery at the hospital, I use patient driven interviews to better understand and improve TGD experiences in healthcare. Participants underscore the importance of ensuring providers use their power to advocate for accessible and informed care guided by the patient’s narrative. These narratives remind me of my own physician’s ability to advocate for the care I needed through my recovery in middle school. Yet, they reinforce the need to expand providers’ abilities to integrate an understanding of identity and systemic marginalization into patient-centered care. While I enjoy and plan to continue research and advocacy, my passion for clinical medicine remains stronger. By acquiring clinical skills, I will implement these vital research findings into my practice through intentionally built patient-provider and provider-provider relationships.

 

There was no one moment where I knew I wanted to be a physician. Rather, it was the culmination of my lived experience, bearing witness to the narratives of others, and a desire to integrate my love for scientific inquiry with advocacy and interpersonal connection. As a physician, I will integrate my mastery of clinical knowledge, extensive experience as a patient, and deep understanding of social determinants of health to reach patients like Mary, who might otherwise slip through the cracks.