The Overpass

I remember medical visits always felt like an epic journey for my family and I. There were a few years in my early childhood where we had “good” insurance and could utilize services from the same medical institution. My parents worked humble jobs. My father a truck driver and my mother a housekeeper and nanny. As immigrants there was always a fear of job security and stability that ultimately led to limited continuity of care. For the majority of my childhood and adolescents my mother was the sole provider of our household, and as a single mother she made several sacrifices to ensure we never went hungry. Looking back, my mother pieced together care for my sisters and I the best way she could. It often consisted of visits to clinics all around Los Angeles depending on who had available appointments, who accepted Medicaid and what worked well with my mother’s schedule.

Our day would start early in the morning. My mother was an early riser, which meant I had to be as well. The smell of her coffee would slowly make my eyes open and alert me to the morning routines happening outside my room. Sisters getting ready for school, dogs barking, and my mother making sure we all knew the game plan for the day. This was part of our routine. We would pack some snacks and a little lunch- often some fruit and some tortillas con frijol negro (black beans with tortillas). Our first bust stop required us to walk a few blocks from our home. I always felt “grown-up” when my mother would let me slip the dollars and coins into the machine to pay for our bus fairs and transfers. After a few miles across town and a bus transfer we would arrive to the bus terminal. From there we would make our way on foot across the freeway overpass. I would slow my pace crossing the bridge (I had a fear of heights) and in those moments my mother would squeeze my hand tightly and wouldn’t let it go until we made it safely across the bridge. Once we arrived to the clinic, we would sign in and wait for my name to be called. What I remember most about my visits to the doctor were the moments when a Spanish speaking staff person was not available. Those days meant I would serve as a patient and an interpreter. Although my mother spoke limited English, she made every effort to understand and do all she could to keep her children healthy. Whether it was a medical visits for my sisters, my mother, or myself; going to the doctor meant my mother had to take time off work, travel by bus, and navigate healthcare often with little guidance.

I ask all my patients about their life outside of the exam room because I know that for me and my family a lot happened just getting to a medical visit. It is not just a way to open conversation; it is a necessary tool for building context to the state of health of your patient. It is these opportunities that a pediatrician has to build trust, understanding, and framework to address the health of their young patients. To be agents of change and leaders in health justice we must think beyond the exam room. I know from personal experience how much a parent will endure to make sure their child is healthy and cared for. It is my hope that as a pediatrician I can be a beacon of safety and hope for my patients; and by delivering care that is holistic I can at the very least relieve families of the burden that is often carried when you do not know who will be caring for the health of your child.

Therapeutic Alliance

“Did you encounter any barriers in order to make your appointment today? How are you handling the changes caused by the pandemic?” I have used these questions with my patients to know more about their life outside of the exam room, because I know from personal experience how much a parent will sacrifice to ensure their child is cared for. For my family, visits to the doctor were an epic journey. It required my mother to take time off work, travel by bus with my siblings and I, and walk over a mile that included a freeway overpass to get to our destination. My mother was the sole provider for our household, making less than $15,000.00 a year as a housekeeper and nanny. Still, she recognized the importance of medical care for my sisters and I. Although my mother spoke limited English, she made every effort to understand my health and the anticipatory guidance shared with her. Looking back, the care I was given was a powerful form of preventative medicine. I now see how this directly contributes to health justice and community liberation. My mother understood this and helped instill in me principles that I now recognize will mold me into an impactful pediatrician.

My mother’s primary care doctor often reminded me that we do not control our patients, nor should we aim to. In 2014, my mother was diagnosed with pancreatic cancer and lived two years past her diagnosis. I witnessed my sisters tend to my mother by making her meals, going on walks with her, and even simply brushing her hair. Without thinking twice, they would always ask her first what she wanted to do, what she needed, and what she wanted to try doing on her own. Through them, I learned how important it was to preserve my mother’s autonomy, to support her decisions to stop chemotherapy and to amplify her voice versus speaking for her. Something her doctor understood very well; and I saw firsthand how it contributed to the positive relationship between the two of them.

Pediatric Personal Statement Final Draft 2021

Visits to the doctor were an epic journey for my family and me. It required my mother to take time off work, travel by bus with my siblings and me, and walk more than a mile—including on a freeway overpass—to get to our clinic. My mother did all she could so that we could keep up with our medical care, even if that meant risking the loss of her job as a housekeeper for which she made less than $15,000 per year. Looking back, the questions: “What was it like getting here today? What would make your visits easier for you?” that our providers asked made all the difference. What may seem like simple questions allowed us to share our housing and economic circumstances and connected us to transportation and other community resources. If it were not for those providers asking us about what life had been like outside of the clinic setting, we would have struggled even more than we already were. My experience with healthcare as a child has echoed throughout my professional and personal life. It has deepened my understanding of the different ways health is impacted by day-to-day challenges. Over the years, the use of questions about patient’s lived experiences outside the clinic walls has revealed the power of narrative, and the impact it has had on me and my development as a rising pediatrician. As a guiding principle, Narrative Medicine keeps me rooted in honoring the human experience; and it reinforces my commitment to uplifting intersectionality and social justice in medicine.

From losing my mother to pancreatic cancer, to navigating healthcare as a queer person, to bearing witness to adolescent patients who have experienced trauma, I have learned that many people suffer in silence because of fears that they will be misunderstood, judged or denied care for simply being different. Too often, patients who do not fit the standard prototype described in medical textbooks get dismissed, are deemed untrustworthy and get labeled as non-compliant. Little to no room is created for marginalized people to speak their truth, even in clinical settings. I know this all too well from my own lived experience. We could have simply been marked as “difficult” by our providers, but they took the extra step and asked, “Why?” It is this practice I bring with me to residency and medicine.

Narrative Medicine has taught me to recognize the different ways an illness narrative is communicated. It has equipped me with tools to reflect on the ways in which patients share the reasons they seek care, what their body unveils, and how to make sense of what is not being said. It reminds me of a well-child visit I had with a thirteen-year old patient. By simply asking about her experience with the pandemic, I learned she had been struggling with social isolation and her depression had worsened. As she guided the conversation, she opened up about her recent thoughts of suicide and self-harm. Had I forced a rigid visit flow or dismissed the opportunity to hear about her life, I would have missed a critical piece to her wellbeing. In the end, I was able to connect her to a social worker and I completed my visit by creating a safety plan with her input. Visits like this remind me that pediatric patients are complex, and patient encounters cannot always be tied up neatly into a bow.

The smallest of patients have a story to tell; and I would argue that embracing Narrative Medicine makes it easier to ebb and flow with the unpredictable nature of a visit with school aged children and toddlers. I was once sent to an exam room for a visit with two siblings, ages four and six. One visit was an ADHD check and the other a well-child. At one point the six year old was counting out loud, the four year old was jumping from exam table to chair, all while their mother tried to share her concerns. I could have been easily overwhelmed by the number of things happening all at once. Instead, I reframed what was happening and realized that what I was witnessing was actually helpful. It helped make sense of the support the mother needed and the dynamic the patients had with one another. My fascination with pediatric health goes beyond the enjoyment I get in joking with children about the frog in their belly, or the bird in their ear. Pediatrics challenges me to use both my creative and analytical skills to piece together the puzzle of an illness narrative.

The patients I have encountered over the years have taught me the lessons of adaptability and lifelong learning. They have shaped me and gifted me countless life lessons and helped me realize pediatrics is where I belong and where I wish to make change. My mission as a physician is to deliver care that values the humanity and narratives of my patients regardless of how young they are. Pediatrics will prepare me to care for young people of all ages and allow me to explore my passion for adolescent medicine and health advocacy. I envision a career where I can serve immigrant communities as well as marginalized youth–including homeless youth, youth living with HIV, and transgender youth. I will continue to forge a path where I can use my skills as a writer, an educator, and community organizer to advocate for my patients and address health disparities. Being trained in pediatrics will surround me with like-minded people and connect me to physician mentors that I can learn from as I develop into a steward of pediatric health. It would be my privilege to discuss this further with you.