Jake Ermolovich is a fourth-year medical student at the University of Vermont, Larner College of Medicine.
In the following blog post, he writes about finding medicine through the experience of his brother’s care.
“His eyes sign language that his hands want to and speak where his mouth can’t. It’s these orbital pools I find myself returning to as I progress through my education, exploring a depth to his experience I could only surmise from the surface before.”
The Eyes of My Brother
I found medicine in the eyes of my brother, and through his eyes I’ve seen the voiceless rise. My brother can’t speak well, or walk even short distances without assistance. His activities of daily living are only given to him—he can’t take them for himself. Despite being over a decade older than me, he still needs help with many things, including how to understand the world and its judgement. My brother has cerebral palsy, epilepsy, and an intellectual disability. These diagnoses are broad and barely breach what it means to be bound by them, as they are only a set of descriptions attempting to understand another’s life. My brother can’t communicate the words that are meant to define him, but that doesn’t stop him from reaching out beyond his body’s limitations.
A Sick Electricity That Overtakes His Brain
Some of the most harrowing moments of his life have stemmed from his seizures; a sick electricity that overtakes his brain, flooding his consciousness until it’s drowned in dark waters. This disordered cerebral static instills fear in even the minds of those it doesn’t control. I’ll never forget the look in my brother’s eyes when these episodes overtake him: at first, I see concern, his eyes worried that something behind them is awry. Then concern cedes to panic, followed swiftly by blankness, as the presence in his eyes is ripped from this world. His eyes sign language that his hands want to and speak where his mouth can’t. It’s these orbital pools I find myself returning to as I progress through my education, exploring a depth to his experience I could only surmise from the surface before.
Strange People Doing Strange Things
I often see reflections of my brother’s eyes in the eyes of my patients.
My brother was frequently hospitalized as a child, affording him the experience of strange people doing strange things to him he didn’t like; I see the same mistrust and anxiety in the patient who “asks too many questions,” when they only want to know how to control the mess made by illness and the attempts to cure it.My brother had many seizures before an adequate medication regimen could control them, which has left him hypervigilant to any change in his body that could provoke the galvanic beast in his head. I recognize his look in the fatigue of a patient who, after another failed SSRI, is left riding the line of “I’m doing fine” and “I’m not safe at home alone.”
His Eyes Are Telling the Truth
My brother would ask for my hand before doing something that scared him—something like meeting a new case worker or receiving a needed vaccine. I see how offering a hand can do something words can’t for the patient on hospice who’s left bereft at the realization they can no longer travel to the island their grandfather was honored on.
My brother no longer lets others draw his blood to check his medication levels, so I do it now. All the pain I’ve seen in him—manifested in outbursts of frustration to fend off the fear—is pain I’ve seen again and again in outpatient offices and inpatient rooms. I can see it in the eyes of those who have suffered at the hands of a medical system that isn’t perfect. I can feel it like the strength of my brother’s impossibly tight grip on my hand, reminding me his eyes are telling the truth. Once his grip relaxes, I’m reminded by my pulsing hand that I, too, am feeling pain.
I See His Pain, Too
I see this pain, too, in the eyes of the resident physicians I’ve worked alongside. Their eyes hoped for their patients to get better, then found the eyes of families to explain why they got worse. Their eyes have found bleary daylight after a night of crying into the nothingness of loss. Their eyes have seen the same loss of trust in a sick-care system that has done so much but still struggles to keep people healthy. When there is so much injustice and suffering in one’s work, it seeps into the life surrounding that work—like a wound bleeding without pause until the gauze is saturated. We tamp down the wound the best we can to survive training, but sometimes we tamp too hard, and the packing disrupts the flow of emotion that brought us to this work.
Catching the Spark
Too often we stomp out any smoldering ember of feeling in an attempt to avoid burnout. Yet without any fire at all, we end up lost in our own little cliche allegories Plato has taunted us with from that cave of his, seeing only shadows of the passion, resilience, and empathy that fueled us. To mitigate this, we must catch the spark that’s catching hold on the orbital floors circling us every day, meeting them where they are. When we see ire, we must understand the passion for life that drives people to anger; kindle that passion within. When we see hopelessness, we must understand the dread of a world with ceaseless suffering; we must be equally as ceaseless to provide balance to the sufferer. When we see negative emotions in our patients, we need not internalize their emotions wholly, but rather take only the pieces that hold value and drive us. Helping a patient to transform these feelings could be the first step in changing their health trajectory.
While much change is needed broadly across the health care system, we must never forget the possibility of change that exists in each physician-patient interaction. From one moment of understanding springs many others, like the branching of a tree. I’m reminded now of the trees in my backyard. I was always the one climbing them while my brother signaled me to go higher, laughing when I did. The bark of the oak left marks on my arms and hands as I ascended, but when another limb loomed above, I was lifted to it by his audible joy. Watch me climb, brother, this is for you.