Dignity

On it sat a 34-year-old man bearing the weight of experiences far beyond his years. Lines of hardship and resilience etched deeply into his weathered skin, telling stories of struggle and survival. His sunken eyes held both wisdom and sorrow, reflecting the tumultuous journey he had endured. Yet, amidst the marks of conflict, there lingered a quiet strength, a determination that refused to be extinguished.

He had escaped to a third-world country after his people fell under the ruthless oppression of a communist regime. He then found himself in Minnesota, where he went on to earn a high school degree. He enlisted and trained as an artillery mechanic in the Army National Guard, where he was deployed to the southern border to enforce immigration law as an immigrant twice over himself.

However, things began to go sideways after about a year in southern California. Double vision, fatigable weakness, difficulty grabbing things, and trouble swallowing began to haunt him. Something wasn't quite right, and he knew he needed help. He was worked up and ultimately found to have a rare form of autoimmunity that was wreaking havoc across his neuromuscular junctions.

When asked to describe it in his own words, he clearly understood the nature of his illness. It was me, however, who needed help understanding what he shared next. After his appointment with us, he would begin a 600-mile trek to the nearest Soldier Recovery Unit. Here, his future would hang in the balance while it was determined whether or not he was still “salvageable.” Salvageable?

Intertwined with anger was a profound sense of sadness, as if a heavy weight had made its home deep within my chest. A gnawing disgust crept its way into every fiber of my being. It was cold, pricking its way down to my stomach, which caved underneath the injustice he had endured.

The quality of care I imagined him receiving wasn't what bothered me—it was the lack of dignity he'd been given. He wasn't a piece of scrap metal: he was an extraordinary human who had defied all odds over 7,000 miles away from his home. Yet, he hadn't sought refuge in a communist state; this was the United States. How could this happen?

As students, we receive robust training aimed at promoting empathy and compassion. We role-play in the classroom, work with standardized patients, and rewatch recordings of our encounters to hone these soft skills. We learn to identify nonverbal signs of emotion and instances when compassionate engagement is warranted. We practice maintaining eye contact, displaying facial expressions, and offering a hand to hold. We are trained to acknowledge, support, and validate our patients. We are taught to be calm and to treat the whole person, not just the disease.

And that's just it: his unpredictable immune system wasn't the only thing I wished for healing—it was his spirit. He was more than a military ID. He was more than an MRN. He was more than any slew of archaic verbiage a Soldier Recovery Unit could drum up. And he was more than a patient who just happened to appear for an outpatient visit at the VA. We have an unmistakable responsibility to champion dignified care. It's what we signed up for, isn't it? To do no harm. To leverage our training as we peer deeply into someone's eyes and examine them for who they are in all facets of their being. To look beyond chief complaints as we partner with those we serve to reach their fullest potential. To guide them through a labyrinth of treatment plans and a health care system that can all too often be daunting and cruel. This particular veteran will forever remind me to embody these very tenets for the sake of my patients, that they may grasp how deeply cherished, profoundly seen, and exceedingly known they are, all in the hope that they would understand how far beyond measure their worth truly is.

Back to the August 2024 issue of ACP IMpact