Louisville Medicine Volume 73, Issue 2 | Page 20

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2025 RICHARD SPEAR, MD, MEMORIAL ESSAY CONTEST In-Training Member Category Winner Seeing the World in a Grain of Sand

“ by Elizabeth Clark, M4

,” I wrote to the peds clerkship coordinator,“ I’ ve had a really rough year. I need this assignment. If you possibly can, please put me at NuLu for outpatient.” A friend who had rotated with her the year before had told me that I would love Dr. Nicole Bichir. After being out of school for the better part of a year on medical leave, I desperately needed to reconnect with medicine, with the thinking part of my brain, and to help myself come to terms with the understanding that I really was safe now, I was well and back in school, everything was going to be okay and it was time to move forward.

Enter Dr. Bichir. In the car on the way to my first day on outpatient peds, I was actually feeling kind of sad. I had really enjoyed wards and was sorry to be done so soon. As the only med student assigned to the NuLu clinic, I was also feeling some first day of school nerves. Where was I supposed to go? Would I end up looking stupid without having my friends there to lean on? Could I keep up intellectually after a year off? When I arrived, there was no sign of Dr. Bichir.“ She’ s in a room,” the NP at the desk at the end of the large open office told me.“ You’ d better go on in. She’ s going to be there for a while.”“ It’ s okay,” I told her,“ I’ ll just wait.” Fifteen minutes later, she tried again.“ Really, it could be hours. Just knock and go in and tell her you’ re the med student. She won’ t mind.”

The exam room was complete chaos. It seemed like there were kids everywhere. Two or three of them appeared to have scarring, the kind you get from serious burns, all over their bodies. A woman in a hijab, apparently better able than I to tune out all the laughing and giggling, was listening intently to an interpreter on an iPad.“ Arabic,” the screen said.“ Oh good, you must be my med student!” A youngish woman in a print dress, ballet flats and white coat flashed a million-dollar smile in my direction.“ Why don’ t you get” – at this point, she said a name that I didn’ t catch and wouldn’ t have helped me anyway, even if I had caught it, given that I had no idea which kid was which –“ up on the table and do his exam while we finish up here?” One of the kids, presumably having managed to deduce that she was talking about him, glanced up. I waved at him to come over and, lacking the words to communicate, instead pulled out my stethoscope and handed it to him to show him that I wasn’ t going to hurt him.

Little did I know, but that afternoon was the beginning of three weeks that would change my life. I’ ve never exactly thought of myself as a global health person. I mean, sure, I kind of like weird tropical diseases and I remember going when I was in high school, long before the idea of medical school ever crossed my mind, to hear Dr. Paul Farmer speak about his groundbreaking work in Haiti and thinking it sounded pretty cool. But in my head, I had put global health people in a box, and it didn’ t feel like I fit in that box. They were brave adventurers like Dr. Farmer, riding motorbikes into war zones to deliver vaccines. I thought of them as thrill seekers, adrenaline junkies, kind of like emergency medicine people, but with some added foreign flair.

However, after that first refugee intake visit on that sunny fall afternoon in Louisville, I was hooked. I spent most of the first week just shadowing Dr. Bichir. Everything about these visits was so different from what I had been taught to do.“ Avoid jargon,” the constant refrain in the standardized patient clinic, takes on new meaning when you’ re trying to communicate with an exhausted and shellshocked parent who speaks only Kinyarwanda and has been in Kentucky for exactly one week, while eight kids are being corralled to receive vaccines just behind you, half of whom will start crying loudly as soon as they see the syringes and before a needle has come anywhere near their skinny arms.

In that first week, I learned to do so many things. Yes, I practiced listening to hearts and lungs and looking in tiny ears and explaining growth charts to parents – a prospect made significantly more challenging when the parent is illiterate, only attended school until the age of nine and has not only never seen a percentile curve before in his life, but has never even encountered the concept of a percentile – but there was so much more. I learned how to help a mother hold her squirming,

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