It’s a funny thing when you tread familiar paths for one final time. The hallways and corridors you’ve paced innumerable back-and-forths suddenly feel like little museums of personal history. I walked down the halls of Harborview for my last time as a chief resident, yesterday. It was my last day of residency—the finish line to a journey I began seven years ago. I couldn’t help but smile thinking about the intern who scrambled across this glass walkway seemingly a lifetime ago—the one carrying five pagers and a hospital phone while hurrying to the bedside of a patient in atrial fibrillation. Or the version of myself who stood in this trauma bay four years ago and opened a man’s chest for the first time, hoping to restore a spontaneous heartbeat, but finding only a cavity full of blood, and a ventricle irreparably torn open by a shotgun blast. These are iterations of myself that seem distant, now. And as I looked out at the clear view of Mount Rainier from the Harborview skybridge, yesterday, it was tempting to construct some narrative of the sweat and sacrifice it took to reach this lofty summit. But if I were to reflect honestly, I know that peaks only exist relative to the valleys upon which they cast their shadows. And we too often overlook the valleys that bracket our spectacular views from the summit. But just as these hospital walls were not built to bracket my personal journey—no matter how many memories I’ve embedded in their every corner—the greatest chapters of our lives are rarely constructed without the immense expense of a much larger community. In medicine and surgery, there are few encounters as profound as caring for the traumatically injured population at a place like Harborview, and witnessing day after day the systemic inequities in injury burden and healthcare delivery. So while I celebrate the soaring achievements of my fellow graduates, I must also recognize the large portion of our surgical training that has been siphoned and stolen from marginalized communities.
To be clear, I have cherished my time at Harborview. I know that I am not alone in attributing so much of my personal and professional growth as a surgeon to the countless lessons learned between its dozen trauma bays and two dozen operating rooms. Here, generations of trainees have learned to open and explore injuries to the chest and the abdomen—to repair bleeding vessels and reconnect injured bowels. Yet, even as I laud the educational opportunities offered to me as a surgical resident in a high-volume level one trauma center, I struggle with the basic truth that the vast majority of patients I’ve cared for in this setting have not chosen to be here. Trauma and the surgical diseases associated with it disproportionately impact people from already resource-depleted communities—people of color, undocumented immigrants, people without access to stable housing, and those battling addiction and mental health disorders. This is not the hospital where most of my friends and family would choose to seek care. And yet, this is where I have stolen piece after piece of invaluable surgical education. It is easy to say that I did not inflict any of the injuries or illnesses that I have been called upon to treat—that I have only done my best to alleviate suffering and restore health when presented the opportunity. It is much harder to acknowledge that my clinical skills and surgical acumen have been sharpened on the suffering of those living in poverty and subject to racial injustice.
Hippocrates once postured, “War is the only proper school of the surgeon.” It is a painful reminder that since the time of ancient medicine, surgeons have honed their skills on men and women placed in untenable situations of conflict. If the current protest by black communities demanding change for how black bodies are policed makes you uncomfortable, or if saying “black lives matter” makes you uncomfortable, please recognize this: the well-trained surgeons who are best prepared to care for you and your family have likely honed some significant portion of their skills operating on a disproportionate number of injured black and brown bodies. This now includes me. And as I graduate and move on to my next chapter—this is what makes me the most uncomfortable.
Jay Zhu, MD
Chief Resident 2020 | University of Washington