A Second-Year Med Student’s Return to Egypt Spurs Insights

I am an Egyptian-American who grew up spending many summers in Egypt. For that reason, I welcomed the chance to work in at Abu El Reesh Hospital, Kasry Al Ainy School of Medicine, a public university hospital as part of the Global Health Fellowship at Albert Einstein College of Medicine after my first year.

Older physicians at the hospital regaled me with stories of how physicians from all over Europe sought to train there decades ago. However, political turmoil and a steep decline in the economy meant that government resources allocated to public hospitals declined, forcing them to do more with less. University hospitals in Egypt are funded through many small, private donations, unlike some of the private cardiac and cancer centers there. Still, these hospitals provide quality healthcare.

Meeting my mentors

The doctors at Abu El Reesh gave me a warm welcome and went out of their way to teach and show me everything possible during my many rotations. For instance, in the malnutrition clinic, the physician let me ask questions and suggest needed treatments. In tropical medicine, I was asked to come up with an extensive list of foods that contain gluten and then educate patients on a proper diet for celiac disease.

I spent hours getting to know these physicians on a personal level. Their spirit and warmth kept me going even when I felt overwhelmed. They demonstrated advocacy, compassion and healing in its rawest form. Interns and residents earn little, and visiting residents even pay the institution instead of receiving a salary. Yet these doctors poured their own money and lives into helping patients. They used their Facebook pages to raise funds for the care of patients and went to the pharmacy to buy medications for those they treated. Senior physicians would go back to the wards after working a nonstop, 15-hour day to spend time with a patient’s family.

Living with loss on the wards

There were many rare medical cases that I may never see again, such as Crigler-Najjar syndrome, epidermolysis bullosa and Alagille syndrome. I feel forever indebted to the patients who allowed me to examine them. They shared their journeys and how illness changed their lives. Every patient I saw changed me and motivated me.

Some lessons were painful, however. I experienced what it means to lose a patient. I couldn’t move the first time a resident said, “That’s it; we can’t do any more.” I remember the screams of a mother as she picked up her deceased son, covering him with her scarf so that she could get to her village before sundown and bury her child. I remember the look of defeat on everyone’s face when we couldn’t save an ob/gyn patient.

When something is important to me, I find it really hard to give up on it. The words “There’s nothing more we can do” were hard to accept. I came to understand that when those words were uttered it became time to focus on the family members because there was more we could do for them. I now know how important it is to learn to cope with grief and loss; it is something I will have to work on. You can’t help your patients if you’re not doing well yourself. Many of us go into medicine thinking of all the lives we are going to save, but rarely do we think about all the lives we can’t save.

My future in medicine

I learned a lot about myself in Egypt. Before the fellowship, I was very interested in pediatrics, but unsure of what field I would pursue. After a summer where I performed CPR on a patient who had experienced cardiac arrest, gave my first injection, learned how to hang blood, palpated an enormous number of livers, did an ultrasound, learned the vertical mattress stitch, assisted in surgery, spent days watching endoscopies and much more, I realized that I enjoyed performing “procedures.” I was happy doing things with my hands even if it was just hanging a bag of blood.

At the same time, I realized that I enjoy taking patient histories and deciphering labs. I understood that I like medicine in all its forms. On my days off, I would go to the hospital because I enjoyed being around my patients and working with the medical team.

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