DESPITE THE NOISE

It requires energy and intention to be a steward of your own life; it takes energy to grow into a space where you understand that your work as a physician is more than impressing those around you with your carefully curated words and presentation, proving your intelligence and your ability to meet your productivity quota. For me, it’s taken years of failure; small and large wins, and more importantly privileged moments with my patients to realize some of the more profound and life changing moments come from the care and bond I have built with patients be it 15 minutes, a day shift, a month long or year’s long journey with a patient. If we are lucky, despite the noise around us, we can learn to recognize our own transformation.

The currents of the world move us with or without our conscious participation; the weight of the world consumes us— even when we are unaware of it. People, life circumstances, world events are in a constant metamorphosis even in periods of our life where we feel we are static or unchanged. Even when we are not consciously navigating and adapting, the energy around us etches itself into our being. If you are not careful you can lose your footing and the tide will pull you deeper into a sea of confusion.

Residency has the power to make you feel like you are being pulled into a fog of doubt and sinking into a bottomless pool of imposter syndrome. These feelings blur and drown out the real world; it can make you lose touch with all the discrete and overt ways the world pushes up against the patients we care for and how real-world crises are a day-to-day experience for some of our patients. It blurs the impact on your well being and perception of self and location to the world around you. Much like other oppressive systems, it makes noise so you don’t hear your own thoughts. It makes you feel so exhausted and worn out that you have no energy to rise up, no space to fight back, so tired that your voice is nothing more than a whisper, so tired that your default becomes silence, so tired that when you are triggered and feel exploited you question whether or not it is all in your head.

Work culture/productivity culture can make you feel guilty for wanting time to process, to reflect and yet also urges you to give all of yourself and know yourself so well that you are constantly seeking to grow. It creates cognitive dissonance that feeds your guilt for not doing enough, for not saying enough, for being slow, for being on a different path than your colleagues, for not being present for your family. It creates confusion.

Mauricio “Jimmy” Franco, MD, MS

You see

Systems of oppression thrive on me not having space and time to process. Systems of oppression thrive on my need to survive. Systems of oppression thrive on me not having time to react to the micro/macro aggressions. Systems of oppression thrive on my task overload so I have less time to think critically about the ways in which it does not support me. Systems of oppression thrive on my isolation. Systems of oppression make noise.

The noise can get so loud that it muffles and drowns out the voices of those who stand beside you; the noise can get so loud that it makes you feel you are working alone. The noise is used to distract. The noise is a strategy.

Despite the noise, there is joy and beauty in our work.

Despite the noise, there are tender and vulnerable moments with patients and colleagues.

Despite the noise, we rise.

Despite the noise, we connect with our patients.

Despite the noise, we sit and bear witness to the strength of our patients.

Despite the noise, we bear witness to their pain.

Despite the noise, we bear witness to their dying.

Despite the noise, we are changed and moved by our patients.

Despite the noise, we heal.

I write and reflect to better serve my patients; I write and reflect to be a better physician and to be a better version of myself. I write and reflect to honor the illness narratives that I have been entrusted with. To be rooted in social justice and health equity requires me to take a critical lens to the systems that train me and the systems that my patients navigate.

Dr. Franco is a pediatrics resident at UCSF. Jimmy approaches his work with a commitment to intersectionality. He believes medicine needs to be radically transformed and is grateful to his mentors for showing him that he can show up as his full self—a queer Guatemalan from a family of immigrants—without shame to support others in leading authentically.