Where I've been... PART I

This is simply a recollection of my journey in medicine.  I've been working on this post for several months.  Here is part I 

      It's been a little more than 10 years since I first landed on a dark tarmac in the West Indies, ready to begin my journey in medicine..
     It started out in Grenada, a small island in the Eastern Caribbean. As a student at St. George's University, my first true clinical experience began in the 3rd world. The people were warm, welcoming delightful and generally happy with their lives. They had access to some healthcare, but nothing like what we have in the United States. I recall open air hospital wards, smiling children with irreparable cardiac defects, held by their mothers with the weight of the world on their emotionally battered faces. I remember a middle aged woman with an advanced lymphoma, engulfing her throat, unable to swallow, wasting away.  I didn't know much " medicine" at this time, but I left Grenada after 2 years, feeling lucky to be part of the US healthcare system that can do so much more.
     The next 2 years of medical school were spent in in Brooklyn New York at a large tertiary care center. Despite being a completely different environment from Grenada,  there was no shortage of illness, despair and poor outcomes. "1st world" diseases were rampant. Obesity, diabetes, heart disease ravaging disenfranchised patients with little hope advancing beyond their current social state. It was difficult to believe despite all our money and technology, how limited our system felt. The hospital was hemorrhaging money like the trauma patient in the ER. The sun was completely blotted out in this downtrodden neighborhood. It was darkened not by the tropical canopies I saw in the West Indies, but by abandoned broken down buildings. It was a different kind of island. It was an island of socioeconomic isolation, poor health and a healthcare system pushed to the brink.
     Next, it was on to an Internal Medicine residency. In this era of multi-system chronic diseases I felt medicine is where I could make the greatest impact. At Drexel University/ Hahnemann Hospital in Philadelphia, I saw the same 1st world diseases I saw in Brooklyn, New York. As a resident, I spent long hours providing hands on care to patients ravaged by chronic disease. End stage renal disease on dialysis, heart failure patients awaiting transplant, copd patients intubated in the ICU, HIV patients with exotic infections and so on. I saw countless complex patients often nearing the end of their journey, their bodies beaten to submission by chronic diseases. I kept asking myself night after night, how could this be happening to so many people. In theory their conditions seemed preventable with simple behavior change. And despite these patient behaviors, I kept asking how could our healthcare system let these patients get so sick. Overworked, and numb from the experience, I started to lose empathy for patients and faith in our healthcare system. From the geographic isolation of 3rd world Grenada, to the socioeconomic isolation of the Brooklyn ghetto, I too was stuck on an island. I always had inclination to do primary care, but everyone around me specialized or became a hospitalist. After sacrificing many years of my life I expected this would be my moment to shine and change the world. Instead, I was a drift at sea, with no direction.