The hardest thing to face in my medical education has not been illness, has not been disability, has not been mortality. People get sick, they get crippled, they die. Often these events are direct consequences of life decisions the patient made to their own benefit or detriment. This is an impersonal war to fight, doctors vs disease, the human equivalent of building dikes to keep out a rising sea. The hardest thing has been the evil, the raw, visceral darkness that afflicts our species, the casual cruelty that brings abused children to our ER, gun shot wounds to our OR, and the ignored and deathly ill elderly to our palliative care. It is hard to think about. It hurts to think about. Without fail ,when faced with the reality of abuse, of neglect, of vicious intentional evil, I want nothing more than to retreat to my bunker of middle class comfort, where my kind and patient parents treated me with nothing but love, and shielded me from the dark vicissitudes of mankind. I can, and have, wallow through spurting arteries and disconnected body parts in the OR. I can watch people die, feeling nothing but compassion and a desire to help. But I squirm and twitch when made to look upon belt and burn marks on an innocent child, when asked to watch videos of helpless children forced by an uncaring world to advertise their skills at oral sex.
Human trafficking, for instance, is the sort of problem that makes me want to curl up and hide, to withdraw from the position I have long sought as one of the people who makes things better. Huge and intractable, it is a monolith of sin and depravity that is hard to even think comfortably about, reflecting as it does the darkest parts of human nature. One shrinks back it, loath to try to understand how it is that members of your species engage in something so soulless, cruel, and disturbing. On a personal level, I have no response to this issue. I can’t even deal with it without resorting to defense mechanisms, the intellectualization and derealization that protect me from the considerable pain of empathy with the millions of children right now being torn apart by greed and sickness of adults who were meant to shelter and raise them. In a way, those defense mechanisms are what you ask me to employ here. The dry context of how this information will affect my practice is a well-meant question, designed to raise the issue in my mind, to encourage me to help. But I find it hard to answer, each thought, each theory, about how I can help falling flat in the face of the sheer volume of pain.
I could talk about the policy of it all, of the overarching need to drain the swamp, to promote education, civil society, and local development in order to eliminate the crushing poverty and insecurity that provides the source of so many of these slaves. We could push for increased enforcement of laws, for political and economic pressure on the countries most known for being purveyors of sex tourism to enforce common international rules. I could promote local efforts to track down the operators of local brothels and the kidnappers and slavers who run them. I can make high minded policy arguments about legalization and regulation of prostitution in order to ensure that only the 11% of women who don’t want out remain in the business. I could talk about the increased vigilance I will employ in my practice, looking for signs of abuse, asking questions no matter how painful or rude. I can talk about how I will be involved in physician lead efforts to improve healthcare for sex workers, to mitigate the pain and destruction that this life inflicts on them. Of course, I could state my intention to provide money and support to organizations that help rehabilitate the victims. All of these are good ideas, all of these can help some of the 27 million people living in shackles, literal and metaphorical. Any of these is a valuable use of time, effort. But none of these changes what is happening now. None of them changes the vast quantity of wrong that touches my life only tangentially. None of those efforts improves the life of a Filipino woman held hostage by two disgusting examples of our profession in our own state. None of these efforts wipes clean the stain of seemingly normal people using craigslist, the internet, cell phones, and the comfortable framework of modern American life to repeatedly rape a 14 year old girl in a motel I drive by every time I fly out of Milwaukee. Even the discomfort, the cringe that I feel when talking about the issue seems a mockery of what those afflicted by this blight are going through.
The one thing I can do right now, for those currently in pain, is to bear witness. To be stronger than my weakness, than my avoidance, and to recognize both the sin in the world and my, and our, current failure to solve it. Of course I will resolve to work in the highly unsatisfactory and slow effort to fix these problems, to fix whatever it is in humanity that lets us do this to a subset of our children. Of course I will be vigilant in my practice, and I will give money and time to efforts hoping to resolve, if not this problem, then others that bear on it. I will use my knowledge and energy to promote policy helping the third world and impoverished areas of our own nation to grow out of the diseased poverty that spawns issues like this and so many others. But most importantly, I will recognize this evil abroad in the world. I will care about its victims as much as I can. I will not shy away.
