The overpowering smell of fresh feces struck me as I opened the

bathroom door. I peeked in and saw Molly, one of my patients, sitting on the toilet
looking like a guilty schoolgirl. Her hands, her walker, the walls, the fake plant,
the floor, the mirror, and even the call-bell cord were completely coated in bodily
waste. I immediately fought off both an overwhelming desire to laugh and the
urge to vomit. During the following two hours of scrubbing and breath-holding, I
learned that Molly had previously been an art teacher before her Alzheimer's
diagnosis. She was likely attempting to finger paint; unfortunately, she chose the
wrong medium. Many more vivid memories, experiences, and smells have
followed since that infamous day, but a singular challenge has emerged and
endured: the preservation of the dignity of patients who have difficult behaviors
and conditions that make it a challenge to focus solely on delivering superior
health care.
As a lead resident care associate at an Alzheimer's care facility, I deal with
many health care providers, families, friends, and caregivers who struggle with
the difficult issue of how to overlook the contextual aspects of dementia and
identify the patient's true needs. I have been called offensive names, pinched,
yelled at, and spit on while attempting to bathe a patient only to discover that this
person had 15 cavities that were causing her pain, manifesting in her difficult
behaviors. By utilizing my unique experiences observing the various stages of
dementia, I hope to become an effective and compassionate physician.
My episode with Molly was not the first patient encounter where I
struggled to maintain an outwardly calm appearance while internally I was
shocked. Some of my most poignant experiences occurred in the three months I
spent living and volunteering in rural Honduras. I translated Spanish in a medical
clinic for American doctors as well as implemented public health programs in
partnership with local community leaders. During my first summer in Honduras, a
man limped up to the clinic at the end of a long day. He shyly shuffled up to us
and calmly asked us to examine his left leg. When he lifted his extremely dirty
pant leg, I could barely hold back a gasp. A vile smell emanated from his leg and
his entire calf was eaten away, exposing bone and muscle in the middle of a
football-sized wound. Black necrotic tissue oozed green pus. With growing
compassion and intense curiosity, I began the laborious task of cleaning this
neglected wound.
I eventually gleaned from my patient that many doctors had insisted on
amputation to treat his horrible infection. He had refused all offers, stating that he
would rather die than lose his leg. Internally, I could not help but to agree with
these doctors. This infection would eventually lead to his demise. However, as he
spoke, I realized that he was not ignoring sound medical advice but simply could
not survive without his leg. He biked many miles each day to his fields and
worked long hours in the fertile soil. Without his leg, this treacherous journey
would be nearly impossible. In Honduras, almost no programs exist to aid the
disabled and there are certainly no handicap-accessible sugar cane fields.
After three weeks of daily wound cleaning, heavy antibiotics and some lessons
on proper hygiene, my patient left the clinic with a tenuously healing leg. I was
satisfied that we had listened to the patient's concerns while treating him to the
best of our abilities. By attending to the patient with the dignity that he deserved,
the doctors and I did not choose the medical path that a textbook deemed
correct, but chose one that addressed that patient's true needs.
I have worked as a dental assistant, clinic translator, public health worker,
and dementia caregiver. I have held a miscarried fetus, assisted in an oral
surgery on an HIV positive patient, comforted a distraught resident who was
reliving the birth of her daughter, and discussed birth-control use with a room full
of wide-eyed Honduran women. So why do I want to become a doctor? It's
simple and selfish. It is what I love, my own personal addiction. I am captivated
by duality of the physician's role as both a detective and a nurturer. This constant
balance enthralls me. As a result, I am the first to arrive and the last to leave any
clinical setting. Witnessing how respectful health care has improved lives has
given me confidence that I will use my unique collection of experiences and
passions to positively contribute to patients' lives.