Everyone says you’re tired during residency, but I thought I would beat the odds; I had set sleep and exercise goals for myself—thinking that somehow made me different. Then I started working. In the past week, I’ve clocked nearly 80 hours at the hospital. Yesterday, my alarm went off at 5 a.m., and I kept hitting snooze. There is no way I can get up, I told myself. But then I thought about the people I’m caring for.
I am a preventive medicine and public health doctor in training, and I’m doing my intern year of medical residency at a hospital in Detroit. In preventive medicine, we ask questions: Why did someone run out of medicine? What limits do they have? How can we make certain screenings more accessible, and how can we best explain their importance?
This month, I’m working on the internal medicine cardiac telemetry floor, where we treat people who have illnesses such as severe heart disease or heart failure. In just the past week, I’ve treated people who have severe drug use disorders but no insurance to help with the cost of their withdrawal medications, and people with heart failure who ran out of their blood pressure medications after they couldn’t afford to refill the prescription. Their vulnerability is what pulls me out of bed when I so desperately want to sleep.
I grew up nearby, in Dearborn, Mich., a city with the highest concentration of Arabs outside of the Middle East. My world was one of family-owned small businesses, dual-language conversations, and immigrants working paycheck to paycheck. I embraced what it was to be Arab: exceedingly joyful dinner parties, with hundreds of cousins, plastic tables, and skewers of meat, which I’d eat with my hands; and the interplay of laughter and always needing just a little bit more time alone.
We’ve buried many young men after an opiate overdose; too few people know what Narcan is.
In my hometown, everyone is bro (used as both a term of endearment and an expression of disbelief), and no statement could be considered truthful without wallah at the end (Arabic slang for “by God,” so ubiquitous that it has become part of the vernacular of non-Arabs all over metro Detroit). Even 10 years after I moved away, on my visits home I’d comfortably retreat to local slang and late-night sahras (gatherings) in garages. I often joke that I did not realize I was a minority until my first day as an undergraduate at the University of Michigan.
I love Dearborn, but it was hard to see its weaknesses and failures until I’d spent time elsewhere. As an undergrad meeting people from all around the world, and even traveling around the world myself, I began almost subconsciously drawing comparisons with my hometown. That left me feeling like Dearborn was both the most amazing place on earth and oblivious to its own systemic injustices. As I pondered a future in public health, I began to recognize how pervasive health inequities and intergenerational trauma subtly deplete people’s resiliency, lowering their quality of life.
In my community, it’s not unusual to know someone who was deported; to know people who lost their home; to know a couple who have a son addicted to opiates; to know a man who died of a heart attack before he was 65. Too many people have had strokes; too few of us know how to prevent them. We’ve buried many young men after an opiate overdose; too few people know what Narcan is. Many women have buried a mother who had never heard of a Pap smear; too many of us still don’t receive adequate screenings—preventive medicine—for breast and gynecologic cancers.
At the University of Michigan, at Oxford, and at Stanford, I found myself in the most privileged circles in the world. Resources were never an issue. I delved deep into health care policy, challenges, and interdisciplinary research. I wanted to not only diagnose illnesses but also determine what might have led to them. Now that I’ve graduated, I’ll confess: I never truly cared about studying science and physiology. They were just two means to an end. What drove me to finish medical school were the rare moments when I could stop doing what was required of me and, instead, spend time in the community doing work that I love.
Nadine Jawad after learning she had matched with the Transitional Year Residency at Detroit’s Henry Ford Hospital, close to her home in Dearborn, Mich. (Photo: Layla Aboukhater)
I often reflect on my community as I learn more about my patients’ lives. Once, as a subintern at a county hospital, I explained to a young man that he’d developed chronic kidney disease while he was in prison, where he’d received no treatment for his diabetes. How many people from my own hometown had been incarcerated without adequate care? In the clinic I staffed every Monday, I explained (through an interpreter) to an unhoused man why he should take lisinopril for his high blood pressure. His reading was 175/95. I’d had the same conversation with my father, almost verbatim.
I’ve returned to Dearborn, where I’m surrounded by reminders of my roots and the responsibility that I carry. I chose the path I did to give the most vulnerable populations a better chance of living a longer, healthier life. Diagnosing disease—the what—is easy; the why is complex. But the why is what will lead to change.
Nadine Jawad, MD ’24, a former Rhodes scholar, Truman scholar, and Knight-Hennessy scholar, is a first-year medical resident. Email her at stanford.magazine@stanford.edu.
