Cups of Joe with Joe
By: Adeel A. M. Khan
"Joe, how're you today?" I asked him. He shrugged. He was a relatively young man of large build, blonde-brownish hair, and had an aptitude for digesting hours of TV sitcoms - and he had been suffering from multi-vessel coronary artery disease for as long as I knew him.
Joseph was a patient at Integris Baptist Hospital in Oklahoma City, where I began volunteering during the summer before my freshman year of college. As a student volunteer I performed small tasks such as faxing records and obtaining supplies from storage as I shadowed physicians to develop my aptitude for medicine. I had gotten to know Joseph through intermittent, yet regular visits over cups of coffee. It’s said every health professional remembers his/her first patient, and I certainly remember Joseph. He never went by Joe - it was always Joseph. As such, I always called him Joe to tease him. It made him grin and appreciate the companionship.
I had gotten to know Joseph well, but I never asked how a man in his late 30s or early 40s at most developed such sever atherosclerotic disease by such a young age. It was clear, however, that Joseph had lived a hard life. He struggled with poverty and obesity for years and after his first transient ischemic attack (TIA), had a downward spiral and eventual stroke. He had little family that could care for him since his needs were so numerous - his diabetic regimen alone was bafflingly complex. His heart disease was so severe, it prevented him from maintaining employment. He teetered on the edge with an ejection fraction bordering clinical heart failure. With no financial stability and limited Medicaid resources, he had few places to turn. And unfortunately, as his condition deteriorated, he began to show signs of likely vascular dementia as well. Through him, I saw how medicine is perceived in the eyes of the patient: a field full of trepidation and only laced with hope.
I recall one conversation with him about his earlier years that left a lasting impact on my desire to pursue medicine and unite it with public health. He detailed his youth and family’s love of fast food, red meat, and his favorite: macaroni and cheese with breadcrumbs. He repeated to me the sentiment he was taught: “you’re not full until your plate is clear.” That lifestyle kept everyone in his family hovering between BMIs considered overweight to morbidly obese. Joseph developed the wisdom that such poor dietary habits were woefully unhealthy, but he lamented that he could not always afford a healthy meal of whole grain, unprocessed meats, and fresh produce. This was a particularly frustrating point to him since he was employed as a grocer. The social determinants of health – heart and vascular health, in Joseph’s case – were so poignant to me, I’ve kept the story pocketed for inspiration and motivation ever since.
When I left for college at the University of Oklahoma in 2003, Joseph was a fairly upbeat and talkative guy. And when I returned one day to Baptist Hospital, I was only barely surprised that Joseph was an inpatient yet again on the Cardiology service, but this time as a transfer from a neurovascular unit. I was shocked to discover that the Joseph I once knew was no longer there: what remained was a frail man whose final stroke prevented memory of me. His cerebrovascular and cardiovascular disease had progressed to the point of debilitation. Heavyhearted, I rose from the cedar chair beside his bed as I parted.
In 2007 after college and before medical school, I opted to pursue an international health opportunity in Egypt available to me through one of my mentors. I had never been to North Africa and did not speak Arabic but was excited to begin rotating through clinics at Ain Shams University and study Modern Standard Arabic (fuṣḥā) at the Al-Diwan Arabic Center in Cairo. The experience was phenomenal and witnessing firsthand such a different clinical incidence and outcomes profile, with different patterns of atherosclerotic and congenital heart disease compared to what I was accustomed to in the U.S. from such cases as Joseph or from glimpses during my visits to Pakistan forged in me an appreciation for global and public health.
With this motivation sparked by Joseph and solidified by Cairo, I began medical school at the University of Michigan (U-M) in 2008 on scholarship. I immediately developed the chair position of the U-M American Medical Association student group to spearhead an event series, Cover the Uninsured Week. During this campaign held in the spring of 2009, I was inspired to shed light on the U.S. healthcare system since it is a distinctly American paradox to have such profound wealth but such shallow public health leading to catastrophic oncologic and cardiovascular disease – Joseph’s story was not unique, after all. The event discussed the primary care needs of uninsured Michigan citizens across the state and notably Detroit to my fellow medical students and faculty. Through this, I had also discovered the Health Unit on Davison Avenue (HUDA) Clinic – a free clinic in inner Detroit. I began volunteering there in 2009 and rose to become its volunteer instructor in 2012. At HUDA, I saw cases of “Josephs” in the making: patients with no health coverage and uncontrolled cardiovascular risk factors and unhealthy lifestyles.
These experiences cemented in me a desire to unite public health advocacy and research with my medical training. In that vein, my passion for public health culminated in my matriculation to the Harvard School of Public Health in 2012 for a Master’s degree in Public Health (M.P.H.). As a now dual-degree dual-institution candidate, my program and ambitions are rigorous and require much support and energy, but as I reflect on my time with Joseph and patients like him for motivation and inspiration, I believe in my future career in academics as a clinician advocating for preventative health and chronic disease mitigation, the skills I gain from my public health and medical training pursuits will help me ensure that those “Josephs” can enjoy just a few more cups of coffee.