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Female doctors on medicine

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Have to acknowledge that many of these have come from a list generated by Rachel Kowalsky tweeting out for recommendations https://twitter.com/rachel_kowalsky/status/1596636362106884096

Rachel Kowalsky

YOUR FIRST PEDIATRIC INTUBATION

https://www.theintima.org/your-first-pediatric-intubation-rachel-kowalsky

First, eat a meal. Then kick your dragons to the curb. The dragons of your self-doubt, my dear! You rode them all the way here. Have you read the chapter? That will help. Let’s go.

1.Dress

in a plastic gown. Gather your endotracheal tube, laryngoscope, suction, stylet, syringe, pink tape. Connect the child to the monitor, the IV to its tubing, face mask to blue bag. Ask for medications early, and dose with care. Never do math in your head.

Joanna Connon

Joanna Cannon’s book ‘Breaking and Mending’ recounts vivid stories from her time as a junior doctor. In this extract, impressive teamwork in A&E restarts a woman’s heart, but the author comes to realise there are many, less dramatic, ways to save lives.

https://wellcomecollection.org/articles/XWeSyxAAACMAxzjS

There are many reasons why people decide to go to medical school, but if you had asked each of us on that first day why we were there, we would have told you it was because we wanted to make a difference. We would have told you it was because we wanted to do something valuable – something important. We would have told you it was because we wanted to save lives.  

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Louise Aronson

A History of the Present Illness

In 16 elegant and original linked stories, A History of the Present Illness takes readers into the lives of doctors, patients and families. Powerful and original, the book offers a deeply humane, striking voice and an incisive portrait of health and illness in America today. Lauded by Kirkus Review as “a promising debut” of a new literary voice, the book tells stories readers haven’t read before.

A History of the Present Illness

Articles

https://www.kevinmd.com/2013/05/physicians-write-2.html

https://hms.harvard.edu/magazine/lgbtq-health/act-three

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Anna DeForest

‘s ‘A History of Present Illness’ + ‘OUR LONG MARVELOUS DYING’

https://www.anna-deforest.com

“A History of Present Illness is a singular read, full of beauty and wit and monstrous truth. It took me down dark corridors of loss and out into the too bright sunshine again. I’ve never read anything like it. Wholly original and shockingly brilliant.”

— JENNY OFFILL, author of Weather

https://www.npr.org/2022/08/21/1118669917/dr-anna-deforest-draws-from-her-profession-to-write-on-sickness-healing-and-loss

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Suzanne Koven

“The numerous self-serving anecdotes are unnecessary. It’s at times preachy and idealistic. This book disappoints if you’re truly looking for self help.”

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Perri Klass

https://www.perriklass.com/books

Victoria Sweet

https://www.victoriasweet.com/books/gods-hotel/

San Francisco’s Laguna Honda Hospital was the last almshouse in the country, a descendant of the Hôtel-Dieu (God’s Hotel) that cared for the sick in the Middle Ages. Ballet dancers and rock musicians, professors and thieves — “anyone who had fallen, or, often, leapt, onto hard times” and needed extended medical care — ended up there. Dr. Sweet ended up there herself, as a physician. And though she came for only a two-month stay, she remained for twenty years.

At Laguna Honda, lower-tech but human-paced, Dr. Sweet had the chance to practice a kind of “slow medicine” that has almost vanished. Gradually, the place and its patients transformed the way she understood the body. Alongside the modern view of the body as a machine to be fixed, her patients evoked an older notion, of the body as a garden to be tended. God’s Hoteltells their stories, and the story of the hospital, which — as efficiency experts, politicians, and architects descended, determined to turn it into a modern “health care facility” — revealed its truths about the cost and value of caring for body and soul.

In God’s Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine Dr. Sweet lays out her evidence—in stories of her patients and her hospital—for some new ideas about medicine and healthcare in this country. In trying to get control of healthcare costs by emphasizing “efficiency,” we’ve headed down a wrong path. Medicine works best—that is, arrives at the right diagnosis and the right treatment for the least cost—when the doctor has enough time to do a good job, and pays attention not only to the patient but to what’s around the patient. Dr. Sweet calls this approach Slow Medicine, and she believes that, put into wider practice, it would be not only more satisfying for patient and doctor, but also less expensive. The New York Times calls her ideas “hard-core subversion”; Vanity Fair judges the book to be a “radical and compassionate alternative to modern healthcare,” and Health Affairs describes Dr. Sweet as a “visionary.”

Michelle Johnston

https://michellejohnston.com.au
Tiny Uncertain Miracles
Dustfall

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Judy Melinek

‘Working Stiff’

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Karen Hitchcock

The Medicine

What happens when a doctor kills a patient? Are GPs overprescribing antidepressants? Does ‘female Viagra’ work? What role can psychedelics and cannabis play in treating pain? What is sickness, and how much of it is in our heads?

In The Medicine, Dr Karen Hitchcock takes us to the frontlines of everyday treatment, turning her acute gaze to everything from the flu season to dementia, plastic surgery to the humble sick day. In an overcrowded, underfunded medical system, she explores how more of us can be healthier, and how listening carefully to a patient’s experience can be as important as prescribing a pill. These dazzling essays show Hitchcock to be one of the most fearless and illuminating medical thinkers of our time – reasonable, insightful and deeply humane.

https://www.blackincbooks.com.au/books/medicine

https://www.themonthly.com.au/author/karen-hitchcock

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Lydia Kang

Adult
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Susan White

‘Cut’

Carla is a young doctor striving to become the first female surgeon at a prestigious Melbourne hospital. When a consultant post opens up, she competes with her lover for the job and thinks she can be judged on merit. But an assault after a boozy workplace dinner leaves her traumatised and struggling to cope with the misogyny coming from every corner of her workplace. Recovering her fragmented memories from that night, Carla begins a fight for justice that will shake the foundations of the hospital she loves.

https://affirmpress.com.au/publishing/cut/?portfolioCats=15

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Sumaya Dave

https://www.saumyadave.com/other-writing

https://www.thefeministwire.com/2013/02/two-poems/

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Carol Cassella

‘Healer’

A Seattle physician has to reevaluate life and career when her husband’s business crashes. Through this tale of love and medical wonder, Cassella uses her 25 years of experience in the medical industry to inform a work of emotional distinction and penetrating insight.

https://carolcassella.com/healer/summary

Dr. Marie Heaton is an anesthesiologist at the height of her profession. She has worked, lived, and breathed her career since medical school, and she now practices at a top Seattle hospital. Marie has constructed her professional life according to empirical truths, to the science and art of medicine. But when her tried and true formula suddenly deserts her during a routine surgery, she must explain the nightmarish operating room disaster and face the resulting malpractice suit. Marie’s best friend, colleague, and former lover, Dr. Joe Hillary, becomes her closest confidante as she twists through depositions, accusations, and a remorseful preoccupation with the mother of the patient in question. As she struggles to salvage her career and reputation, Marie must face hard truths about the path she’s chosen, the bridges she’s burned and the colleagues and superiors she’s mistaken for friends.

https://carolcassella.com/oxygen/summary

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Lucia Gannon

All in a Doctor’s Day: Memoirs of an Irish Country Practice by Dr Lucia Gannon, published by Gill Books

https://www.irishtimes.com/culture/books/a-gp-s-work-lifesaving-balance-i-could-not-care-for-others-if-i-was-not-caring-for-myself-1.3869521

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Rachel Clarke

How does it feel to confront a pandemic from the inside, one patient at a time? To bridge the gulf between a perilously unwell patient in quarantine and their distraught family outside? To be uncertain whether the protective equipment you wear fits the science or the size of the government stockpile? To strive your utmost to maintain your humanity even while barricaded behind visors and masks?

Rachel is a palliative care doctor who looked after the most gravely unwell patients on the Covid-19 wards of her hospital. Amid the tensions, fatigue and rising death toll, she witnessed the courage of patients and NHS staff alike in conditions of unprecedented adversity. For all the bleakness and fear, she found that moments that could stop you in your tracks abounded. People who rose to their best, upon facing the worst, as a microbe laid waste to the population.

Her new book, Breathtaking, is an unflinching insider’s account of medicine in the time of coronavirus. Drawing on testimony from nursing, acute and intensive care colleagues – as well as, crucially, her patients – Clarke argue that this age of contagion has inspired a profound attentiveness to – and gratitude for – what matters most in life.

https://www.theguardian.com/books/2021/jan/23/breathtaking-by-rachel-clarke-and-intensive-care-by-gavin-francis-review-two-superb-doctor-writers

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Heather Frimmer

Heather Frimmer is a radiologist specializing in breast and emergency room imaging. Her first novel, Bedside Manners, was published in 2018 and has received several awards including National Indie Excellence, Readers’ Favorite and Independent Press awards. She completed her medical training at Weill-Cornell Medical College, New York Presbyterian-Cornell and Yale New Haven Hospital. She lives with her husband and two children in suburban, Connecticut. Her second novel, Better to Trust, releases in September 2021.

Bedside Manners

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eKinari Webb

https://www.guardiansofthetrees.org/

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Module focussing on representations of alcohol in Irish literature

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Session #1

– On positive portrayals of alcohol and pubs, with a beer mat as prop

Just as a ‘trailer’, opened with the Guinness ad that uses the “We Have All The Time In The World” song and ends with the slogan ‘Pure Genius’ and a symbol of the trademarked Guinness harp while Armstrong sings the words ‘only love’.

To put literature in a clinical context – with alcoholism as the presenting condition – I read from Danielle Offri‘s essay ‘The Poetry Ward‘ about how she has incorporated poems into her ward rounds with trainee doctors, and even involved one (Jack Coulehan’s ‘I’m Gonna Slap Those Doctors‘) in her communications with a patient.

We moved on to Flann O’Brien’s ‘The Workman’s Friend’ poem from At Swim-Two-Birds as a starting point for a session exploring how pervasive and often positively represented pub life and alcohol are in Irish society as reflected in a number of poems, including:

I also mentioned the idea of Irish literature as patient and our job being to diagnose it.

To allude to how some of the work of the post-Joyce time was sub-par, I quoted from Nuala O’Faolain’s memoir, Are You Somebody? (New Island Books, 2018, p 92) >

… the culture [of literary Dublin] was terribly dependent on drink. There was too much public, anecdotal life and not enough personal, lyric life. There was too much drinking. Drinking means bad breath and crusted shirt-fronts and shaking hands and bottles of milk wolfed down as a meal and waking in the morning on a pile of coats with no clean knickers and being thin, being cold, being sick. And drinking is, after all, about getting drunk. Fine people all but prostituted themselves to get the money to get stupidly drunk every single night. I saw Myles na Gopaleen urinate against the counter in Neary’s one night. That’s what being a drunk means – waking to the evidence of repeated lonely humiliations that drive you further and further away from anything but drink. And whatever that kind of drinking did to me, it ruined women. I can think of only a few of the women (and I’m not one of them) who hung around McDaid’s who were not, sometimes, squalid. You would think that way of life had been designed to test people to their limits. Certainly it could not be survived: only abandoned.

Session 2 – in the pub

– On more damaging portrayals of alcohol and pub life in Irish literature, with actual pint of Guinness as ‘prop’

A poem-crawl session aimed at plying the participants with a skinful of drink-poems so that almost before they realised it and with minimal effort on their part they’d have got drunk on a sense of the medium (Irish literature) & of the theme (alcohol) over a relatively short period of time:

  • ‘Aubade’ by Michael Hartnett – a sort of follow-on poem to O’Brien’s ‘Workman’s Friend’, being in a similar metre & form, but with the refrain being the growing need to call a doctor.
  • ‘All Alcoholics Are Charmers’ by Martina Evans
  • ‘Bar Fly’ by Nessa O’Mahony
  • ‘Quitting the Bars’ by Paula Meehan

We ended with a discussion of what I think is kind of a ‘found poem’ by a man called Jim Long, who I gather was a client of Cork’s Simon Community. It was kindly given to me by Kathy D’Arcy who had it from an anthology (Mosaic) put together by Cork Simon in 2005. My sense – without having been able to confirm it yet – is that Jim was ‘interviewed’ and this story of his relationship with Phyllis was made into this poem by the editor of the anthology. It’s a heart-wrenching ‘Fairy Tale of New York’-like story of love challenged by the harsh realities of addiction and street living.

Session 3 – back in classroom

– On alcohol-aided abuse and control as theme and tumbler of whiskey (actually apple juice) as prop

To highlight the effect of all that alcohol on society, on people, at the deepest level, we read and talked about Doireann Ní Ghriofa‘s ‘From Richmond Hill’:

Home from hospital, you doze in my arm, milk-drunk,
all eyelashes, cheeks and raw umbilical, swaddled
in the heavy black smells of the brewery.

 ... Down gullets and guts went the porter,
went the pay, went the nights and days. ...

 ... As I watch your eyes open,
the reek of roasting hops knits a blanket of scent around us.

We read extracts from Edna O’Brien’s Down By the River with a focus on how alcohol may or may not be a factor in James’ sexual abuse and raping of his daughter, Mary; as well as on how Irish society is represented in terms of the repression of true feelings and emotions and their displacement to empty formulas in conversation, distorted relationships, and unhealthy reliance on alcohol.

We discussed the inability of various people in Mary’s life to prompt Mary to say what was going on or to be able to help her; and put that in the context of how doctors need to have particular patience & the skill of close listening (// close reading in literature) to be able to communicate with young people; and an empathy and imagination that enables them to imagine possibilities and explore them – abilities that could be enhanced by reading literature.

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On the topic of repression and not being equipped to talk abour certain things, I quoted again from Nuala O’Faolain:

“Yet I had no confidence at all … at the business of love. Over the next few years, the few times I more or less ‘went all the way’, it wasn’t because I wanted to, but because I was too shy about intimate things to talk about it. I didn’t have the self-confidence to indicate ‘no’. Or – when it came up, wordlessly, the first time, I didn’t have the words to say that I didn’t want to. Then, by doing it, I gained the confidence to say we should stop. This was the worst possible way of being with young men who were at least as confused as I was.” (page 56.)

Session 4 – 

– On teenage pressures and personality disorders, with numerous (empty) bottles of vodka as prop & game of drink bingo (with water)

We read a part of the second chapter, ‘Saturday’, from Louise O’Neill’s Asking For It, and discussed drinking among young people, the reasons for it as presented in Asking For It, the consequences, and how convincing or not the portrayals of their behaviour are in the novel compared to our own experiences.

We focussed on the malevolence of the central character, Emma, and where that might have come from – nature v nurture etc.; relationships with parents; ambition etc. And we discussed how Emma’s abuse of alcohol in the first part of the book shifts to her mother later on.

I then used Emilie Pine‘s essay ‘Something About Me’ from Notes on Self, in which one finds remarkable parallels from real life, to set up a ‘dialogue’ between the fiction & non-fiction and help elucidate the relationship Emma has with her mother.

We discussed the different kind of repression that seems to be at the heart of Asking For It – a failure to confront issues together, to guess at or ‘see’ what is right before our eyes, a failure to listen to each other without judgement and thereby enable divulgence, truth, confession; and instead turning a blind eye, pretending. There’s also, behind all that, a failure to nourish, to give space to, to protect, and speak up for etc. the next generation.

I suggested doctors needed to be part of that move to stand up for and protect young people, to prioritise their safety & their rights (above keeping up appearances etc.) & the importance of listening non-judgementally and in ways that it is clear to those speaking that there will be no judging, to young people, to each other; & encouraging the dealing with issues that can cause so much harm to people.

Session 5 –

– On alcoholISM, with the normality of wine as prop

With the alcoholism context established by extracts from Leslie Jamison’s The Recovering, Lucy Rocca’s talk for Alcohol Action Ireland about her alcoholism >https://vimeo.com/126926989, and from Mary Coughlan’s song ‘Delaney’s Gone Back on the Wine’ (He didn’t move out right away/Spent a few evenings just tearing out his hair/While all the kids just stared./And we moaned about who really cared.”) and an interview with her about shame & not having the words to describe the abuse she experienced at the time; and the sense of the medical profession’s contribution to normalising alcohol from some brief references (e.g. Shaun McCann’s An Immodest Proposal); we revisited Louise O’Neill’s Asking For It in particular reading extracts that dealt with Emma’s mother’s rapidly developing reliance on wine as family life deteriorates, mirroring Emma’s reliance on vodka in first part of the book.

We then read & discussed the amazing portrait of an alcoholic at the outer fringes of life that is Eileen Casey’s story ‘That Woman’ (from Snow Shoes) and the clinical presentation of alcoholism as seen in Emilie Pine’s essay ‘On Intemperance’ from Notes to Self.

Themes that came up:

  • Misconceptions of what alcoholISM ‘looks’ like
  • Importance of children >/</= Individual’s needs/desires
  • Cultural differences in relationships between young people & where alcohol fits in
  • Attitude of medical professionals to alcohol – too blasé? 
  • What can medics say to harmful/dependent drinkers with responsibility for children? 
  • Need for doctors to use their voices to speak out against alcohol?
  • Burden of alcohol morbidity on healthcare resources & individual medics
  • Public health policies on alcohol in society

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Session 6 –

– On alcohol & death, with a liver in formaldehyde as the prop, in the old anatomy lecture theatre, TCD

The participants, with final prop in the foreground.

Introduced the theme using Dorothy Molloy’s poem ‘Gethsemane Day’ with its almost unbearable juxtaposing of the grimness of a final diagnosis with the jolliness of a nursery rhyme metre:

They’ve taken my liver down to the lab,
left the rest of me here on the bed;
the blood I am sweating rubs off on the sheet,
but I’m still holding on to my head.

What cocktail is Daddy preparing for me?
What ferments in pathology’s sink?
Tonight they will tell me,
will proffer the cup, and, like it or not, I must drink.

https://www.irishtimes.com/culture/books/poetry-round-up-balancing-life-and-death-on-a-knife-edge-1.4074487

We read & discussed extracts from Anne Enright’s novel The Gathering (Jonathan Cape 2007) about the Hegarty clan, as told through the voice of heavy drinker, Veronica, as she tries to get her head around the life and death of her alcoholic brother, Liam, & the widespread dysfunction in her family:

This is the way my mind runs … while my brother is decanted and transported and embalmed (the whiskey must help)

p. 83

I drew attention to the considerable number of parallels between Enright’s plot and the ‘true-life story’ of Nuala O’Faolain & her brother, Don, as recounted in her memoir Are You Somebody?  (New Island 2018)

I saw black rot in his finger-tips. I never saw anything in my life as – as indifferent to me and all the living – as that blackness. His body wasn’t even pretending to carry a person any more. What or where Don was, was the most unanswerable question. I never heard silence like there was in the little room with his body in it. I never saw anything more immobile than Don in that still place…

p. 262

Finished up by sharing this harrowing short video about alcohol & suicide from Alcohol Action Ireland > https://vimeo.com/239804874

Truthsaying: The need for honesty from patients & doctors: session # 5

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With themes of truth & hope underpinning the session, it being International Men’s Day, we read texts mostly by women about pregnancy, labour, babies and girls!

We started, though, with a run through Yeats’ ‘Paudeen’. They’re getting there. We had a recap on last week, and a summary of Maeve Binchy’s ‘Anna’s Abortion’.

From that we read and analysed an extract from Emilie Pine‘s ‘From the Baby Years’ section of Notes to Self. The extract dealt with the loss of her one and only pregnancy. We discussed how particularly invested Pine was in the pregnancy (“I see that I’m shaking”) and how that comes through in her hope & wishful thinking in the face of contrary information/evidence > “Maybe I am wrong. / Maybe the date is wrong.”

We discussed how despite our ideals of professionalism and standardisation, we nonetheless often sense and operate by other, more human realities >

“I have a moment of hoping this coincidence [of going to the same university as the doctor] will make her well-disposed towards me”.

We mentioned how bizarre it is how we often act contrary to our truths, pretending because of not wanting to reveal our uncertainties or to risk appearing not in control > “I pretend like I’ve done this before”.

I emphasised how honestly Pine was recounting all of this now as the narrator. We discussed the contrast between how Pine is aware of the constraints on the staff when it comes to pronouncing the still growing foetus dead, and her actual anger >

“I am furious. At the situation and, specifically, at them. I am a woman, in grief, and these women will not look me in the eye as a fellow woman and tell me that I’m not going to be a mother.”

We discussed the possibility that shame felt by the midwives was behind their failure here. We discussed the blunt honesty of Pine’s admission of how she felt observing the pregnant women outside the National Maternity Hospital > “I would be a better mother. I deserve it more.”

I emphasised how honest a writer she is in her retrospective analysis of her actions and thoughts >

“I am so deep into this that I don’t even see the problem with comparing not being pregnant to a serious illness.” And I therefore suggested she was a welcome/useful voice to hear in the context of how complex the doctor-patient relationship can get, with two flawed “entities” contributing to it. (It is too often presented over-simplistically as rude doctor failing innocent patient.)

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We moved on to Maggie O Farrell‘s I Am, I Am, I Am, specifically an extract from the chapter called ‘Abdomen 2003’ that recounts the birth-plan for and delivery of her child. (I used the adapted version published by Time magazine.) We discussed how incredibly rude (almost literally: not credible) the consultant, Mr C, was. I paused on and parsed the sentence: “I wish now I’d left there and then, but at the time I was so astonished I complied.” I asked whether or not O Farrell was being as retrospectively honest as Pine here. Was it just astonishment?

[I diverted for a moment to read this important passage from Pine’s last chapter:

The stinging irony, of course, was that my entire talk was about ways that women are intimidated into silence. And here I was, with a platform to speak [having just given a lecture on the silencing of women about rape], finding myself with the same difficulty. The Faculty Chair’s comment [“I find it hard to reconcile how you look and your manner with your subject matter. I mean you look … I don’t want to use the word ‘cute’ but …”] implied that I shouldn’t be talking about rape. It is more than just tedious, this women-should-be-seen-but-not-heard attitude. It is a way of telling women to back to where they belong, back to being silent. I am gobsmacked that I still encounter this attitude in the university. And I am, most of all, weary of having to come up with something in response. I should have called him on his misogyny. But in the moment that he said it, I did not even allow myself to think about the implications of his comment. I wanted to look professional. I wanted to seem strong. I wanted to move on. As so I side-stepped. Which is, of course, a kind of silence.

I suggested Pine’s analysis was possibly true for the O Farrell situation too.]

The reappearance later in the episode of Mr C as O Farrell’s “saviour” was useful in setting up the idea that sometimes the rude doctor is all we’ve got, and maybe we just have to learn as patients how to deal with it, how to communicate with them to protect ourselves.

We contrasted, as O Farrell clearly intends, Mr C with the stranger in beige scrubs who comes to her emotional rescue while “a room full of people … are frantically working to save [her] life.” > “He stepped towards me, away from his wall, and took my raised hand. He enfolded it in both of his. I gazed up at him mutely. His touch was infinitely gentle but firm and sure. He stayed with me while they stitched and stapled me together again; he took the weight of my head and shoulders as they lifted me from the operating table onto a gurney.” [Italics added.]

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We then read & analysed a story written by a man, Yay! (albeit a Michael Longley type of man > “I’m finely attuned … to the feminine side of the men I like. I really don’t like men who are pumped full of testosterone. I like my men to have a large dose of the feminine virtues.”) ‘The Girl with a Pimply Face’ by William Carlos Williams is one of my favourite texts to discuss with medical students because at first the male doctor’s sexualised descriptions of the teenager he meets on a house visit (“She had breasts you
knew would be like small stones to the hand”) make him seem just “creepy” (as was said today). We analysed the story in considerable detail and discussed too many things to summarise here, but with similar themes as above, of honesty, truth telling, self-awareness … and the sources of hope amidst all the negativity and human failure.

The girl with acne acts like Pine & O Farrell wish, with hindsight or in the very moment, they had acted.

The Williams story is set in a poor, immigrant neighbourhood where people from socially disadvantaged situations do what they have to and can to survive. The doctor too. He (like Sassall in Berger’s A Fortunate Man) in the identifies more with them than he does his colleagues, and he sees in the teenager a sign of something that offers hope. (“She was just a child but nobody was putting anything over on her if she knew it, yet the real thing about her was the complete lack of the rotten smell of a liar.”)

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To emphasise the socioeconomic angle of this (and of the Berger text from last week), I read the only poem of the week, Julia Donaldson’s brilliant version ofThe Magic Paintbrush (with equally brilliant and clever illustrations by Joel Stewart, which I showed them as I read):

"He slips the brush into her hand
And tells her to be sure
Never to paint for wealthy folk
But only for the poor."

I say straight up to them, emulating as best I can the girl with pimples: what if the paintbrush is your medical qualification and what if we told you only to treat poor people. That stirs things up a good bit. I tell them class is over.

‘Christ Stopped at Eboli’

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The film opens with the Carlo Levi figure in a very reflective mood, surrounded by his portrait paintings of the peasants of southern Italy where he was banished by Mussolini’s government in 1935, and where he found himself forced back into medical practice to do what he could for the sick and ailing, impoverished and ignored people he encountered there. He promised them he would return but he never did.