Global Health Track NCFM: Vocation

We awoke early this past Sunday morning, several minutes before the tropical winter sun emerged over the horizon. The previous week included several long days with visits to multiple sugar mills, a dairy factory, and a zoo in order to provide on-site primary care services for the employees at these various businesses. But I did not feel at all tired on this early morning. This was the start of the most anticipated day of my time in Mauritius, and like the eastern sun about to emerge from its nightly repose, I was eager to begin.

By the time the first rays of light appeared beyond the sharp peaks surrounding Mauritius's central plateau, we were on the road, using the approaching dawn as a beacon to guide our journey to the heretofore unexplored eastern side of the island. The endless cane fields, vestiges of the mercantile colonialism that defines this island's history, rippled like the surface of the ocean as the winter winds barreled across the coastal plain. We traveled along the haphazard Mauritian roads, free at this time of the usual bold pedestrians and reckless drivers overtaking other vehicles without a modicum of foresight. Coastal plain gave way to plateau. The car engine protested this modest ascent with its implacable whining, but it ultimately delivered us to the requisite elevation. Stray dogs emerged from the fields on occasion to examine the disturbance at this early hour, and they scuttled back into that rhythmic green sea when their curiosity was satisfied. After an hour of ascent, shifting gears, and sightings of several grottoes dedicated to the Virgin Mary that line so many of these meandering Mauritian roads, we arrived at l'Église de Saint-Julien, the Church of Saint Julien, where my great granduncle John Egan was pastor for the final 20 years of his life.

The parking lot was empty, as Mass was not to begin for some time. The church looked better suited for the Irish countryside with its simple gray stonemasonry, contrasting the tropical palate of yellow and white-painted concrete more typical of Mauritian churches. As an Irish relative who had also visited this church told me, this was a testament to the craftsmanship Uncle Jack had refined as a laborer in Ireland, which he applied enthusiastically to his numerous construction projects during his time here. We took several photographs of the church as parishioners began to walk in, and they sent quizzical glances our way. We walked inside, and I was taken with the simplistic beauty of the stone church. A modest altar was flanked with banners bearing messages in French and Mauritian Creole, signifying the linguistic and cultural diversity of this nation. I introduced myself to the priest, and he was thrilled to meet us. He announced our presence to the congregation, and we were greeted warmly by many of the parishioners. He ushered us to a seat near the altar, and the entrance hymn began shortly thereafter.

During Mass, the final verse of the Gospel reading caught my attention: "When he disembarked and saw the cast crowd, his heart was moved with pity for them, for they were like sheep without a shepherd; and he began to teach them many things" (Mark 6:34). At the start of his homily, the priest emphasized the importance of discerning one's vocation and following it with passion and devotion. He referenced the dedication to vocation displayed by my uncle, Father John Egan, who left his home in order to serve a community in a faraway land, to be a shepherd to a flock that needed him. After the Mass, the priest led my wife, me, and a small procession of older parishioners who knew my uncle when he was still alive into the graveyard. Some of them shared stories about my uncle, and these tales revealed a convivial, outgoing man who was dedicated to his flock and to his mission. The priest said a blessing over the grave, and in due course we found ourselves back on the road driving away from the church.

The word vocation originates from the Latin "vocare," meaning to call. From the time

I first understood the concept of choosing a career, I have wanted to be a physician. In

this sense, it has been one of the enduring missions of my life to become a doctor and

tend to the sick. A little over one year ago, I graduated from medical school, and I thought I had realized this dream of mine. If I learned anything throughout the course of my intern year, however, it was that dedication to a vocation requires constant discipline, relentless passion, and above all, devotion. Throughout the past year, I found myself succumbing to the familiar trappings of intern year to which I had previously believed myself immune: cynicism, resentment, impatience. Hardly the virtues I hoped to espouse in my first year as a doctor. A patient interaction that occurred last week encapsulated some of the frustrations I have felt since graduating from medical school. I was working in the emergency department with Dr. Bhulah. A patient came in because he had not been feeling well for the past several weeks. He complained of increasing fatigue, thirst, hunger, and unexplained weight loss. We recognized the symptoms of new-onset diabetes, and a point-of-care test of the patient's blood sugar revealed an alarmingly high value. Dr. Bhulah recommended an overnight admission for further testing to rule out diabetic ketoacidosis and to control his blood sugar. The patient refused as he had plans to attend a birthday party later that day. Dr. Bhulah and I exhorted him to stay, citing the risks he posed to his health and safety if he declined admission. These pleas were ineffective; Dr. Bhulah prescribed some medication the patient agreed to take, and he departed from the clinic. I have had similar encounters during which patients declined indicated, even urgent, treatments and seemed inexplicably indifferent to their health. These experiences are frustrating for the physician, as I can attempt to equip my patients with the tools they need to improve their health, but I often cannot convince them to heed my advice. All of these accrued frustrations surfaced after this patient refused his treatment, a torrent of minute failures and self-perceived imperfections raging against the fragile edifice of my own ego. What to do in such a scenario? Throw up my hands in defeat? Eschew the better angels of my nature for an attitude that succumbs to gallows humor, that greets the indifference of patients with indifference of my own?

Yet—amid these little temptations to deviate from the higher path of the good physician, these enticements to give in to apathy and stray from empathy, I have the example of Uncle Jack. The example of the good shepherd. The humble servant, as some of his parishioners called him last Sunday. The tireless laborer who worked alongside his flock on numerous construction projects to rebuild churches after devastating cyclones. Who carried pipes over his shoulder on a moped up the perilous mountain road to the village of Chamarel in order to supply water to the church and school. Who did not command his flock from a position of austere authority, but who rather exuded warmth and gregariousness, who won hearts through effort, through commitment, through trust, through working side by side with those whom he served. Uncle Jack, Father John Egan, who shunned the paternalism that those in positions of power too often embrace, including physicians. Who followed his calling truly and faithfully. Who now, 54 years after his death, inspires his great grandnephew across time and space to better serve my own patients, to better realize my vocation.

This will likely be my final post from Mauritius. Mark Twain, who visited Mauritius in the 19^th century, famously wrote a description of the island he heard from a native Mauritian: “Mauritius was made first, and then heaven, heaven being copied after Mauritius.” After spending my international rotation here, I am inclined to agree with this statement. It is a beautiful country with warm, hospitable people and a fascinating, complex history. It possesses breathtaking mountains and some of the most picturesque beaches I have ever seen. I have learned a great deal during my time at La Nouvelle Clinique du Bon Pasteur, and I am grateful to Dr. Tadebois and all the other physicians at the clinic and at North Colorado Family Medicine for making this dream of mine a reality.

Below, some final photographs of my time in Mauritius. Thank you to all who have read these musings.