'A Medical Student' and 'A Boy Named Marcos'

The issues of global health and poverty seem far removed from the consciousness and conscience of most Americans. On the Upper East Side of Manhattan, where Weill Cornell is located, the global health crisis feels remote indeed. Often, we lose touch with our collective ethical obligation to remediate these disparities.

Unless one has seen the situation for oneself, the needs are almost impossible to imagine.

I first witnessed extreme poverty as a Cornell medical student working in Ecuador during the summer of 1984. I was assigned to Hospital Baca Ortiz, the premier children's hospital in Quito. It was a concrete shell of a building, half completed for over ten years following an oil boom and bust. We worked in Quonset Huts and an ancient structure in the shadow of the construction above.

We took care of lots of very sick kids. Although we were at altitude, some families of African descent brought their children to our hospital for sickle cell crises. All the kids were painfully undernourished. This and antecedent poverty were the cause of most, if not all, of the problems we saw. Infectious diseases were common, largely because the children were susceptible and exposed to foul water. My preceptor, a wonderful pediatrician who eventually became the country's health minister, taught me that malnutrition was the principal diagnosis.

Mostly, I remember a six-year-old boy named Marcos who had a completely remediable tetrology of fallot. Marcos would squat purple and short of breath in the hallways watching other children play. Some 24 years later, I still can see his bright and loving eyes. I remember the day I went up the stairs to his ward to learn that he had died.

Perhaps today's Weill Cornell medical students might have been able to arrange passage to New York for cardiac surgery. I know they would try and then perhaps fail or succeed. But it never even occurred to me as an option. To this day, I regret that: my failure to intercede or try to save his life. It was a failure of imagination that stays with me.

The following poem seeks to express the profound effect that one little boy had on me. Years later, in 2005, it was published in The Oncologist.

                                                                                    Joseph J. Fins, M.D.

                                                                                   Chief, Division of Medical Ethics

                                                                                    Weill Cornell Medical College

 

 

 

MARCOS

 

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Crouched like a frog you sit

Unlike the other children who pass

atop that miniature chair painted white

through this place,

and watch the other children

you will inevitably pass to another

pass through the corridor.

where children are never sick.

 

And how I will miss you

And while you sit still

as I ascend the stairs to your floor

unable, though willing, to partake

where you hold court

in the games the other little ones play

and find you gone.

You're set apart, alone.

   

For that golden heart

At six You're smaller than

that precarious pump

most kids at three,

still propels you to joy

yet you loom large as you struggle to

as we approach each morning.

get around and just breathe.

   

How marvelous is your simple purple grin

Your world is different, Marcos,

that peers out beneath your crew-cut hair

though you'll never understand.

and the curious way

By a cruel twist of fate You're

you explore the universe with your fingertips.

forever to be unlike any of your mates.

   

Knowing that time passes

Forever blue in the face,

you seize each moment for all its love,

perpetually out of breath,

grunting, hugging, reaching for the hidden prize

your heart of gold serves everyone--

and pulling a mustache or a stray hair

but yourself.

to make earthly contact from the realm beyond.

Fins JJ. Marcos. The Oncologist 2005;10 (7):557.