University of British Columbia – Doctor of Medicine – 2021
It was a cool, spring afternoon outside the long-term care facility I volunteered at. There was a light breeze in the air and the yard was dotted with shade from the large surrounding trees. Annie, an older patient with white frizzled hair, rolled up to me in her wheelchair. She had a small trowel in her hand.
“Dig down a quarter of an inch and sow the seeds inside”, she said.
Throughout my high school years, I would see Annie about once a week. We would stroll to the community garden together and I would help her with her little plot. It didn’t take long before she let me grow whatever I wanted, even amongst her cherished bed of roses.
“The cucumbers are sprouting!”, I cheered.
Annie taught me the joy of gardening and the satisfaction that can be found in nourishing life. I hadn’t realized it at the time, but it was through our gardening sessions that she had instilled in me the ideals of community medicine – the principles of equity, justice, and of course, prevention.
As the spring breeze transformed into warmer summer afternoons, I started to take notice of the differences between the plants that had sprouted. “Why is the cucumber growing so vividly, and the corn so stagnant?!”, I complained. Annie chuckled at my naivety.
“Not all plants need the same amount of water”.
You see, there are millions of different plant species on this planet and they all have the same basic needs: water, soil/nutrients, and sunlight. Some plants need more of one thing, while others need more of another. No two plants have the exact same needs. If we give the same amount of water to cacti as we do to water lilies, the cacti will surely rot.
This too is true in medicine. If we give same amount of care and medical attention to everybody, the healthy will continue to be healthy, while the vulnerable will start to fall behind. Just as we don’t water cacti the same amount as we water lilies, we don’t prescribe vancomycin for every single infection. Different people, different cultures, and
even entire communities have differing needs from one another. In both plants and humans, this often stems from an unequal level of access to resources; health equality, where everyone is given equal amounts, will never be as effective as health equity, where everyone is given what they need.
As I began to integrate this lesson of equity to the watering needs of different plants, I realized something still wasn’t quite working. “Now the corn is growing really well, but the tomatoes nearby look so sad! What’s going on?!”, I yelled in frustration.
Annie explained, “A large part of how a garden grows depends on the ways in which the different plants relate to one another. For example, corn grows really tall and shades the plants around them. If tomatoes (a sun loving plant) are grown too close, they’ll be stunted in comparison”.
Like gardening, medicine too is a relational practice. Culture, socioeconomics, race, gender, sexuality, geography – the social world – influences and informs how individuals and whole communities interact with health. Just as in gardening, there is a mistake in omitting the social and environmental contexts of a population. A 13-year-old girl, born and raised in a large Canadian suburb, requires a different type of attention than an 80-year-old man living in a rural community. As physicians, we must always be aware of the environmental and social contexts of our patients’ lives.
“Now that I’ve given the plants all the water, sun, and nutrients they need, and I’ve grouped companion plants together and incompatible plants apart, they’re beginning to look really happy. The only problems now are the number of bugs! Should we use an insecticide spray?”
“NO!”, Annie jolted. “There are ways we can enable the garden to take care of itself!”. If we use an insecticide spray, we’ll only treat the issue at the present moment. The bugs will most likely return and it is unsustainable to continue to use insecticides each time. Annie taught me how to do something better; she taught me how to prevent the pests
from ever becoming a problem in the first place. “Give the garden the ability to defend itself, and it will never have pests again. Let’s build a home for ladybugs! They will protect the garden and we’ll be pest-free for years to come”.
This same concept exists in medicine too – if we only treat the surface issue, we’ll never get to the root cause. We could give antibiotics to an injection drug user every time they come into the hospital with an infection or we could provide them with clean needles, education around sterile injection techniques, and a reminder that we’re a safer, stigma-free space. I prefer the latter. If we can prevent illnesses from happening, wouldn’t that be better for the patient than treating them after the fact?
By synthesizing and integrating these three simple gardening lessons, I’ve been able to sustain a thriving garden of my own. And as I continue to reflect on my current progress through medical school, the more I realize that gardening is not unlike the practice of tending to a healthy population. In both, we need to understand and respond to the unique needs of individuals, how they bring their environmental and social contexts to the table, and how they can be empowered towards self-sustainability and prevention.
When I finish my medical training, I would like to be for the community, what Annie was for her garden. The kind of doctor that focuses on equity, social justice, and prevention; the kind of doctor that treats a patient’s mold allergies, while simultaneously advocating for sustainable and affordable housing solutions. And…finally, one day, in my old age, just like Annie, I’ll pass the lessons I’ve learned onto a whole new generation. After all, what better form of prevention is there than education itself.