“Why are you studying that? Philosophy won’t help you save lives.” If I had a dime for every time someone said this to me, I could single-handedly fund an entire class’s medical school tuition. Being a pre-medical student who majored in philosophy feels like being the only person asking “why” in a room full of people asking “how.” I have thought to myself many times that there is no balance to be found between these two questions, and that I have set myself up for failure by not sticking to one department of study. However, in these moments of doubt, one illuminating patient interaction comes to mind.
As an EMT in San Diego County, I primarily serve patient populations consisting of lower socioeconomic classes, those with substance abuse disorders, and those with lifelong comorbidities. Many of my patients have complex comorbidities and mobility limitations that make safe transport more difficult than our equipment admits. There was one patient in particular who fit the bill for all of these descriptors. She was an elderly female weighing just under 300 pounds, with no motor function on the entire right side of her body due to suffering a stroke a few months prior to me meeting her. Additionally, she had a history of substance use. The final barrier was that she lived on the second floor of an apartment complex with no elevator, a building that was bearing the marks of long-term neglect. Let’s call this patient Molly.
The stairs’ the limit
The job of my partner and I was to safely transport Molly back to this apartment from the hospital where she was treated for a blockage in her intestines. Part of this job involved lifting her up the stairs to her apartment using a device called the “stair chair.” The stair chair is a seat with rolling tracks that line up with steps to “easily” roll a patient upwards. However, the fatal flaw of these devices is that they failed to account for real patients. Not only do bariatric patients struggle to fit on the seat, so do patients of average weight. On top of the uncomfortable seat design, the rolling tracks are notorious for malfunctioning. It was no surprise that my patient expressed concern about being able to tolerate this device before we even left the hospital.
There are stair chairs designed for bariatric patients. However, in many EMS systems, specialty equipment is not reliably available on every call or at every ambulance company. Rather, many places entrust the EMTs to simply make it work; and that’s exactly what we were told to do. So, like any obedient EMT would do, when we arrived at the patient’s staircase, we set the stair chair up and assisted Molly to the seat. The initial problem was that the seat was far too narrow for her body, and the armrests on either side of it wedged her into place with little support. Then came the major challenge. She was able to maintain a seated position for all of 10 seconds before succumbing to the lingering effects of her stroke. The motor loss to her right side made the position unbearable and unsafe.
Due to these motor restraints, Molly began to flatten her body out, extending completely as if she was lying stiffly on a hard floor. The stair chair isn’t designed for this position, so she began to slide off the device toward the ground as the armrests continued to constrict her body in a way that looked almost suffocating. With pressure on either side of her abdomen, she lost control of her bowels as she reached the ground. My partner and I moved quickly to carefully lift her from the ground back onto the gurney where she could continue to lie flat. We placed a blanket over her to preserve what dignity we could.
We then called the fire department who helped us arrange for transport back to the hospital, where she could seek treatment for any sustained injuries and find a housing option that was more accessible. But, this step felt hollow. I knew that the “housing options” Molly would be shuffled into included underfunded, overburdened facilities that had only enough resources to keep people, not care for them, if she could afford them at all.
This was one of the first moments I recognized the failures of both our health care and social systems, which manifest through the bodies of the most vulnerable. Some may say this boils down to poor planning or an unfortunate oversight. But, grounded in philosophical analysis, I knew that this was a form of structural violence. This harm doesn’t come from one moment, but from a lifetime of neglect.
The hidden curriculum of suffering
Michel Foucault, a philosopher who analyzed the relationship between power and knowledge, wrote of an idea called subjugated knowledge. This type of knowledge is that of the marginalized. It exists outside of dominant or mainstream systems. This knowledge and experience is dismissed or invalidated by institutions that have authority. Those same institutions often claim to be objective, like medicine and law. In other words, real-life subjugated knowledge is the lived experiences of patients and the wisdom provided by marginalized communities. It is the embodied reality of patients like Molly, which cannot be neatly sorted into a chart, dataset, or protocol.
I understood Foucault’s theory most clearly while cleaning the feces that covered Molly’s arms and legs as we waited for her hospital room to be prepared. It was undeniable now; her lived experience, her story, and her pain had been overwritten by a system more concerned with insurance claims and clinical efficiency than humanity. Those who had chosen profit over providing accessible equipment and the institutions, which made a second-floor apartment her only housing option, had taken up all of the space, power, and discourse until there was no room for the knowledge her body was providing in real time. Molly’s knowledge was subjugated because up until now, no one had considered the power behind it to be enough to change the systems that put her in this position.
Finally, I no longer felt like I had to choose between the why and the how. I saw how powerful a symbiotic relationship between philosophy and medicine could be. Philosophy helped me reflect on this experience and process my emotions about it. Most importantly, it gave me the language to name the violence and injustice of it. I am unaware of the rest of Molly’s story, but I am able to advocate for others like her.
Questioning medicine
While philosophy isn’t able to teach me CPR, how to apply a tourniquet, or administer epinephrine, it taught me how to acknowledge the internal suffering that leads to a physical manifestation. It showed me that beyond looking at what is happening to a patient and how it is happening, I need to first ask why it is happening, why it keeps happening, and why the system designed to care for people falls so short everyday.
My hope for the future of medicine is that we don’t continue to discount the why questions. Medicine can be both a study of the physical body and an understanding of the human condition, where asking how may save a life, and asking why might change the system that puts the life at risk in the first place. Dignity is not optional, it has to be engineered into our equipment, our health care systems, and our definitions of ‘good care.’
As it turns out, philosophy did not set me up for failure in medicine, it set me up to progress it forward.
Lauryl Cardoza is an emergency medical technician.
