A Letter To Medical Students

Today we had the honor of attending a beautiful memorial ceremony for the willed body program of Texas Tech Medical School. The group of students in attendance were full of freshness, light, enthusiasm and love for learning. Not only were they embarking on a noble profession of doctors, but they were also poets, singers, classically trained pianists and storytellers. It was a wonderful experience to have those kids in front of us, talking about the difference my dad and other donors made in their medical training and honor their lives. Here is the letter I wrote to them so they could know my pops as more than just a body, but rather their first patient, a great man full of life and love and his story.

Dear Medical Students,

First of all, let me congratulate you on your decision to go into an incredibly fulfilling and rewarding profession. The healthcare world is changing so rapidly and I encourage you to be part of the revolution, rather than the status quo. More on that later.

I’m writing this because I was in your shoes nine years ago and I didn’t have the chance to know the person who would become my group’s greatest anatomy teacher. My body had painted toenails, a sweet face and left ventricular hypertrophy. 

When my parents made the decision to donate their bodies to medical school years ago, it seemed like a natural choice. Both of them have dedicated their lives to helping others, it made sense that it would continue after they passed.

So in honor of my sweet father, I write this to you today so that you can look at him as more than just a cadaver. He was a great man of many talents and skills and the kindest gentleman the world has ever known.

My dad was born in Brooklyn, NY. He grew up in the Marcy projects on Hopkins Street, the same area of town many hip-hop artists rap about and some of the greatest baseball players originated from.  He grew up playing, ‘wallball, kickball, stick ball, baseball, basketball’ as he would tell me in his later years. If the game had a ball in it, he played it. His momma was Puerto Rican, his father Filipino, straight from the Philippines. He was a Filirican, as he called himself his whole life.

Dad worked hard at three things: sports, his family and kindness.  He went to Central Missouri State as a wrestler and dominated the state in the sport. He was also one of the only non-white dudes in his college who was rushed for numerous fraternities. Everyone wanted him. His best friend from college said at his memorial, “Mat didn’t walk around campus, he bounced around and everyone knew him”. He sang in a doo-wop band, he tap- danced and danced salsa, and fixed things around peoples homes and on campus. He was a true renaissance man.

After college, he wanted to avoid the draft, so he joined the Peace Corps. Dad helped build a school, a train station and a community in Guapiles, Costa Rica. Again, everyone in that little town knew him and loved him. The mayor of the town invited him to stay to be the principle of the school, but dad had to return home. When he did, he was immediately shipped off to officer training school and prepared to go to Vietnam.

Upon arrival in what I call “the war that destroyed a great man”, he was assigned a hilltop outlook spot for three months. Alone, on the lookout during the day, unable to sleep because your life could be taken if you did, he held that spot until the bitter end. He would tell me the story, always ending in tears “Every few days they would drop food and water for me and then take off”.  This is where I believe the telomeres began to shrink, the neurofibrillary tangles began to form and his memory started to fade. I would want to forget that type of isolation, wouldn’t you? Then he was called to the front lines, where he had to protect kids aged 18-23 from bullets and death. He failed everyday. I’ll spare you the details, but the man with the biggest heart in the world, had his heart and soul break daily during this time.

He returned a broken man, but a glimpse of his youthful spirit still burned. He moved to Chicago to work as a social worker for the Seton/St. Joseph healthcare system. Again, another natural position, taking care of others was his thing. Dr. Margaret, a mentor in the social work field, who taught him everything he needed to know about the work, soon adopted him. He became the favorite and go-to medical social worker. He trained 3^rd and 4^th year medical students and residents on what he and his crew did. Doctor after doctor made him their lifeline and he acquiesced graciously.

He married a Mexican girl so she and her daughter could stay in the U.S. after meeting her only once. At least that’s the way I like to tell the story. She turned out to be quite alright, so he stayed married, fell in love and five years later, they had me.

He was the quintessential poppa. He taught me to swim, ride a bike, throw a ball, perfect my gymnastics flips and flops. He built me a loftbed with a desk below and a pimp condo for my red-eyed mice. Throughout these years, he played softball, basketball and volleyball. He was also the father-figure to many of my friends throughout middle and high school.

We moved to El Paso in 1985, where dad worked almost 15 years serving others and fighting for justice. He held positions at Project Amistad to Foster Grandparents to the Housing Authority. He even had a stint as a high school teacher. The job that did him in, was right in the hospital where you may do your residency, Thomason, next door, where he was a medical social worker in the ER. Three twelve hours shifts often turned into exhausting, mind, spirit and body draining 14-15 hours days. Then he started losing his memory and his personality changed. That’s what happens with dementia. He was so young, we were convinced it was a brain tumor or normal pressure hydrocephalus, reversible causes of dementia. He became angry quickly, frustrated fast and did a complete 180. Mom knew something was wrong when he called me Erica instead of sweetheart for the first time.

When his mind began to fade, I called his neurologist from college. I felt entitled to have a conversation with him on a professional level, since I was pre-med, we’re cocky little students, aren’t we? He took my call “Erica, don’t you know that Alzheimer’s disease is a diagnosis of exclusion and a diagnosis means a lifetime of lost hope?” I didn’t care. I wanted him to start him on Aricept immediately and if that flipped a switch on my dad, we would have an answer. We were all desperate. We just wanted our dad, husband, grandfather and brother back.  

Those seventeen years of AD were very hard for me as a daughter. I was gone physically, living 600 miles away. My mom was his main caretaker and she was his queen and touchstone until the end. Seeing that relationship taught me so much about medicine and the human spirit. Doctors don’t have the hardest job, caretakers do. We get to go home at the end of the day. We get to sleep at night when our patients get restless. We get hostile patients escorted out by security guards.  Caretakers do not get this. They maintain the title of husband, wife, sister, brother and the overwhelming weight of the monster that takes their loved ones mind without any respite or help.

In 2014, my mom asked me to come home to be my dad’s PA. I had trained at Harvard and learned breathing techniques, meditation and yoga that could grow telomeres and calm an agitated, sundowning dad. I had a certificate in nutrition and knew the monumental importance of food as medicine, particularly a mostly plant-based, high fat diet for my dads ailing brain.  I was on it. I would come home for a couple of weeks then drive back to Austin to work. Then in August 2014, he was diagnosed with chronic lymphocytic leukemia. His hemoglobin was 7.0. We had to make the decision to transfuse or not transfuse. We chose to transfuse.

Though there are no studies on the subject of blood transfusion and personality changes, it doesn’t mean it doesn’t exist. EBM has its place, but anecdotal evidence has its value and validity as well. When dad received his first transfusion, I was still in Austin. My mom called me sleep deprived and desperate. He had gone from calm to manic and aggressive within 10 cc’s of the new blood. He stayed this way for days. After two weeks, he began to calm down. After two more weeks, he was back to his normal self. Another CBC was done and sure enough hemoglobin back to 7.2. My mom made the decision to transfuse him again. This time, I came home, no one could handle him, so we placed him in hospice.

His physician, Dr. Vaililis, heard our story and worked with us to find the most comfortable outcome for all. The day after Thanksgiving 2014, we found a bed for him at the VA nursing home. It was good enough, but mom never felt like they could care for him like she did. She was right. Five months into his stay at the VA, he became more lucid, almost prophetic in his dialogue. Mom said it was time to bring him home. I made them move back home too.

She bought a hospital bed and we arranged their living room into his sanctuary. We hired MA’s to relieve us. This was the best decision of my life, leaving medicine to spend time with my loved ones. If you’re ever in this situation, always choose love and family, in the end, that is all that matters.

Something happened that you won’t find in your medical textbooks in my time back home. Dad came back, the father I knew as a child and teenager was present again. He had more moments of lucidity in those two months than he had in 17 years. He knew my momma, my sister, his grandchildren, his sister, me.  We joked, danced, ate, walked and played almost every day those last months of his life.

Then on July 29^th, 2015, mom and I woke up at 4 am. We opened the French doors to let the cool desert air blow in.  I laid next to dad and played Beach Boys and Mozart. The sun began to rise over the mountain. They say the last thing to go is your sense of hearing. We called his granddaughter in Florida and she said goodbye, his best friends in Chicago and they gave them sweet stories. I called my sister over and woke my aunt Emma up. All four of us sat around his bed and after lots of tears, laughs, goodbyes and kisses, at 6:59 am, surrounded by his favorite girls, my dad took his last breath.

That’s the story of Matias Benedicto, Jr. The man whose body you will have before you in your anatomy lab. He was a badass till the end. I hope you will honor his body and his life by passing on the gift he gave to you in your treatment of your patients.

A gift he gave to so many. A life filled with service, love, kindness and endless dancing. RIP dad.

I tell dad’s story in hopes that it will encourage you to listen to your patient’s stories. Realize that each and every time someone walks into your exam room they are far beyond just a diagnosis. Make sure you hear and listen to them as more than just a disease, symptoms, lab numbers or imaging. See them, hear them, as human beings with feelings, emotions and fears who have spiritual, financial, relationship, job, life struggles, just like you. William Osler, founder of Johns Hopkins, said that it is more important to know the person who has the disease than to know which disease the person has. He believed there was little physicians could do until they saw how the patient lived outside the limited realm of the exam room. Don’t let your empathy be dulled by the industry, administrators, overwork or fatigue. Find it in a connection with your patients and their stories. Even when you’re seeing 30 patients a day, you can immediately connect with them, make eye contact, shake their hand, be present. Examine them beyond just heart and lungs, touch is therapeutic and healing in itself. Ask them how they’re doing. Ask them about something outside of their symptoms. As them what they want. Ask their caretakers what they want. Practice self-care, as it is critical to healthcare. Make sure you’re taking care of number one, so number one can take care of the masses with heart and compassion. Laugh, play, commune, and eat healthy food. Have hobbies and create outside of clinic. Leave your ego at the door. Shift your perspective from expert who knows all to guide and partner who can has the training and the understanding of the science.  Show up and then shut up. Listen and let your patients tell you who they are and how you can help them. You’re about to embark on an amazing life of service.

Thank you for reading and I wish you luck along your journey.

Sincerely,

Erica Benedicto