Author: Meher Kalkat

The 2023 Building Trust Essay Contest, sponsored by The American Medical Student Association and the ABIM Foundation, asked medical students to engage in a reflective writing exercise about their experiences where they or someone they know received, shared, or acted upon misinformation in a health care setting

I set the microwaved cup of instant coffee on the table so hard that it sloshes. He looks at me with guarded eyes. Despite trying to stay positive, this is not exactly an ideal start.

Working with refugees seeking asylum has taught me that trust is not easily won, and nor should it be. For someone who has lost so much to tell you their stories, it requires the willingness to try establishing a connection over and over again.

“David,* you need a root canal due to the deterioration of your teeth,” I explain the procedure to him and its importance to his health, but he shakes his head vigorously to make me understand.

“They will sell my teeth to the government. They will use it to track me down or frame me for a crime.”

David’s fears are far from unfounded. His deep mistrust of the medical system is borne from experiences in his home country, where the government arrested people for crimes they did not commit, and health care providers turned over patients to the police. His misinformed beliefs are rooted in conversations with other refugees that have warned him that people may pretend to help him only to send him back to his home country.

He has little reason to trust me after our few hours of meetings over the past few weeks. My eyes settle on his knuckles glowing white as he clutches the coffee cup.

I soften my voice. “I know it is scary. This procedure is completely safe. All they will do is…”

He cuts me off, exclaiming in frustration. “No! Too many words! I don’t want it, I told you.”

Instead of immediately responding, I take a moment. My mind wanders to my niece, remembering her eyes brimming with tears as she screamed that she didn’t want to go to the dentist because it would hurt. We showed her a video, explaining what each tool did until her tears subsided. Maybe combating misinformation isn’t just the information itself but finding the best way to communicate it to the other person.

I pull up a video on YouTube that explains the procedure. I watch as his tense shoulders relax, smoothing into gentle curves just as the frown of his lips settles.

I ask a little too cheerfully, “So… what do you think?”

He looks at me for a moment. He is still unsure, but I can see his grip on the Styrofoam cup loosening. I allow myself a moment to hope.

“Not today, I think.” He hitches his jacket over his shoulder as he prepares to leave the appointment. I feel the familiar stone of disappointment settle in my stomach as I shuffle the stack of papers stained with coffee.

He pauses at the door. “Next week? Next week we can watch the video again?” he asks.

I smile wider. Nod. “We can watch again next week. Maybe I’ll even write a song to convince you.” David nods back at me. Not exactly a smile, but an affirmation we will try again next week. And the week after. And as many weeks as he will let me try to earn his trust.

Misinformation is a door that offers a peek into the corners of another person’s mind. Although these conversations may be fraught with tension and disagreement, they are also an opportunity to understand more deeply. Building trust is a series of small steps that do not always arrive at a solution. Although it may not have the outcome I hope for, it is still as valuable as an appointment where mutual trust comes quickly.

I believe the most difficult piece is accepting that agreement is not always promised. My first months of medical school were energized with idealism and the belief I could win over every patient. Now, I have a more subdued approach. I sit beside the patients. I listen without judgment. I wonder about the amalgamation of life experiences that have led them to their beliefs, ingrained value systems, and this very conversation.

I do not pretend to have all the answers. Perhaps this is ultimately what draws us together. Even at odds, reaching out to each other across a vast divide, we can all acknowledge that we are doing our best to find meaning amidst the messy beats of life. So that even if our conversation does not end with agreement and a handshake, there is a promise to keep reaching across the divide, listening and sharing thoughts over a lukewarm cup of coffee.

Meher Kalkat is a third-year student at the Johns Hopkins School of Medicine and is originally from West Palm Beach, Florida. She is passionate about medical education, physician and trainee wellness, and combating mental health stigma. In her free time, she loves to sing karaoke, bake, and take photographs.

*Note that name and any identifying information have been changed.

The American Medical Student Association and the ABIM Foundation partnered to launch the Building Trust Essay Contest. Medical students were asked to reflect on a time where they built, lost, or restored trust in a health care setting.

Learn more about this year’s contest: www.abimfoundation.org/essaycontest

It took exactly three Tuesdays. Each week, I knocked timidly on the door, waiting for his characteristic gruff “come in” before I dutifully entered the room clad in the paper gown. I would approach the bed, chipper as ever, as he glanced at me through lidded eyes of disdain.

A brief history of our interactions would read as:

Tuesday #1: A cup of Jell-O and please turn off the lights.

Tuesday #2: Do you guys have Call of Duty? Fine, can I just have FIFA.

Tuesday #3: I’m good for today.

and then…

“Tomorrow was supposed to be my prom, you know,” barely a whisper behind me.

My tongue felt as if it was glued to the roof of my mouth as I turned ever so slightly, waiting. I could sense the air saturated with tension.

He laughed bitterly. “They told me I’d be out of here by now. I promised my girlfriend I would take her.”

Each word dripped with acid that ran off his tongue and pooled at my feet.

I swiveled slowly, afraid I might spook off this moment of rare vulnerability. I mustered a weak, “I can’t imagine.”

I had hoped this would be a benign offering, but his head snapped towards me so sharply that I stepped backwards.

“No. You CAN’T imagine. I bet you got to go to your prom, didn’t you?”

It was more of an accusation than a question. Bracing myself for his next inundation of rage, I nodded my assent wordlessly.

But his anger dissipated as quickly as it came. He shut his eyes tightly and leaned his head back against the steel bar of his hospital bed. The movement was so familiar, so practiced, that I could tell he had assumed this exact position before, searching for meaning in this unholy campground.

I suddenly realized that when I entered every week, I was intruding on the most intimate moments of his life. I could see it more clearly: my knock, the threat of an invader as he haphazardly tucked in the corners of his Tuesday.

“They promised I would be out of here. I don’t know why I believe them anymore.”

Suddenly, I remembered a slight caveat, a correction to my previous answer.

“Well actually… I only made it to one prom. The other prom I was in a full leg cast because I tripped and broke my knee.”

He glanced at me beneath the curtain of sandy-brown hair as I looked back at him, no longer afraid to meet his eyes. We challenged each other in silence for a few moments until his bubbles of laughter burst forth.

“That has to be the dumbest thing I have ever heard.”

We were both doubled over at my clumsiness as I assured him that I had fallen onto the pavement with a satisfying thwack.

There was an imperceptible shift. Our Tuesdays were now intertwined. In sharing a piece of my history (and an embarrassing one at that) I had reminded him that I was also fallible and human.

“Damn. Well at least cancer is a better excuse to call a raincheck than being a klutz.”

I see medicine as an opportunity to forge relationships in unexpected ways, its core remaining the in-between moments of people connecting in shared spaces. As the hours of my shift unraveled, he confided in me his tricks to get extra dessert and his frustrations that his hair was falling out in clumps.

It took three Tuesdays for me to learn that fostering trust is a broken and messy process, oftentimes taking one step forward and three steps back. It is no easy feat for someone in their most vulnerable moments to invite you into the complicated prism of their lives. Instead of expecting an easy connection, I have learned to sit with the awkward and uncomfortable. Even when it feels like no headway has been made, continuing to knock on the door is its own kind of promise. I may not always find a quick joke or common thread, but I can choose to show up anyway.

As I stepped outside onto the slick sidewalk that Tuesday, I knew without turning that he was watching from the window. So, I let my feet skid on the asphalt as I pirouetted dramatically to the ground.

From a dimly lit window on the 4^th floor of a children’s hospital, I was rewarded by a toothy grin and slow clap before the curtains swung shut.

Meher Kalkat is a second-year student at the Johns Hopkins School of Medicine and is originally from West Palm Beach, Florida. She is passionate about medical education, physician and trainee wellness, and combating mental health stigma. In her free time, she loves to sing karaoke, bake, and take photographs.