A Socially Mobile Survivor’s Guilt

Patricio Ruano, MS2

Tears stream down my cheeks as I gaze out of my medical school’s building at the city below. As the sun rested on the horizon, I realized that I was staring out West – out back to my home, where I could only hope that all was well without me. I turn my head upwards, examining the glass panes that span four stories high as a mile of hospital buildings shine through them. I feel a tear land on the palm of my hand. The same hand that, just months prior, was helping my mom wrap tamales in banana leaves to sell at church on the weekends to reach ends meet. I feel the warmth of the setting sun on my face as I close my eyes, wipe my tears, and remind myself of who I am.

For years, my neck was locked upwards at medical buildings from the streets below as I could only imagine the pride I would feel when I finally achieved my own space among these halls to become an inspiration of a physician to myself, fueled by the lessons my family and heritage bestowed upon me. Indeed, I did feel pride. Initially, I received the call in March of 2021, and as I heard the words, “You’re in. You’re going to be a doctor,” my knees buckled under me. My mom caught me as she yelled, “Thank you! Thank you so much!” into my cell phone, her pride shining through. When my dad got home, I could barely contain my excitement. When I broke the news, he looked up at me with a distraught look. I could hear a lump form in his throat as he said, “Hasta a Michigan?”

Hasta a Michigan. Thousands of miles and three time zones away, my destiny, as well as my entire family’s destiny, was being set. “Mi hijo quiere ser médico” turned into “mi hijo va ser médico” in an instant. Finally, my promise to my family that their life of work would cease under my watch, that I could care for them as they gave everything to care for me, could be fulfilled. This was it.

Squeezing six people in a two-bedroom house and surviving off less than $30k a year in Los Angeles, we were in survival mode for as long as I can remember. My family tenderly gave all they could to get me here with what they had, even if it was not much... During my childhood, I completed my homework on my neighbors’ internet, grateful they forgot to set a passcode. We relied on free produce from a food pantry my mom would call “El Mercadito'' for holiday meals. Pairs of shoes came once a year, and clothes were all hand-me-downs from siblings and cousins. On the weekends, I’d accompany my dad to his work as a handyman, promoted from holding ladders to painting the walls on my own as I aged. I would attend school on Mondays with paint crusted on my arms and face with pride, a marker of the strength my family showed in order to provide me with the most they possibly could. Despite the glares I received from the kids whose houses looked like the ones I’d see in my favorite Disney shows, I felt no shame. The kids whose houses were ones with multiple stories, a pool, a big yard, and parents who were home before dusk. To everyone I met, I made my pride known, even going as far as introducing myself as Guatemalan and Salvadoran to my teachers as a kid.

It was this life that crafted who I am, a life whose lessons I could write endlessly about. The life where I would chase down ice cream trucks with my cousins as we clutched the three dollars our grandma gave us in our tiny hands. The life where I met the homies with whom I could always catch a game of basketball or ride from one end of Los Angeles to the other on our 12-speed bicycles. The life where my siblings and I would track down taco stands and cheap Dodger tickets on a random Thursday night. The life where I would climb water towers to find the perfect view of the city. The life where I would carry my 93-year-old grandma in her wheelchair to the sands of Pacific Ocean beaches so she could feel the warmth between her toes for one last time as I tell her all about the islands we could see in the distance.

I open my eyes as the warmth of the setting sun leaves my face, my tears halted as I’m encompassed by the love of my memories and my hopes for my future.

Hasta a Michigan. Where I first felt prideful, I now feel ashamed. Ashamed, feeling as if I had left this past life behind and traded it in for one of polished professionalism and ivory towers. Ashamed that I am living better and healthier on medical school loans than I ever did before. Ashamed of changing the way I speak so those who grade me don’t think lowly of me. Ashamed that I used to be among my own but now walk halls where those like me could be counted on one hand. Ashamed that I might look like an outsider to the very community that raised me as I don my white coat and walk across the street to the hospital.

Pride and love have somehow turned shame and guilt. The shame and guilt often encompass me more than the pride and love of my past life - except on the days when I’m reminded not only who I am, but why I need to be here.

On the days when I meet Latinx pre-medical students and am told, “you’re the first Latino person I’ve met in medicine.” On the days when our screening clinic at the Latino Health Fairs turns into a patient discovering abnormal blood glucose levels, and I’m able to connect a community member to a primary care physician, to be told at a later community event, “Hice una cita con el médico y controlamos mi azúcar.” On the days where I advocate for the Latinx lived experience in admissions committee meetings and work to ensure the next class has more Latinx experiences than can be counted on one hand. Especially on the hard days when I’m pelted with rain in freezing temperatures as I load boxes of food into Latinx community members’ cars at food drives, waving goodbye at families in melancholy as I realize the children in the backseat are living the same experiences I look back on every day. “¡Que le vaya bien!”

I am reminded that my past life finds its roots in my present actions and future dreams. I find the love I felt in my past life in my LMSA peers in Michigan and the community members I help support. I see my cousins in the kids I see in the Emergency Room, my tias in the patients in the Inpatient wards, and my grandma in the old lady I put corrido music on for in the Palliative Care wards.

What feels like time away from my origins to learn the clinical foundations that will one day make me a great physician - whether it be in lecture halls or halls of hospitals - is ultimately only as temporary as I will allow. My LMSA peers and I have not allowed ourselves to be pulled away from the loving, tenacious, and inseparable community that gave us the lessons that would bring us to becoming medical professionals of our own. Ultimately, when my studies are complete, to my family - both born and found - I will be back.

About the Author:

Patricio Ruano is a 2nd year Medical Student at Michigan State University – College of Human Medicine born and raised in Los Angeles, CA. After learning of the field and participating in Hazelden Betty-Ford’s Summer Institute for Medical Students, he currently further explores an interest in Addiction Medicine. In medical school and during his time at California State University – Channel Islands, Patricio has worked for years to bring higher education outreach and equity to underserved communities, believing that only a proper representation can enact a just change. Outside of academics, Patricio enjoys staying physically active, playing video games, connecting with nature, and spending time with his pets Izzy and Trisha. He is also a lover of all foods!

About the Work:

In this work, I reflect on the life that brought me to medical school. The life of a low-income Latino growing up in Los Angeles, CA. I realize that as I push further into my medical education, privileged to be in situations I used to dream about, I am overwhelmed with a guilt of the contrast between the life that brought me here and the life I live now. I believe this is an issue stemming far past imposter syndrome, an issue bleeding into the territory of a type of survivor’s guilt from needing to temporarily leave one’s roots to pursue something great. Something all too felt in children of immigrants, this emotion carries into the process of medical education. It is through some reflection on the importance of diversity and representation seen in this work that I, and so many others with my story, am fueled to continue my education.