Courage is a quality or mental state that allows one to face difficult challenges and conquer fears with confidence. Courage is also necessary for making tough decisions, especially those in opposition. Making the right decision isn’t always easy or popular, which is why a leader needs to have the courage to make tough decisions when necessary. Whether standing up for important principles, facing down enemies, or charting a new and difficult course, a leader will always be defined by his or her courage or lack thereof.
At the Baqai Medical College and Hospital in Karachi, Pakistan, in June 1994, I remember a case of a forty-year-old man presenting to the clinic with a history of recent weight loss, fever, and night sweats. He was very overt about his weight loss. He was being assessed by a different provider at our clinic, and I was overhearing her assessment and plan from afar as I managed my own patient. At some point, I glanced over and noticed the emaciated man. His image is still burned into my memory. I noticed there was no eye contact between the patient and the other physician, who was taking notes on his patient chart. She told the patient that she would give him analgesics and some vitamins. As she said that, I noticed very conspicuous enlarged lymph nodes on his neck from about twenty-five feet away. He was also sweating and actively appeared to have a fever. My clinical intuition told me that the patient was suffering from some form of lymphoma and needed to be admitted for a lymph node biopsy to distinguish Hodgkin’s lymphoma from non-Hodgkin’s lymphoma. The presence of Reed-Sternberg cells would indicate Hodgkin’s lymphoma. Excusing myself of my patient, I decided to go to the attending physician, and I politely asked her to allow me to see the patient to confirm my diagnosis and hospitalize the patient. Permission was granted, and I examined this patient and confirmed Hodgkin’s lymphoma diagnosis through the biopsy and other testing. Both the patient and physician were thankful to me for this intervention.
Now I am sure many of us have found ourselves in similar situations where someone is suffering or is having a problem being managed by another person or even unmanaged. In these situations, to maintain good relations, we usually become bystanders and try not to interfere with that individual and those tending to that individual’s issues. For instance, in the work environment, you may see a coworker having an issue with his or her computer and be unwilling to help because it is technically not your responsibility. However, it requires a certain degree of courage and boldness to directly tackle the issue despite what your coworker might think. The person could indeed thank you for your kindness, but he or she could also take it negatively, as you help could make him or her feel inferior or incompetent. As a physician, I could have permanently damaged my relationship with the attending physician tending to her patient by interfering and perhaps making her feel incompetent, but it was the right thing to do because of the patient’s treatment. And, therefore, his quality of life superseded the mutual friendly relationship between us.
