First, Do No Harm… – Shannon Frost Greenstein

When I think back to my childhood – the earliest part of it, the part I once refused to think about – I still don’t quite understand how I could have gotten here. But at the same time, I recognize things could not possibly have transpired any differently.

It must be because something stops being trauma when it starts being motivation; and because the best way to avoid martyrdom is to stay alive.


It’s Match Day.

It’s the day medical students find out where their residencies will be, where their careers will begin, where they will make breakthroughs and witness medical miracles and accidentally kill patients and everything in between.

It is the culmination of 16 years of schooling, and it happens at every medical school in the country, all at the same time; thousands of doctors-to-be, opening a sacred envelope, discovering their futures and lamenting their failures.

I stand with my envelope, alone. All around me are my fellow students, surrounded by family, surrounded by friends, surrounded by the whole world, it seems. I am the calm eye amidst a hurricane of excitement in the room, the center of an orbit, my gravity warping space-time so everyone else is repelled around me into a vast radius.

It has been this way since the first foster home.

It was this way through all of public school, to be honest, and private university, and my top-tier medical school as well. I am a perpetual outcast; I am a pariah. I’ve been alone most of my life, but I have not been lonely. I have, instead, been working towards this, towards this exact moment, towards my destiny.

I know exactly when I decided to be a doctor. It happened in a split-second, in one of those life-changing moments that stick with you and subconsciously guide your every action, evolution disguised as instinct disguised as survival.

I will never forget it. I was a little girl, and I was watching my mother overdose.


I know how dramatic that sounds, but it’s not hyperbole. It’s also not what you think. Watching someone overdose isn’t like Pulp Fiction, and it’s not like 8th grade health class would have you believe, either. It’s quiet; deceptively sweet, like the poppies in The Wizard of Oz beckoning Dorothy to lie down and rest.

I was little, like I said, and I shouldn’t remember this, but I do.

I watched her for a bit, lying there, not moving. I think my prepubescent brain expected something to happen, the next link in a logical chain of events, but what I didn’t realize was that her chain was ending. I didn’t realize that the only thing standing between me and that inevitability was a Savior.

I sat there as precious moments ticked away, waiting for her to get up, or die, or seize or vomit or scream or anything. Instead, she just…slept.

The rest of that day is a flurry of motion in my memory: the landlord’s frantic steps when I finally called to say she wouldn’t wake up; police cars pulling up in front of our apartment; the EMTs bustling around our tiny living room, administering Narcan, doing CPR, loading my still-inexplicably-alive-mother into the maw of an ambulance.

There was a social worker, kind but aloof, desensitized to the trauma she glimpsed every day. She was the first in a long line of state-sponsored adults who would decide my life away as the years passed. There were more police officers, asking questions, demanding answers, pumping me full of soda and nervous energy.

Surprisingly, my mother didn’t lose custody; not that day, anyway. The above scenario would repeat more than once before the government decided to take me from the only home I had ever known. It was dysfunctional and depraved, sure, but it was also still my home. Leaving it for an endless string of foster placements was nothing short of life-shattering.


What really sticks with me about that day was the belief I had, the certainty which only a child can hold, that life would get better. I remember my conviction that my mother would wake up, that she would recover, that someone would fix everything and give me a future.

Of course, that didn’t – and doesn’t – happen.

Things got steadily worse, and no one came along to give me a future. The next decade-and-a-half was as terrible as you would expect a childhood spent in the foster system to be; but that isn’t what led to my current Hippocratic quest. My calling to medicine did not come from the horror of my youth – except maybe as a grain of sand irritates the oyster until a pearl is finally formed. What my journey did accomplish was to birth my need to rise above the hidden curse in my DNA, the genetic component of addiction that I knew – even in adolescence – would be a risk for me. You see, I could never abide being just another orphan of the opioid epidemic. I have refused, my entire life, to be an academic statistic or a cautionary tale.

I have, instead, always been determined to matter.


What I mean to say is, the day my mother overdosed, the day I decided to become a doctor, I witnessed a miracle. While it may only have prolonged what I now understand was never meant to be, Western Medicine managed, in front of my eyes, to bring my mother back to life.

Through a tiny window in an ER hallway, I watched the attending physician administer volts of electricity to her temporarily-stopped heart, and I made a decision: I was going to be a doctor, too. Someday, I was going to provide that hope for a little girl in the future, one who also might believe things would improve, if she just wished hard enough.

That stuck with me through the system, through all my schooling. I learned that the only person who was going to give me a future was me; I learned that no one can fix an addict but themselves. And I learned the art of healing, the art of saving a life. I learned how to keep a child’s mother breathing long enough for things, just maybe, to finally turn around.

Because that’s all I ever wanted, the whole time.

Things never did turn around for me – so I turned them around myself. And I am becoming, if you’ll forgive my hubris, one hell of a doctor.


Around me, the noise level is nearly unbearable, excitement wafting through the air like smoke, and now the whole room is counting down; counting down to the moment when it has either all been worth it or all been in vain, when that for which you’ve worked so hard will either come to fruition or leave you desperately wanting.

I stare at the envelope, trying to will its contents directly into my brain by osmosis. Even as I watch the large digital clock mounted on the wall, red seconds ticking away the last moments of my youth, I am terrified for the countdown to reach zero. If it WAS all in vain – if all of my work, all of my dedication, all of my soul I’ve poured into this endeavor was for naught – then I haven’t just let myself down. I have let down all the little girls I could have helped down the road, all the parents I could have saved. My years of training would be a meaningless sacrifice, the martyrdom of my childhood without any of the perks of sainthood or fame.

A few seconds left, and I can see all the students around me poised to rip open their envelopes; shoulders raised, fingers tense, looks ranging from exhilaration to apprehension to abject fear. I allow myself, for the briefest of moments, to think about the very slim possibility that the envelope in my hand contains precisely the news for which I’ve been hoping.

The countdown reaches the end, and there is a pause, a second of inaction, like the entire room is not convinced of the validity of the number zero. Then, as if choreographed, there is a frantic burst of energy as hundreds of burgeoning doctors rip away paper to reveal their paths.

Shouts, exaltations, swear words and wails echo from the walls, but I swear I can even hear the silence from individuals whose envelopes contain disappointment. I feel a flash of sympathy; as someone who has been let down so many times, I’m well acquainted with that particular emotion.

Still, I haven’t opened mine, because it’s not like there’s anyone waiting to see what’s inside. A murmur in my head, the voice of my inner monologue, whispers a prayer to a deity in whom I stopped believing long ago.

Please, it begs, let it be U Penn. Please, so it wasn’t all a waste, let it be U Penn.

I take one more moment to wish, with all of my being, and tear into the envelope. I discard it and unfold the paper inside, neat business creases dividing the document into perfect thirds as if it’s normal correspondence, as if it isn’t the most important piece of paper I’ll ever read in my life.

My eyes anxiously dance over the letterhead, the date, the addresses, the electronic signature, searching out the words I’m so hoping to see.


School Code: 2310089

Applicant Name: Hannah Reynolds


Program Code: 170354

Program Name: Cardiac & Thoracic Surgery

Institution Name: Hospital of the University of Pennsylvania

I blink unbelievingly, in awe at what I am seeing. I hear my inner monologue again, a resonant soprano that chatters constantly in my brain, that I always try to ignore, that holds the cumulative power of a lifetime of trauma.

You know what this means, right?

I do.



You didn’t think it was altruism, did you?

Oh, you did. That’s so cute.

My calling has been to medicine, yes. My goal is to sanctify life, to save it, to keep mothers and fathers and sister and teachers among the land of the living, sure. That’s what I’ve always wanted.

But, at the end of the day, we are all human. And what is more human than an innate need for justice?

We live in a meritocracy, you see, and I realized at a very young age that nothing commands more respect than a physician. People will see the letters after my name – people will see my alma mater on my curriculum vitae – and they will listen to me. They will trust me. They will believe what I say, and believe I have the purest of intentions in saying it.

No one will remember, however, that Philadelphia’s Department of Human Services ruined my life. No one will remember how they took me away before things could get better, how the social workers and police and judges and foster mothers were a collective force to endure, a Sisyphean boulder on my back as I struggled to grow, to live.

But I remember.

I remember bureaucracy, taking everything from me; I remember impotence, feeling dehumanized by the system. Most of all, I remember helplessness, my omnipresent childhood companion. Now, however – as a U Penn-trained doctor, as a pillar of the community, as the American Dream made incarnate – I will finally have what I never had before.

I will finally have power.

I will have power because knowledge is power. But power corrupts like opioids corrupt like the foster system corrupts, so is it really any wonder that I plan to wield my M.D. like a weapon – my education a switchblade in the scabbard of my mind – for payback, first and foremost?

Growing up in this city of Brotherly Love, I was screwed by both nature and nurture. But now – I will finally be taking my vengeance for both.

Shannon Frost Greenstein is the author of “More.”, a forthcoming poetry collection from Wild Pressed Books. She is a Pushcart Prize nominee, a Contributing Editor for Barren Magazine, and a former Ph.D. candidate in Continental Philosophy. Follow her at or on Twitter at @mrsgreenstein.

Image via Pixabay

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