Dr. Abdul El-Sayed is the executive director and health officer of the Detroit Health Department.
I've always been deeply impatient. It’s probably one of my biggest flaws.
A life of service to me is a life that matters. My impatience derives from a deeply held religious belief that our permanent place is not our life on earth; it is after having passed. Imam Shafi said, “Time is a tool: either you use it, or it will be used against you.” There is a responsibility to address imminent challenges today—with the recognition that you don't always have tomorrow.
You only have 24 hours a day, and people have rights on you. I serve a community of 700,000 people, and what we are building in Detroit is going to affect how people think about urban public health in the future. I also have the responsibility to be a good son, a good husband. I am not a father yet, but, when and if we get there, a good father.
I struggle with what balance and presence mean across different facets of my life: what the trade-offs look like, what you can ask your family to give up for the work that you do, and what you should give up for the people you know need you most.
Presence is the courage to be willing to just experience what the world is giving you at the moment. That is the problem I struggle with and spend most of my time on. I don't think there is a right answer. Like many things, it’s probably a pendulum.
I spend most of my days dealing with the complexities of the human condition. One of the mistakes that people in positions like mine often make is to blame people for their problems. The minute you allow yourself to be an actor in the bigger picture is the minute you realize that you are the people you serve.
You can’t do service-oriented work without being truly empathetic and recognizing the deep imperfections of humans—how beautiful people are, and how terrible they can sometimes act to one another. The same people. It doesn't mean that they are fundamentally incredible, or fundamentally otherwise. It's just part of being human. This is the truth of humanity, and we are all part of that. We all make bad decisions sometimes, and most often we want to make more good decisions.
Every Monday morning, I review the cases of the infants who passed away the prior week. I accompany our mortality team to go visit some of these homes—usually of single mothers. The first young woman whose home I was invited into was talking about mothering her twins, one of whom passed away. She said, “I did everything right and the baby still died.”
On the one hand, in her own mind, she did everything right and on the other, we as a society failed her in so many ways because the circumstances of her life fundamentally changed the kind of decisions that she could make. You must recognize who you are serving, why you are serving them, and the pain that comes with our failure. In public health, you bear witness to human pain, deep human pain and loss. You can’t solve the whole [problem], but perhaps you can create circumstances within which that happens less.