T was the last patient of a busier than usual morning. “New patient, establish care” was her reason for visit. As I would soon find out with the help of our remarkable Arabic interpreter, T and her family recently moved to our area after spending the better part of 3 years moving from refugee camp to refugee camp trying to escape the ravages of the civil war in their native Syria. Considering the hardships, T seemed to be doing well. “Maybe she looks a bit pale,” her mom stated, but both dad and T disagreed with her, smiling and saying that mom is a worrier.
As we do with all of our new immigrant patients (many of whom come from conflict-afflicted areas in the Middle East), I ordered a point of care hemoglobin and lead level and then left the room. A few minutes later one of our nurses found me.
“Hemoglobin of 8. I already obtained blood for a full CBC with manual differential, but please order it officially.”
I let the family know the low value, gave them a prescription for a multi-vitamin with iron and promised to call them with results from the CBC later on in the day. I was worried but having patients with anemia from this part of the world was definitely not unusual considering their circumstances.
As the afternoon session rolled along, I honestly had forgotten about the pending CBC results. It was well past 5 and the clinic nearly empty when the head of our hemopathology lab called me. This is never good news.
“Hey, Alex [I know him well] you sitting down [definitely not going to be good news]. T’s smear is, unfortunately, teeming with blasts.”
Those words cut me like a sharp knife, feeling nauseous just thinking of the pain that the parents would feel when I break the news to them. I dreaded the phone call but knew it had to be done now. Fortunately, our Arabic interpreter was finishing up some calls with our nurse and volunteered to call the family with me. He is not only a very capable interpreter, but a genuinely kind soul and I was so grateful that he would be helping out.
When we called using the speakerphone, I could hear the father cry in disbelief as the news sunk in. Then the long silence as dad told mom and his daughter, followed by more crying now from several people. I started tearing up and fumbled my words as I explained immediate next steps to the family. Our interpreter’s eyes were wet as well, and I found him having to be more deliberate in his speech as he struggled to contain his emotions.
After she was admitted, I visited T often, each time greeted by her parents who seemed happy to see a familiar face (though, they had just seen me that one time in clinic), and by T who looked more and more tired as the chemo regimens progressed. I found myself thinking of her nearly every day on the way to work and on the way home, and she was commonly part of our dinner time prayer requests at home. It seemed that this seemingly random patient and her family had become part of my psyche, as have other patients in the past, never far from my thoughts.
As T went on to have a bone marrow transplant, it became harder to see her, but I still saw the family occasionally in the hospital cafeteria or when they brought their other child to the clinic. It felt like I was seeing dear family members and an earnest hug exchanged each time silently telling each other that we care. Recently, when our oncology colleagues let us know that the BMT took well and that T was improving the clinic staff and I walked around elated as though we won the lottery, but better.
It’s strange how an event can impact you. T was one of 40+ patients we saw in clinic that day, yet she has left such an impact on many of us. I find it amazing how a chance meeting at the end of a busy shift, with a family who probably never even heard of Columbus Ohio a few years ago and coming from a town in Syria that I had never heard of, left such an impact on me. Maybe it is because T is the same age as one of my daughters or that her dad reminds me of a favorite uncle of mine. Maybe it is because we have seen our share of suffering among our recent Syrian immigrant population and T was just the emotional tipping point. Yes, maybe, but I think it’s more. I think it is because patients and families like these make you realize that we are all part of a larger human family.
The person I credit with convincing me to become a pediatrician, now a retired professor at Hershey Medical School, told me that the best part of being a pediatrician is that your patients become like your family. You celebrate the happy moments with them and feel joy and pride from their accomplishments. However, he warned, you also feel the pain when a family member hurts. You were so right Dr. Berlin, and I wouldn’t have it any other way.
Alexander Rakowsky is a pediatrician.
Image credit: Shutterstock.com