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First Person: A Sanctuary for Those with Nowhere to Turn

Liroff, Meghan G. MD

Emergency Medicine News: May 2017 - Volume 39 - Issue 5 - p 32
doi: 10.1097/01.EEM.0000516476.97713.e7
First Person

Dr. Liroffis proudly Detroit born and bred. She just completed an emergency medicine residency at Henry Ford Hospital where she has chosen to stay on as staff. She is still carving out a professional niche, but her interests include medical student education, health care justice, and Detroit. Follow her on Twitter @gaffmeg.

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I am an emergency physician in Dearborn, MI, a community that boasts the largest Middle Eastern population outside the Middle East. When the president releases one after another of his “travel bans” against people from majority-Muslim nations, I see firsthand the people to whom these laws would apply, and I interpret it as cruelty.

Harry Chapin sang, “It's funny when you get that close; it's kind of hard to hate,” and this has been my experience. I have hundreds of tender stories about immigrant and refugee families that have humbled me. The lessons that I have learned from them have taught me not only about medicine but also about humanity.

I was inspired by an 8-year-old who came in with right lower quadrant pain. Her beautiful and articulate refugee hijabi mother gave me a history, and then I turned to examine the child. As is my practice to determine the symptom of anorexia, I asked the child, “What's your favorite food?”

“Pizza!” she said.

“Well, if I had a whole pizza right here, would you gobble it all up? Or would you say, ‘No, thanks,’ maybe later?'”

She gave the most surprising and selfless answer yet. “I'd share it with my mom.” This child is putting kindness into the world, and our community would be lessened if this child were not here. And this child did turn out to have an acute appy.

I learned that the look of a patient who is having a myocardial infarction crosses all cultural barriers. A 90-year-old Arabic man came in with that look — eyes wide open, pall of still terror, beads of sweat on his upper lip; it's a look that is unmistakable. In these situations, I'm always struck by how similar people really are. To that man's family, however, he was one-of-a kind, a patriarch. He was accompanied by his bilingual grandsons who were able to help us gather more history and explain the treatment in real time rather than fumbling with the translator phone. I was awed by the sense of family: They show up, they put someone else's needs ahead of their own, and for this man, after the nitro infusion kicked in, they made him laugh.

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Complicated Grief

Witnessing family dynamics, and especially interacting with hijabi women, has expanded my definition of feminism. It is not my intent to homogenize an entire culture, but I can't help acknowledging a certain pattern: These women are awesome. One woman came in complaining of back pain. She spoke beautiful English, used intentional language, and gave a history without prompting. She said, “...point spinal tenderness, no history of heavy lifting, pain worsened at night, no weight loss, weakness, or saddle anesthesia.”

I know a physician when I see one. Her eyes lit up when she talked about completing training overseas, but she could not practice here because the recertification process coupled with family demands was too great. I imagine myself in her shoes: knowing what I know about the rigors of medical education, how I've sacrificed my 20s, the many family holidays I've missed, the isolation and anxiety of exams and residency to achieve something of which I'm intensely proud, something that provides earning power, autonomy, and something that holds so much meaning for me. What if I had to leave all of that behind for the safety of my family? What a complicated grief that would be.

Some may say that someone with medical knowledge should know better than to present to the emergency department for something that could have been addressed by a primary care physician, but I'm learning that many of the people who are new to this country are offered Medicaid that covers emergency care only. So much is starting to make sense: There is no primary physician in the picture. In effect, I am a primary care provider because the system demands it.

When I am frustrated during a shift about the volume in the emergency department for presumably nonemergent complaints or the act of taking a 30-minute history through an inadequate translator telephone service, I have to constantly remind myself of the many reasons a person crosses the threshold of the emergency department and how this place must be a sanctuary for so many people who, for whatever reason — medical or otherwise — have nowhere else to turn.

The job is an honor. Because of my experiences working with immigrant and refugee Muslims, especially in this political climate, I feel morally obligated to speak my truth to power. As emergency physicians, we treat our patients with kindness and respect; we are a part of the opposition to racism, injustice, and hatred. We are activists.

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