I’m working at CLSC Parc-Extension, a clinic where most of the patients speak very limited English or French.
The most common language spoken by patients is Bengali, followed by Punjabi and Urdu. We work with interpreters all the time. Even the older people are more likely to speak Greek or Italian than English or French. This is a new challenge for me.
It’s a new program. Most of the teachers here are in their first years of practice. The oldest ones, just hitting their 40s, were my former residents. As often happens with new programs, they’ve recruited some fantastic residents with smarts and a pioneer spirit.
Two of the residents, Harmeet and Ahmad, are actually native speakers of Punjabi and Urdu, respectively.
Harmeet grew up in the area, and sometimes people recognize him as the smart little boy who used to run around the Gurdwara. He’s a true Bill-101 baby. Having done his education in French, he’s most comfortable writing his medical notes in that language.
Ahmad was a sergeant in the Canadian forces before he became a family medicine resident. Most of the other residents come from Université de Montréal, ready to take on the challenge of doing a residency at McGill University.
It’s incredible how much you can understand when listening to a medical interaction even when you don’t speak the language.
One day I was watching Ahmad seeing an old lady. They were speaking Urdu. I catch a few words here and there: “sugar . . . pressure . . . OK?” Suddenly the old lady stops short and looks intently at Ahmad. She stares silently at him for what seems like a long time. Then she breaks out into a long and voluble stream of questioning. I see Ahmad’s back stiffen, his face grave.
He sighs. Gently, he asks her a question. I catch the name Fannie Fortier Tougas, one of the first-year residents. The old lady stops again, thinking. She smiles, shakes her head, touches his hand and replies. The tension evaporates. They smile at each other and finish their interaction.
A few minutes later, Ahmad comes in to review the case. He’s going to up her diabetes medications, give her some vitamins and do some blood tests.
“What was happening in there?” I ask him. “There seems to have been an intense discussion.”
Ahmad looked sheepish. “Oh, you heard that?” he says. “You see, I come from a minority ethnic group in Pakistan. In fact, the reason my family immigrated here was to escape persecution. Regular Pakistani Muslims are not supposed to interact with us in any way. The patient just figured out, because of my name, that I must be Ahmadi.”
“So then what?” I questioned.
“Well, I offered to have her change to another of the residents, like Fannie, perhaps. But she chose to stay with me because she said that I am a good doctor and that I understood her.”
“Are you OK with that?” I ask him. “You don’t need to expose yourself to discrimination.”
“No, it’s OK,” Ahmad replies. “She can’t help how she was raised, and we have an excellent relationship. I feel like I am getting her tuned up, her diabetes and hypertension are finally getting controlled, and it is rewarding to see her so much better.”
Later that day, I’m watching Fannie. She has a man in his 50s slumped over in his seat, every bone radiating depression. His friend is with him, translating for him in broken English. It strikes me that everyone here is speaking a second language. The story unfolds slowly, painfully, the patient’s profound depression making his speech hesitant and slow, his eyes almost closed, his body slumped in the chair. His friend, a large, brash man, towers over Fannie. He’s vaguely intimidating but obviously concerned.
Fannie’s struggling too. This is one of her first cases as a resident, one of her first times working in English, one of her first times working through an interpreter, all not easy. The story emerges. The patient’s been here for about 15 years. He works as a truck driver and has a wife, a 17-year-old daughter and a 9-year-old son. His daughter just graduated high school, and he’d written back to his home country to arrange a marriage for her. The daughter told him that she doesn’t want to get married yet. She wants to go to college. She wants to be a nurse.
“What did you say when she told you that?” asked Fannie.
“I beat her,” said the patient, “I beat her and locked her in her room. I am the father! I decide!”
I feel a rush of rage wash over me. How dare he!? Who does he think he is? Where does he think he is? Part of me wants to rush into the room and throw him out. Instead, I listen carefully.
“What happened next?” asks Fannie, her voice carefully neutral.
“When I came home from work, they were gone.” The patient begins to sob, his shoulders heaving, his voice cracking. His friend awkwardly pats his hand. He explains that when the patient came home, he found the house empty, his wife, his son and his daughter all gone. He’s been unable to find them. Now he lies in bed weeping, unable to work, barely eating, a broken man.
“Is there anything you do that makes you happy?” Fannie asks. She’s trying to help him cling to life. She’s probing for insight so she can help him try to rebuild his family.
“Playing soccer in the park, with my son made me happy,” the patient says, now openly sobbing.
Fannie and I actually have an idea where his family is. His wife and daughter were known to the clinic. It wasn’t the first time his heavy hand had fallen on those he loved best. With the ongoing story of violence and this new and even more serious event, his wife was ready to make a move and leave. Our nurses and social workers have helped them get to a shelter and are helping them to have a new life. The daughter has enrolled in CEGEP, on her way to an independent life and career.
I think about these two patients, both displaced from the certainties of their lives in their home countries. They have, for complicated reasons, chosen to leave the world they grew up in to make a new life in Canada. The dominant culture here is so foreign, so strange to them. Some are ready to embrace it and go forward, and some are stuck and cannot adjust. I think about my grandparents, who all made their similar choices, my parents who grew up with foot in both cultures, they helped make me who I am and Canada the country that it is.