This is a unique sociopolitical time to practice emergency medicine.  As a recent residency graduate working in a Freestanding ED in Dearborn, Michigan, my medical education has taken a back seat to a more relevant and enlightening cultural education.

Dearborn, with a population of about 100,000, an incredibly diverse city.  Aside from the heterogeneity of White, Black, Asian and Latino Americans living together, nearly 40% of Dearborn’s population is of Arab descent.   There is a mix of Arab Americans (both Christian and Muslim) and recent Arab immigrants, who are mostly Muslim. Arabic is the second most common language spoken in Dearborn, with many recent Arab immigrants not able to communicate in English at all.

Before I started working in Dearborn, I had heard stories of the strict Muslim customs; wives in burkas following steps behind husbands dressed in western clothes, appearing demure or subservient.  Despite my liberal Detroit-based upbringing and education, I had little first hand exposure to this culture before.  I was worried I would struggle to be respected by my male patients, or grow frustrated witnessing of deference a woman to her husband. Well, months into this job, I am pleased to tell you, my worries were unfounded.

First and foremost, I have learned that there is no correlation between a woman’s modesty and her level of confidence.  My position as a physician has not been questioned; I am shown almost a genteel form of respect by female and male patients alike. More often than not, as I enter the room male patients will stand out of deference.  Not since Catholic school have I seen manners like this; it has taken me aback.  I contrast this to my recent experience with a young white male saying, “thanks, Baby,” as I walked out of the room after an exam.  “You’re welcome, sir, but it’s Dr. Baby, to you,” I responded.

The language barrier has been as difficult to navigate as I expected.  My trusty interpreter phone fits the bill most of the time. Until it doesn’t. For example, the cultural and communication issues around pelvic examinations for my Arab speaking Muslim patients are unexpectedly challenging.  Frequently, despite having described the exam in depth through the interpreter phone, there are still unanswered questions, with many women undergoing this exam for the first time.  It is logistically impossible for me to hold the phone and do an exam concurrently and I won’t perform this invasive and intimate exam without reliable communication..  So I have had to do is ask relatives, who are often male, to help with any interpretation. Husbands, cousins, and even brothers have stood behind a curtain waiting to interpret; which they have done without embarrassment or complaint. I have witnessed these men willingly put someone else’s needs ahead of their own and accepted any emotional discomfort.  

Last week, I diagnosed a pre-teen patient with Bell’s Palsy.  She was completely fluent in English but her parents did not speak a word.  I gathered the history from the child.  She was bright, composed, and articulate: she had total possession of self. I gathered the history again with the interpreter phone from the father.  At the end of the conversation I discussed the treatment, the disposition and follow up, and complimented him on the intelligence of his child, “shokrun, shokrun, Hamdullah, (thank you, thank you, thank God),” he said and bowed and smiled, quickly hanging up the phone. With such tenderness that still gives me goose bumps, he cradled his child’s head and graciously kissed her forehead.  A child should be worshiped like that.

I am practicing emergency medicine in an area that serves many immigrants and refugees from predominantly Muslim nations.  I watch the news and feel nauseated at the demagoguery and the cruelty of the current administration.  I hear alternative facts.  While in effect, I have experienced people: people who are sick and scared, people who are so far from home, people who worship their families, people who deserve more than what we are able to provide in the emergency department. The fact is that I have been changed, and continue to be changed by my interactions with my patients. Social justice is at the core of emergency medicine practice and the reason I chose this field in the first place. I consider my job a privilege.  I consider my job to be a part of the resistance.

Lately, I have been telling all my patients as I give discharge instructions, “I’m glad you are here.”