It wasn’t the first time I’d encountered prejudice at the clinic. I could tell that my patient was disgruntled the moment I called him from the waiting room. Unsmiling, he grabbed his coat and cane and walked toward us as aggressively as his limp would allow.
I introduced the medical student and asked his permission for her to join us. He gave a curt nod and charged past us, down the hall toward the exam room.
We followed behind, and I gestured to the student to observe his gait: he favoured his left leg, swinging it out to the side with each step so that his foot wouldn’t strike the floor. He had sustained a spinal cord injury in a bomb blast in Iraq five years earlier.
He came straight to the point once he’d been seated. “You send me to Korean doctor!” he accused. I’d referred him to a neurologist. I found the report and looked at the letterhead.
“Dr. Nakamura is Japanese-Canadian,” I said.
He waved his hand impatiently. “This,” he said. He put an index finger next to each eye and pulled upward, his eyes slanted slits. He turned to the medical student and repeated the gesture, emphatically. The student was of Chinese descent.
“Send me to different doctor,” said the patient. “Not that kind.”
“The fact that Dr. Nakamura is Asian has nothing to do with his abilities as a doctor,” I said. “I won’t make a second referral based on that.” He humphed with displeasure but didn’t protest further. I went on to review the recommendations in the consult letter with him.
I wondered what to do about the slant-eye caricature. Perhaps it was just an effort at communication by someone with a language barrier. Maybe refusing the second referral was enough of a stand for today. He was a recent arrival, and immersion in Canadian culture would eventually teach him more tolerance, I reasoned. And so I left it.
The visit ended, and we saw the next patient, and the next, a steady stream through the afternoon. I meant to debrief with the student, but we were caught up in a whirlwind of paperwork at the day’s end, and then she was gone. Her rotation was over, and we never discussed what happened in that exam room.
I began to wonder what was worse, his gesture or my allowing it. For months and then years, I watched for her at the clinic and at conferences. At first, I wanted to explain. Then, I wanted to ask forgiveness. I couldn’t do either. I didn’t find her.
My patients faced discrimination themselves, of course. A few months before, after we’d finished a morning of six consecutive Arabic-speaking patients, Hani had seemed preoccupied. “Is everything okay?” I’d asked.
“I’m upset about the shooting,” she had confessed.
So was I. So was the entire nation. A few days before, a twenty-four-year-old Canadian soldier was killed while on sentry duty at the National War Memorial on Parliament Hill in Ottawa. He was shot twice in the back by a lone assailant. Passersby had rushed to perform CPR, and had said the Lord’s Prayer with him as he lay dying on the grass.
The gunman, Michael Zehaf-Bibeau, had gone on to storm the Parliament buildings, where he died in a shootout. He was Muslim, and the shootings were deemed a terrorist act.
The soldier who died was Nathan Cirillo, and the pictures of him on the news, taken from his Facebook account, made the events all the more horrifying: kind eyes, a wide smile, his young son in the crook of his arm, his dogs in his lap.
Hani’s eyes were filled with tears. “On SkyTrain now, I feel ashamed of my headscarf.”
“Did anyone say anything to you?” I pressed.
Once one of my Afghani patients, a thirty-year-old father of two, had told me casually that he’d been called a terrorist on public transit. He was one of the Pashtun men who’d interpreted for the Canadian military during its mission there, and was offered refugee status in Canada for his own safety when the military pulled out in 2011. I’d been angrier than he was.
“No. No,” Hani said quickly. “Nothing has happened. I just feel people looking at me.”
I realized that I’d always had the luxury of being inconspicuous. When I take public transit, I enjoy the swaying masses that crowd the SkyTrain cars, a heterogeneous blur of shapes and colours, backpacks and strollers, beards and ponytails. I feel absorbed into the throng. I’d assumed everybody did.
I have never waited at a bus stop, shopped for groceries, or walked through a neighbourhood without the implicit understanding that I have every right to be there. My belonging is never in question. I am only a second-generation Canadian, but I cannot be told to return to a country a half-world away because my features and dress give no hint as to where that might be. It is a privilege I hadn’t recognized I held.
I live where refugees are least likely to settle in Vancouver: on the North Shore. Due to the cost of living, refugees tend to migrate south and east from Vancouver proper to Richmond, Surrey, Burnaby, and Coquitlam.
For my first years in practice I lived in East Vancouver with my husband and young family. We were squeezed onto a twenty-five-foot-wide lot, in a one-hundred-year-old Edwardian house with a sleeping porch off the master bedroom, eaves pressed against our neighbour’s. We turned thirty and the vibrancy of urban living lost its appeal. At night, our house throbbed with the neighbour’s music, and a new nozzle on the garden hose would disappear within days.
We moved to Deep Cove, to a weathered house on stilts overlooking Indian Arm, screens of massive firs and cedars between us and the neighbours.
“It’s so civilized!” I remarked to Pete shortly after we moved into the neighbourhood. Properties were kept uniformly tidy. It was safe enough that not only could we forgo a house alarm, we could leave the doors unlocked. No one rummaged through the blue bin on recycling day. We’d go to the Cineplex Esplanade or White Spot restaurant, and I’d look around at the homogeneous crowd around us and feel a camaraderie: we were all hardworking families who took the canoe out on weekends. And virtually everyone, I noticed as an afterthought, was white.
One day as I drove up Cove Cliff Road toward home, I saw a figure walking a mid-sized dog. I didn’t recognize the dog, a blue merle Australian shepherd, and slowed as I approached what I assumed was a new neighbour. He wore brown dress pants and a cream shirt with the sleeves rolled up. I passed him and glanced at his face. He looked Iranian.
My unfiltered gut response, which horrified me even as I registered it, was What is he doing here? I instantly felt ashamed. Did I welcome immigrants, so long as they kept to my exam room and the suburbs east of Vancouver? Was working at a refugee clinic while living in an affluent North Shore community a farce? I tried to tease my response apart. Part of it was the surprise. A Persian man walking a dog in my neighbourhood was an undeniably unusual event. The other issue was that I associated Iranians with the clinic. Deep Cove, peaceful and calm, was where I sought respite from my work. The sighting felt like a jarring crossover of work life into my personal life.
When I met him walking in the woods a few days later, I introduced myself and welcomed him to the neighbourhood. His name was Saeed, he told me with a Farsi accent. He had just moved with his wife and two young sons into the house over the hill.
We have often crossed paths since, he with his dog or his sons on bikes, and I going for a run. We always stop to chat.
19
I PULLED A CHART FROM THE rack at the front desk and read the name of the next walk-in patient. Jesus. I’d seen enough Colombian refugee claimants to know this one. “Hey-Soos?” I called confidently into the crowded waiting room. No one moved. “Hey-Soos?” I tried again. Two dozen faces gazed at me impassively. Then a Latino man politely raised his hand.
“I’m Jesus,” he said, pronouncing it like an evangelical preacher. “I’m Jesus, if that’s who you’re looking for.”
It frustrated me that the clinic expected physicians to retrieve their own patients from the waiting room and escort them to the exam room. For years, I had chafed at the inefficiency of this system. I wanted to revolve through two exam rooms, with the next patient always ready in the oth
er room, seated by the medical office assistant. When the clinic commissioned a community engagement survey, the most interesting part was the unsolicited comments. One patient reminisced, “The doctor would personally call me by name from the waiting room. Years later, I feel warm inside remembering that.” Other respondents also mentioned this practice fondly. All those years rushing down the hall to call the next patient, impatient to get to the real work, and I’d had no idea that this inconvenience to me was therapeutic for the patient.
I made a concerted effort to learn patients’ names, with proper pronunciation. I would read the name on the chart and make a valiant attempt at it. Ahdiyeh? The patient would nod, but with just enough hesitation that I knew they were humouring me. “You say it,” I’d say, and they would, quick and effortless. I’d try to mimic them, struggling with the foreign phonemes. Patients always looked one part delighted at my efforts and one part embarrassed for me. I felt a little foolish sometimes, but if I expected patients to push past their self-consciousness to practice English, rehearsing their names was the least I could do.
Sometimes the name on the chart wasn’t recognizable to the patient. The Myanmar patients came from a culture where they could change their name at will, to reflect a change in life. They had no surnames, and their first names often incorporated an honorific title. A boy named Htay might grow up to be called Ko (“older brother”) Htay, or Saw (“mister”) Htay. For the purposes of Canadian immigration paperwork, though, one name had to be designated the surname. And so, addressing a patient with a chart labelled Saw, Htay as “Mr. Saw” or “Htay” or “Htay Saw” did not actually qualify as calling him by name. Although our clinic forbade writing on the chart cover, once I sleuthed the patient’s true name, I pencilled it onto the chart label. I was certain that rapport was jeopardized by addressing patients by a name that was not theirs.
There were so many Abdullahs and Farzanahs coming through the clinic that it was hard to keep them straight. The endless spelling variants didn’t help: Mohammed, Muhammad, and Mohamad were all my patients; so was Moh’d, his name apparently abbreviated on an application form on the other side of the world a year ago and now his immutable Canadian legal name. Husband, wife, and children—whether from Iraq, Bhutan, or Somalia—rarely shared a surname, making it challenging to determine and recall family relationships.
If I didn’t have both the chart and the patient in front of me, I found it very difficult to match the history to the patient. In all my years at the clinic, I’d had one patient named Brian. I can still recall his face and detailed medical history, because his name was distinct and familiar.
There were other unforgettable names. Some of the Myanmar children relocating from a jungle camp in Thailand to downtown Langley were named for British rock stars. An optimistic new mother named her Canadian-born infant son Skilful, but misspelled it.
When I had been pregnant with my third child, a daughter, I had considered every female patient’s name as a contender. My favourites were the Hispanic names: Luciana, Catalina, Alessandra. I cared more about the aesthetics of a name than its meaning. I knew my considerations were superficial when I noted the significance of names to my patients.
One of my Iranian families had fled to Canada when they converted from Islam to Christianity. On their second visit with me, the father drew some paperwork from his briefcase. “Name change for our son,” he said, nodding at the four-year-old boy sitting on his mom’s lap. “Please sign.”
I looked over the documents. They were requesting a name change from Mohammed to Joshua.
In the end, I named my daughter Ariana, to mixed reviews at work. “That’s the name of the Afghani airline,” the Farsi interpreter informed me doubtfully.
“We plan to call her Aria, after my grandmother,” I reassured her.
With increasing dismay, she replied, “But Aria’s a Persian boy’s name!”
20
THE FIRST TIME I SAW Li he was seated at the end of a pew in the waiting room, trembling. It wasn’t a fine hand tremor or the bobbing head of the elderly, but a visible vibration of his entire body. His face had such a strange grey-white sheen to it that I wondered briefly if he was wearing makeup. I introduced myself and he clung to my hand with both of his, head tilted back, a gesture of supplication so archaic and desperate that I felt embarrassed. The Mandarin interpreter sat next to him, looking nonplussed and wearing a throat-closing amount of perfume.
In the exam room, the interpreter unhurriedly hung up her coat, retied her scarf, and settled back in her chair. “How are your children, Doctor? How old are they now?”
The patient sat on the edge of his seat, knees apart and legs angled back under the chair. Suddenly he leaned back, dug in the front pocket of his jeans, and handed me a business card:
THOMAS STRIKER
LAWYER – AVOCAT – ABOGADO
900 W GEORGIA STREET, VANCOUVER
“Lawyer sent him,” said the interpreter. “Needs a letter.”
It wasn’t uncommon for immigration lawyers to direct asylum seekers to our clinic for a medical legal report to document injuries sustained during persecution in their country of origin. Li, I learned, had been held in a “re-education by labour” camp in China for two years for practising Falun Gong, a Chinese spiritual movement. During his imprisonment he’d been beaten with electric batons, and he had the scars to prove it, he told me. His wife had died in the camp.
I pulled out a ruler, marked to the millimetre, and seated him on the exam table. “I know it’s painful to recall the awful things that happened to you in the past,” I said, “but the more information you can provide, the more detailed the report I can write, and the better the case your lawyer can make.” The interpreter relayed this, and Li nodded. “Let’s go from head to toe,” I said. “Tell me about any injuries, and show me any scars.”
The Istanbul Protocol is a set of international guidelines for the documentation of torture and its consequences, adopted by the United Nations in 1999. At eighty-three pages, it had been my weekend reading a few months earlier. After a Saturday breakfast of pancakes and bacon, I’d sat on the couch with my coffee to read the chapter, “Beatings and Other Forms of Blunt Trauma.” I’d done some yard work and then reluctantly read “Suspension” and “Other Positional Torture.” Before we brought the kids to the pool I’d planned to read about asphyxiation, but I couldn’t do it. The manual is a sickening read, and I regretted trying to work it into a Saturday with my family.
The Istanbul Protocol’s “Annex III: Anatomical Drawings for Documentation of Torture and Ill-Treatment” is a set of printable blank diagrams of the human body on which to mark the patient’s injuries. There are eight pages, viewing the body from every angle: front, rear, side. There are close-up diagrams of the genitals and the soles of the feet. An entire page is devoted to hands. There’s a skeleton on which to document bony injuries, and thirty-two teeth sketched in grim, forensic detail. I printed the package while Li changed into a gown.
He began by pointing to a scar on his chest, a pale area the size of a credit card.
“Electric baton,” said the interpreter. “During interrogation.”
I measured it out with my ruler, then carefully shaded in a rectangular area on the chest of the figure on my printout, drew an arrow to it, and labelled it, “Depigmented patch, irregular margins, 8.3 cm wide × 5.5 cm high.”
For the next thirty minutes I measured and described Li’s scars as precisely as I could, and he told me the circumstances of each injury. At the end, the figure on my page had markings on almost every surface of its body and the patient retched into the sink.
I told him I was sorry we’d had to do this. I told him I was sorry that he’d suffered so much, and that he didn’t deserve any of it. I told him that I’d like to see him again in two weeks, and that I’d connect with his lawyer in the meantime.
When I saw Li next he leapt to his feet when I walked into the waiting room. He was as shaky and pale as the f
irst visit, but managed a smile. The clinic had been unable to book a Mandarin interpreter, so once in the exam room I dialed the Provincial Language Service. We were soon connected to an interpreter who, from the sounds of it, was going through the grocery store checkout with kids in tow. I put her on speakerphone and positioned the phone on the counter, midway between me and the patient.
Li leaned toward it and started talking immediately, urgently.
“He says that last time he didn’t tell you everything that happened,” said the interpreter. “He says some things happened that didn’t leave scars that you can see.”
Li spoke so forcefully that the interpreter struggled to get him to pause, so she could relay the story to me, piece by piece. The patient had been sexually assaulted by the prison guards, on multiple occasions. He described the first attack in awful detail, and then moved on to the second.
The interpreter balked. “I won’t continue,” she said suddenly.
“Pardon me?” I said. Li paused, mid-story, confused.
“I’m going to hang up.”
“But we’re not finished!”
“I have children, you know!” She sounded like she was about to cry. “I won’t be able to sleep at night.” She was still in the store; I could hear the beep of scanners.
I couldn’t believe it. How could she complain about having to hear these stories when the patient had had to experience them? It was her job to translate whatever the patient disclosed, not to fold when the topic got uncomfortable. I had children, too, and I was already having trouble sleeping at night from countless stories like this one, but I was soldiering on. I was angry that she sought self-preservation, and I was angry that it was too late for me.
Your Heart is the Size of Your Fist Page 10