Your Heart is the Size of Your Fist
Page 15
I wasn’t. I’d even bought a new white coat with a Peter Pan collar for the occasion.
The crowd gathered in front of the Immigration and Refugee Board office. There were colleagues from the refugee clinic, physicians from St. Paul’s Hospital, nurses, midwives, passersby, and, at the edge of the group, a handful of curious patients.
When one of my patients had mentioned that he might attend, I worried that his PTSD might be triggered by seeing law enforcement. I warned him that police would likely be present.
“Why?” He was alarmed.
“Just to keep everyone safe. To make sure no one falls off the sidewalk onto the street.”
In months of weekly encounters, I’d never seen him smile, but at this description of police work he had laughed in amazement.
“My name is Martina Scholtens, and I’m a family doctor,” I told the crowd. “One of the basic tenets of medicine is, ‘First, do no harm.’ Whether you do clinical care, work on a population level, or develop government healthcare, that ought to be a guiding principle.” I invited the crowd to repeat the phrase throughout my speech.
I told the crowd of an eight-year-old Iranian boy whose life-saving medication wasn’t covered by the new federal health insurance structure.
“Do no harm!” chanted the crowd.
I told the story of a Mexican child who had neither his medications, specialist visits, nor hospital admissions covered.
“Do no harm!”
I talked about the financial costs of the cuts to hospitals and taxpayers. I pointed out that newly arrived refugees were future Canadian citizens—our future colleagues, children’s classmates, and neighbours, and that we ought to be investing in them. Only treating disease that threatened the Canadian public was degrading; putting patients in the position where they had to beg for medications was humiliating.
“Do no harm!”
Healthcare should not be used as political leverage in immigration policy, and the dignity of my patients was not dispensable.
“Do no harm!”
Then I raced back to the clinic in time for my first afternoon patient. It was Yusef.
“I heard you on the radio this morning,” he said. I’d been on CBC’s Early Edition with Rick Cluff. Yusef marvelled that I could publicly disagree with the government without fear of repercussions. “We want to say thank you, for your help,” he went on.
I was surprised by how closely he had followed our campaign. While I had seen advocacy as distinct from direct clinical care of the patient, something I did off the side of my desk, it was clear that Yusef saw it differently.
“We have made you a Facebook fan page in Arabic,” he said.
28
I FIRST FELT THE BABY MOVE at sixteen weeks: a soft swipe, a sliding sensation. Then the movements changed to knocks, small thuds, bumps, and turns. I often lay on the couch, pants unbuttoned, both hands on my belly, waiting for baby to buck and shift; its solid presence took my breath away.
At twenty-seven weeks, three days, I had a globe of a belly, a baby cardigan on the knitting needles, three very pleased children, and a nonstop pace at the office that kept baby rocked to sleep most of the day.
I disliked that pregnancy forced me to bring my personal life into the office. I didn’t have pictures of my kids on my desk, I was vague when curious patients asked where I lived, and on Monday mornings I never volunteered my weekend activities to the staff. But my pregnant belly, no matter how discreetly swathed in muted professional clothes, begged comment from everybody.
When a patient came to see me for a follow-up after a miscarriage, I was acutely aware how difficult it might be for her to see her doctor pregnant. As I called her from the waiting room I felt I was flaunting my fertility. I willed my belly to shrink down a little, to look less jaunty, but her gaze was fixed on it as she approached. She grabbed my arm, looked at me earnestly, and said, “I’m happy for you. I really am.” I could tell she was, and I was moved by her graciousness.
Not everyone was happy for me. I had lunch with a colleague in town for a conference, a forty-something man with no children, and he asked what benefits I received as a member of our provincial medical association. I listed them: malpractice insurance rebates, education funding, maternity leave benefits . . .
He interrupted me. “Why should others pay for your lifestyle choice?” He gave a short diatribe on the injustices borne by childless men. I tried to interject but gave up when he complained about having to pay taxes for neighbourhood schools, which didn’t benefit him directly.
“If you get a leave to have a baby, I should get paid leave to take a watercolour painting course,” he concluded.
A few days later he swung by my office on his way to the airport. He set a steaming coffee on my desk and offered contritely, “You can have as many children as you want, Martina.” It wasn’t an apology for his position, I knew; it was an effort to mend the damage done to our friendship by articulating it.
I began my maternity leave a week before my due date. I waited impatiently at home, hovering between two worlds—missing the clinic, and not yet consumed by the newborn days. The baby was born two long days past the due date.
I included the requisite statistics on the birth announcement. I was precise, to the gram, the minute. What I cared about, though, in the days after her birth, were the other details. That my semi-retired doctor came up from a day at his cabin digging a garden for raspberry canes, for his last delivery. The warm blankets piled on me postpartum, white flannel with pink and blue stripes, the softness gone after hundreds of launderings—how they reminded me so strongly of both nights on call in the same hospital and my previous deliveries. The red birthmarks on my newborn daughter’s eyelids, symmetrical flames, perfect.
“Raspberry canes? Those are just the hormones talking,” said my girlfriend flatly. Maybe it was. Did it matter what magnified the incidental facts around her birth? I was still sifting through the experience, letting the details settle. I didn’t have any perspective yet, and I was hardly coherent.
Before I left the hospital, the public health liaison took a history from me and asked after my occupation. “I’m a family doctor at a refugee clinic,” I said, and I was almost startled to hear myself say it, as if I’d suddenly remembered it. I turned away as tears came. Hormones and lack of sleep, yes—and a sudden brief nostalgia for a life that seemed to have very rapidly receded. Most of all, though, the grateful realization, as I sat cross-legged in the hospital bed with my infant daughter in my lap, considering my work, was that I have this—and I have that, too.
I felt rich. Three daughters and a son. And I felt unified with my patients. I thought about how the process of birth is fundamentally the same the world over: pain, mess, relief and, if we are lucky, joy. I thought of Junah, just months from delivery, and imagined her with her prize in her arms, the baby wearing the same white flannel gown and yellow knit hat as my daughter.
We named our daughter Ilia Tove. Several times in the first week the entire family spontaneously migrated to her room, forming an admiring semicircle around her crib. Her siblings adored her. “Hey Ilia!” said Leif the first time he met her, waving his hands gently in her face. “Dynamite!” and his fingers burst apart in a soft explosion. Ariana imitated her startle reflex perfectly. And Saskia pored over my baby books: “Mom! Did you know that in a few months you can mash up a banana and feed it to her?” Pete walked around with a pink flannel burp cloth over his right shoulder, ready to soothe the baby that looked just like him.
Ilia attended three show-and-tells during her first week. “She breastfeeds,” Leif told his Grade 1 class. “She breastfeeds breast milk. From my mom’s breasts.” He patted my right breast for good measure. “All her life, my mom’s body has been saving all the milk she ever drank to feed this baby,” he went on knowledgeably. “It even saved all the milk my mom drank as a little girl.”
When Ilia was a few weeks old, Pete asked casually from the couch where he was reading after dinner, “Do you
miss our old life?” The relief to hear it said! I did. I missed the old routine, driving in to Vancouver in the mornings with four-year-old Ariana in the back seat, CBC on the radio, and a day at the clinic ahead of me. Yes, there would be a similar routine in a few months, with an infant in the car and a gradual return to work, but those other days, with their own particular details about which I was already sentimental, were done.
“I guess you’ll never have another son-baby, hey, Mom?” Leif asked cheerfully as he ate his after-school snack the next week. I could have cried. I had saved all my kids’ clothes in anticipation of this possible fourth, and now that she’d arrived I had boxes of corduroy pants, sneakers, and little ball caps to set afloat. Somehow my daughters’ infancies seemed preserved through newborn Ilia wearing their hand-me-downs, but I couldn’t kid myself: my son’s baby days were over.
And then I overheard Ariana greeting her little sister. “Good morning, Ilia,” she said seriously. “It’s your medium-sized sister.” Saskia was still the oldest, and Leif was still the only boy, but the crown of youngest child had been passed from Ariana to Ilia, by my choice. Then, after church, an elderly woman tugged on my arm, admired the baby and confided, “Mothers have a very special relationship with their youngest daughter.” At that moment Ariana came into view with her long dark pigtails, her thin legs in purple boots making their way across the room to the gardens outside. There she was, the daughter with whom I would have had that extra special relationship—except I’d taken that from us and given it to this newest baby.
Those first two months, I missed my bodies. The one before this last pregnancy. The one before I had ever been pregnant at all. The pregnant one, even; that at least looked purposeful. A week postpartum, sitting at the breakfast table, Leif gestured at my paunch with his spoon and asked, “You know why that looks like that? Because all the equipment is still in there.”
Most of all, I struggled with the loss of my identity as physician. At the little goodbye party over cake in the chart room in November, I had asked the clinic to please just stagnate until I returned. Of course, I expected them to forge ahead and do all sorts of interesting things while I was away, and I hated to not be a part of it. Some of my patients, like Yusef, requested four-month supplies of medications to tide them over until my return. I didn’t comply, but I understood. I was grateful for the locum covering for me in my absence, but I was jealous of her, too. I missed the collegiality of the clinic, the focus on others’ lives, the escape from my own head, the sense of contributing to the community, the academic stimulation. I’d be back to work in the spring, but in the meantime, I felt unmoored.
Yet how I loved my daughter’s little face. I marvelled that someone I couldn’t have imagined months ago could feel so inevitable, could have an entire family happily orbiting around her. My sorrow was not ingratitude. It was simply an acknowledgment that for this new mother, mixed in with the bliss of those first six to eight weeks, were feelings of loss and grief.
29
I RETURNED TO WORK WHEN ILIA was four months old. Yusef was booked to see me on my first day back. We traded details on our babies. Ahmed was a month old. Yusef showed me pictures on his phone of Junah cradling a baby with fuzzed black hair and wide eyes so dark they swallowed his pupils. “He’s beautiful,” I said, but I was looking at Junah. She smiled with her lips closed, serene, all weariness gone from her face, lifting her elbow to tip Ahmed toward the camera.
Upon returning from maternity leave, I’d promptly looked up Junah’s file to read the delivery report and newborn assessment. It had been a spontaneous vaginal delivery at thirty-nine weeks, I read, scanning the report, and the baby’s exam was normal. She’d taken risks that I had not advised, and the result was an uneventful pregnancy and an eight-pound seven-ounce healthy son.
The family doctor in Surrey who had provided care for Junah’s last four months of pregnancy and attended the delivery had agreed to take on the Haddads as patients. We were a few months past their one-year anniversary in Canada, when I usually discharged patients from the clinic. Today was Yusef’s last visit with me.
“Party for Junah’s birthday,” Yusef said carefully at the end of the visit, with his Arabic accent. “You come, Doctor?”
He sat in the patient chair to the left of my desk, long legs crossed, shoes shined. There was no interpreter. Eager to practice his English, and, I suspected, to optimize the intimacy of the visit, he now declined Hani’s assistance and insisted on seeing me alone.
It was mid-afternoon, and I was cheerful and unguarded on my first day back. “I don’t know,” I said as I printed his prescription. “When is it?”
He seized on this suggestion of interest. “You come? Junah so happy! I tell her Doctor come.”
“Well, I don’t know if I can make it,” I said. “What day is it?”
“You tell the day you can come,” he said.
That felt all wrong, organizing a birthday party around the doctor’s availability. I refused to name a date.
“I choose date,” Yusef said agreeably. “I email you. You cannot come, I change date.” He gathered his coat and umbrella and murmured again as he left the exam room, “Junah so happy when I tell her.”
I’d never been invited to a patient’s birthday party, but I already felt uneasy. Had this been an exam question during my medical training, I would have stated with certainty that attendance would be unprofessional.
But when I thought about the actual practice of physicians I admired, it was less clear. A Vancouver obstetrician hosted an annual party at her home for the new parents, with a legendary Bellini machine. My father-in-law golfed with his physician. My own family doctor listed his home address publicly, to ensure he’d always be available to patients. All of the above seemed unprofessional in theory, but reasonable in practice. Noble, even.
The next day Yusef emailed me at my work address. The line spacing was odd, and he had clearly used a translation service; the effect was poetic:
Hello my doctor,
First, thank you for everything.
We came to the most beautiful city in the world before more than a year.
From the first day you was balm for us and eased the pain of alienation.
We always see you as more than a doctor for us we consider you a close friend.
Doctor, for all of this and other we will be very happy if you accepted the invitation to celebrate Junah’s birthday on Sunday March 10 at 4 PM.
From there he detailed an elaborate itinerary that involved touring the city of Surrey in his friend’s car and visiting White Rock beach before returning to his home for the birthday party.
I was moved by his invitation—and I resented it. I didn’t want to be a special guest. I was the host, in my exam room.
I strove for a professional but cordial reply. A relationship with a physician, I told him, was special, with limitations on how we could engage outside the clinic. I declined the city tour and beach visit, but would try to come by the house briefly during the party to give my regards to Junah. I hoped he understood, I concluded.
He replied immediately: “Yes, yes, of course, Doctor.”
The Surrey address was a few minutes off the freeway, on a street where everyone drove by hurriedly on their way somewhere else. It was a neighbourhood of low apartment buildings, with old couches and bikes on the balconies and scrappy lawns. As I approached, I slowed uncertainly, trying to make out the address numbers in the winter dark. Then I saw Yusef at the parking entrance, waving at me. I pulled in and rolled down my window.
Yusef welcomed me with formality, and directed me where to park. He wore a suit jacket and cologne. I was deliberately dressed exactly as I did for the clinic: navy wool pants, a blouse in a small print, and low heels. Only the stethoscope draped around my neck was missing. Business attire was unimaginative, but festive dress felt downright dangerous. I was determined to preserve some kind of boundary.
We walked into the building together. I knew th
at most of my patient demographic lived in poverty, but I had never actually witnessed it. The halls were dim, and garbage was piled next to the doors of some units. I could taste something sour—stale cigarette smoke, or cat urine. Had I been alone I would have felt unsafe.
Upstairs, Yusef ushered me into his apartment. I entered the living room, dull beige, unadorned except for a row of plants crowded in the windowsill, and harshly lit by an unshaded bulb hanging from the ceiling. In the centre of the room was a table loaded with food. Next to it stood Junah, smiling shyly, with makeup on and the bundled baby in her arms. Nadia and Layth were lined up beside her.
A man and a woman stood up from the loveseat and introduced themselves. They appeared Middle Eastern but their English was fluent. They had met Junah and Yusef two weeks earlier at the local high school, they told me. We were the only guests.
I wished Junah a happy birthday, and good health in the coming year. I presented her with a small kalanchoe plant wrapped in green foil that I’d picked up from Safeway on the way over. I’d had to choose between two discomforts: buying a gift for a patient or showing up at a party empty-handed. The plant was well-received.
So was I. I sat on the couch, and Junah and Yusef sat on chairs opposite me and beamed at me. I was clearly the guest of honour.
Yusef spoke in Arabic to the other guests, who turned and looked at me. “So you’re their doctor?” asked the man doubtfully.
“Yes.”
“I’ve never heard of a doctor going to a patient’s birthday party,” he said.
“They typically don’t,” I said. He waited, but I had nothing more to say.
We sat in silence. Never at a loss for words in the clinic, I could think of nothing to say. I already knew the intimate details of their lives, down to their monthly budget and what they dreamed about at night. In the office, nothing was off-limits. Here, nothing seemed appropriate.
“I show you house?” asked Yusef.
“Yes, please.” I followed him through the apartment. The kitchen was warm and savoury, the dishes from food preparation piled on the counter. The master bedroom contained nothing but a double bed. Nadia and Layth shared the second bedroom. There were no sheets on the mattresses, just a rumpled blanket on each one. The single bathroom was so small that it would be awkward for a lone occupant to close the door.