Wednesday, December 9, 2009

A day at the refugee clinic

I get up at 6:40, always reluctantly. I shuffle downstairs to eat a bowl of granola with yogurt while checking email. Ten minutes later Ariana shouts from her bed, "I want to wake up now! Time to wake up!" and forty-five minutes of prodding three kids through the morning routine begins. If they are dressed and seated at the table by 7:30, I make them tea in a white elephant teapot.

We wind our way out of Deep Cove, dark waters to our left and hulking mountains to our right, with CBC Radio 2 playing. I adore Tom Allen's voice and think how my patients would benefit if I could speak in such kind, good-humoured tones. Forty-five minutes later and I've dropped two kids off at school, the youngest at preschool, and parked the van in a neighbourhood five blocks from the clinic.

As I walk to work, I often dread a day of seeing patients. I wish desperately that I were a pathologist working at VGH, looking up from my microscope periodically to gaze out over a view of False Creek. I feel immense pressure to be fully present for each of my patients and in the moments leading up to the start of my day it sometimes feels unbearable.

I am one of five part-time family physicians at the refugee clinic. I typically have five 30-minute appointments booked for the morning.

9:00 My first patient is a 27-year-old Ethiopian woman with a new diagnosis of HIV. I break the news through the interpreter, who is clearly shaken. The patient is distraught. I explain that HIV care and prognosis is different in Canada than it was in her village. Grim though this task is, the face-to-face, front line provision of care to this crying woman seated before me strikes me as an incredible privilege on my part, and any longing for the detachment of a pathology lab slips away.

9:30 The next patient is an elderly Afghani widow with hypertension and depression, well-known to me. At the end of the visit she tells me that when her son was severely wounded in Afghanistan years ago he became a pastry chef. She produces two Ziploc bags of cardamom-flavoured pastries, one for me, the other for the interpreter.

10:00 A 42-year-old Burmese woman comes in for her first well-woman check. I do a pap smear, bimanual exam and breast exam. She had never heard of these exams before I introduced the concept at her last visit. The idea of screening for disease, rather than treating it as it presents, is a novelty to her.

10:30 An elderly Bhutanese man, illiterate in his own language, presents with symptoms of prostatic enlargement. I pull up a diagram of the prostate on Google images and he stares at it. I am not sure how effective my teaching is.

11:00 A Congolese woman comes in for follow-up of her PTSD. She also needs documentation of her torture scars for a medicolegal report. She weeps as she describes how each wound was inflicted. I make detailed notes and feel ashamed of the human race.

The morning is not quite that orderly. One patient brings her two children, and because they've spent ninety minutes getting here on public transit, I feel compelled to fit them in. Two patients are late. The other physician and the psychologist tussle with me over the Farsi interpreter. An infectious disease physician calls to discuss my patient with echinococcosis. The nurse taps on the door to ask for a signature on a parasite medication prescription.

I leave for a quick lunch with my colleague at the Indian place a block away. We head out the back way, bypassing the waiting room that's already filling with the afternoon patients. The clinic is so busy that taking time to eat or pee induces feelings of guilt.

I see prenatal patients on Tuesday afternoons. I have a medical student today. I let her palpate fetal parts and find the heartbeat with the doptone. She is thrilled; I can tell she's going to tell her classmates all about it tomorrow and I feel nostalgic for those fresh and glowing medical student days.

I'm ravenous with hunger by the end of the afternoon, and briefly consider the Fibre One cereal samples, Tums smoothies and chocolate Caltrate Soft Chews in the cupboards. I resist and head out into the December cold to pick up Ariana.

Forty minutes later we pull into our driveway. The cedars are stirring from the wind blowing up Indian Arm and the docks across the water are decorated with Christmas lights. Deep Cove is serene and worth the commute.

I open the front door and the entrance way is strewn with backpacks and toques. We head up to the kitchen where Pete - who cooks every night - has prepared a meal of grilled salmon, asparagus and French bread. Everyone tells anecdotes from their days, including me, but the story I attempt to tell Pete is interrupted so many times that it fizzles out and doesn't seem worth finishing.

I put the kids to bed at 7:00. I crawl under the covers with my five-year-old for a few moments and he suggests, "Hey! How about you move out of Daddy's room and move in here with me?"

I answer any urgent emails and then watch a movie, too often something like Blood Diamond or The Killing Fields or Lost Boys of Sudan, one that turns out to be overwhelming after a day at the clinic. If we've thought to chlorinate the hot tub, Pete and I will spend ten minutes before bed with piping hot water up to our necks, gazing out at the towering spruce trees across the way and the moon on the water.

And then bed, the sweet, delicious coolness of sheets and pillow, and I am asleep in minutes.


  1. when I saw that you were gonna describe each of your morning petients I got so excited I actually got a bowl of chips and some coke to thoroughly enjoy the read and enjoy it I did!! I miss your blog. Thank-you for the smiles.

  2. Loved reading this, as always. Your writing is like art.

  3. Wow! What an amazing post. I often feel like a cop-out, as a pathologist. Real people overwhelmed me -- I became too wrapped up in their stories and pain. Luckily, when I perform FNA's and round on apheresis patients, I get a small dose of people medicine. I enjoy the interaction, but also love getting lost again inside my scope - the images are beautiful, soothing, and detached.

    Your writing makes me want your job. Can't wait to read more.

  4. I miss your blog too. Your writing is beautiful.

  5. Thank you for this, it has given me a lovely read this morning while I wait for my girl to wake up.

    I miss your blog, too! Hope that you are doing well!

  6. You really have a crystal clear way of describing things. I join the chorus of people who miss your blog!

  7. Such lovely writing. I'm an NP and reading this instead of catching up on dictations like I should be :). Your fresh point of view and inspiration renews my energy and enthusiasm for patient care.


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