Suzanne Smith was an elderly white woman who experienced a violent assault some odd years ago. Since then, she’d never been quite the same. Plagued by fears and sleepless nights, the concepts of medicine and psychotherapy were alien to her, and from my understanding in speaking to her children prior to her coming in, she wasn’t keen on speaking to medical professionals. The sole catalyst of her winding up in my office: the passing of her husband. With her life partner departed and no other avenues to turn to, her children pushed her to meet with a psychiatrist. She did so, as reluctantly as one could, I imagine.
When she walked into my office, she looked fragile. A delicate pace underscored her hesitation with it all. She slowly found her seat, looking at me with eyes that exuded fear. I had of course seen patients like her before. It’s hard to disentangle the empathy and emotion you feel looking into someone’s eyes, especially when you need to be an objective and analytic clinician. But I try to do so as much as humanly possible. A shrink shouldn’t have their judgment clouded by emotion, despite immersing themselves in it day in and day out.
I introduced myself. She introduced herself. A few moments of silence passed as she looked at me and the decor in my office and fiddled with her purse before resting her gaze back on me. I didn’t want to push. I’d let her start the conversation and tell me her story. I’d gone into psychiatry for moments like these. Moments of unimaginable tension where I could make a difference. I could help her, maybe. I didn’t want to botch things and fail her.
As her eyes eased and she began to breathe comfortably, she said, “I…I’m glad you’re not one of them….” It was said with an air of suspicion and paranoia. I didn’t understand. Did I read the wrong chart?
“One of who?” I asked.
“The immigrants. Like the other doctors that work here.”
She was referring to my colleagues. ”Why is that?”
“They scare me, and I can’t understand them. And they’re Islamic or Arab, or Lord knows what. I don’t know what’s going through their heads. I’m sure they’re smart, but I don’t want to deal with them. No.”
It took me a moment to digest what she’d said. In truth, I momentarily thought she was talking about me. Because the irony here was that my colleagues were neither Arabs nor Muslims, but I was both.
While I’ve certainly had to experience racism throughout my career, it had never taken me off guard in such a peculiar way. And never from someone I’ve had such a power differential with. For a moment, I didn’t know what to do. Do I just treat her? Do I defend my coworkers—or my ethno-religious background? That would destroy any chance of rapport I had with her. And aren’t I here, sitting in my seat, ready to listen and take action, for her? And what if she finds out that I’m an Arab? My last name is ambiguous enough, but I don’t know that Ibrahim is. Would she even know what an Ibrahim is?
“I gotcha. Let’s talk about why you’re here….” and with that, the conversation moved on. We never went back to it. I treated her and prescribed medications. She ultimately trusted me, took her medications and began improving. She also saw the white therapist that I very cognizantly referred her to. She slept better and, in her old age, reclaimed a portion of her life that she’d lost. But the encounter stayed with me longer than I expected it to.
What exactly was my role here? I certainly have an obligation to rebuke xenophobia, but is it my obligation to my patients’ suffering that I should put first? In that instance, I thought so. But what exactly am I supposed to treat as a psychiatrist?
I still think back to that interaction from time to time, knowing that I hadn’t failed my patient (at least on a superficial level), but wondering if I had failed myself.
13 thoughts on ““One of Them””
Your story shows a remarkable amount of compassion for a patient who carries a deep burden of grief and who has a history of trauma that is largely unknown to you. Your description describes a woman who is fearful of categories of people and we don’t yet know why but she is reluctant to talk about her past traumas and current fears, which are likely related. As such, you chose not to confront her biases but to meet her where she was that day, help her by prescribing medication, and matching her to a therapist who wouldn’t trigger the fear she had disclosed to you intentionally or unintentionally as it could relate to past trauma. Your caring clinical manner came first in treating the patient and will hopefully serve her (and you) well in the long run. This was clearly so difficult for you as a professional and as a person with feelings of your own who has been discriminated against in the past and anticipates the experience again in the future. I applaud you for starting where the client needed you to begin, for hearing beyond her spoken words, and then telling a supportive community about the pain that ethically doing your job caused that day so we could support you in turn.
Perhaps not every mind can learn tolerance, but perhaps as she recovers she can look back on your mutual interaction and realize that you showed her the gift of tolerance.
“First do no harm” and I think that means harm to the patient. You did her no harm and likely helped her to get a meaningful life back.
I can believe you remember this incidence. She did you harm, and I am sorry you had to deal with what she said. I think you did very well by her.
As a female physician from the 1980’s I can say that I faced similar remarks about not wanting a “girl doctor” and why wasn’t I a nurse, etc. It is better to handle it as you did – beautifully caring for the patient. We are to care for our patients – not change their upbringing. Many of us are facing patients with very differing opinions now with the pandemic and the tightrope is just as challenging. Ultimately, as you did – we just return to our calling.
Gender is certainly considered a barrier by some, but to compare that with race, disparity and bigotry is akin to exhorting, ” I have a …… friend, colleague, family member who is blah blah blah…” It isn’t even close. Whitewashing racism, attempting to compare it to sexism is just another attempt at downplaying its devastating impact, and is embarrassing in its lack of recognizing the continuing effect on minority providers. Please. Do better. Please.
Showing understanding and empathy is not the same as equating. This isn’t the Discrimination Olympics.
I have been told to “take the banana boat back” to where ever I came from as I wasn’t welcome in “his country”—!
Many times, it’s the upbringing and the lack of interactions with other cultures that causes this sense of entitlement.
I’m so sorry that this happened to you. But I want to affirm you: I believe that YOU DID THE RIGHT THING. It was SHE who did the wrong thing, due to either her upbringing or life experiences. You could never have helped her heal if you had charged out of the gate with talk of how wrong she was. The beautiful by-product of your care and wisdom is the opening it might give: perhaps one day she learns of your ethnicity but by then she’ll be most moved by your humanity.
As a patient if I had a physician who did not stand up for themselves, I would wonder if they could stand up for me if necessary. Likewise, dear doctors, I support your not taking discriminatory crap from anyone in a professional situation. Also, this story makes me think of my excellent urologist, who probably is rejected by some patients based on his ethnicity. Three years ago, he insisted on a workup for my adrenal adenoma that all of his lily white predecessors had ignored. It first appeared on CT scan over a decade earlier, but no one who saw it cared. This January I will have it excised. As it turns out, I have Cushing’s syndrome — finally diagnosed after about 15 years of progressive, debilitating illness. My ethnically interesting urologist probably saved my life. And I also must confess that I have developed my own intolerance — of medical incompetence. That’s the thing that patients should be discriminating against.
Very delicately written — and all the more powerful for its nuance and ambiguity. Just as the interaction has stayed with you, I suspect your story will stay with me.
so eloquently said…as a gay pediatrician I have failed myself so many times and it haunts me.
L, you have not failed yourself. The bigots have failed you. You have put your patient’s well being before you own as we all do so often. Each time you did not respond to a homophobic remark, you did it to maintain trust with your patient or his/her/their family. I am so sorry you were confronted with all of that bigotry.