Martina Scholtens - Your Heart is the Size of Your Fist

Copyright 2017 by Martina Scholtens

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Edited by Lynne Van Luven

Cover design by Tree Abraham

Cover image by Rebecca Wellman

Interior design by Pete Kohut

Proofread by Claire Philipson

Permission for the use of quote from Susan Cains Quiet: The Power of Introverts in a World That Cant Stop Talking (New York: Crown Publishers, 2012) has been kindly granted by Penguin Random House LLC.

LIBRARY AND ARCHIVES CANADA CATALOGUING IN PUBLICATION Scholtens, Martina, author

Your heart is the size of your fist : a doctor reflects on ten years at a refugee clinic / Martina Scholtens.

Issued in print and electronic formats.

ISBN 978-1-927366-68-4 (softcover).

1. Scholtens, Martina. 2. RefugeesMedical careCanadaAnecdotes. 3. ClinicsCanadaAnecdotes 4. Physician and patientAnecdotes. 5. PhysiciansCanadaBiography. I. Title.

RA564.9.R43S74 2017 362.1086'914 C2017-903017-5

We acknowledge the financial support of the Government of Canada through the Canada Book Fund and the Canada Council for the Arts, and of the Province of British Columbia through the British Columbia Arts Council and the Book Publishing Tax Credit.

For Pete

PREFACE

I WORKED AS A FAMILY DOCTOR at Bridge Refugee Clinic in Vancouver, Canada, from 2005 to 2015. The clinic provides care to one to two thousand new refugees arriving in British Columbia each year. I started fresh out of residency, spent my thirties there, and ended up becoming the clinics medical coordinator. As a clinical instructor with the Faculty of Medicine at the University of British Columbia, I supervised a steady stream of students and residents over the years. I heard and told a lot of stories.

My clinic days end with chartingupdating the patients medical records with their concerns, my findings, and our plan. But I often follow that with writing down for myself the details of something that moved me that day. Sometimes I write to reflect, sometimes to memorialize the patient.

There is a third reason I write: advocacy. I support refugees, the Canadians who welcome them, and a robust refugee policy. With increasing media coverage of refugees following cuts to federal health coverage in 2012, Canadas commitment to Syrian refugees in 2015, and policy changes south of the border in 2017, I read and listened to a myriad of opinions on our countrys newest residents. Much of what I encountered was inconsistent with what I saw in my exam room. I thought my vantage point might be worth sharing.

This book was written with the utmost respect for patient privacy, for what the Hippocratic Oath calls holy secrets. While all events and conversations depicted in this book occurred in some form during my decade at the clinic, details have been altered so that the patient cannot be identified. Some stories are a composite of multiple patient encounters, about an experience common to many refugees. Others stories are shared with patient permission; even then, I have not used their names. I have made every effort in the details included, withheld, and modified to preserve the trust of both the doctor-patient and the writer-reader relationship.

EAGER TO PRACTISE HIS ENGLISH, Yusef waived my offer of an Arabic interpreter for his appointment with me, as he usually did. After a year in Surrey, a suburb of Vancouver, Canada, he and his wife, Junah, had mastered the language enough to order lamb from Save On Meats and to ask the bus driver for directions to the refugee clinic at Main and Broadway in Vancouver. They did not, in fact, have the fluency for a doctor visit.

I ushered the couple into my exam room, where they sat down, beaming.

Yusef came straight to the point: I want to kill you.

Pardon me?

I want to kill you. He gazed straight at me. I stared back, wondering if Id need to use the panic button hidden beneath my desk. He was composed and spoke quietly; it was hard to know whether to take this as reassuring or chilling.

I try, this week, he went on. Twice, I try to kill you. His wife nodded.

I thought back over my week. It had been uneventful. Tell me more.

He pointed to the phone. I try to kill you. But no one answer.

Oh! Call me! You tried to call me!

Yes, yes, call, he corrected himself. What mean kill?

Murder. Make me dead.

They laughed until they had to dab at their eyes with tissues.

I laughed too, a chuckle of relief. I marvelled that they were crying with laughter at a joke about death. A year ago, Id never have believed it.

YUSEF HADDAD? I CALLED INTO the waiting room after consulting my day sheet. Junah Haddad?

The clinic waiting room was furnished with salvaged church pews, the oak worn smooth from years of waiting on God and the doctor. The furniture had struck me as incongruous when I started at the clinic, but Id since decided it wasnt that unnatural a fit. Church and clinic were both places where people gathered to seek answers, sites of congregation and confession.

A family of four sat patiently on the pew at the far end of the waiting room, facing me, beneath a window overlooking the parking lot. They didnt seem bothered that the clinic was running fifteen minutes late. They looked resigned, like they were accustomed to waiting. They fit the demographic of the new family scheduled to see me that afternoon: an Arabic couple in their forties, with two teenage children. They stood uncertainly as I repeated their names. They looked tired and bewildered.

Theyd arrived in Canada earlier in the week and were staying at Welcome House, transitional housing in downtown Vancouver, until they found permanent housing. I knew their past few days would have been a confusing rush of orientation sessions and registration for everything from a bank account to health insurance. The husband held a transparent sleeve containing the paperwork the family had been issued in the past week.

I extended my hand and introduced myself. Im Dr. Scholtens. Sometimes Muslim men refused my offered hand, believing that Islam forbids non-essential contact with a woman who is not wife or family. Yusef didnt hesitate to grasp it. He didnt smile, but his eyes met mine. He was tall, over six feet, with wide shoulders and a narrow waist. He was well-groomed, hair slicked back, dark moustache neatly trimmed. He wore a button-down shirt and navy trousers. His shoes gleamed with fresh polish.

Junahs handshake was quick and tentative. A white headscarf with a green print band was wrapped tightly around her face, without a wisp of hair showing. She was almost certainly a brunette, but with her blue eyes and fair skin, I could imagine her as a blonde.

The teenage son was almost as tall as his dad, but his face was boyish and he stood awkwardly. His younger sister, in jeans and a pink headscarf, studied me with interest. I smiled at them.