Clinica day patient exposure and sampling by me

Dr. Orez brings her in from the internal ward, one more patient to be interviewed by the eager first year medical students. They call themselves by now 1/8th MDs.

Around the conference table sat the eight students in their white coats, with a clinical book passed around to read about the previous patient and her case: scleoderoma.

Um Salem walked in, a short lady, with her head covered, not wearing the regular hospital gown, small arms and feet, round trunk, low voice. She sat at the edge of the chair, put her elbow on the table across from me. There was an air of loss around her: the world barely seemed to exist. The other 10 persons in the room were almost not there to her. She was only brought in to leave as soon as she could.

I speak Arabic, surely, the only Arabic speaker in my group. Shouldn't I be the one to interview her? There is no language barrier and I should be able to understand what Um Salem says.

What steps to keep in mind? At this point of our training, it is supposed to be history of present illness, social and medical history, allergies, medications, family history. Drugs. Okay, I can do this. I think to myself.

After slowly explaining who I am, who the students are, the purpose of our interview, I ask what her name is.Does she understand my accent? Does she remember my name? Is she curious about where I come from? Why I speak Arabic and why my accent is different? None of this seems to matter to Um Salem- she is barely with me in the room as I would ask her questions; she barely maintains eye contact, as she looks throughout the window, around the room, and mutters a few words repeatedly: diabetes, high blood pressure and pain. Do I make my questions more specific? Do I leave it open ended? None of the techniques seem to work and I have no idea what kind of a person is sitting in front of me.

For the first time, I realize when a patient walks into the room, s/he brings more than a disease, a complaint or a cough. S/he brings in a story of the environment of where s/he lives, other people's stories, behaviors and cultures. Pain. Diabetes. High blood pressure. Tin houses. Yes, tests. Then she began coughing.

A classmate tells me, "Ask her for long she has been coughing."A week. The logs....she says. And then our doctor explains what was known as the "Bedouin lung", that because women cook using logs, they breathe in different chemicals, rendering them susceptible for pulmonological complications. Um Salem lives in a tin house, cannot use the logs to stay warm, cannot cook, and has people bring her food. She has been to the hospital before because of breathing problems.

The many words that I have used in Arabic trying to understand her story are not going to provide me with the picture of where Um Salem lives, nor is she going to explain to me about her environment. We come from totally different worlds- and even though I have explained who I am, who the students are, I am not sure that it make any sense to her. I am not sure that my questions about her health, my description of her pain, and her condition make sense to her, at all.

We both speak Arabic and yet the language seems to be common symbols for different meanings, worlds, experiences and lives. After seeing other Israeli patients who are active, who exercise, who do folk dancing, who wanted to get better- Um Salem highlights a complete opposite of the previous realities. Living in a tin house, with no electricity, no running water, not being able to cook, at the age of 70, with certain diseases. How did the world come to be to her?

Another classmate says, "Ask her, Has she been to a local healer?"But, how do I ask her this? It seems that even though the Bedouin population is different than the people in the city, they always use the health care system. She had given birth to all of her children at the hospital. What would I ask her? Do you go see a sheikh so that he makes you feel better? Does he do seher (magic)?

There is no way to translate the question applicable to parts of Africa or South America to Um Salem's situation and language. When you started feeling bad, who did you see first?Kopat Chulim. el mirpaha. Sounding the most awkward and the craziest perhaps to Um Salem, I ask her if she saw a sheikh, knowing that my question does not ask about the same idea that my classmates have in mind.As the interview ends, we, the medical students, have an idea of what her medical condition is and what it is induced by perhaps.

Yet, as she left, I am not sure that I completely understand what Um Salem's diseases is, what she thinks it is, how she comes to see it and experience it. Her lung case, if that is the case, seems to be as unimportant to her as the entire interview. I see her walk out of the room, realizing that though we seem to communicate, I do not know or understand the first thing about her, that though the doctors might give her antibiotic, she probably does not have any idea about what is injected in her and why. If I countmy days by numbers and calendars, she might count hers by the time left for her in the hospital before she leaves. Or, she might never count anything at all. To live in world with no numbers- Possible. I smile As Um Saleem walks away. Um Salem: Sometimes, the spirit of the desert cannot be captured in words, understood or felt. And the grains of sand are not perhaps meant to be measured and counted. Pain. Diabetes. High blood pressure- this is all there was to it. She is right. And I am humbled for expecting myself to know her entire story and understand her. She still has much to teach me.