uncooperative toddler backwards on her lap so I could attempt to paint fluoride on his teeth while he wailed. I was taught how to do a MUAC, wincing internally when the cardboard cuff showed every single child in the family to be severely malnourished.
During lulls in the day, if there were any( there usually weren’ t), or more often, after everyone had gone home for the day and it was just us and the janitorial staff left in the office, Dr. Bichir and I talked. She told me about the mystery illnesses that so often crop up amongst new arrivals, made infinitely more difficult to diagnose by her patients’ apparent collective terror of visiting subspecialist offices. Time and time again, I heard her try to explain why it really wasn’ t possible for her to identify worms in the brain without taking a special picture, and that she needed someone else to take that picture, because she couldn’ t do it in her office. The parents would listen politely and then inevitably ask,“ But can’ t you just treat him here?”
We talked about other stuff too, about career planning and taking board exams and about our pre-medical school lives – her, therapist, me, musician. We discussed her kids and my horses.“ I think she might be my spirit animal,” I told the friend who had first suggested that I pursue this assignment. She just laughed and said,“ I told you so.” And then, of course, we did all the things that we were supposed to be doing together too, looking at pictures of inflamed ears and vaccine schedules and learning to write a prescription by hand.
The second week, she started letting me out on my own. Amazingly, I found that with her guidance, it wasn’ t as hard as I thought it was going to be. I handled the various interpreters with ease, choosing my words carefully to minimize confusion, just as she had taught me to do. I pulled the milk pictures out of the folder where they lived on the back of each door over and over again, never having stopped before this rotation to consider that the colors on the milk bottles meant something, and that that“ something” might not be entirely obvious to people who had not spent their whole lives perusing the milk aisle at Kroger.
Late one afternoon, while she was tied up with yet another chaotic refugee intake visit, she sent me down the hall on my own to see a toddler for a well child visit.“ You’ ll like this one,” she told me.“ She’ s really cute.” She grabbed my arm, causing me to pause momentarily on my way out the door.“ By the way, her mom is a doctor, but if she’ s there, don’ t worry, she’ s really nice.” A surge of terror ran through my body. To my relief, when I entered the room, I found that the child had arrived that day with her dad. Crisis averted. However, the most surprising part about the whole visit turned out to be how, after doing well child after well child on kids with parasites and TB and unusual hemoglobinopathies and a variety of congenital malformations and trauma, so much trauma, this very normal visit, in my native language, with a precocious little girl with educated, stable, comfortable parents, was almost kind of … boring. I mean, she was very cute, don’ t get me wrong, but it didn’ t present the level of challenge that I had apparently become accustomed to.
“ Sometimes I worry that it’ s doing a disservice to students to be in this clinic for third year rotations,” Dr. Bichir told me one day.“ It’ s just so different. I worry that you don’ t see enough‘ normal peds things.’”“ I’ ve logged every diagnosis on my list,” I told her.“ All of them?” she asked, a little disbelieving.“ Everything except … obesity,” I told her, scanning the list on my laptop. She laughed.“ We can fix that this week,” she told me. And we did. Turns out, even kids that show up to this country malnourished and underweight can end up on the other end of the bell curve after a few years in America.
Near the end of my time at NuLu, I went to see a preteen girl for a sick visit and a preschooler for a well child, siblings who had arrived together, with their father in tow.“ If they mention the fire,” Dr. Bichir told me beforehand,“ don’ t worry too much about it.”“ What fire?” I asked her. A bomb had fallen on the refugee camp that they used to call home, she explained. A large fire ensued, sweeping through their tent. Some of the siblings had been badly injured and one had died. With that image seared into my brain, I entered the room to find a cheerful, active, laughing little girl, busy crawling over all the furniture, and a remarkably poised sixth grader, eager to tell me all about school and show off her newfound English skills, which far surpassed those of her father, meaning I had to stop every now and again to summarize for the interpreter. The resiliency of kids never fails to surprise me.
This, I have come to realize, this is my happy place: a packed day of complex patients, all requiring interpreters, who will almost inevitably bring you surprises at every turn? I’ m aware that this might sound like hell to a lot of physicians, but I truly, genuinely loved it. I probably would’ ve performed better on the peds shelf exam if I hadn’ t spent so many hours at NuLu. Undoubtedly, many of my classmates, who all seemed to go home from their outpatient rotations at 3 p. m. rather than 7 p. m., did perform better. But I wouldn’ t trade the experience I gained there for anything.
That experience was what it was because of Dr. Nicole Bichir. I picked up so much seemingly by osmosis, simply by watching and listening to her. She shared her expertise with me generously, willingly, every day, taking time that she could’ ve spent at home or grocery shopping or sleeping, taking that time to teach me just one more thing. She gracefully held my hand through things that I didn’ t know how to do, while simultaneously giving me the freedom to fly when she knew that I was ready. So far as I’ m concerned, she is a treasure, and I’ m proud to call her my mentor, colleague and friend.
On one of my last days in the clinic, she asked me if I wanted to go start a refugee intake visit without her. She was still tied up, yet another visit that had looked like nothing on paper but had turned out to be a lot more complicated than anticipated. I must’ ve hesitated slightly. I knew how important the intake visits were to her, that first visit for so many families to what would ultimately become their medical home, an anchor in the turbulent seas of life in a brand-new country. I got that million-dollar smile again.“ Don’ t worry,” she told me.“ You can do this. I’ ll be right behind you.”
Elizabeth Clark is a fourth-year medical student at the University of Louisville School of Medicine.
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