Lisa Jacobs, in her nonfiction piece, March Manic (Intima Spring 2019) describes a long shift on a psychiatric unit. She is “beyond exhausted” to the point of having questioned her own grasp on reality.

As a case manager in a Baltimore City hospital, I once spent hours attempting to find placement for a homeless 19-year-old addicted to heroin who needed long term IV antibiotics. When I asked if I might call her mother she replied “I don’t give a fuck” but retracted her permission as I was leaving the room. I pretended not to hear. The next day I was told she had signed out AMA (Against Medical Advice). a colleague said, “Get over it. She was a waste of time and resources.”

A suicide attempt. A Syrian teenager. A team of American psychiatrists whose training suggests he is out of the woods. But, to Dr. Ibrahim Sablaban, something does not sit right. The son of Arab refugees, Dr. Sablaban sees hidden red flags in the teenager’s story.

“When Suicide Speaks Arabic” (Fall 2020 Intima: A Journal of Narrative Medicine) is a story of quiet compassion. It is a story of intuition born from upbringing—of a physician who sees a slice of himself in a patient who is in need of understanding.

It is also, at its core, a story about cultural representation. Dr. Sablaban instantly connects with his young patient by speaking in Arabic (citing that he had “already heard [the] story in English, and from [his] experience, it could be a distant language”). He is able to parse out the boy’s feelings of shame and sinfulness by referring to his own understanding of the Islamic faith. This was not at all the patient he had heard of earlier during rounds; this “was a tragedy waiting to happen.”

Dr. Sablaban’s story of connecting with and ultimately facilitating better treatment for this young Syrian boy can be viewed as a stroke of luck—a happy encounter and a happy ending. But he ends his piece with a striking sentence: “I can’t help but feel like it was more a story about failure than success.”

And it could be made out to be that way. Many knowledgeable and experienced physicians spoke to the patient before Dr. Sablaban did. Yet, it was his cultural knowledge, not his medical knowledge, that ultimately helped this boy.

Some sobering statistics: 0.4% of US medical doctors are Hispanic, while Hispanic individuals make up 17% of the American population.1 4% of US medical doctors are African American, while African American individuals make up 13% of the American population.1 Similar statistics hold for the majority of minority groups throughout the country. This lack of racial representation in medicine is widely cited, and efforts (albeit small ones) are underway to address it.2

Dr. Sablaban’s story, however, is about more than racial representation. Race is not equivalent to a language. Or a culture. Or religion. Race is not at all encompassing, and racial representation would not have been enough to fully address this teenager’s needs. Perhaps, then, there must be an adjustment to the discussion about diversity in medicine—about the need for physicians who “look” (i.e., race and gender) more like the population they are serving.

Perhaps the need is for physicians who simply are more like the populations they serve—who speak the languages, practice the religions, and have had the experiences that their patients face every day.

References

1. Sullivan, Louis W. Missing persons: minorities in the health professions, a report of the Sullivan Commission on Diversity in the Healthcare Workforce. 2004.
2. Cohen, Jordan J., Barbara A. Gabriel, and Charles Terrell. "The case for diversity in the health care workforce." Health affairs 21.5 (2002): 90-102.

Sunidhi Ramesh is an MD Candidate at Sidney Kimmel Medical College at Thomas Jefferson University. She graduated Phi Beta Kappa from Emory University in 2018 with degrees in sociology and neuroscience and is the managing editor of "The Neuroethics Blog." She has also served as the education co-director for the Philadelphia Human Rights Clinic. Ramesh’s writing has been featured in Stroke and Vascular Neurology, Retina Today, and the American Journal of Neuroradiology. She authored the Winning Essay in the 2019 International Neuroethics Society Essay Competition and has written chapters on neuroethics and neurotechnology in various textbooks. Ramesh works on research spanning neurology and neurosurgery, particularly focused on perceptions of invasive brain surgery, intra-arterial chemotherapy, and the implementation of tele-stroke protocols in hospital emergency rooms. Her non-fiction essay “3:43 AM” appears in the Fall 2020 Intima. @sunidhiramesh