by Danielle Ofri
The 2018 midterm elections dominated everything for weeks, but the day after the election, things were basically the same in the hospital. Illness doesn’t take a break for politics, sickness never goes out of style. And so, on the Wednesday morning after the elections, it was work as usual when the nurse interrupted my stream of everyday afflictions to let me know that my next patient had answered “yes” to a screening question about suicidal thoughts. This jumps a patient to the top of the priority list and we quickly ushered him in. I hadn’t seen Mr. A (a pseudonym) in over a year, but physically, that was fine: His hypertension was well controlled with just one medication, and he’s managed to beat back his diabetes with a vigilant diet. His mental health, though, was a different story.
Mr. A is the classic immigrant success story. He emigrated from southeast Asia two decades ago. A professor in the sciences in his native country, he came to America to further his studies and ended up staying. But because he was undocumented, he was unable to work in his field, and so he manages a restaurant instead. All three of his children attended magnet schools for the gifted. The oldest is premed in college on a full academic scholarship, with the other two poised to follow.
But business hasn’t been good lately. Mr. A had to let go of five of his 10 employees, he told me. He himself stopped drawing a salary, living off his savings for the past two years. This had been distressing enough, but now he’s worried about getting deported. “If I get a parking violation,” he told me, “I could end up in handcuffs.” He held his up his wrists, joined with invisible shackles.
Mr. A has been working in the court system for 10 years trying to legalize his status. This year, though, he was informed that his case had been dropped. No reason was given. His lawyer told him bluntly, “It’s not a good time to reopen the case.”
Tears brimmed in Mr. A’s eyes as he told me about his fears for his family and his frustration about not being able to improve things. “There’s nowhere to turn,” he said. He told me he felt as though the country had given up on him and all he had to offer.
These last two years have been traumatizing for so many of my patients. The rabid anti-immigrant, anti-Muslim, and anti-Hispanic rhetoric have instilled fear and insecurity. The spike in anxiety and depression in our patients has been palpable. The poisonous misogyny and racism emanating from the administration and its supporters have taken their toll. And for staff, the relentless assault on healthcare has been especially dispiriting.
My visit with Mr. A seemed to crystallize all the bitterness of what has been unleashed in this country, and the suffering it has inflicted on people who truly make America great. Mr. A creates income for five Americans and their families, he pays $50,000 every year in taxes, and his children are shining examples of the American dream. And yet our country has managed to beat him down so much that he feels his life is no longer worth living.
We in the medical profession are supposed to help our patients manage their illnesses. We’re even accustomed to the dealing with the many nonmedical issues that affect our patients’ health—insurance, literacy, housing, food, transportation. But as the basic tenets of our society are being wrenched away, we are increasingly powerless. I can use my medical training to treat anxiety and depression, but there’s nothing in the medical playbook for acute national rejection. I have tools and colleagues to help a patient with acute suicidal ideation, but there’s no algorithm for the flogging of basic humanity. In medicine, we are taught to seek out and eradicate the etiologic agents of disease. But what do we do when the etiology is our very country?
Mr. A and I methodically sorted through his symptoms and agreed on a treatment plan. He said he would not actually kill himself, because of his devotion to his wife and children—he was willing to contract for safety on that. We decided on a medication to help with his acute symptoms and I made referrals to our psychiatry team and social worker.
But as Mr. A’s physician there wasn’t much I could do to ameliorate the root causes of his distress. My primary clinical intervention, it seemed, was to pass to the box of tissues back and forth between us. At one point, I put my hand on his shoulder. “Please know,” I said, “that not all of America feels this way and so many are fighting to change this.” It sounded pretty thin, even to me, but still, I felt obliged to say something. After all, it was my own father’s journey to America sixty years ago that enabled me to be sitting here in a white coat. With luck, Mr. A’s journey would allow his son to do the same thing for a future generation of patients.
The midterm election results felt liked we’d clawed back a bit of our country. But still, it wasn’t enough to heal the damage done to so many people. We still live in a country that sees fit to dehumanize and denigrate our neighbors and fellow human beings. And that dehumanization does real harm, to real people. I see it everyday in my patients. We can try our best to treat the symptoms, but what we really need is to treat the cause.