Refugees

We pour in like refugees from trains that never deviate from their morbidly accurate schedules. We are weary and anxious, unsure of our fates in this foreign land. Silently, we stand in line shifting our baggage of X-ray films and lab reports from one arm to the other. Some of us look fit and composed, showing only a little fatigue. Some of us look frail and exhausted, our vitality draining away in this windowless basement.

It is morning in the Oncology Day Care Clinic, and we are cancer patients being processed through the system.

"Our computers are down, so we have to check everyone in manually," the harried clerk announces apologetically. The explanation offers little comfort as the line inches forward.

Some of the travelers talk in muted tones. "I hope I can go back to work soon," a young woman says to her mother. With a plaid scarf covering her wispy bald head, she looks barely old enough to have a job. "You will, honey. You will," the mother reassures her. But the worry on her face is not about her daughter's job.

A handsome looking couple in their 60s steps up to the check-in window. They are well-dressed – he in a coat and tie, she in a tweed suit and heels. They look out of place here – too optimistic and nonchalant, like they accidentally got off at the wrong stop. He takes the clipboard and begins to fill out the long first-time patient form, as if simply signing the proper papers will get him passage on another train. He belongs somewhere nice, far from the glare of cold white floors and cancer, maybe in a mahogany paneled board room.

There is an endless supply of us. The door keeps opening. The waiting room fills faster than the nurse can mispronounce the name of the next person to be examined. Meanwhile, staff members – doctors, nurses, clerks, and social workers – briskly traverse the clinic waiting room, carefully avoiding eye contact with us. With their photo ID security cards hanging around their necks like protective shields, they look energetic and exempt from disease. But I have learned that even my 20-year career as a physical therapist does not exempt me from the cancer journey.

This is a carefully organized event where people from both sides of the tracks are permitted to mingle. There are those who stride along in blue hospital scrubs, white lab coats, or business suits looking healthy and energetic. The rest of us wander, limp, or are wheeled down the corridors, feeling lost and uncertain as we check the overhead signs for directions to our next destination. Only in the fluorescent light of an examination room do we have exchanges with the smart, confident people. We hand them our tickets of blood work and films.

I am one of the lucky ones. I come out with good news. "Nothing to be alarmed about. Recheck in six weeks." My only concern now is driving home in rush-hour traffic.

On my way out, I am startled to see a frail middle-aged man curled up on a vinyl sofa. A coat protects his shoulders from the air conditioner's chill, and his wife watches him like a sad faithful hound. She looks shrunken and frozen. Her puffy eyes show all the fear and uncertainty that she carries for a man too exhausted to carry it himself. I slow my stride so I don't disturb them, and I search for something comforting to say. The words don't come, and, helpless, I move on.

The relief of a good report makes my folders of X-rays feel lighter, as I step outside and squint into the sunshine.

But I am haunted by a scene I had witnessed earlier. While waiting in the clinic this morning, I had watched a pale, hairless woman in a scarf and faded sweat suit slowly approach the desk and lean on it for support. A cumbersome proboscis-like dust mask covered her nose and mouth to protect her from germs that her weakened immune system cannot fight. The clerk was about six feet away at the copy machine with her back to the counter. The patient had waited a moment for the clerk to notice her, and when that didn't happen she said, "Excuse me," followed by something else that I couldn't understand because the mask muffled her voice. Without turning around, the clerk said in a loud insolent tone "I can't hear you!" The patient had then strained through the heavy mask and her own fatigue to repeat her request louder.

A knot of fury had gripped my stomach then, partly on behalf of the fragile patient and partly because this same clerk earlier had abruptly dismissed me – and had given me incorrect information. At the time I had not confronted her. But I had envisioned myself being heroic – stepping behind the desk, spinning the young clerk around to face me, and telling her how rude she was. In my mind's eye, I had told her how her thoughtless behavior drains the life out of someone who is already burdened by a life-threatening illness. But I had been a coward. I had done nothing.

As I replay that scene, what troubles me most is not the actual incident, but my failure to take a stand. The knot in my stomach tightens. I feel the shameful truth emblazoned on my back: "Here is a healthy person who had a chance to do the right thing and didn't." I cannot leave like this.

I walk back into the hospital to Patient Admitting and pick up a Patient Feedback and Suggestion form. Now, fueled more by humility than anger, I write a brief account of my observations, including the clerk's name and my own name and phone number. Although it's not a dramatic step like personally confronting the rude clerk in front of her victim, it proves that someone is watching how one human being treats another.

But like refugees from a foreign land, we keep coming no matter how well or how poorly we are treated. And I, as a physical therapist and cancer survivor, must remember what it is like to be a refugee when I care for my own patients.

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