Smiling Toothless

Maria Sami Ramia

doi:10.1370/afm.1778

Abstract

In an impoverished outreach clinic in Beirut, a young boy’s unique thank you answers a physician’s questions about the meaning of her profession.

I was sitting in one of our most underprivileged satellite clinics early Monday morning trying to feel hopeful in a place with so much despair. This place is notorious for its horrific living conditions. No electricity, no water, no sewage system; homes not fit for living in, not fit for anything. Being a fourth-year family medicine resident at the American University of Beirut, our training includes going to outreach clinics in impoverished areas in the suburbs of Beirut. These areas have recently become overpopulated with Syrian refugees because of the current political situation.

Being faced with a lack of sufficient medications, poor follow-up, poor compliance due to cost, depression due to abuse and poverty, and so much more has left me more than distressed on many different occasions. I have recently been battling with my thoughts regarding our outreach clinics. Ideas of how our efforts are futile in light of the horrific living conditions the refugees are in have left me troubled despite all my efforts to remain as detached as possible.

In another attempt to shelter my emotions, I had made a decision to not recognize anyone. I had skillfully learned how to focus on my patient’s medical condition without focusing on my patient. I would gracefully show my deepest concern and my utmost care toward my patient’s wound without making much effort in realizing or understanding the roots of this wound or the wound bearer. It was easier to treat anxiety, pelvic inflammatory disease, or what have you than to treat Karim, Salma, or Farah.

That morning, I had seen a few patients already.

Case 1: scabies… solved.

Case 2: urinary tract infection… solved.

Case 3: depression… not much to do.

Case 4: depression/anxiety… sigh… not much to do.

It was not until my fifth case did I have to do what I had been trying to avoid all morning: recognize my patient, remember a person, remember a face, remember his eyes.

Case 5 was Mohammad, a 6-year-old boy who came last week. He had ugly lesions on his face of 2 weeks’ duration for which topical treatment had not helped. His face left an impression on my mind, but not because his was a difficult medical case. He simply had impetigo. What bothered me most was that last week, during our encounter, he was expressionless. No smile, no frown. Dull aching eyes screaming of misery. When I saw him, I used up all my tricks to build rapport while doing my routine examination. I tried hard to “look for any mice in his ear,” listen for any “music in his lungs,” make sure he hadn’t “swallowed my cookies” as I checked his tonsils. Nothing—my efforts were futile and that expressionless expression lingered. Had he copied my decision not to recognize anyone?

Mohammad was back for follow-up. My heart sank as he entered the room, reminding me of my futile efforts to alleviate pain. Then, trying to be hopeful, I decided, “At least his mother got him back for follow-up.” So I greeted them quickly and told Mohammad to come closer so I could see his face. That expression of forbidden grief and emptiness, it almost made me forget why he came. And then as I snapped out of his world, I realized that the lesions were gone. Antibiotics do work! And suddenly, full of pride, I said, “Your beauty is back… they are all gone.”

Little did I know the power of those words as I said them.

Mohammad smiled. His lips did not part. He did not show me any teeth. It was a beautiful simple smile. It was a thank you. I tried to look away as this uncomfortable choking sensation in my throat started and my vision became blurry.

A little boy caught up in a war he cannot possibly understand….

What is war? War is a simple excuse for us to inflict suffering on each other. Anyway, what can I do?

What do I know of politics?

I quickly controlled my emotions and smiled back; I did not part my lips. Just a simple smile, not showing any teeth. A smile saying thank you. Mohammad reminded me of why we were there.