Feet of iron and clay.

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 ³¹ “Your Majesty looked, and there before you stood a large statue—an enormous, dazzling statue, awesome in appearance. ³² The head of the statue was made of pure gold, its chest and arms of silver, its belly and thighs of bronze, ³³ its legs of iron, its feet partly of iron and partly of baked clay. ³⁴ While you were watching, a rock was cut out, but not by human hands. It struck the statue on its feet of iron and clay and smashed them."

- Daniel 2:31-34

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What would it be like if the world around you was just a cacophony of voices repeatedly trying to make you understand? Like, if your body was sick with complicated things that require a real, solid explanation and you couldn't get one because of something really simple? And okay, maybe it isn't simple, but mostly it's a hurdle that we can almost always find some way to jump with some effort. This time, that wasn't working out so well.

Especially because I was tired.

I admit that this has always been one of my deepest fears both as a caregiver and a human being. That I'd find myself somewhere where no matter how hard I tried or how many people I asked NO ONE could speak a shared language with me. And, perhaps, being a native English speaker who admittedly doesn't have much of a travel bug, it's a little less likely to happen to me in the first person sense but the truth is that, especially in a public hospital, this could happen while caring for a patient. Fortunately, even when it's super difficult, we generally find a way to overcome this for patients. So my fear has always been that someone would come who'd landed here through some obscure means. Wait. "Obscure" sounds pompous so I take that back. The word I'm looking for is one that describes a person making it some place without any clear explanation of how. And I took back that word because usually it is more tragic than obscure and perhaps not knowing the fine details isn't such a bad thing.

Sigh. I'm rambling. I know.

So check it. This is what happened to me recently. I saw this man who'd come to America from a very small village in a remote part of Africa. He spoke not a word of English. Hmmm. There I go exaggerating again. He spoke like ten words of English and one of them was his country of origin and another was what sounded like the dialect he spoke. My resident carefully teased out what he could and learned that, just maybe, his native tongue had enough similarities to French to use this to interpret. And so, through the language-line interpreter, he tried to see if this might break through and explain to our patient what was going on.

"This is not French or even close," the interpreter said. "And he is not understanding French. I'm afraid this won't help."

And this time the right word was selected because we were "afraid" too.

So we were back at square one. Looking into the eyes of this man with skin of such a strikingly dark hue that I longed to hear more of his story. Who are you? How did you get here? What brought you here? Where is your family?

None of these words were clicking. He just sort of smiled and nodded his head repeatedly. Which only made me want to communicate with him more.

Shit.

A few more phone calls were made. Dead end. Dead end. Dead end. Somebody speaks THIS but not THAT. And THAT is what we needed but thanks for offering THIS.

Shit, again. This was exhausting.

"These lab abnormalities are serious," my resident said. He pressed his lips together and sighed hard. "I don't know what to do. But let me think for a minute, Dr. M. There has to be something we can do."

And me, I admit that I was already feeling defeated. Like in my head saying those white flag rebuttals like "DO WHAT?" and "WE'VE DONE ALL WE CAN."  So thank goodness that resident was there with me with his fresh eyes and spirit to advocate for this patient in ways that I fell short in doing.

Yeah.

And so. Let me tell you what happened next. That resident started hunting even more people down. Two different refugee support organizations to be exact and even a phone number from the patient's cell phone. Eventually, like nearly an hour later, he found someone who spoke the patient's language. No, it wasn't easy at all, but he did. And that person assisted in at least helping our patient know where to go and why.

And, honestly, I was kind of amazed and ashamed at the same time. I call myself a patient-centered physician and I think I mostly am. But there are these days that I run out of steam. The road is muddled with speed breakers and my energy wanes. I know this is what happened to me. I know it is. I gave up. I admit it, I did. I'm so glad that my resident didn't.

"Thank you for standing up for him," I said quietly. "You made a difference today. I think I felt myself giving up. No, I know I did. I'm glad you were tenacious."

And that resident looked at me and half smiled. Then he said, "You know what, Dr. M? I said to myself, 'Somehow this guy figured out how to get this appointment at Grady and even get the lab work that has us all freaked out.' Even if you speak English that's no easy feat. But he managed it which told me that somebody, somewhere was helping him and that if we could find that person they'd help us, too."

Simple enough. And not obscure at all.

"That makes perfect sense," I said.

"Yeah. I guess I just imagined this man walking all the way here. Maybe not literally but definitely figuratively, you know? Like he marched here all the way from his village and through whatever situation that was bad enough to have forced him away from everyone and everything he knows to be in this strange land. You know? That made me want to at least try."

And I liked the way he said that because it wasn't melodramatic or self-important or any such thing. It was just filled with the kind of humanity that you hope and pray more doctors have than don't.

We are not a perfect species by far, we doctors. Even the senior of our brood are works in progress. One of the hardest parts of our job is to allow ourselves to keep learning, keep growing and keep seeing. To be unafraid to examine our feet of iron and clay along with our patients in an effort to be better.

And so. This morning, I woke up and thought of this. I sip my coffee, stare out of the window and reflect. I imagine a man walking from sub-Saharan Africa all the way to Grady Hospital with his feet of iron and clay and imagine that it took more iron than clay to make it. And then I take a deep breath, dust off my own and prepare to fight for all of the people on journeys like him. I allow myself to learn from the examples of my junior colleagues and to be reinvigorated by their zeal. Then I try to do better.

I do and I will. 

Yeah.

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