This doctor used to think his Philly hospital was immune from political anxiety

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Anxiety over U.S. immigration issues is roiling some medical residency programs.

For the past several decades the feeling in the medical and scientific community was that we were immune to politics, that we were above it, safe in our realms of patient care and academics. It took a divisive presidential campaign, and then an act of horrible violence, to shake that belief out of me. 

It started the day after Election Day, when a very different feeling pervaded the halls of the inner city Philadelphia hospital where I work. The normal level of conversation was down to a few hushed whispers, and heads were down in the hallways as people passed by silently. Outside a dark, cold mist and steady rain provided the perfect backdrop to the gloomy mood.

Elections have come and gone, but this was different because of the rhetoric. Dark promises of rounding up immigrants, of imposing a religious test to enter the country, of a government registry for certain people had become an important part of the campaign. These ideas now seemed legitimized. Our faith in a cohesive reality had been shaken.

These issues are acutely relevant to my hospital. It is a working man’s and woman’s hospital, from the people who clean it, to the nurses who take of patients, to the doctors who try to heal. A lot of the staff are African-American, and a lot of the resident physicians are from abroad—India and Asia and the Middle East and so on.

Unlike on primetime TV shows about doctors, there is no glamor in the work the residents do. It is long hours, often up all night, with very little pay and often very big personal debt. At my hospital, the residents are taking care of some of the sickest patients in the region, and they do it selflessly.

These residents don't expect to get prestigious research grants some day from the National Institutes of Health, or to lead the Food and Drug Administration. The vast majority will remain in the trenches, diagnosing causes of chest pain and shortness of breath, caring for patients in underserved parts of the country, in order to fulfill visa requirements. They will fill out endless paperwork and fight with insurance companies to get our citizens the best care in the world.

These feelings of anxiety post-election were experienced at training programs throughout the country. Trainees are in a vulnerable position because they cannot yet practice on their own. Compounding this is that fact that many are here on work visas. The rhetoric during the presidential election hit them in a very personal way, sending a post-election wave of fear like nothing I have experienced.

Medical program directors throughout the country posted on a national online forum what they were doing to calm their trainees.  Many stated that they were doing simple things, like recognizing their residents’ pain and vulnerable position. They reinforced that medical centers are places of tolerance and respect, and made sure trainees knew that their program directors were not going to abandon them.

It felt good to read these posts. But living in Philadelphia, I felt confident we would weather the storm especially well. Despite reports of violent acts committed after the election, I never thought such acts would touch our residents. Like most in this country, I have a sound belief in the goodness of its people, of the peaceful transfer of power, and most importantly that there is common decency despite differences.

And then one of my fellows got attacked while in New York City.

She is getting married soon, and went to the city to do some shopping with a friend and have dinner. The women left the restaurant and walked, arm-in-arm, through the city in the twilight darkness of a mid-November night. They heard a man call out.  The women didn’t look back, but quickened their stride.

The voice only got louder, finally screaming out, “brown girl!”

Before they could run, my fellow -- she is an American whose parents are from Pakistan --  felt a violent shove in her back. With no time to raise her hands, she crashed to the sidewalk, breaking two teeth and her nose as she struck the concrete.

Her friend screamed for help, and the man ran off .

Word quickly came back to myself and the other fellows in the program about what had happened. As a group they are extremely hard working, up all night staffing the  intensive care unit, doing procedures and taking caring for our most vulnerable patients. These young doctors are not just the safety net of the hospital, they help comprise the city's safety net.

The majority of my fellows are from minority groups. Some are Americans. Some have work visas from abroad.  With the changing political tide, and especially after the incident in New York, these valuable members of our team now  felt the country that had invited them  in was now turning against them. I huddled with them in a conference room, and tried to reassure them that whatever was going on out in society, that they would have the backing of the fellowship, hospital, and university. It felt like thin words.

On the online programs directors forum, I saw that one physician had advocated for a “wait and see” approach. "The fear of the unknown is always more exaggerated than the reality.” I posted a rebuttal, arguing that we must speak out to uphold our values of a free and tolerant nation. I also stated that recent history has shown us many examples of reality being much worse than any perceived fear.

Now, with the president's immigration order singling out people from seven majority Muslim nations, exactly what we hoped would not happen has become reality. Around the nation, resident doctors from the listed countries on the executive order have been sent back, while others with green cards who were traveling can't get back to their hospitals. Others who are in the U.S. fear what might happen if they should have to go home for a family emergency.

We have no idea where this is going to end, and if other bans are coming, or other doctors detained.

This  affects  the scientific community as well. International scientific conferences are held with the promise of being able to invite investigators from all parts of the world. Many of our scientists and laboratory technicians who work in our universities come from abroad. Even if not included in the list of banned countries, these orders will have a chilling effect on scientists’ desire to come to this country to learn and share their knowledge.

My fellow got her teeth repaired and her nose healed enough that she could make it down the aisle on her wedding day. But as a medical and scientific community we are reeling from the actions of this new administration. Regardless of our preferred candidate, we need to be a strong voice for tolerance and democracy.

One participant on the online forum argued we should focus not on politics but on helping residency programs. My response: How are we going to have programs if we lose residents?

Doctors and scientists have tremendous responsibilities both professionally and personally. Now is the time to stand up for our patients’ rights, our medical residents’ rights, and the rights of all of our citizens.

Michael J. Stephen, M.D., is Associate Professor of Medicine at Drexel University College of Medicine, and directs the Fellowship in Pulmonary and Critical Care Medicine.