As patients moved in and out of the modest office for their appointments, their duffel bags and luggage in tow containing all their personal belongings, the day unfolded in typical fashion. Yet, within the confines of this psychiatry office catering exclusively to the local unhoused population, “normal” took on a unique meaning. The narratives of childhood neglect, abuse, drug addiction and homelessness recounted by these patients never ceased to startle me as a third-year medical student. Despite the wealth of knowledge I gained from connecting with these patients, I found it challenging to relate to their profound struggles and felt a strong sense of helplessness due to my inability to offer meaningful help.

Around midday, Mr. A entered the office with a duffel bag slung over his shoulder, his long hair obscuring his eyes as he glanced downward. The attending informed me that Mr. A was a 42-year-old established patient struggling with a history of prolonged undiagnosed schizophrenia and depression. Discovering his diagnosis at the age of 40 during one of the lowest points in his life — when he was homeless and a decade deep into a battle with drug addiction initiated as a means to escape his symptoms — was a jarring revelation. As Mr. A settled into his seat, he cast a brief glance in my direction, and a smile suddenly illuminated his face. As a Middle Eastern Muslim woman who wears the hijab, my identity and cultural heritage are often apparent to those around me. 

“Where are you from?” he inquired. 

I conveyed that I am originally from the Middle East, and his demeanor noticeably shifted, his excitement becoming more palpable. In Arabic, he warmly greeted me with “Assalamualaikum,” and proceeded to tell me in English that he is originally from Libya and came to the United States many years ago. I reciprocated the greeting, sharing that my father had briefly lived in Libya for his primary education. Mr. A proceeded to tell the doctor that while he still hears voices occasionally, he is no longer having visual hallucinations and feels his condition is improving.

“My biggest concern these days is the fear of my medication being stolen at the shelter while I sleep at night,” he remarked ironically.

Amidst another pause while the attending put orders into the chart, Mr. A asked him if it would be alright if he and I spoke in Arabic. The attending gave his immediate blessing. 

In Arabic, Mr. A unfolded the narrative of his life to me, sharing that he was a skilled chef in Libya and expressing a deep sense of longing for his homeland. He revealed that his parents remained there, while his daughter lived in a different state in the United States.

“I don’t really know anyone in Florida, I mostly came for the benefits for my health.” 

He went on to describe in a somber tone how it has been difficult to rejoin the workforce, and confessed that it had been a long while since he last spoke to anyone in his family.

“Why is that?” I pressed. 

“I don’t wish to worry them. Nobody knows about my current situation, and I feel ashamed of the path my life has taken” he responded quietly. 

He proceeded to describe how his hallucinations often make him feel unlike himself and he would not want his parents and daughter to see him as a monster. I felt my heart tighten and could not help but glance at all his belongings on the floor, conscious of his current living situation at the Salvation Army shelter.

“My parents would not agree with taking these medications that affect your thinking and mind,” he stated. 

This immediately struck a chord with me, having heard similar sentiments about psychotropic medication from my own family members growing up. Mr. A and I share a culture in which many believe a person suffering through mental health tribulations may simply benefit from prayer and a closer connection to God. My heart sank a bit as it became evident to me that this truth likely contributed to his unaddressed psychiatric issues in his early life. 

“It is not something to ever be ashamed of. I believe the stigma around mental health is slowly improving as education increases among our communities,” I reassured him. 

Mr. A’s gaze carried a distant expression as he contemplated my words for a moment. He proceeded on a lighter tone, boasting to me about his daughter’s achievements and how she was studying to become a lawyer. As he moved his eyes down toward my white coat, a sudden realization seemed to startle him.

“Is your name Malak?” he asked. 

I confirmed it was, and he took a deep breath as tears pooled in his eyes.

“That is my daughter’s name,” he said in a heavy tone. I could only smile, finding myself at a slight loss for words. He turned his gaze back to the physician, 

“I have not spoken my language with anyone in over five years. This is like therapy for me right now,” he stated as he motioned between us. 

A smile lit up his face despite his tears, and he continued to express gratitude to the physician for affording him the chance to feel more like himself. In a heartfelt moment, he went on to share how my presence evoked memories of his daughter, as if I had been sent to gently remind him of the importance of family and heritage in life.

At the conclusion of the visit, Mr. A wished me well in my journey, encouraging me to continue to pursue a wonderful medical education and be a light for others. I thanked him and wished him the same, conscious that our paths will likely not cross again during my brief three-week rotation at the clinic.

“That was the first time in two years I have seen him smile like that,” the attending remarked after Mr. A exited the room. A sense of joy washed over me, particularly in light of the initial feelings of disconnect I had been feeling with the patients at this clinic. In that moment I made a promise to myself to never undervalue the inherent ability within each of us, as distinct individuals with diverse backgrounds, to forge meaningful connections and impart positive influence. Mr. A’s request to communicate in Arabic highlighted that patients often possess an awareness of their own needs. This underscores our responsibility as healthcare providers to strive to fulfill these needs to the best of our abilities. My presence and ability to connect based on our shared background despite the differences in our life circumstances offered a unique opportunity in this instance to do so.

Image credit: “Homeless” (CC BY-NC-ND 2.0) by Hanibaael