Acad Psychiatry 31:412-413, September-October 2007
doi: 10.1176/appi.ap.31.5.412
© 2007 Academic Psychiatry
Worlds Colliding
Serina R. Deen, B.A.
Received October 3, 2006 and accepted March 22, 2007. Ms. Deen is affiliated with Mount Sinai School of Medicine, New York.
As I waved my badge in front of the electronic monitor and saw the light blink green in acceptance, I trembled in my freshly ironed white coat. Beyond that blinking light and that locked door was a world of mystery and adventure. A world where normal rules of social conduct do not apply, where the real and surreal intertwine. I was excited and nervous and terrified. I was entering the psych ward.
I cannot tell you exactly what I expected to find. Something along the lines of white walls, fluorescent lights, and nurses in starched white uniforms with perfect nurses caps and friendly but strict smiles. Patients wandering around in gowns, muttering to themselves, screaming at the walls. Chaos. Which was why I was shocked when I opened that heavy metal door and found myself staring across the hall at a thin, short Indian woman in a hospital gown, with her salt and pepper hair in a long braid down her back.
She could have been my mother.
My first rule coming into this rotation was to not stop and stare, but within the first minute of entering the ward I had already broken it. I stared at her, and she stared back at me, and she smiled. It was a look I had received many times before from patients in the hospital. A look of kinship, of understanding. You are my people. I flashed a quick smile back, and looked away. I had been prepared for psychosis, mania, depression, but not for this.
As I passed her, she stopped me.
"You are Indian?"
"No," I responded with a smile. "My parents are Sri Lankan."
It was standard response of mine that reflected my sense of conflict on the subject. It said, Yes, I should be able to relate to you, our ancestors come from the same peninsula. I ate similar curries to you growing up, wore bright colored saris to weddings where the bride and groom never dared look up at each other, and took my shoes off before I walked into anyone’s home. But that was a world my parents had created here to make them feel like they hadn’t completely abandoned their home. I also had my own world that they would never understand, where I rode bikes and watched Sesame Street with my best friend Scottie, ate hamburgers and french fries, and went to my high school prom. So yes, my parents are Sri Lankan, but no, I am not like you.
I smiled as I quickly walked away. I found my attending and the rest of the team and we sat down at a large conference table together to interview the newest patient on the ward. Since this was my first day, I would sit and observe the interview, but later on, I would be conducting them. As my resident walked away to get the patient, I wondered what a psych interview would be like. Do you ask the patients if they’ve had all their immunizations, and if anyone in their family had high blood pressure? What do you do if they cry, if they get mad at you, if they yell? I was pondering how I’d handle these situations when the new patient was brought in. I looked up, and it was her. My resident said, "Everyone, this is Sharmila."
Another look. She was staring right back at me. And this time, it was not with a smile of recognition. This time, it was a smile tinged with embarrassment, with shame. And I felt it too. She was not Sharmila. She was Aunty Sharmila. In South Asian culture as I knew it, elders were always addressed as "Aunty" or "Uncle." It was unheard of to call anyone old enough to be one’s parent by their first name. But this was Sharmila standing before us. Standing before us in the psych ward, stripped of her title and her sari, naked in front of us except for a thin gown.
The interview was long. She looked down for most of it but would occasionally glance up at me, sitting across the table. I tried to smile when she looked up, to pretend that I was not uncomfortable when they asked her about her sexual relations with her husband, to pretend I was a professional when I actually felt like an eavesdropper.
She was depressed. She had tried to commit suicide. Twice. You could tell that she was not used to talking about herself, that she was so out of practice she didn’t even know how to do it. She did not know why she had been staying home so much lately. She did not know why she could not sleep, why she was not eating that much. She could not tell if she was happy or sad. Yes, it is true what her daughter said, she had been crying a lot lately. But she did not know why. And so on. What particularly struck me was that after every question that she could not answer, she apologized. She was sorry she did not know, she was sorry for taking our time. It was almost as if she didn’t feel worthy of being there, as if she wanted to shrink up into a little ball and disappear.
When my resident indicated that the interview was over, she smiled, said thank you to everyone, apologized for taking our time, and quickly shuffled out of the room.
My attending told me that since she was the newest patient, it would be good for me to follow her. I’d write progress notes on her in the morning, talk to her during the day, and relay any questions or concerns she had to the rest of the team. I agreed with a lump in my throat. I’d never had a conversation with an Aunty before that did not start with how I was doing in school, proceed with how my parents were, and end with how I was doing in school. If she did not feel comfortable talking to team of trained psychiatrists about her problems, how would she feel confiding in me, a mere child?
I knocked on her door, asked her to come talk with me in the lounge. It was relatively quiet in there, except for Geraldo confronting a pregnant teen’s octogenarian boyfriend on the TV in the corner. We sat down.
"I know we met during the interview, but I wanted to reintroduce myself. My name is Serina. I’m a third year medical student here."
"Ahh, that is nice."
"I’ll be talking to you each day, seeing how you are doing here, if you have any questions, that sort of thing."
"Okay."
"Is there anything I can get for you right now? Do you need anything?"
"I’m okay."
"This must be pretty overwhelming for you, being in such a different environment."
"It’s okay."
"How are you feeling?"
"I’m okay."
"Well, I’ll let you get settled in. I just wanted to say hello and see if you needed anything."
As I started to sit up, she said, "You look south Indian."
"Oh really? I get that a lot. I guess Sri Lanka and south India are pretty close to each other."
"You have nice eyes. I wish my son would marry someone Indian."
"You said earlier that he just moved away, right?"
"Yes, he moved in with some woman. And they are not even married. They are just ‘going out.’ What is this ‘going out’? I don’t understand. He says that does not mean they’ll get married."
I was shocked. It was the most I’d heard her say all morning. And I realized with that question that I was not just a child to her, nor an eavesdropper. I was an interpreter. I knew what her world was like, having grown up in it, but I was also fluent in this American culture that is somehow similar to what you see on TV, yet not exactly so.
I tried to explain the nonexclusivity of dating, the more serious nature of going out, and the commitment of being engaged. She was listening, and I could tell she was making a great effort to understand. After I finished, she asked me more. What do you do all day in college besides study? Why do you need to go on vacation to Europe to "find yourself"? What does "finding yourself" actually mean? I thought to myself that they really should make a manual of some sort, "The Parents’ Guide to Understanding Confused South Asian American Children." I tried to explain the best I could from my experience.
After I’d finished explaining, and she’d indicated that she somewhat understood what I was saying, I thought I’d try asking Sharmila about herself again. I asked her if she’s been feeling any better since she’s been at the hospital. Once again, I got an, "I’m okay," and then she looked away. I sensed that our conversation was over, and that maybe I had done something wrong. I told her that it was nice talking to her, and she should come find me if she wanted to talk some more. And I walked away, feeling confused. I thought I had made a connection. I thought that she would open up, tell me what was wrong. How would I be able to help her if she wouldn’t talk about how she was doing?
I spent the rest of the day in lecture but I couldn’t get Sharmila out of my mind. Why would she want to hurt herself? What was she holding back?
Would she tell her son about me?
As I went back to the ward to gather my belongings and leave for the day, I saw Sharmila sitting in a chair, staring at her feet, lost in her own thoughts. But she looked up and saw me, and she smiled. And this time, I didn’t mind that smile. This time, I actually gave her a genuine smile back. Maybe I couldn’t fix her problems. Maybe I couldn’t make her happy. But I thought that I should take comfort in the fact that, although she spoke perfect English, Sharmila was relieved to find someone here who actually spoke her language.
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