Chapter 1
Exiting the restroom where I’d been unsuccessful in removing the vomit stain from the front of my white coat, I’d barely taken two steps before my physician’s assistant spotted me.
“There you are, Dr. Rosen, you’re in room nine next. Here’s a clean coat.”
“Thank you, Martha, you read my mind.” I shed my soiled coat, grabbed my stethoscope and other items from the pockets, and tossed the garment to my assistant. She handed me a clean white coat which I slipped on, all without missing a step as I strode toward room nine. We’d done this drill many times, synchronizing our moves for maximum efficiency. I often imagined my coat-switching exercise must be similar to refueling a jet in the sky. After I’d filled my pockets with the items in my hands, Martha removed my nametag from the dirty coat and handed it to me. I attached it to the upper pocket on my clean coat with the alligator clip. “Who’s the patient?”
Martha smiled and held out a clipboard for me. “Evan Fields and his mom. Forearm laceration.”
Continuing to walk, I grabbed the clipboard. “Thanks.” Martha started to speak, but I interrupted her. “I know, I know. Room nine.”
Martha, a stout woman in her late thirties with short brown hair and a pasty complexion, slowed down, letting me approach the waiting patient on my own. When I reached the door to room nine, I knocked twice to let Evan and his mom know I was about to enter, then stopped. Obvious waste of time, I reminded myself. I slowly opened the door to the small, cluttered exam room, the familiar Shrek poster the first thing that greeted me. Pushing the door farther, I saw Evan sitting on the firetruck exam table, his mother seated in one of the two adult-size chairs. The two children’s chairs were empty.
As usual, my jaw tightened a bit upon seeing the computer terminal, like the others found in every exam room. It sat innocently enough on a small table with a faux wood top near the sink. The best thing one might say about the computer is that it united all physicians practicing in the clinic and in clinics and hospitals across the country. Male, female, black, white, brown, tall, short, progressive, conservative, they all hated the computer, the bearer of the despised Electronic Health Record, or EHR. After two years in the clinic, you’d think I would be used to it, but I wasn’t. I still resented its intrusion into the time I spent with my patients and their parents. Instead of having a comfortable discussion with that now almost passé element known as eye contact, I needed to spend most of my appointment time sitting before the terminal and typing. Resigned to postponing my long-planned ax attack of the computer, I logged in and quickly confirmed Martha had made sure all the necessary information such as patient’s name and age, parents’ names, address, insurance, and reason for visit was up to date.
Evan and his mom looked at me and smiled while I signed “Hello.” They each responded with a reciprocal sign. Both Evan and his mother are profoundly deaf. I was the only clinic doctor or staff of any sort proficient in American Sign Language, so it was always up to me to see the severely hearing-impaired patients, something I enjoyed.
Evan was holding a bloody washcloth over his left forearm. His mother was signing furiously, informing me that Evan had fallen while climbing a tree, and cut his arm on the sprinkler below. I signed to Evan, requesting to take a look. He peeled away the washcloth, revealing a ragged two-inch gash on the lateral aspect of his forearm. I conveyed that I needed to clean the area and put in a few stitches.
I left the room to get a suture kit, returning a few minutes later to find Evan sitting on his mother’s lap. “He’s afraid,” she signed.
I explained it would only hurt when I injected the numbing medicine, and when we were done, I’d give him a dollar bill he could use at the dollar store a few blocks away. That’s all the encouragement Evan needed. I anesthetized the area, cleaned it, and put in five stitches. When I was done, Evan’s mom signed that she was proud he was so brave. I spread antibiotic over the wound and handed the boy a crisp dollar bill—one of six I had in my pocket. Most days I needed at least three to coax my patients into submission for various procedures.
I broke away to sit on the stool facing the dreaded computer so I could enter information about the visit. I usually spoke to my patients as I typed, often just small talk. My inability to sign while I typed made me hate the EHR even more. After I finished typing, I instructed Evan and his mom how to care for his injury. Mother and son motioned their thanks, I handed Mom a printed set of wound care instructions, gestured goodbye, and backed out of the room.
Martha wasted no time in finding me. “Five-year-old girl in room four for kindergarten physical. New patient. Good luck with that one. Mom has heavy accent. Chinese, I think.”
The UC San Francisco pediatric clinic was always busy. In addition to the myriad clerks, physician’s assistants, nurses, and doctors rushing through the halls, there were the patients and their entourages. Each small visitor was accompanied by a parent, sometimes two, often with one or more siblings or a grandparent. Between the ages of two and eight, patients and siblings frequently ran through the narrow hallway, not mindful of anyone or anything in the way.
Making my way to room four, I dodged three-foot-high twins running in front of their mother, the colorful LEDs on the soles of their shoes flashing erratically while they laughed and bumped into the legs of strangers. According to the clock above the clerk’s station, it was 11:30. Two patients behind already, I picked up my pace, brushed back the stray hairs that had escaped my low ponytail, noticed the name tag on my coat that read “Erica Rosen, MD, Pediatrics,” was crooked, and knocked on the door of room four.
From within, I heard the muffled voice of a young woman. I barely made out, “Come in.”
I straightened my name tag and before opening the door, glancing up in time to see the clinic director, Dr. Gabe Lewis turn the corner and walk in my direction. As usual, his white coat was clean and pressed, his hair looked ready for a photo shoot, and he looked more like a TV doctor than a real one.
Avoiding eye contact, I pushed hard on the door and walked in. The door slammed behind me.
“Hello, Ms. Chen,” I said, consulting the clipboard. “I’m Dr. Rosen.”
I gazed around the familiar room with torn posters of SpongeBob SquarePants, The Little Mermaid, and Minions. The two adult-size chairs were empty. An attractive, thin young Asian woman with short hair sat in one of the little chairs, a small child on her lap with its face buried in her chest. The child had straight shoulder length shiny black hair.
Damn, I thought. Martha didn’t get the kid stripped down to her underwear. Only took her shoes and socks off.
The woman seemed nervous, unable to speak for a few seconds. When she finally spoke, it was with a heavy Chinese accent. “This Wang Shu, Doctor. I Ting, his mother.”
“Pleased to meet you,” I said, happy my roommate, Daisy, had exposed me to her parents and their heavy Mandarin accents countless times. Over the years, I had developed an ear for understanding their speech.
“Hello, Wang Shu,” I said in my winning pediatrician’s voice, smiling. “How are you today?”
The child didn’t move. “He shy,” Ting said.
Knowing Asians pronounce “he” and “she” the same in their native tongue, the inappropriate gender reference didn’t surprise me.
“I understand you’re here today to have Wang Shu’s kindergarten physical form filled out.”
“Shi. Yes.” Ting reached into her purse and handed me a two-page form, folded in thirds.
I took a moment to examine the form. It looked familiar, resembling many I had filled out previously. I sat in front of the computer and checked the EHR. Other than the patient’s name, age, address and mother’s name, her chart was blank. It wasn’t unusual to have patients with no medical insurance. “Has Wang Shu had her vaccinations?” I asked.
“Shi, yes. Everything. He have very good medical care. The best.”
“I’m glad to hear that. Do you have some documentation?”
Ting looked at me blankly.
“Papers that list her vaccinations.”
“We come from China. He get them there. I not have papers, but I know he get everything. Very excellent medical care.”
“Wang Shu doesn’t start school for over a month. Can you have the information sent to you?”
“No. Not possible.”
“You must have shown documentation when you moved here. How long have you been in this country?”
“Two month.”
“You speak English very well for someone who’s been here such a short time.”
“I study hard.”
“Since it was only two months ago, you should still have the documentation of vaccination you showed to pass the health inspection when you came here.”
“I not find it.”
“If you don’t get the documentation, we’ll need to revaccinate her. Without proof of vaccines, she can’t go to school.”
“Oh. He no like more vaccine. But no choice.”
This woman seemed intelligent, clearly educated enough to speak English and know about vaccines. But something didn’t seem right. “I have to ask you this,” I said in my gentlest tone so as not to alarm her. “Did you enter the US illegally?”
Ting burst into tears.
I grabbed a tissue and handed it to her. “It’s okay. You can tell me. I won’t report you. But if you came here illegally, I’m going to insist that Wang Shu also have a TB test.”
“I know he not have TB,” Ting said, her tears now a slow trickle. “He very healthy, never around people with TB.”
“Well, she needs the test. I can’t put other children at risk.”
“No, no,” Ting said, still sniffling. “He have BCG vaccine.”
The BCG vaccine is given to protect people from TB in countries like China, that have a high incidence of the disease. When a TB skin test is given to people who have had a BCG vaccine, the test is often falsely positive. I turned to the child.
“Now, Wang Shu, I’m going to have to examine you,” I said, wondering if the child understood a word I was saying. “Don’t worry, it won’t hurt.”
I got up from my seat at the computer, picked up Wang Shu and placed her on the exam table. For the first time, her tiny face was exposed as she looked straight at me. Black hair cut into short, straight bangs across her forehead. Light olive skin. Typical Asian features, with a small nose and epicanthal folds in upper eyelids. I almost gasped. Light blue eyes. What I was seeing was not possible.
