TransplantInformers Book Club: Medicine In Translation

Ofri's Opus Image courtesy of Beacon Press

Well, half the work is done for me in our latest literary treat. Medicine In Translation: Journeys with my Patients is a fantastic memoir from Dr. Danielle Ofri, a physician at Bellevue Hospital in New York. And it already has a book club guide. I became interested in Dr. Ofri’s work after reading her recent article in the New York Times about the success of Israel’s implementation of an opt-out organ donation system.

Ofri writes in HuffPo about the book’s origins,

 I wanted to focus on the cultural, linguistic, socio-economic, and religious challenges they [her immigrant patients] faced in getting their health care in a foreign country.

My editor then pointed out that I had just been a patient myself in a foreign country. Although being pregnant and having a baby certainly isn’t as medically complex as truly being sick, I definitely faced many challenges being a patient in Costa Rica [where she moved to improve her Spanish]…

The book also highlighted what turned out to be a defining metaphor: the parallel between immigration and illness.

People who “emigrate” from the land of the healthy to the land of the sick have much in common with people who emigrate from one county to another. It is a new culture, with its own language, customs, and mores. Doctors are, in many respects, interpreters of the culture of medicine.

Ofri’s memoir traces the ways her clinical work and her personal life blend together in unexpected ways. Her intermittent encounters with Julia Barquero are of particular interest to TransplantInformers readers. Barquero is an undocumented immigrant and is in need of a heart transplant. Ofri outlines the complexities of Barquero’s situation and huge barriers for immigrants who seek transplantation as a viable treatment. She honors Barquero’s resilience despite these difficulties, but never does so in a cloying or patronizing way.

The book tells each of her patients’ stories with visceral detail and a critical subtext swirling beneath. Ofri is not afraid to ask tough questions both of her patients and of herself. Though bordering on litanies, her internal monologues are some of the most insightful moments in the book. Here is an example of one such monologue:

Of course, Julia Barquero wasn’t any random undocumented immigrant; she was the real person sitting in front of me, the patient I was caring for. Of course she deserved a heart transplant, for the simple reason that she was going to die without one. This conclusion was patently obvious to me. It was simply ethically just.

But we always told our interns not to practice medicine by anecdote. Wouldn’t this simply be practicing ethics by anecdote? Why should Julia Barquero merit a heart just because shes was sitting here in my office, just because she’d been successful in sneaking into this country illegally?

For those who are concerned with donor recruitment in diverse communities, Ofri’s book is a useful source for understanding several issues about migrant health care in the U.S. and intercultural communication in medicine. Those who do donor outreach and education are often in similar situations, trying to assess and allay people’s fears, impart the right medical knowledge and work to communicate with cultural sensitivity. The concerns Ofri expresses about her own misgivings and mistakes, as well as her valiant efforts to make cross cultural connections, are a great example for how donor recruitment professionals can self-reflect on their work to improve their communication and understanding of the groups they want to reach.

Far from being a self-congratulatory text, Ofri’s work shows the day to day struggles of a physician at work and the many hazards and hopes of medical practice. And while the sentiment might be that these struggles can never measure up to the suffering her patients experience, that kind of empathy demonstrates the power of the narrative in medicine; the stories we each other tell matter.

For more information on Danielle Ofri visit http://danielleofri.com/. Follow us for more on undocumented immigrants and transplantation (and an additional nod to Ofri and the Barquero case),  in an upcoming crosspost with AccessDenied.

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