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CMAJ. Dec 11, 2012; 184(18): 2028.
PMCID: PMC3519142
Spiritual currency
Fawad Aslam, MBBS
From the Division of Rheumatology, University of Arkansas for Medical Sciences, Little Rock, Ark.
Correspondence to: Fawad Aslam, fawadaslam2/at/gmail.com
 
“May God bless you. May He bless you in this world and in the hereafter”; an utterance that culminated many a patient visit when I practised back home in Pakistan. Edentulous women, their faces a mosaic of countless wrinkles, would raise their hands in prayers and then tap me on the shoulder as I bowed down slightly. It felt as if being knighted by the queen herself. When I was fresh out of medical school, such encounters filled me with a sense of purpose. An unseen energy permeated my soul as I attended to the poor and destitute. This feeling was shared by many colleagues in Pakistan, an overwhelmingly Muslimmajority country.
figure 1842028f1
Image courtesy of © 2012 Thinkstock
We saw thirty to forty patients in each half-day clinic at the government hospitals. The hallways teemed with the sick and the deprived, looking at us as gods among mortals, their eyes brimming with hope, and their pockets empty. Being seen by a physician was considered an achievement, even a personal favour by some. The patients sat huddled together in a single room presenting their complaints; multiple patient–physician encounters occurred simultaneously, across the same table. Privacy was a matter of concern for only those with the most intimate problems, who spoke in hushed tones as their eyes darted around to embarrass an eavesdropper. We did what little we could do in the circumstances and we made little in monetary terms — but the coffers of our souls were overflowing.
Alas, the desires of the flesh overtook those of the soul. The deteriorating professional and political situation dictated a move. Did I feel like a rat jumping a sinking ship? No, I justified it, most of us did, and pledged to return and to serve. I had the resources and the capability and thus managed to enter into the American medical system where, it seems, I am well entrenched now.
Of the multitude of differences that I noticed, one was the conspicuous absence of God in the patient encounters. Only rarely would a veteran of the Great War depart by invoking His blessing on me. That was the long and short of it. This was a bit of a surprise to me. I recalled “religion being the opium of the poor,” and most of my patients here were of the lower socioeconomic classes, generating the expectation, in me, of a more religiously inclined expression. Perhaps I was visibly of the other faith and thus not an appropriate recipient of a religious blessing, although many times I have been considered Hispanic, based on appearance. Perhaps they were not sure of my reaction to the mention of an article of faith in an increasingly secular society. Perhaps I was not palpating the consumerist pulse of the society and the patient–physician encounter was just another business transaction which did not require a payment in spiritual money, or perhaps this is just how it is.
As I moved through the years, this striking absence of God became less discomforting. I am neither a deeply religious person nor an absolutely blind subscriber to dogma. I am receptive to new ideas and opinions, and time provided me with the answer. Time allowed me to cultivate long-lasting relationships with my patients; it allowed me to experience the new environs in which I had been living a hitherto relatively insular existence. Things became more manifest as I started practising rheumatology. I began to sense the presence of gratitude in the eyes of my patients, a sense of trust radiated from them after candid discussions about their diseases. In each handshake, I could sense the compassion that bonds us humans together, makes us one. I now could sense the warmth in the seemingly perfunctory “Have a good day doc.”
The universality of the smile and that of the tear dawned upon me. Beneath the pastiche of linguistics, differences in health-seeking behaviour and articles of personal faith, I saw the same responses whether resigning to their god, whatever and whoever, in times of prognostic annihilation or when dismissing the sinister with a chuckle.
The old women here may wear dentures, their wrinkles may be tauter, their physiques may be less frail and their use of makeup a bit excessive, at least more than what I was accustomed to, but it is the hearts that matter, and inward they are, more or less, the same. And it is such a reassurance. I am more at home now and in receipt of both material and spiritual currency.
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