He was just another immigrant detainee asking for his protocol medical check-up at the local walk in centre. Usually this was a request for some pain relief – sleeping on police station benches with no blankets leads, unsurprisingly, to back pain. Accompanied by two overstretched police officers who could not communicate with their detainee, he was summarily triaged by the nurse with the intention of ticking boxes before he went back to the centre.

“He’s fine, well actually his heart rate is a bit fast – 120,” was the corridor handover before I went in.

Walking in I saw a young man (age and name officially unknown as minors are less likely to be repatriated) who was sitting on the trolley with his head in his hands Not being able to offer even food to these detainees is frustrating, so being friendly and taking time to have a chat is usually what I aim for.

Not responding to Spanish, I tried French at which point he looked up. So caught up in his world he didn’t even realise I was speaking in French. All he could say was “I’ve lost everyone, I’m completely on my own.” Trying to calm him down I asked him where he was from. He named a town in a French speaking African country and kept looking at me, waiting for a reaction. To my shame I didn’t recognise the town until googling it, finding out that most of the town folk (men, women and children) had been tortured and killed a couple of years ago. It would have been on the national news but I hadn’t registered it past yet another massacre in yet another far off country; distant from the world in which I live, comfortable, mostly without fear and generally with only first world problems to contend with. I felt a sudden wave of sadness flow over me, but I couldn’t allow it to linger. Exposed on a regular basis to so much sadness, in addition to poverty, addiction, and abuse, whether at work or on the street, I’ve learnt that blocking much of it out is the only way I can survive; the only way that stops me become completely cold when I meet up with individuals. 

Slowly he started to tell me how even before losing his family he had had to stop playing football because he would become dizzy with chest pains. He hadn’t consulted anyone in his home because he couldn’t afford it. He looked witheringly at me when I suggested it might be serious and he needed to be seen by a cardiologist. He was more than aware of the danger at that time, and now. Maybe the desire to act on his symptoms had been diluted by the massacre from which he had been spared. Maybe he didn’t feel worthy, thankful to be alive and not wanting to push his luck; a need to stay below the radar, avoid detection, blend into the background, and not come to the same fate that had become his family.  

I did an ECG, and had a discussion with the police who were initially less than impressed that a long standing condition was being sent to hospital but who did understand once I translated a bit of the background, explaining that he was on his way to the ED hopefully to see a cardiologist and to somehow get in to the system. The reality, and my fear, was that after a few days the detention would be over and he would be on the streets with no address and the potential to be moved on at any time. I hoped not. I hope that he was taken into the medical system and that he received some help for his physical health.

As for the solitude of this patient: that was heart wrenching, but the possibility of him ever receiving post traumatic therapy is beyond even my optimism.

This young man was just one of a multitude of patients whose individual stories have touched my heart. I think of him at the strangest of times, often when work should be far from my mind. Recently I’ve realised that at times these memories can engulf me. Doctors often say that the day they stop caring about their patients is the day they feel they should give up the job they do. The day I stop thinking about these patients will be a sad day but at the same time the fact that I can’t leave him in my work mind also suggests that I need to stand back from clinical medicine for a bit and take time to recalibrate, reconnect and re-establish my normal.

Whatever that may be.