Sitting next to the window, I was looking down to vast landscape Texas has to offer. It was only my second week of being in the US, I was still getting over the fact that I am here working towards my next big break in my career as a doctor- to get into a residency program. A very nice-looking middle-aged gentleman was sitting next to me and next to him towards the isle, was a young lad, both of them, it seemed like, were returning home to Houston from a short weekend getaway. Sitting in the seat in front of us was a young couple, with a toddler. The gentleman next to me started a conversation with the couple, asking about their son’s age, telling them about his short getaway with his son. At some point, he decides to turn to me, taking me a bit by surprise, and hits me with a question, “so where are you from?”. “I am from Pakistan”, I said with a quick reflex, appreciating his gesture of engaging me in a conversation. “Oh are you!”, said the gentlemen and with an equally quick reflex turned towards the toddler, “aren’t you lucky you are not born is some third world country?”, followed by a laugh from his son sitting next to him. I was shocked, so much that I was pretty much rendered speechless. Do I make an equally snarky comment? Do I put him on the spot by calling him out on his subtle attempt to make me feel unfortunate compared to the toddler? Do I try to educate him? I just stayed quite, let him feel good about his ignorance, and turned back to the window, staring at the clouds.
That was my first such encounter in life, where an attempt was made to make me feel different, and not the good kind of different. It made me realize that even in a very politically correct america, some may find it hard to resist the feelings of xenophobia.
Fast forward one year into my residency in a hospital in the Bronx, NY, the segregation was very obvious. There were residents from two different programs running the hospital. One group that was primarily based in the hospital in the Bronx, almost all of whom were foreign medical graduates (FMGs), and the other, primarily based in a very prestigious hospital and medical school in Manhattan (let’s refer to them as American medical graduates or AMGs), who were rotating through the hospital in the Bronx. Interestingly, the FMGs, though affiliated with the program based in Manhattan, did not have any rotations scheduled in the very well known hospital in Manhattan, but on the other hand, the AMGs had rotations scheduled not only in the hospital in the Bronx but also in other hospitals around the city and it’s boroughs to experience a variety of patient population and hospital settings. This model was not limited to this one specific educational institution and can be clearly seen in many big institutions, almost making it feel like the FMGs were needed more to run the hospitals where the AMGs would not prefer to go. One may think that this may be because of FMGs not having sound medical training like that provided in US medical schools. However, it should also be noted that FMGs have to go through the same set of testing that the AMGs go through, the USMLEs. These tests are standardized and the FMGs must score as high as possible as they know they are already at a disadvantage being FMGs.
One morning, rushing to the hospital, being late for morning rounds, which in this specific rotation, consisted of a small group including the attending cardiologist, one FMG resident and two AMG residents. I walked into the unit 4 minutes late, to find out that the attending decided to start the rounds without me. Understandable, I should not have been late. I apologized and embarrassingly joined the group. My attending ignored my apology and continued with the round, which I considered my punishment. Two days later, one of the AMG residents was late. “The trains are awful in the morning”, said the attending, “probably should wait another five minutes”. The resident walked in and was welcomed by a big smile, “hello doctor, we have been waiting for you”. I smiled as well, trying to be a good team player, but 5 years later, here I am writing about it, because I have not been able to forget that feeling, calling which a rejection would be too harsh, but it did feel somewhat similar.
What I found amusing that New York is truly a cosmopolitan city with people from all around the world, one would expect people working there to be not bothered by where someone comes from, but that may not always be the case. Years later, in a much smaller city in central Pennsylvania, I feel a lot more at home than I have ever felt. The commonly believed to be “conservative” Americans have been far more welcoming than some of the most liberal ones that I had to deal with in a multicultural city like New York. What I described above is not even close to some of the incidents that others have had to face in different parts of the world. The US has been nothing but giving and accepting to foreigners, at least for the most part, but it is somewhat sad to see that even the most educated lot, whose job is to help others, are not immune to the natural bias against the outsiders. It may be very subtle, but it is there, and the effects may be very long lasting.