Toronto – medhum.org

The Happiest Couple

Dave Hsu — Mon, 28 Jul 2025 12:38:11 +0000

A Chinese City Doctor’s Notebook–Chapter Four

After eighteen years of clinical practice, I think I’ve looked after somewhere between four and five thousand patients in total. Some patients I meet only a handful of times. Others I know like extended family. There are all types of patients: pleasant ones, well-behaved ones, as well as difficult ones that try my patience and of course, some that I’d rather forget.

Of course, most of my patients are Chinese immigrants and immigrating is a difficult business, not something to be undertaken by the faint of heart. New home. Often a new language. Usually a whole new culture. The immigrant experience means uprooting a person or a family from all that they are comfortable with and placing them in a strange and unfamiliar setting.

If being an immigrant is hard, then being an immigrant as a senior citizen is even harder. Try learning English for the first time when you’re in your sixties and seventies. Try going to the bank or dealing with a leaky faucet when you are a stranger in a foreign land. And yet, I’ve seen countless examples over the years of Chinese seniors starting over in Canada somewhere in their sixth or seventh decades. I often wonder. What is it that makes them want to start over yet again in their life? Is it simply that they want to be closer to their children and grandchildren who’ve come to Canada? Is there nobody left back in their home country? Do they really know what they are in for? Can anyone really be prepared for it?

In my own family, I’ve seen this process of elderly immigrants play out firsthand. Both of my grandmothers spent portions of their later years living with my parents in Toronto, with varying degrees of success. Through them, I witnessed just how difficult it could be to be an elderly Chinese immigrant in Toronto, which is probably, with its enormous Chinese population, already one of the most Chinese-friendly cities in the world outside of Asia.

In Taipei, my grandmothers could walk outside in the mornings and bring back fresh produce and noodles from the market down the street in their respective neighborhoods. Never mind that the produce in the Food City and Miracle Food Mart of my childhood was nowhere near as a fresh or tasty as the food culled on the subtropical island of Taiwan: in Toronto, our family lived in the suburbs of Scarborough, and later North York, so my grandmothers could only visit a store if my father was free on the weekends to drive them.

Chinatown, Toronto

Of course, my grandmothers couldn’t read or speak much English. In the era before cellular phones and Google maps, my parents taught them to navigate the Toronto subway system by memorizing the pattern of the coloured tiles at the individual subway stations, back when the city made a point of individualizing each station’s appearance. Dundas Station meant yellow coloured tiles. This was important because this way my grandmother knew which spot to get off if she wanted to find Chinatown.

My maternal grandmother abhorred Canada. Her complaints were plentiful: the produce didn’t taste fresh, the winter weather was too cold, it was too difficult to go places without a car and the language barrier was insurmountable. Ultimately, nothing about life here was as easy or as convenient for her as life in Taipei. At some point, she actually learned enough English to pass her Canadian citizenship exam. But years later, she defiantly informed me that she had returned all that knowledge back to her teachers. She had forgotten it all.

My paternal grandmother didn’t voice her complaints about Canada as much. Whether it was because she was more content, or simply because she tended to keep more to herself, I’m not sure what she ultimately thought about being a Chinese immigrant. But watching from afar as she spent the long months from spring to fall in our house (she always returned to Taiwan before it got too cold), living with my mom while my father was mostly out of the house, I couldn’t help but surmise that things weren’t really that easy. She didn’t learn much English, and save for her morning walk around the neighbourhood, she rarely ventured outside the house, preferring instead to spend most of her days watching satellite television from Taiwan. Living with grandchildren you don’t know very well, a son who is usually at work, and making nice with your daughter-in-law on a regular basis; this was another form of the Chinese Canadian immigrant experience.

This phenomenon, that of the frustrated elderly immigrant, is one that I’ve seen countless times in my medical practice. Flummoxed by a language they don’t understand, struggling to live under the roof of a son or daughter-in-law that they aren’t completely in sync with, and often tasked with the thankless job of babysitting little grandchildren for no pay, the immigrant elderly experience is fraught with trials and tribulations. And that is before real crises hit the family: a car accident, or a health situation, or worse. Crises are difficult enough when you are surrounded by your social safety net of familiar family and friends. But now, imagine being in an unfamiliar country when life unloads a crisis as it is wont to do. The examples are endless, but the end result is the same. Frustration, resentment, and ultimately regret. Why did we ever bother to come here?

Over the years, I’ve seen versions of it all. Disinterested adult children chauffeuring their elderly parents to doctor appointments, and those children then falling asleep in the chairs while their parents are describing their symptoms next to them. Other times, I’ve seen seniors get chastised verbally by their children when they try to ask me one question too many. I’ve treated elderly patients who got into physical altercations with their son-in-laws. And it goes both ways too: I’ve seen adult children come to me to request Prozac knowing that their mother-in-law will be arriving a month from now.

When I sat down to write this piece about elderly immigrants, I thought about which of my patients I really wanted to know more about. One couple, the Chens, immediately leapt into my mind. I’ve changed their names here to protect their privacy.

Photo of an elderly Asian couple
by TRAN NHU TUAN

On the surface, there’s nothing special about them. They’re an elderly Chinese couple, living in Toronto while their children live elsewhere. They aren’t particularly well off, and they spend their retirement doing typical Chinese immigrant senior citizen things: attending doctor visits, taking classes at the community centre, and so forth.

But dig past the surface, and they are unique. They’ve been married for over sixty years, and they are quite possibly the happiest, most resilient seniors I know. When things happen to them that would certainly derail others, they laugh about it, avoid blaming others and then move on. I’ve seen it happen in my office many times.

A few years back, Mr. Chen was struck by a car while crossing the street as a pedestrian, injuring his shoulder. For many patients, this would be a cue for initiating legal proceedings and a demand for compensation, as well as an endless stream of doctor visits and requests for pain medications. How did Mr. Chen handle it? He laughed it off, dismissed my question about “who was at fault” in the accident and recovered within a few months while doing some exercises with a physiotherapist.

Not too long after that, Mrs. Chen was found to have a slowly growing brain tumour. For many patients, this would be cause for anxiety, angst and even hysteria. But for Mrs. Chen, it was just another fact of life. She decided that in her mid-eighties, she didn’t need to risk surgery, and she’d continue to live day by day, even though the neurosurgeons thought that a more aggressive approach might improve her mortality and her quality of life, especially if her vision were to decline further. But they didn’t take into account that she was already fine with her quality of life and didn’t see the need to potentially upend things with surgical complications. Now, three years later, she’s remained the same, happy, laughing patient, who always makes a point to end our visits with a “good bye“ or ”thank you very much,” spoken in English that she learned in her English as a Second Language class.

Actually, I’ll correct what I said earlier. The Chens aren’t just the happiest seniors I know. They are quite possibly the happiest, most well-balanced people I know. What is the secret sauce of their happiness? That’s what I set out to find out. And that’s what I explained to them when I brought them into my office to be interviewed a few weeks ago.

This is their story.

The first thing to point out is that neither Mr. nor Mrs. Chen’s life was easy. If we suspected that part of the magic sauce of resilience is the ability to live a peacefully blissful existence in a Garden of Eden type environment, the Chens’ lives, dating back to their childhood, shows that this is not the case.

Mr. Chen was born in a small town in the province of Shanxi, in Northern China in 1937. At that time, China was at war, trying to stave off Japanese occupation, and so he grew up in an environment where war and violence were everywhere. In fact, the Japanese began bombing his town of Qixian three days before he was born. As a child, he watched as soldiers of all the different warring sides-the Communist People’s Liberation Army, the Nationalist Kuomintang, and the Japanese—took turns filing through the town’s lone major road. His father was a businessman who later made a name for himself selling tea and often had to travel. Mr. Chen remembered that for some years, he would see his father only once a year. Fortunately, their family avoided major mishaps during the war years, but he remembers seeing body bags piled up by the side of the road. When World War II ended and the occupation by Japan ended, he recalled seeing people dancing in the streets.

Meanwhile, Mrs. Chen was born in 1938 in Tianjin in Northern China, one out of four children. Her father was a businessman, and her mother was a housewife. During the war years, her family moved regularly, living at different times in Sichuan, then Nanjing, and finally in Shanghai.

She had some recollection of planes flying overhead while she lived in Shanghai, and that her mother didn’t want her to attend school for fear of violence. But for the most part though, she didn’t see much of the violence of war firsthand.

Of course, the cycle of war in China didn’t end when the Japanese occupation ended. After the Japanese departed, the Chinese Civil War between the communists and the Kuomintang promptly resumed and only ended with the Communist Party victorious in 1949.

By liberation day of that year, Mr. Chen’s father had moved the family to Beijing. He was now a sixth grade student and heard the horns and sirens announcing the liberation of China.

Culture Revolution (wikimedia)

He would go on to continue his education in Beijing, and it was here that he witnessed the Chinese Cultural Revolution taking place. He was a university student in Beijing by the time the Cultural Revolution reached full swing, but he kept his nose out of politics and was not much directly affected. By now, there were no more actual classes in university. As engineering students, they spent time working in factories. He even recalled how during the Great Leap Forward, the students busied themselves with trying to figure out how to make iron into steel at Mao Zedong’s behest.

Meanwhile, Mrs. Chen had studied to become a mechanical engineer. She was one of only three women studying computers at her university, Tianda in 1960. She went on to study in an engineering school and then became a professor from 1961 until her retirement in 1998, at the age of 60.

Spread out over almost two decades, the Chinese Cultural Revolution under Mao Zedong marked the complete upending of all societal norms. Scholars were vilified. Universities were closed. Anyone with links to bourgeois thinking or a questionable family background was blacklisted. Countless people lost their lives and countless more lost their livelihoods.

Mr. and Mrs. Chen’s experience through the Cultural Revolution was notable mostly in that they managed to remain apolitical. Academics came under siege during the Mao era, and intellectuals were frequent targets of Mao’s reforms. They knew that it was better to avoid political conflict than to get into the heat of it.

Mr. Chen still remembers how a colleague of his being was almost buried alive before being rescued at the last minute because he refused to recant certain political beliefs. He remembers peers of his losing their jobs as well as outbursts of bloodshed on the campuses at those times.

When asked how he managed to survive this, he admits that he wasn’t that bothered by the political crises that surrounded them. He learned mostly to keep his mouth shut and keep out of trouble.

Mrs. Chen, meanwhile, became a scribe during meetings during the Cultural Revolution. In fact, she points out that her propensity for smiling and laughter showed up even here, as people identified her during these meetings as the “one who was always giggling.” On a more serious note, she remembers colleagues of hers who died during the years of infighting, but like her husband, she avoided most political issues herself.

Of course, all my elderly patients from China are survivors of the Cultural Revolution in one way, shape or form. And of course, there is a survivorship bias here. I’m talking to survivors, those who not only lived through it, but those who lived through China’s gradual rebuild, through Tiananmen Square, through Deng Xiaoping, and now live through to be able to tell their tales as Chinese Canadian immigrants.

Of course, while China was engulfed by these years of political upheaval, the Chens moved on with their personal lives. They had already met as university students but really got to know each other better in their final year of university. They ended up matching positions in Beijing together in 1962 and have been together ever since.

The Chens have two daughters, both of whom are now successful computer engineers with graduate degrees from prestigious North American universities. Their grandchildren are also studying to become engineers as well.

When her children were small, the Chens were busy as young academics. They were fortunate that Mrs. Chen’s hours weren’t long. She only taught two to three classes a week. Furthermore, the university had a kindergarten on site, and her mother came to help look after the grandchildren so that they could continue to work.

When asked about parenting tips, Mrs. Chen points out that they’ve been asked this very question many times by their friends over the years: “Your daughters are both so successful. However did you manage to inspire them?”

Mrs. Chen tells me that she believes in parenting by example. She and her husband were both academics, so books were always plentiful in the house, and the parents could always be found reading. So, in time, the children saw them doing this and became intellectually curious themselves. “Don’t yell and berate,” she informs me. “That style of parenting doesn’t work anyways.”

What is unique about Mr. and Mrs. Chen’s immigration story is that while they have lived in Toronto for more than fifteen years, their two daughters have never lived here. This was a result of curious circumstances, but of particular relevance to our discussion.

When they first decided to come to North America to be closer to their children, one of their daughters was still studying in Manitoba and the other was on Long Island. Toronto, they reasoned, was roughly equidistant between Long Island and Winnipeg, and so they settled here.

A few years in though, their daughter in Manitoba married a Dutch husband, and before long, she had relocated to Holland to be closer to his family. This meant that the Chens would no longer be equidistant between the two daughters.

Still, rather than hinder their immigration experience, the fact that neither of their children are nearby seems to have strengthened their immigrant experience and actually gets to the root of how the Chens have thrived in Toronto. The Chens have never been reliant on their children. They made a point on arriving in Canada, to seek out the local LINC (Language Instruction for Newcomers to Canada) program, and began attending English classes on a regular basis. With no children to take them around, they’ve learned to make use of public transit. She tells me about how many of her fellow seniors at the community centre are reliant on their children to get around in Toronto. “They’re miserable,” she says. “They can’t do anything without their children.”

In my experience, many Chinese immigrants, even younger ones, pay only lip service to these offerings. With the influx of Chinese immigrants to Canada, it is possible to carry on a passable existence here and almost never speak English. But the passable existence has limits. You can rely on using exclusively Chinese-speaking service providers only so much, and there’s certainly a limit to how much patience your own children will have for acting as your translators.

The Chens moved into an apartment building near a bustling shopping centre, replete with a neighbouring Chinese grocery store and a large population of Chinese seniors. This is a far cry from other seniors like my own grandparents, who often end up living with their children in the suburbs, trapped on suburban streets where the nearest community centre or grocery store can’t easily be accessed except by cars which they cannot drive.

Through their English classes, the Chens became connected to various local Chinese community groups. Mrs. Chen proudly recalls that this was where she was introduced to me, having been informed that there was a local family physician who spoke Mandarin and was accepting new patients.

“Everyone is Welcome” by Katie Moum

When asked what her overall sense of her immigrant journey is, Mrs. Chen tells me that she is most grateful for how she is treated by people in the Canadian service industries. A case in point: earlier in the week prior to our interview, she had received a notification of an error in her tax return from Revenue Canada. She took it upon herself to call Revenue Canada herself, and explained to me that in Canada, if she tells the agent on the other end of the line that her English isn’t very good, the person will invariably slow down and cheerfully take their time helping answer her questions. She says that this is a level of personal attention that simply doesn’t exist in China and is one of the things she is most grateful for here.

I think back to my own experiences dealing with the service industry, from my cellular provider to Revenue Canada. I’ve experienced many feelings when dealing with these people, but gratitude has never been near the top of the list.

These days, when the Chens visit their children in the US or in Holland, things are pleasant. Both of their daughters married foreigners. One of their son-in laws is Dutch and the other is American. They describe their son-in laws as both being extra polite, and extremely attentive to their daughter’s needs. But of course they would describe them this way. It only makes sense for such a happy couple to be able to get along just fine with their son-in-laws.

After sitting and talking to the Chens, I took away several ideas from their story. It seems that a stressful childhood environment does not preclude being happy and balanced as an adult.

But the most remarkable trait of this amazing couple that I have learned is their willingness to adopt a growth mindset. I wonder who taught them this? Certainly, they grew up long before terms like growth and fixed mindsets became common parlance. I wonder if this comes from their background as educators. How else can I explain their willingness to come to Toronto, a country in a strange land where they had no existing family members? How else can I understand their enthusiasm for learning English at an age when many elderly are convinced that an old dog can no longer learn new tricks?

From this growth mindset, comes the steadfast determination to look after themselves and remain independent from their children. They know they can look after themselves, and their children know it too. In this day and age of complicated intra-family dynamics, when the best-selling psychology book on Amazon is titled Children of Emotionally Immature Parents, I realize the Chens have somehow figured all this out and they didn’t need a self-help book to do it.

We model ourselves, whether consciously or not on the people around us. When I was younger, I imagined that my life as a senior probably would mean living like my grandmothers: a lot of sitting around, imbibing television shows while grumbling about how nothing is quite as good as it was in the good old days. But then I think about the Chens, and it makes me realize that we’re never really too old to reinvent ourselves, or too old to move to a new country, or even too old to learn a new language. All is possible, as long as we remember to smile and laugh.

Web image by Li Lin.

Additional Chapters from A Chinese City Doctor’s Notebook

When Your Body Isn’t Yours

01.12.26 768

From Tigers to Otaku

09.16.25 1635

The Happiest Couple

07.28.25 1382

The Things We Don’t Talk About When We Talk About Dying

05.13.25 1961

One Patient, Two Systems

02.24.25 2639

The Emperor of All Maladies by Siddhartha Mukherjee

Dave Hsu — Fri, 14 Mar 2025 19:20:36 +0000

From Apollo on Call–a Medhum Podcast

For more than a decade, I kept running into the Emperor of All Maladies at various bookstores, book shops, and libraries. Siddhartha Mukherjee’s Pulitzer Prize winning biography of cancer would glare at me from its position on the bookshelf, daring me to read it, but each time I saw it, I would mull over the idea of reading a 450 page history of medicine book, shake my head, and move on to something lighter and less strenuous. Mostly, tired from my day job as a family doctor, I just wanted to read something less medical.

Last fall, it happened yet again. I ran into the Emperor of all Maladies once more, this time at my local library’s annual used book sale. For the princely sum of $1, I picked up the book, flipped through it, and thought, why not?

What I discovered was a book that was all that I had expected it to be, and more. Yes, it’s a long, exhaustive read. Yes, it contains long sections of exposition, explaining the details of how protein kinases and mRNA work on a molecular level. But it’s also eye opening and moving and manages to make the connection between what happened in hospitals and clinics a hundred years ago with the state of not just modern oncology, but modern medicine as a whole.

Last fall, I joined MedHum and before long, we realized MedHum needed a podcast. But what would we talk about? And that’s when I realized that Mukherjee’s book, with its vast scope, and comprehensiveness would be the perfect starting point for the show.

Then I thought, I needed to convince someone to read this book with me. And who better than my literary podcast buddy, Mr. Luki Danukarjanto. Luki is a career coach, writer and the founder of Focus Inspired, a service dedicated to helping people achieve meaningful career change. He also lives in Toronto.We’ve been talking about books on the W5H Book Club podcast together for the last several years. Why not read about medical humanities?

The result is two dudes who love to read talking about a great book.

Welcome to the premiere episode of Apollo On Call. Enjoy.

Dr. David Hsu

TRANSCRIPT FROM THIS EPISODE

Confrontation

Dave Hsu — Mon, 02 Dec 2024 18:37:57 +0000

A Chinese City Doctor’s Notebook–Chapter One

The place: a nondescript, ramshackle medical clinic located on the second floor of a large Chinese mall, located in the suburbs of Toronto, just north of the city, circa 2008.

Our narrator, the protagonist, is a newly minted family physician, a Chinese Canadian who grew up not far from this neighbourhood.

On this otherwise nondescript morning, I get into the office and find that the first patient of the day is already waiting for me.

On my way into exam room eight, I grab the large patient file that sits in the file holder just outside the door. Many of these files are for longstanding patients of the clinic, and even though I’ve only been working at the clinic for just over a year now, I’ve basically inherited them and their problems from the doctors who worked shifts here before me.

Inside the room are two middle aged Chinese men. One is a stocky, heavy built man in work clothes. Next to him is a clean-shaven man wearing a dress shirt and slacks. I vaguely recognize the larger man. I’ve definitely seen him before. I’m not sure who his friend is.

The two men greet me enthusiastically.

“Good morning doctor,” says the man I recognize.

“Here, we bought you a cup of coffee,” says the other man. He points at a styrofoam cup of Chinese mall coffee that is sitting on my desk.

I nod and smile. It occurs to me that it is odd that they are so friendly. But it won’t be the last odd thing to happen to me on this day.

“What brings you in today?” I ask in Mandarin. I’ve gotten used to speaking Mandarin during the majority of my patient encounters at this clinic. In fact, I’ve spoken more Mandarin since I started this job than I have in the preceding ten years, maybe since childhood when I spent a year living in Taiwan.

The man in the dress shirt speaks. “Do you remember filling out a life insurance application for him recently?”

As he speaks, I open the manila folder and start flipping through the chart to orient myself. I do remember this chart. The patient, the blue-collar worker, is not a regular patient of mine. I’ve only seen him once or twice in the past over the last few months, for prescription refills, and a discussion about his hypertension. Most of the chart, years and years of doctor visits, predates me.

A month or two earlier, a request came in from an insurance company, asking me to provide a letter documenting the patient’s medical record. Insurance companies use these records to determine if a patient should qualify for life insurance, or how much of a premium they should pay based on their pre-existing medical conditions.

“Yes. I do remember filling this out for you.” It is starting to dawn on me what the purpose of this visit is. The problem here is that the patient has a long history of high blood pressure, and he’s been consistently noncompliant with his treatment. I flip further back through the chart. There are multiple records of high blood pressure readings over the years, and lists of medications that were prescribed that he never ended up taking.

All of this was documented in the note that I sent back to the insurance company last month when they asked me for a record of the patient’s medical history.

Now it’s the patient’s turn to speak. “I don’t understand why I didn’t qualify for insurance. I have no health problems. What did you write on the insurance application?”

I brace myself. I know he won’t like the answer. “I didn’t write anything special. I just told them what happened at your doctor visits based on what is written in the chart.”

“You told them that I have high blood pressure?”

“You did have high blood pressure at the last visit.” I turn the notes to the page from the last visit. “Your blood pressure was 154/96 at the last visit.”

“I don’t have high blood pressure. I feel fine.”

Of course, the patient feels fine. Hypertension is a silent disease. Patients usually don’t feel anything.

“Why don’t you check my blood pressure now? I’ll prove to you that I’m fine.”

I can feel myself start to tense up. I’m not really sure how to extricate myself from this situation. I agree to check his blood pressure as a way to buy myself some time.

I put his arm inside the blood pressure cuff and pump the cuff. I use the silence to think about what I should do next but there isn’t enough time. Nothing comes to me.

Not surprisingly, the reading is elevated.

“160/100” I report. I try not to sound too triumphant. “It’s still high.”

The patient ponders this for a moment.

The friend decides to try a different tack. “Doctor, my friend here is trying to apply for health insurance. Can you please help us out? “

“I’m not sure how I can help.” As I say this, I look up and notice once again, the styrofoam cup of coffee. Now I see the gift for what it is. A payout or a bribe. Either way, something dirty.

“If you can just write a letter explaining that he is healthy and he doesn’t have these issues, we can take it to the insurance company. Please help us out.”

I have to choose my words carefully here. It’s harder for me to do this in Mandarin and I wish I could speak English here. “I can’t do that. It’s in the file. I can’t change the record.” I open the file and show the two men. The patient has a long history of high blood pressure. It isn’t one reading, or one visit, but a pattern of high readings over many years. I try to explain this in as simple Mandarin as I can.

“Really? All we need is just a letter, explaining that he is healthy.”

For a moment, I’m tempted to write them a letter, just to get them out the door. But what purpose would it serve? There’s no way around the fact that the insurance company has already received my prior correspondence clearly documenting the high blood pressure readings. I can’t lie to them. I think about my medical license, my career, and the prospect of losing it all over a two-dollar styrofoam cup of coffee.

I shake my head. “I can’t do it.”

In medical school, we attend classes on how to conduct patient interviews. We’re taught ways to de-escalate angry patients who are upset about things like having waited too long in the waiting room. For patient visits that are spiraling out of control, we’re taught the importance of body language. If a visit is going nowhere, we’re taught to stand up and move towards the door. This will suggest to the patient that this discussion is coming to an end. So this is what I do. I get up and move towards the door.

The patient and his friend look offended. “Why are you getting up? We’re not done talking.”

I’m now feeling very edgy. Medical school didn’t teach me what to do in this situation. A pit is forming in the bottom of my stomach. My sympathetic nervous system has kicked into overdrive.

“I don’t have anything more to say.” I manage to force out this sentence in slow, stilted Mandarin, but my stomach is churning.

“Why can’t you help us?”

“I didn’t say I can’t help you. But you’re asking me to do something I can’t do.”

“You’re a doctor. A doctor is supposed to help people.”

I’m lost for words now. I stare back at the patient, the gears in my brain spinning frantically but to no avail.

“You call yourself a doctor? What kind of doctor are you?”

In our training, we’re taught a formula of what to say to patients in this type of situation. If a total breakdown in communication with a patient occurs (I’m pretty sure when a patient is pressuring the doctor to do something illegal and unethical, this would be grounds for a total breakdown), we’re taught to say something along the lines of “I feel like we’re having a breakdown in the patient-physician relationship, and we cannot continue this way. It might be best if you find another doctor to try to help you.” Right. You try translating that sentence into Mandarin. You try translating that sentence when a large, Mandarin-speaking man is breathing down your neck and asking you what kind of doctor are you?

I try to come up with that sentence, but all my years of spoken Mandarin at the dinner table with my parents, and two years of university level Chinese fail me in that moment.

I’m trying to say that our relationship is breaking down, but what actually comes out of my mouth is this sentence:

我不喜欢你的态度

This translates roughly into “I do not like your attitude.” In hindsight, maybe the sentence sounds too much like how a parent might lecture their teenage son when said son refuses to take off his headphones to hear whatever lecture the parent is offering. Or maybe it’s simpler than that, that maybe nobody likes being told that they have an attitude problem. Or maybe it was just the moment. I’ll never know for sure.

In the next instant, the patient leaps up and charges at me.

Terrified, I bolt out of the room. Luckily, I am already at the door of the exam room and in an instant, I am down the corridor, with the patient hot on my heels. Near the end of the hall, a friend of mine, another doctor in the clinic, comes out of his room to see what the commotion is about, and manages to get between the patient and myself, giving me a moment to flee to the relative safety of the computer room in the back of the clinic. I shut the door behind me.

Outside, I hear the ruckus continue. My friend and one of the receptionists are trying to talk the patient off the ledge while the patient is hurling epithets at me in Mandarin. As I stand there, my entire future career flashes before my eyes. I tell myself this: if he makes it into the room, do not throw the first punch under any circumstances. But if he throws the first punch, then what?

Over the years, I’ve been asked many times what it’s like working almost entirely with Chinese patients in a language that isn’t my native tongue. I’ve even given talks to the Medical Mandarin club at the University of Toronto about how to conduct medical interviews in Mandarin, and I have a few prepared answers for the students. But the full truth is too hard to explain. Only this incident can explain it.

The truth is that I speak Mandarin well for a Chinese-born Canadian but compared to a native speaker, I am only just getting by. I can order food at a restaurant. I can understand television dramas from China and Taiwan. I can even haggle with a salesperson over the price of a speaker system if need be.

In time, my medical Mandarin has improved too. When I started, I only knew a few medical catchphrases that my parents spoke at home. I knew how to say, “Hepatitis B” and “cholesterol” and “blood sugar.” The rest of the terms, I gradually learned from my patients over the years, as we talked about erectile dysfunction, menopause, thyroids, and everything else under the sun.

All of this is great for my vocabulary, but the truth is that anyone can order dishes off a menu if they practice enough times, and the rote conversations that fill Mandarin textbooks and audio Mandarin lessons can be memorized and rehearsed until one can fool most people into thinking one is proficient. What I’ve learned about languages from medicine, and most specifically, through this incident, is that true mastery of a language should also include being able to nimbly think up an intelligent, appropriate response when one is under emotional pressure.

Thankfully, this scenario doesn’t occur that often. In the years since, I’ve had to teach myself to be very, very careful when having emotionally charged conversations. And over time, I learned a technique that I could deploy now if necessary. If a situation like this encounter were to recur in the future, I would stick to English to avoid miscommunication and to retain control of the conversation.

Fortunately, the office manager managed to talk the patient into calming down and the door to the computer room was not barged through, and there were no fisticuffs. It was, to date, the closest I’ve ever come to physical blows in my adult life. The patient had initially demanded that I come out and apologize, and insisted they would wait outside the office until I reappeared. But eventually, the manager explained to the patient that if he kept on threatening the office, we might just have to call the police.

As for me, for a few weeks thereafter, I thought twice about walking down the long corridor to the underground parking lot alone, but time passed and eventually this incident moved out of the forefront of my mind and life went on. I never saw the patient or his friend again.

Web Image by Brando Makes Branding