Physician Martina Scholtens worked at BC’s only refugee clinic for 10 years. Photo by Brooke McAllister. Your Heart is the Size of Your Fist Martina Scholtens Brindle & Glass (2017) I returned to work when Ilia was four months old. Yusef was booked to see me on my first day back. We traded details on our babies. Ahmed was a month old. Yusef showed me pictures on his phone of Junah cradling a baby with fuzzed black hair and wide eyes so dark they swallowed his pupils. “He’s beautiful,” I said, but I was looking at Junah. She smiled with her lips closed, serene, all weariness gone from her face, lifting her elbow to tip Ahmed toward the camera. We were a few months past their one-year anniversary in Canada, when I usually discharged patients from the clinic. Today was Yusef’s last visit with me. “Party for Junah’s birthday,” Yusef said carefully at the end of the visit, with his Arabic accent. “You come, Doctor?” He sat in the patient chair to the left of my desk, long legs crossed, shoes shined. There was no interpreter. Eager to practise his English, and, I suspected, to optimize the intimacy of the visit, he now declined Hani’s assistance and insisted on seeing me alone. It was mid-afternoon, and I was cheerful and unguarded on my first day back. “I don’t know,” I said as I printed his prescription. “When is it?” He seized on this suggestion of interest. “You come? Junah so happy! I tell her Doctor come.” “Well, I don’t know if I can make it,” I said. “What day is it?” “You tell the day you can come,” he said. That felt all wrong, organizing a birthday party around the doctor’s availability. I refused to name a date. “I choose date,” Yusef said agreeably. “I email you. You cannot come, I change date.” He gathered his coat and umbrella and murmured again as he left the exam room, “Junah so happy when I tell her.” I’d never been invited to a patient’s birthday party, but I already felt uneasy. Had this been an exam question during my medical training, I would have stated with certainty that attendance would be unprofessional. But when I thought about the actual practice of physicians I admired, it was less clear. A Vancouver obstetrician hosted an annual party at her home for the new parents, with a legendary Bellini machine. My father-in-law golfed with his physician. My own family doctor listed his home address publicly, to ensure he’d always be available to patients. All of the above seemed unprofessional in theory, but reasonable in practice. Noble, even. The next day Yusef emailed me at my work address. The line spacing was odd, and he had clearly used a translation service; the effect was poetic: Hello my doctor, First, thank you for everything. We came to the most beautiful city in the world before more than a year. From the first day you was balm for us and eased the pain of alienation. We always see you as more than a doctor for us we consider you a close friend. Doctor, for all of this and other we will be very happy if you accepted the invitation to celebrate Junah’s birthday on Sunday March 10 at 4 pm. From there he detailed an elaborate itinerary that involved touring the city of Surrey in his friend’s car and visiting White Rock beach before returning to his home for the birthday party. I was moved by his invitation — and I resented it. I didn’t want to be a special guest. I was the host, in my exam room. I strove for a professional but cordial reply. A relationship with a physician, I told him, was special, with limitations on how we could engage outside the clinic. I declined the city tour and beach visit, but would try to come by the house briefly during the party to give my regards to Junah. I hoped he understood, I concluded. He replied immediately: “Yes, yes, of course, Doctor.” The Surrey address was a few minutes off the freeway, on a street where everyone drove by hurriedly on their way somewhere else. It was a neighbourhood of low apartment buildings, with old couches and bikes on the balconies and scrappy lawns. As I approached, I slowed uncertainly, trying to make out the address numbers in the winter dark. Then I saw Yusef at the parking entrance, waving at me. I pulled in and rolled down my window. Yusef welcomed me with formality, and directed me where to park. He wore a suit jacket and cologne. I was deliberately dressed exactly as I did for the clinic: navy wool pants, a blouse in a small print, and low heels. Only the stethoscope draped around my neck was missing. Business attire was unimaginative, but festive dress felt downright dangerous. I was determined to preserve some kind of boundary. We walked into the building together. I knew that most of my patient demographic lived in poverty, but I had never actually witnessed it. The halls were dim, and garbage was piled next to the doors of some units. I could taste something sour — stale cigarette smoke, or cat urine. Had I been alone I would have felt unsafe. Upstairs, Yusef ushered me into his apartment. I entered the living room, dull beige, unadorned except for a row of plants crowded in the windowsill, and harshly lit by an unshaded bulb hanging from the ceiling. In the centre of the room was a table loaded with food. Next to it stood Junah, smiling shyly, with makeup on and the bundled baby in her arms. Nadia and Layth were lined up beside her. A man and a woman stood up from the loveseat and introduced themselves. They appeared Middle Eastern but their English was fluent. They had met Junah and Yusef two weeks earlier at the local high school, they told me. We were the only guests. I wished Junah a happy birthday, and good health in the coming year. I presented her with a small kalanchoe plant wrapped in green foil that I’d picked up from Safeway on the way over. I’d had to choose between two discomforts: buying a gift for a patient or showing up at a party empty-handed. The plant was well-received. So was I. I sat on the couch, and Junah and Yusef sat on chairs opposite me and beamed at me. I was clearly the guest of honour. Yusef spoke in Arabic to the other guests, who turned and looked at me. “So you’re their doctor?” asked the man doubtfully. “Yes.” “I’ve never heard of a doctor going to a patient’s birthday party,” he said. “They typically don’t,” I said. He waited, but I had nothing more to say. We sat in silence. Never at a loss for words in the clinic, I could think of nothing to say. I already knew the intimate details of their lives, down to their monthly budget and what they dreamed about at night. In the office, nothing was off-limits. Here, nothing seemed appropriate. “I show you house?” asked Yusef. “Yes, please.” I followed him through the apartment. The kitchen was warm and savoury, the dishes from food preparation piled on the counter. The master bedroom contained nothing but a double bed. Nadia and Layth shared the second bedroom. There were no sheets on the mattresses, just a rumpled blanket on each one. The single bathroom was so small that it would be awkward for a lone occupant to close the door. I thought back over various conversations I’d had with the Haddads in the clinic, and retrofitted them into the context of this apartment. I matched the insomnia to the bed, the trouble concentrating on homework to the shared bedroom, and the loneliness to the anonymous Surrey apartment complex. The family had been in clear focus for me in the clinic, the rest of their life a blurred abstract. They lived here, though — not in my exam room. “Eat!” Yusef commanded when we returned to the living room. It took me three servings to realize that clearing the plate indicated that I was still hungry, and signalled Junah to heap it with more dumplings and date-and-sesame balls. I finally tried setting it down with a few forkfuls of food remaining, and my hosts nodded with satisfaction. Shortly after, the other two guests excused themselves. I wanted to follow suit, but it hadn’t even been an hour since I’d arrived. With my departure, the celebration would be over. I remained seated on the couch and sipped the tea Junah served. After a few minutes of silence Yusef left the room and returned with a flat cardboard box the size of his hand. He set it on the coffee table, shook off the lid, and pushed the box toward me. Inside was a stack of photos. They were smaller than the standard four-by-six-inch Canadian prints, with rounded corners. I laughed with delight at the top one, an image of a much younger Yusef, with the lean build and unapologetic hair of a man in his twenties, leaning over the open hood of a car. The next was of an extraordinarily pudgy baby whose distinct facial characteristics I immediately knew to be Layth’s. Beneath this was a photo was of three children, two boys and a girl, seated on a blanket in a shaded courtyard filled with potted plants. These were the pictures the Haddads had brought with them when they fled Iraq, I realized. I went through the entire stack, exclaiming with recognition as I flipped through the catalogue of their life before we met. The Haddads gathered around me, pleased with my reaction and offering commentary on the different scenes. Yusef sat on one side of me, Junah on the other, and Nadia and Layth leaned on the arms of the couch. Ahmed slept in Junah’s lap, his right arm flung up over his head, hand balled into a little fist. His heart was the size of that fist, I thought, tiny but robust, and one day, God willing, it would be the size of his father’s. If he were anything like his parents that fist would be one of gripping strength, an antidote to the fists of aggression that had obliterated the life in the box of photos. An hour later I drove home to the North Shore, eyes drawn to where the silver of the March sky met the dark ridge of the mountains. The magic always seemed to be where two things brushed against each other, I thought. It was why I liked the beach, and conversation, and dusk. In the exam room, too, the patient and I were two eternal spheres that rubbed up against each other, making a little spark to see by. Most was left unknown. It was that thin line where we met that was beautiful. I pulled up to my weathered 1970s home overlooking the waters of Indian Arm, neighbours obscured by massive cedars, with a minivan in the driveway and bikes strewn across the yard. My home had never seemed so splendid, or so preposterous. A few days later I received an email from Yusef with a photo attached. The plant I had given Junah was in bloom. The text, poetic as always, had been garbled in translation. I gathered that the flowers reminded them of my visit, and both made them extraordinarily happy. Every few months I receive a message — usually from a patient, often stripped of the subtleties afforded by fluency in English — that reminds me why I am a family doctor. I read Yusef’s email twice, tagged it don’t forget, and archived it.