Sam* started attending my GP practice at the same time I joined. She had no extensive list of medical conditions yet she had frequent doctors’ appointments for minor complaints – in summer she would come with a cold, in winter with hay fever and all year round with tiredness.
She startled easily if someone spoke too loudly or the telephone rang. When she once arrived five minutes late for an appointment, she had volunteered that there were no clocks in her flat, since they were a reminder of time spent away from loved ones.
Sometimes Sam would roll her fingertips on the old scars that spanned her wrists. I asked about those scars (and traced their criss-crossed pattern with my eyes) but Sam would shake her head and hide her arms.
We went on in this fashion for some years. I was no longer the new doctor. I stopped looking for things that probably did not exist. Then one year a medical student came to us on a placement. He was in first year and this was his initial encounter with patients. He was given the task of researching and writing about a patient’s journey. He spent the day with me: we saw people with heart disease, diabetes, headaches, depression and dementia. Somewhere between these 10-minute appointments, there had also been Sam, who had come in with “not a particularly memorable” sore throat. To my surprise the student chose Sam.
Sam was taken aback that the young student doctor wanted to write about her but bit by bit she told him her story and with her permission he wrote it down. A while later Sam and I read it together.
Samia was brought up in a small village in the Indian subcontinent. Her life was busy yet carefree. She wished that time could stop there – she was happy. But her parents felt she had crossed a marriageable age and were worried – perhaps even more so because they had other children and dowries to provide for.
By a quirk of fate, in the nearby village a man had come from the UK in search of a bride. Samia’s parents hoped their daughter might be considered because she was beautiful and they belonged to the same caste as this man.
Samia was chosen and the date was fixed for the marriage – a few days before the groom was to fly back. Forms for her passport and visa were secured to start the process of her leaving for Britain. The procession came and the marriage ceremony was performed, with Samia’s father spending a substantial part of his savings on the wedding.
The groom returned to Britain and Samia to her parents. She was happy because she would travel by plane for the first time. She dreamt of a beautiful place where lambs grazed on lush green hills. Her only sadness was that she would move so far away from her family, friends and even her animals.
Her husband did not ring her, but Samia and her parents assumed he was busy in his job. Eventually, she got a plane ticket and all of the family arranged a van to go to the airport to see her off.
Her husband’s parents received Samia when she arrived in the UK – he was not there. Her father-in-law told her that he was at work. The days passed, with her seeing her husband rarely. It was a big family. Eventually she learned he was living with someone else.
She was soon introduced to the work she was to do, which included cooking and cleaning. Her life back home was tough, but here it was hundred times worse. When she complained it was decided that she should be sent back but Samia could not go back. She would not be the cause of pain and disgrace to her beloved family, no matter how much she needed them in her despair.
Her refusal made the situation worse. The hatred became visible. Her husband hit her sporadically. On one or two occasions other family members slapped her too. She was humiliated repeatedly with bitter remarks. Samia’s father-in-law had incurred business losses since her arrival and she was blamed for that too. In the end when there seemed to be no way out, Samia attempted suicide.
Someone took her to the local hospital. From there she had gone to a women’s refuge, and then moved from city to city, refuge to refuge until she had come to us.
Samia tried to put her life back together. She got a divorce, found a job, a place to live and even made a few friends. But home was still several thousand miles away. She longed to be with her family but lacked the courage to turn up alone, divorced and with nothing to show for her parents’ efforts.
Samia and I both finished reading. That is how the story would have ended – except that it didn’t.
Our student left but Samia had started talking and healing. She told me about her scars, her childhood, her siblings, her parents and even her pet goat. She told me of her aspirations for a better life when she had come here and her disappointment when her hopes had come to nothing. But after despair had come fortitude and courage. Then I did not see Samia for a while – she had gone to see her family. That had been her happy ending.
Samia had needed space and time to open up and heal. At the beginning I had asked the questions but she had been too traumatised to talk. I then focused on her medical problems and fixing only what was apparent. Samia’s story made me realise that sometimes we all need a fresh perspective on the same problem, perhaps even more so when some time has passed. It can occasionally lead us to question our initial diagnoses.
*Sam is a composite of this GP’s experiences of patient care
- In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here
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I treated Sam for minor complaints. I didn"t see the domestic violence victim
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