One thousand kilometers.


It wasn’t until midsummer when I finally managed to visit my friend, a family physician in a southeastern city in Iran near the Pakistan border. We had worked jointly on a few medical research projects, and at the time he was fulfilling a public service obligation, as was his wife in a nearby town. I arrived, drained, at his office as dusk fell. His setup was just as I had imagined: a weather-beaten building, rudimentary equipment, a very basic medication cabinet, a few rooms in which to see patients, a terraced residence in the rear, and a dilapidated Land Rover next to the beat-up ambulance. My friend read my thoughts from the look on my face. “You get used to it,” he said. “I’m supposed to leave early in the morning,” I murmured. We sat in his office to catch up just as the call came from his wife. Doubled over from an acute attack of abdominal pain, she was on the way to the local hospital. She needed him. Throwing on his coat, my friend asked, “Cover me for a few hours. I’ll be back soon.” Again he read my face. “You’re it. It’s just you. But nothing happens at night. Anyway, you have my number,” he shouted over his shoulder. Here I was, suddenly alone, with the silent, bitter-cold night of the desert, the chirping of crickets, the distant barking dogs. I turned on the radio for company and started working at my laptop. It was past midnight when I heard a knock at the door. I was apprehensive and did not answer at first. The knocking was repeated again and again. “Who is it?” I asked, in Persian. The answer came in English. “Please open the door. We need help. Please!” I opened the door to a Pakistani family. A worn, withered man embraced a small girl of about 5. A woman, utterly exhausted, held something wrapped in her arms. I assumed it was an infant. I caught their anxiety, their panic. I reflexively let them in. The mother unwrapped the infant and a stench filled the air. The little girl started crying. I saw a half-naked, dehydrated infant lying immobile in diarrhea. I thought he might be dead. I moved closer and heard his gasping breath. “Quickly! Wash your baby under the tap.” I ran to find a catheter and an IV setup. I opened the window and the door to let in fresh air, placed the setup and the catheter by the infant, and gave his mother a towel to dry him. I searched the cabinet to find IV fluids and when I turned back, I saw that the mother had inserted the catheter and started the IV. Her husband explained. “She works in a clinic in Pakistan and knows some procedures.” I nodded. Thank goodness, I thought to myself. I had been worrying about getting venous access in this infant. I connected the IV fluids and checked his vital signs. “Where have you come from?” I asked. “We are from Pakistan. We were displaced because of the flood,” the man replied. “But that flood is far to the East, very distant from here . . . .How—” The man interrupted. “I am a school teacher. The flood washed everything away. We lost everything. We had no other choice but to come to a friend of mine who lives in Iran. We walked. We came 1000 km in 6 days and were kept at the border for 2 days. They would not let us in. We had no papers. Our situation got worse. My son got sick, and no medical care was available.” I searched my pack and found chocolate and biscuits. They were ravenous and thirsty. I gave the small girl the chocolate and the parents the biscuits. The man continued. “I found an Afghani near the border who told me he would take us into Iran for no charge. We followed him, all of us—my wife, my daughters, and my son.” “Your daughters?” I interrupted him. At this, the man began to weep. The mother turned her face to conceal her tears, and the little girl hugged her father frantically. The man spoke through his tears. “In the mountains the Afghani and his friend demanded money; we had agreed there would be no charge. I told them that we had no money. They threatened to leave us alone in the mountains to die unless I gave them my daughter. He said he wanted a wife. I told him that she was only a child, but he insisted that she was ready for marriage.” My mouth hung open in horror. He continued. “That seemed the only way to save us. They took us near this city and went into the mountains with our daughter . . . ” I was in shock. Having 2 daughters of my own, I could empathize deeply with this man. I raised my head and managed to say, “That was the best decision in that situation— your only option. I know that police will help you get your daughter back.” The man quickly replied. “Please do not call the police. They will only send us back, and we will not get our daughter back.” “You need to get some rest. Let me find something for you.” I went to the next room and called my friend, speaking in Persian. I subconsciously noted the father’s apprehension, that I might be calling the police or the officials, whereas I was merely asking for some blankets and the way to get into the residence. When I returned to the office, no one was there. They were gone. I searched around the clinic but found no sign of them. The man had not known that I was just a visiting friend, that I had been calling this friend to whom I spoke Persian. Protecting his family, the man assumed I was speaking with the authorities, and he fled with them. I looked for them. I searched throughout the city the next day, as you would have. I never found them. I had lost them. I doubted that I would ever experience the loss of a patient such as this again. Annals of Internal Medicine On Being a Doctor

DOI: 10.7326/0003-4819-156-4-201202210-00016

Cite this paper

@article{Malekpour2012OneTK, title={One thousand kilometers.}, author={Mahdi Malekpour}, journal={Annals of internal medicine}, year={2012}, volume={156 4}, pages={321-2} }