Homelonging

 

SYNOPSIS

Illustration by Eva Vázquez

 

Primary care doctor Tseganesh Selameab brings us inside her practice as a provider for immigrants and refugees, and describes one of the most common ailments she sees: “homelonging.”

 
 
 

LISTEN

 
 
 
 
 
 

storyteller

 

Tseganesh Selameab is a wife and mother to three creative and amazing girls, all living in St. Paul, Minnesota. She is an internal medicine & public health doctor at Ramsey County Public Health by day, and a medical education disruptor at the University of Minnesota Medical school by night.

 
 
 

RESOURCES

Mentioned in the episode:

 
 
 

CREDITS

Hosted by Emily Silverman

Produced by Emily Silverman, Sam Osborn, and Carly Besser

Edited and mixed by Sam Osborn

Tseganesh’s story was coached by Adelaide Papazoglou, with support from Head of Story Development, Molly Rose-Williams. It was performed live at The Nocturnists’ “Together Again” show in San Francisco in June 2022.

Emily’s interview with Tseganesh was recorded at The Hideaway Studios, Minneapolis in December 2022.

The Nocturnists original theme music by Yosef Munro

Additional music by Blue Dot Sessions

Illustration by Eva Vázquez

This episode of The Nocturnists is sponsored by FlipMD from GoodRx.

This season of The Nocturnists is sponsored by The Physicians Foundation.

The Nocturnists is made possible by the California Medical Association, and people like you who have donated through our website and Patreon page.

 
 
 

CME

CE/CME credit is not currently available for this episode. Join our mailing list to be kept in the loop of new offerings!

 
 
 

TRANSCRIPT

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The Nocturnists: Stories from the World of Medicine
Season E5, Episode 5: Homelonging
Episode Transcript

Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.

Emily Silverman
You’re listening to The Nocturnists: Stories from the World of Medicine. I’m Emily Silverman. Today's episode features one of my favorite Nocturnists storytellers from over the years, primary care physician, Tseganesh Selameab. Tseganesh is a primary care doctor and in today's story, she brings us inside her practice as a provider for immigrants and refugees, and describes one of the most common ailments that she sees among her patients, which she calls “homelonging”. Tseganesh works as an internist and in the field of public health at the Ramsey County Public Health System, and she's also the Associate Director of the Center for the Art of Medicine at the University of Minnesota Medical School, where she organizes storytelling programming for medical education and practice.

We'll hear more from Tseganesh about the amazing work that she does. But first, let's take a listen to the story that she told live on stage at The Nocturnists show in San Francisco in June of 2022. Here's Tseganesh:

Tseganesh Selameab
It's cold, that March morning, when Rachel and I decide to meet up for our COVID-coffee and walk. I had left our practice at the county hospital, and I hadn't seen Rachel for a while. So I was so excited to see her waiting for me outside of the downtown coffee shop. We grabbed our steaming cups of coffee, and we meandered down to the farmers' market, while she told me that Julie was leaving County and all the new efforts of our Chief of Medicine to increase our productivity.

We were kind of perusing the cheese and chutney, and sharing pictures of our kids: hers, a not-so-little toddler, and my three rambunctious girls. And I was telling her the untold stories of the horrors of distance-learning for our family. And it wasn't really until we cross the stone arch bridge and started zig-zagging our way through these half-frozen puddles, that we started sharing notes about one of my old patients, Hanin, that Rachel was now taking care of.

So, spoiler-alert... I'm a primary care doctor. So, I cure no one and I cure nothing. There was this one time I pulled out a retained tampon, and... that is a story for another time. So, I remember when I first met Hanin. I worked in the county hospital, with this big workroom. And I sat on the computer, kind of getting acquainted with her. She was complicated, which meant she had a lot of diagnoses and ICD 10 codes, like diabetes (which is E11.9), hypertension (which is I10). And then, she had more interesting ones, like Sjogrens and sero-negative arthritis, Vitamin D deficiency, PTSD. And I read through all of that, kind of went through what her old primary care doctor had said about her, all the specialists' notes. And that familiar green light went off on the computer, and I knew she was ready. So, I made my way down these, like, white-tiled hallways, and I knocked on the door. I thought I heard her say, "Come in," so I walked in. And there was this woman, who was sitting there, much much older than the 61 that it said in her chart. And she looked a bit cross. And she wasn't really paying attention to me, because she was too busy digging in the pocket of her walker looking for something she had to show me.

So I went and I got my chair, and I pulled it a little closer, and I counted five different braces that she had on that day. She had two that were supporting her wrist, one on her knee, and both of her ankles. So, I took a deep breath and sat down and introduced myself to her as her new doctor. And I said, "Tell me Hanin, how are you doing today?" And she said, "Doctor, I am not good. I am not good." And that's how we started most visits.

That particular day, it was pain. That was the big thing she wanted me to address with her. So we came up with a plan, and she went home. And, you know, she'd had multiple follow-up visits, and, at one point, she was really struggling with insomnia. She couldn't sleep. So I said to her, "Well, let's go up on the amitriptyline that we're using for your pain. Let's bump that up a little bit, and I'll have you come back and see me." So she came back. Amitriptyline did nothing for her insomnia, but it made her Sjogrens worse, and it made her have really dry, tacky mouth, and she felt horrible. So we went back down on the amitriptyline. Another time, she had this very weird stomach stuff that was going on. She was nauseous and couldn't eat. I had no idea what tests to order for her. I knew it wasn't the meds, but I didn't know what tests to order for her. And she'd go home.

Hanin was an immigrant, and she would also come to me before she was getting ready to go home. So I would do her pre-departure visits. She would come, and I would go through her immunizations. She's typically gone for a while, so I would make sure she had enough medications for the time she was gone. And then we'd have that follow-up appointment set for when she came back. I loved those appointments. I loved waiting for her to, like, tell me about what happened. And I would sit in that workroom again, and wait for that green light. And I would walk a little quicker down the hallway and knock on the door. You know, we'd get settled, and then she'd start telling me about what happened when she was home – all the things that she had experienced. And, at some point, I would say, "All right, well, Hanin, let's... let's talk about your health. How was your pain? You know, your sleep, even, like, this weird stomach stuff we were working on... How was that?" And she said, "Doctor, everything gets better when I go home."

I, too, am a refugee. My family came here from Ethiopia, in the late 80s. So home to me is a little mix of y'all, like distressed jeans, which are really hip right now. We were the OGS with that. So home for me, is a little mix of those distressed jeans with a netela, that I would wrap around my shoulder. Home was clear Coke... Right? Clear Coke, with a little bit of injera that I would eat. Or, it sounded a lot like a little R&B and hip-hop, and it was mixed with tizita. But, I didn't get to go home for many years; it was like 20 years. And then... I was getting married. So, for my wedding, we were gonna have everything be Ethiopian. Right? We're gonna have Ethiopian music and food and dancing. And everyone in my wedding party had to wear an Ethiopian outfit. So, my mom and I got on a plane, and we went home.

Twenty years. I had no idea what to expect. But we get off the plane, and I take this deep breath in and... Oh my gosh, I'm in my childhood. I am riding down these unpaved roads on this bike. I am in Sodore for, like, family vacations, but guarding my food from these, like, vicious monkeys, because they're a little aggressive. And I'm at my grandma's house. My... my grandma's... For Christmas Eve, right? My grandma's not really religious, but she wanted to make sure her grandkids knew what Christmas was about. So, she would buy a huge Christmas cake... a birthday cake, on Christmas Eve. And we would all stand around it, all her grandkids, and we would sing "Happy Birthday" to Jesus. This is what you do.

So, we stayed in... at least for a while; did a... Oh, my gosh, I would.... tons of shopping. And, one particular day, we go past the shop, and there's a dress that my mom thinks will work really well for the Meles, which is, like, the thing after the wedding. So we go in. If you know anything about Ethiopian shopping, it is a competitive sport. My mom is pro. So we walk into the shop, and before you know it, we are getting served some coffee and some tea. We're sitting down, and she's in her element discussing what kind of embroidery on what material. When was it going to get ready? And oh, let's get into the price. So I left. I had to get out. And I did. And I went outside. And I leaned over the balcony. And I wanted to go home. I wanted to go home; I wanted to walk around freely. I wanted to talk without making mistakes. I wanted to go to Target.

It turns out home is... It's really complicated for us refugees and immigrants. Home is not so much a place, as it is a wound. We're branches that are growing on this tree, and one day a gardener comes along and rips this branch, and says, "I'm going to graft you to this tree that is America." Grafting, to be successful, depends on connections. Connections, even down to the vascular level. As immigrants and refugees, we know that. We look for our community; we look for connection in how we celebrate our rituals, our weddings, and our funerals. We look for connection in the spices for our kibbeh. We look for connection in our children. We name them the name of our ancestors, and we wait for them to speak to us in our native languages.

We look for connections. Because we know if the connections are strong, not only does that branch survive, but it thrives and eventually produces flowers and fruit. But the opposite is also true. For many of us, those connections are really weak. They're really frail. And all we can do is survive, and just hold on. And then, what does a gardener do in that situation? A gardener makes salves and balms, and tends to that branch, and tries to salvage and see what can be recovered over many years.

So, the Monday after my walk with Rachel, I'm in my new practice. I have a standing desk now, and I love that. I'm between Mike and Chi. And there's a blue envelope that's waiting for me. The blue envelope tells me that there's a new arrival. One of the best parts of my new job is I get to take care of refugees when they first come here, sometimes within the first 72 hours. And I open up that blue envelope; take out the paper. There's a grainy picture of my patient in the left upper hand corner, and I flip through it for all of the diagnoses and ICD 10 codes, and what their doctors had said before. The green dot comes on, and now I follow a gray carpet (with some weird pattern on it) to the door. Thi, our current interpreter, is waiting for me. So, we knock on the door, and walk in. There's a lovely grandma waiting for me, with her even older and lovelier husband, and their daughter is also watching. So I pull up my chair. I sit down, and introduce myself to them as their new doctor. And I say, "Tell me. How are you doing today?"

Emily Silverman
So I am sitting here with Tseganesh Selameab. Tseganesh, thank you so much for being here today.

Tseganesh Selameab
Excited, Emily. Thanks for having me.

Emily Silverman
So Tseganesh, you are one of the most beloved storytellers/collaborators/people in The Nocturnists family. And, I was wondering if, maybe, you could start by telling the audience how you got involved with The Nocturnists.

Tseganesh Selameab
I can't even remember when I first listened to your voice, Emily. And so, you've kind of always been in my ear. You did that live show in San Francisco last year, which got me really excited. And went through the coaching process with you; I got to be in that show. And I went there with the sole mission...I told all my friends... I said, "The reason I'm going to San Francisco is to have The Nocturnists do a show in the Midwest." And that's, kind of full circle.

Emily Silverman
Yeah, so for the audience, Tseganesh is at the University of Minnesota, at the Center for the Art of Medicine, and we are collaborating on a live performance, in Minneapolis, on Saturday, April 22. I'm just gonna go ahead and plug it early in the interview….

Tseganesh Selameab
Totally.

Emily Silverman
Because why not?

Tseganesh Selameab
Totally.

Emily Silverman
And, I'm just so excited to, you know, be working with you, in this capacity, after falling in love with your voice, back in the Summer of 2020.

Tseganesh Selameab
I've always believed in the power of storytelling. Just in the... in how we share our stories of our patients, and how we talk about ourselves, and to be able to bring that storytelling to Minneapolis with, like, our friends and our community, is going to be amazing, incredible.

Emily Silverman
I love hearing about people's paths to medicine. So, tell us about Tseganesh becoming a doctor. What is that journey?

Tseganesh Selameab
So, Tseganesh has always wanted to become a doctor. My parents don't know where it came from, but there's never been a second career or an alternate path. It's what I've always wanted to do, since I was a little kid. When I was in Ethiopia... I grew up in Ethiopia; I came to the United States when I was 12. But, when I was young, there were these first-aid clubs that were really big in Ethiopia. And I was obsessed with first-aid. I had gotten the book, and I would walk around pretending to, like, cure people. And, I knew how to do a first-aid carry, when I was a little kid.

So, it's sort of what I... I've just never seen myself as anything other than being a physician. I had this idea when I was like... I tell the story with all seriousness. I thought, in my head I was, like, hey, when we came to the United States, when I was 12 years old, I was like, "Well, I'm going to work in Africa, because that's where all the need is." And I always imagined myself working there. And then there would be this prince, and he would be widowed, and I would save his children. And then, we would fall in love and get married. And I thought that was exactly why I was going to go to medical school. Turns out, it didn't quite work out that way. And then when I was in college... So, again, I always thought the real need was elsewhere. And then when I was in college, I started working a lot in the inner city, particularly in Chicago, and I was blown away at the disparities that were there. I... I just had not known. I hadn't known that people struggle to get food, and you had to make decisions about your medications and rent. And so, when I was very young, it completely pivoted what I wanted to do, with where I wanted to practice medicine. And so, I really focused on that and on urban health care. And that included a ton of refugees and immigrants, at least in the communities that I lived in. And that was that. That's how I ended up in medicine.

Emily Silverman
You mentioned in your story, or, at least in one of the versions of your story, that, as a doctor for immigrants and refugees, you sometimes get to see people really early on, even within the first 72 hours of their arrival to the United States. Tell me more about your role as a doctor for this population. Is it always an initial, like, intake appointment? Or, do you also take care of people, you know, years and years after they've arrived? Or, what is that setup like?

Tseganesh Selameab
I take care of all of the above. When I first started practicing in Minneapolis, I worked in our big County Hospital in Minneapolis. And, there are immigrant populations, that we saw, were very established. So, we have a huge Somali population that has been very prominent here since, probably, the 90s, and so we have people that have been here for 20-30 years. You know, first and second generations. We also had a lot of Vietnamese.

And then when I crossed the river, and went to St. Paul... Even though they're really close to one another, it's like you've entered a different world. And, oh, in the clinic that I worked in, we're seeing a ton of new Karen Burmese refugees. And we're seeing a lot of Nepali patients. And very brand new, brand new established patients, along with all the kind of populations I had seen at Hennepin, as well.

So, we take care of everyone. The "new arrival" is a... more of a formal process, of migration through the, you know, resettlement programs. Minnesota has a lot of community organizations that do resettlement work, and we happen to be one of the established clinics, where that work has been going on for a really long time. So, we just end up seeing a lot of brand new refugees through that... through that path.

Emily Silverman
So, when you sit down with somebody who's just arrived, is it usually an individual? Or is it an entire family? And what is that more formalized process like? What does it entail? How is that visit or appointment structured? What are you looking for? What are you asking? Are you screening for things? Share a little bit about what that's like.

Tseganesh Selameab
So, when someone comes here through a resettlement program, they've usually lived in a refugee camp, or have, you know, sought asylum in a different country, and have gone through some pre-departure screening that the CDC has recommended. And then, upon arrival, they will be offered a visit at any clinic. But, usually, in Minnesota, a lot of this is done through the Department of Health, where they coordinate the information that is gathered in the pre-departure screening. It becomes a file. So, I talk about it in my story as this envelope. But it really is; it's like blue envelope, that has all the paper documents from their screening exams.

And we're really fortunate in Minnesota, that we have a strong public health department that organizes all of that, and then refers refugees to particular clinics. So, our clinic; there's a clinic in Hennepin County. There's some clinics throughout the cities that are used to doing this work, and are used to accepting those patients. And so, it's very organized. It's not always the case in other states, where it is really that organized. That paperwork can get lost, or people don't get follow-up in the way that they ought to. So, it's... That part is interesting: What you get access to really depends on where you land as an immigrant, what state you end up landing in.

So, they come here. And then, we will sort of follow-up on any chronic medical conditions that they have; get them to specialists if we need to get them to specialists, or to dialysis, or wherever else we need to get them to, and kind of coordinate care for them. And, you know, finish immunizations, and any additional screenings that we have to do as well.

Emily Silverman
I'm sure you've done this many different times, with many different people, from different countries, different settings, different contexts. Different reasons for coming over to the United States. But, I'm wondering if you've noticed any common threads in all of these intake appointments. Like, is there a question that people tend to ask? Or, what do you notice as you work with this population? It's just such a pivotal moment in life, like, this moment of arrival. And I'm just curious if there are, like, themes or patterns that come up.

Tseganesh Selameab
I think the one thing that is consistently true is how "other" the experience is. Even though there's some preparations of what it's like to come to the United States, from wherever you happen to be coming from, it is a completely "other" experience. Nothing about it is familiar, even in the doctor interactions. If you practice medicine in other countries, how you interact with doctors is completely different. Things that we take for granted, like autonomy and individual decision-making, and patients having a right to refuse... All of those things are actually learned skills that happen later.

So, when I see a patient who's really new to the country, there's a lot of just... Like, honestly, just orientation to health care. You know, here's my job. I know I'm your doctor, but you get to say "no", and you get to share in this decision-making. Which is... which is very different. Even when you're going through the IOM prod... The migration process is... It's... If, you know, you have to do the certain things in order to be able to move to the next step, and you have to do these other things to get to the next step. And, all of a sudden, you land in the United States. And, as a physician, I'm telling you, you have autonomy. You get to say "Yes"; you get to say "No". And it's very jarring. In the middle of everything else being jarring. You know, how was milk bought here, versus back home? How do your kids go to school? The language is completely different. You can't just go to the pharmacy to get your medications. You have to deal with the weather, and a climate change that... There's nothing that is familiar.

Every day, you're, like, getting a little more comfortable, a little more familiar. And that process plays itself out in every every... how ever people get here. And, it's really, really hard. Can... You can imagine, right? You know, my parents left their home at 45. I'm 45 now, and if all of a sudden, someone said, "Here we go. Now you're going to live in Belgium. Good luck with that." You know, and just left you to your resources, it's... I can imagine it, but it's a very different experience to viscerally experience it, or watch someone go through that transition.

Emily Silverman
I'm sure, having gone through it yourself, you understand it better than most, and I was wondering if you'd be able to say a few words about coming over when you were 12. And, you know, dealing with the new climate and the new schooling system, with this dream of becoming a doctor.

Tseganesh Selameab
My sister and I ... The unique... The unique part of our story is, we... When we came here, we initially came for the summer. It was going to be a summer trip, and so my sister and I came here very excited. We'd heard all about America. My parents had been students here in the 70s. And we'd watched enough American movies, where we had this romantic idea of what America was going to be like. And so I remember a lot of excitement. Everything that was new was exciting. You know? The... like, one time we discovered that Minute Maid made orange juice, but it also made orange soda. At that time, there was Minute Maid orange soda. Blew our minds! We're, like, it has the same name! But it's totally different! I'm not kidding.

We'd fight over who would step on the little things that opened up the automatic doors, you know. So, we were kids; it was a big adventure. It was just really, really fun. And we didn't understand. It was a... when got out, that my parents really made the hard decision to stay. And so, the adjustment for me, for my experience of it, was exciting, and then supremely disappointing. When you start going to school, and you're like, "Well, this is nothing like what I expected." So there was that transition. For my sister, who was probably way wiser than I was... She's younger than me. She had a deeper sense of what we were entering into, and that sense of loss and kind of anxiety around it, I think she felt more than I did. You know, for me, it was just a ...awesome adventure. And for her, she was more trepidatious, I would say.

Emily Silverman
And in the story, you talk about this idea of “homelonging”. That your patients, you know...Maybe they've been here a short time, or maybe they've been here a long time...that they will sometimes have symptoms, illnesses, afflictions, that are difficult to categorize. And then you notice that when they make a trip home, their bodies seem to, like, perk up in a way? Or, I don't know, maybe the pain goes away or something like that. So I'm wondering if you could talk a little bit more about this phenomenon of homelonging. I think, in an earlier version of your story, you say you wish that there was an ICD 10 code for it, which I thought was really funny. But, talk to us more about homelonging,

Tseganesh Selameab
Yes. I see this in my mom and my dad, for example. I see my mom go home and become this very different person than who she is here. And over and over and over, I've seen it with immigrant patients, especially those who have a... like, a continued strong connection to home. Whether that's family or language, or even politics, if there's something that ties them to where they came from, they... they live with that sense of loss, every single day that they're here. You know, everything is still... Even though it's getting familiar, it's just... doesn't taste the same, it doesn't smell the same, it doesn't look the same. It's just harder to be in your own skin here.

And I guess that I notice it a lot in my parents, and then in my patients. And then, you know, when you go back to what is familiar... Like, for me, it's Target, right? I talk about, in my story, going back to Target. When you go back to what is familiar, your entire being can be present and relaxed, and you can be fully in the space that you occupy, because it jives. It makes sense, with everything else about you.

I've stopped even... I noticed it, and my friend Rachel, who was in the story, and I talked about it a lot. With some of our very chronically ill patients, who are really struggling, who are refugees and immigrants. And how it's just lovely when they do get to go home, because it's more healing than any... anything I can do for them here.

Emily Silverman
I'm sure a lot of it is the sights, the sounds, the smells, just like you said. But, I suspect there's also something deeper there about like, you know, where you came from. And, I can't remember if I shared this with you already, but I'm adopted. And so, for the first 35 years of my life, I didn't know anything about my ancestors. And, it's only been recently that I've gotten some of that information. And, I'm... I think for a long time, I had this attitude that was kind of like, "I don't care," you know; "I don't need a past." But then once I got the information, it was a very emotional experience.

And so, I'm just curious to hear you reflect, maybe a bit, about this idea of, like, ancestry, where we came from. Like, staying connected to that, while also maybe letting go of that, in some way as we evolve and as we change. Like, how do you think about the past, and where we came from, and its importance in our day to day lives?

Tseganesh Selameab
My heart just like, blew up, like. And I didn't know that about you, Emily, but I... I... You've heard about these forests? These trees? So, trees talk to each other, right? They... In older forests, there's this whole under-the-ground, this inner working of, like, webbing, and micro-organisms, and all these things that connect trees to each other. And when you have a really good healthy forest, you'll have a maple and a pine that help each other survive through different... different seasons. So, when one is down, the other one is providing nutrients. And, you have this whole host of micro-organisms underneath too, that are helping with communication. And it turns out, like, the forests that are, like, established, and are interconnected to each other, do so much better. And if you take one of those trees, and, like, plant it somewhere else, it just doesn't do as good. It'll grow, but not in the same way as when it's interconnected to its roots. And, I mean, nature has, like, multiple examples of that. And, we humans are nature. We are part of nature. We need the grounding, and the interconnectedness of us to each other. And, being able to trace that... that... I don't know. I think immigrants are just the closest example to seeing that uprooting happen and watching the sequela of that. Like, yeah. I mean, I'm fine. But would I have been just as fine if I lived all my life in Ethiopia? I don't know.

Emily Silverman
So one thing I liked about your story was that there was an unexpected component, where you talk about getting ready to get married, and going back home. Going back to Ethiopia, and being immersed in the sights and the sounds and smells of the place. And I thought the narrative was going to be kind of like this homelonging narrative, which is, you know, I went home. And then, "Finally, I felt back at home," or something like that. But then there's this interesting twist, where you actually have to step out of the shop, because you're feeling overwhelmed. And you're actually homelonging for the United States, and so there's been a shift. And, for you, home, as you said, is much more complicated. So, I'm wondering if you could speak a bit more to that.

Tseganesh Selameab
My sister and I talk about this a lot. We talk about this, a lot of our immigrant friends, how we are very much "third culture kids". And, there's a sense of not fully being American; not fully being Ethiopian. And for years, I lived in that. You know, I just kind of created my third culture. I took a little bit of this and a little bit of that, and I... I created this third culture, this narrative that I had for myself, but there was always this feeling I held on to, that... But truly, home was Ethiopia, you know. Even though I am... live here, my connections and rootedness were really going to be in Ethiopia. And, we couldn't go back. Just our circumstances. We just weren't able to go back. So, I didn't travel back a lot when I was a kid. And when I went, I was in my 30s. And it was very interesting to me, because there was this initial nostalgia that hit me when I was there. It smells the same. Addis smells exactly the same as it did forty years ago. And there were... You know, my school was still there; my house was still there. And it was very lovely. But that was the trip where I realized I am very, very, very, very American. Home is not there anymore. It's not... It's not there anymore; it's not in Ethiopia. It felt like... It was... It was sad. It was sad, because there was definitely a loss there. I'm like, "Oh, this place isn't... isn't where I'm going to be. It's not where my heart is. It's not where I'm comfortable. It just isn't home anymore."

Emily Silverman
That process of "what home is" changing over time, is that something that you see in your patients too? And do you talk to them about that, at all?

Tseganesh Selameab
So, I have a friend who, who's a genius – Shailey Prasad, who's a genius in Refugee and Immigrant Health – and he actually drew a graph for me on the back of a napkin one time, as we were talking about this. And he talks about how there is this initial excitement, that most immigrants go through. Then, there's a massive disappointment. (So, my experience of this disappointment with this country.) And then, you reach this place of, kind of, a new... a new way of normal; a new way of being. And it changes, depending on the age that you come.

And, for a lot of people though, the same thing happens when they go home. There's this initial nostalgia, there's a massive disappointment, and then they come to this new understanding of their... of their relationship to their new home. So it's interesting, because for some people, the... the bounce up, never comes up as high. So, for some people, like my patient, Hanin, she's like... It's never... It's never gonna be good here. She just... There's not enough connections for her here; there's not enough that she loves here or feels comfortable for her here. It won't be as bad as when she first came, but it'll never be as good as anything that she could get to, when she goes home.

And then for people like me... It's actually harder for me to go to Ethiopia, because it's harder for me to be there, than it is to be here. So, my level of satisfaction, after the initial disappointment, is much higher. America will never be 100% home for me, as it's going to be for my children, or as it's going to be for my children's children. I'm always "other". There's a little... There's always otherness, that is here. But, it's going to feel better for me than if I'm in Ethiopia. Like that... that change. Like, what feels comfortable for me, is not going to be nearly the same.

Emily Silverman
So Tseganesh, if you could leave with a message, or if there was anything that you wanted to say to The Nocturnists audience, what would it be?

Tseganesh Selameab
I tell medical students this all the time. You know, we start off, as first-year students, closer to the people that we serve than any other time in our medical career. And as we move on in training, we start getting more specialized language and more specialized skills. We start becoming very different financially, too. We start earning a lot more money than the patients that we serve. And, we start becoming more and more isolated from our patients, in very unconscious ways. So, it isn't intentional; we're just doing our job. We're just going to residency; we just happen to do fellowship. And now, we're like cardiovascular surgeon.

And, I think, the more we can start as physicians understanding community as us. We are community. I am a mom, who has a PTO, who lives in St. Paul, who goes to this YMCA, and shops at this Target; whose laws of the city really affect me, in the same pool as my patients. I think the more we can understand that, then I think we can do our works with much more joy. And then, I didn't get to say this, but... And then, you realize that you are really deeply held, and loved by your community. I can't tell you how...how many ways... that my community, my patients, have shown up for me.

I'll tell you this quick story. During COVID, our clinic was... When it first started, and we were just figuring out protocols on what was safe and what wasn't safe. As doctors, we were doing the screenings at the front door of my refugee and immigrant clinic. And one of my patients, who's a Somali man (who himself is challenged; he's an amputee), had come to the clinic. Had come up the stairs. I remember him, on his crutches, coming up the stairs. And he had sat down. I was trying to use an interpreter, but it wasn't going well. I think he came for a refill. And he's points to the mask. And I say to him, I'm like, "I'm sorry, I can't give you a mask. I don't have any to give you." And I, like, kind of move my hands like this. And he leaves. And then, soon after, he had gone to the store, and bought two masks and brought it back for me, because he wanted to make sure that I was safe. He was, like, "You told me you didn't have any masks, and so I went and I bought masks for you." And, I just have never felt more held than when he did that. So, our community just shows up for us. And so, it eases some of the work that we... that we do as physicians.

Emily Silverman
Tseganesh, it's just such a joy to... to chat with you, and to hear your story, and I cannot wait to give you a big, big hug in April, in Minneapolis, at our live show.

Tseganesh Selameab
Thank you Emily and the whole Nocturnists crew, for creating and holding space for all of us. And you're part of the community that holds us up. So, really, thank you.

Emily Silverman
I have been speaking with Dr. Tseganesh Selameab. Tseganesh, thank you again.

 
Season 5The Nocturnists