The patient, an Iraqi man who spent the past four years in Jordan, heaves himself onto the exam table and settles back, head on the papered pillow. I ask to look at his belly and he pulls up his green knit sweater, then loosens his pants, untucks his checked shirt and tugs that upward, too.
I've seen a lot of abdomens, thousands and thousands, but I'm taken aback by this one. It's riddled with six-inch scars. It looks like graffiti, insolent purple strokes made on the sly. It's illegible to me. The marks aren't from trauma or torture; they're surgical scars in a foreign language.
If you lay a Canadian-born patient on my exam table and ask me totell their medical story from their abdominal scars, I can give a fairly accurate account. The Pfannenstiel incision, a discreet line skimming the pubic area, suggests a Caesarean section. Three short, neat scars scattered over the right upper quadrant point to a laparoscopic cholecystectomy. The one-inch line angled over McBurney's point is almost certainly from an appendectomy.
But examining patients from the world over at the refugee clinic, I've seen many a scar that's baffled me. What surgery could possibly have required an incision running from under the right ribcage, across the belly to the left lower abdomen? What series of procedures would have resulted in a flank criss-crossed with red finger-length scars? Why is the appendectomy scar five times the length I would expect?
The preceding history is often vague. The Iraqi man tells me simply, "The surgery was to stop the pain in my stomach." I order some blood work and arrange an ultrasound to provide some clues.
There is a wildness to these scars. They startle me sometimes, they're so bold and unsophisticated. They make the Canadian medical system in which I am ensconced feel safe, careful, predictable and tame.