Give Me Another Letter

“What’d you learn today?” Mama asked in Arabic.

“Ehhh, we just did some lower limb stuff. Nothing exciting. You want a quiz question?”

“Sure! But nothing too hard. It’s been a while since I’ve learned this stuff.”

I gave a halfhearted laugh. “Tell me, what is the name of the structure that the head of the femur inserts into?” I said, speaking clearly to ensure she understood the question.

“Hmm, I know this one.” A long pause. “Don’t tell me…actually, give me a hint. What’s the first letter?”

“A,” I said. “You got this! I know you know this!” “Hmm, okay, give me the second letter.”
“ACETABULUM!” she shouted.
The joy in her voice made my day.

Mama is the smartest person I know. In Egypt, where my family is from, all high school seniors are required to take a standardized exam, the scores from which determine the careers young people can pursue. Of the quarter million students who took the exam in 1983, Mama finished in the top hundred. Her score of 96.5% surpassed the national minimum score of 89% required to enter medical school. She enrolled in College of Medicine-Tanta University, a respected medical school nestled in the Gharbiya Governorate of the Nile Delta Valley.

As a medical student, her work ethic was unmatched. She was a “gunner” long before I knew the term. She quickly soared to the top of her
medical school class, granting her the freedom to pursue any specialty when the time came to choose. Her male classmates would whisper snide remarks to scare her away from competitive specialties they also wanted. “Don’t you think Ophthalmology would be hard for you, especially as a woman who wants a family?” they’d ask. My mother saw through their games, working hard to edge them out when it came time to begin residency.

She went on to correct countless cataracts and corneal abrasions as an ophthalmologist. She managed many difficult cases, the most memorable being a young boy from the countryside whose eye had been impaled by the horn of a water buffalo. Her attention to detail and compassion towards patients catapulted her to the top of the Egyptian medical community. In 1996 she landed an opportunity to pursue a PhD in the United States. As is the case today, an American education was one of the greatest honors an Egyptian professional could receive. The decision to leave was easy.

It took years for my parents to adjust to American culture, but they learned to navigate its currents in snowy Syracuse, New York. The PhD program kept my mother busy, testing her ability to be a mother and professional at the same time. I remember afternoons with my younger brother, Omar, spent spinning on laboratory chairs, trying to mimic the centrifuge reactions she was performing. Mama, hunched over a microscope, would periodically glance over at us, flash a smile, then resume her work.

After earning her PhD, Mama took a part time job at the Syracuse Eye Center while studying for the dreaded USMLE exams. She knew her stuff—she had been a practicing physician in Egypt, after all—but the adjustment to practicing medicine in English coupled with the speed of the exams made them more challenging. It took her three tries to pass Step 1, and she made easy work of Step 2, passing both the Clinical Skills and Clinical Knowledge portions on her first attempt. Step 3, however, proved a different monster. By 2013 she had failed the exam two times, and was slowly building herself back up emotionally to take it a third time.

As each exam required months of preparation, Mama grew nervous that her age (midforties at the time) would make her an undesirable candidate for residency. Having been removed from clinical settings for over a decade, she pursued an internship in Chicago to make herself competitive. She shadowed family medicine and internal medicine doctors, splitting her time between the small suburb of La Grange and the city’s south side.

Around the same time, my father suffered a serious cerebellar stroke. He spent months in the hospital with Mama glued by his side, meticulously doublechecking all the medicine that went into his care. His rehabilitation plan was no small undertaking, requiring a strong support system to see it through. With my brother and I in college, the burden of his care mostly fell on her. I pleaded with Mama to allow me to take time off from school to help her care for him, but she insisted I stay. Nothing more important than education, she reminded me.

As the years passed and with my father’s condition gradually improving, Mama, then approaching 50, found herself in a difficult spot. Her heart longed to practice medicine again, but she knew my father’s dependence on her wouldn’t allow for it. She came to terms with her situation, spent every night in prayer, and eventually made peace with the fact that she would never practice medicine in America. Yet there was still one thing left to do: pass Step 3. She might not be able to practice, but she had every intention of proving to herself that she could pass that exam.

Mama studied hard during any free time she had. I’d often catch her buried in her heavily annotated copy of First Aid, eyes closed and whispering back the material to herself with a cup of tea in hand. She took the exam during the summer of 2014, a couple months after my college graduation. When the scores were finally posted, Omar and I were out watching Guardians of the Galaxy. When we returned, an echo of sobs resonated through the house. We found Mama curled on a couch in the family room, eyes swollen. She had failed the exam—by one point. One point. I’ll never forget the image of Omar holding Mama on the couch, trying to console her, as she hysterically proclaimed herself a failure. My heart hurt for the patients that would never experience her care. I grew bitter towards the medical system that made it so difficult for immigrants to succeed. And I was sad for Mama, the most selfless, loving, caring human being I’ve ever known. If anyone deserves to have happiness in this life, it’s her.

Life went on for Mama, but the memory of that exam still haunts her. Sometimes while on Facebook scrolling through her newsfeed, a post from one of her former medical school classmates will pop up. Many are respected doctors, some associate professors at large universities. Upon seeing their titles, my mom can’t help but wonder how successful she would have been had she never left Egypt.

In search of new opportunity, my parents relocated to Northern Virginia in the summer of 2016. While packing their belongings, Mama came across a crumpled edition of Egypt’s AlAhram national newspaper in the bottom of a coat closet. On the front page was an old photo of Mama dutifully half smiling. Her flowing black hair is pulled back tight. Her picture was the first of three rows of black and white photos of young people, each being recognized for a different academic achievement. The caption to Mama’s portrait read, in Arabic, “Heba Abdelmaksoud, top 1989 medical graduate of Egypt.” I asked Mama about the picture.

“Sometimes, whenever I am down, I like to look at this picture to remind myself of where I used to be,” she told me.

I wish my mother could see that she is anything but a failure. Failures don’t raise children who go on to become journalists or medical students. Even today, when I catch myself complaining about an upcoming exam, I think of Mama’s arduous journey. I understand that where I am today is a direct result of her foundation and example. Sometimes, when I smile at patients, and they smile back, I like to think it’s her essence they are smiling at.

Following most days at school, I make the short walk to my bus stop directly across the street from the Moran Eye Center. On one particular day, the wait for the bus was taking longer than usual. As I rummaged through my book bag for my headphones, I realized I had forgotten my daily call to Mama.

She picked up after the second ring. “One day, habibi, when you finish with school, I will be your first patient,” she said.

“I got you!” I replied. “You ready for today’s question? Which cranial nerve innervates the trapezius?”

“Spinal Accessory Nerve!” she exclaimed, without asking for a letter.

MED '20

Ali Etman, MD is a Family Medicine Resident at the University of Arizona College of Medicine-Phoenix. Originally from Syracuse, New York, he enjoys playing pickup basketball, indulging his sweet tooth, and sharing his story through spoken word, rap and short stories.

Rubor Participation:
2020 Story, "The Unspoken Fraternity", web edition
2019 Story, "Snoop"
2018 Staff
2017 Short Story