Immigrants, the Emergency Physician and the Election Day

The most recent Election Day — extraordinary in so many ways — seemed a typical Tuesday inside the emergency department (ED) at Elmhurst Hospital Center in Queens, NY. We weren’t busy, but within hours I had treated patients from five continents. We used staff interpreters to speak to patients in Spanish and Mandarin, as well as the phone-based “language line” to converse in Russian, Bengali and Fujianese. Recent data show that 71% of residents of the Elmhurst neighborhood are foreign born, the highest proportion in New York City.1 Although our ED that day reflected this, each additional language seemed as commonplace and fitting as each new laceration, motor vehicle collision or appendicitis case. By my next shift three days later, Donald Trump had become the president-elect and I realized how directly my patients and practice could be affected. During physical examinations, foreign-born patients nervously joked about the heightened possibility of deportation. Mindful of Trump’s campaign promise to remove three million immigrants and to defund “Sanctuary Cities” such as ours, I didn’t know how best to reassure them.2 I would feebly suggest that mass deportation seemed absurd or even un-American. The patients tended to smile back, polite but unconvinced. Beyond the obvious traumatic impact on immigrants’ lives, these deportation threats would also harm the specialty of emergency medicine. The largest and most meaningful studies in emergency medicine typically include urban hospitals with significant foreign-born patient populations.3 More individually, physicians encounter countless immigrants and refugees over their years of training. During my own residency at Bellevue Hospital Center in New York, these patients regularly exposed their personal stories and their ailing bodies to me — often on the worst day of their lives. I would not be the doctor I am today without these people. For emergency physicians — a politically diverse group slightly more likely to favor the Republican Party — the ironies of this immigration debate can be nauseating.4 Contrary to the common narrative of the presidential campaign, immigrants are significantly less likely than U.S.-born residents to come to the emergency department.5 Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York