1. Contillo, Christine BSN

Article Content

"Should I ask Ms. Patel if Priyanka is a good eater?" I asked Francine. "Maybe we should ask her if Priyanka watches too much TV," she suggested. Although Ms. Patel and her three-year-old daughter had yet to be called into the treatment room, Francine and I, colleagues at a vaccination clinic for pre-schoolers, had seen the girl in the waiting room.


Priyanka was chubby and getting chubbier with each visit.


We'd seen Ms. Patel and her three small daughters a few times in our clinic. Ms. Patel arrived in the United States with her husband and two eldest girls just two years before. She still wore a traditional sari and had waist-length black hair pulled into a long braid. Her English wasn't strong; she was inclined to answer with a nod. If necessary, she spoke in nearly a whisper. Her girls were shy and well-behaved, dressed neatly in Western-style clothing. They had kohl-dark eyes and musical names. Even to them she spoke quietly.

FIGURE. No caption a... - Click to enlarge in new windowFIGURE. No caption available.

But this afternoon Francine and I wanted to know more about the family's habits. We debated about how to get the information we needed without making Ms. Patel defensive.


Dr. Fitzgerald, our medical adviser, decided to take the direct approach. As mother and daughter entered the room, Dr. Fitzgerald looked at Ms. Patel, pointed a finger at Priyanka, and said "What are you feeding this child?"


"Muffins," Ms. Patel whispered.


"How many?" demanded Dr. Fitzgerald.


"Sometimes three, sometimes many more."


Dr. Fitzgerald shook her finger. "No more muffins," she said. "No more muffins," she repeated. Francine and I remained silent, as did Ms. Patel, who lowered her eyes to the floor.


When Ms. Patel and her young family didn't show up for their next two appointments, we weren't surprised. Our phone calls and postcards went unanswered, and we labeled the charts "lost to follow-up."


Several months later there was a knock on our office door: it was Ms. Patel and Priyanka. The change in the girl was remarkable. We'd expected a chubby little girl to follow her mother through the door; instead, Priyanka was taller and considerably slimmer. We all oohed and aahed over her, smiling and pointing at the same time. Priyanka loved the fuss, and her mother giggled with delight. But at the end of the visit Ms. Patel pulled me aside. I'm still not sure why she chose to speak with me that day; maybe I was just the one who smiled more.


In halting English she asked to confide in me. Her voice was strong as she explained that she hadn't seen her own mother in more than two years, had no one to ask about child care, and was afraid to admit her inexperience. She was overwhelmed by her limited finances, by the needs of her young daughters, and by her desire to make them Americans. Her closest contact with American culture was her husband; he worked long hours in a bagel shop and brought home bags of free, day-old baked goods. "My husband," she sighed, shaking her head.


"My husband told me that all Americans ate muffins."


Ms. Patel haden't allowed her daughter unlimited baked goods because she was a bad or lazy mother. In her quest for assimilation, she believed she had discovered the perfect recipe: a high-fat, calorie-laden, oversized chocolate-chip muffin. And in a roundabout way, she was right; reaching out to a stranger brought her one step closer to her own assimilation.