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Becoming the First Neurointensivist in My Country

By Dr. Toufic Chaaban

It was 2:00 AM at Beirut-Rafic Hariri International Airport, moments before a long trip to the United States. I was drinking coffee and trying desperately to distract myself. At the time, I was 30 years old, recently engaged, and a fresh graduate in pulmonary and critical care. I was on my way to begin a U.S. graduate medical education program on a J-1 visa for subspecialty training in neurocritical care.

After enduring hard, emotional goodbye moments with loved ones, I did not engage in productive self-care. Instead of thinking positively as I was about to embark on my journey, I sat worrying about a number of things…

Is my paperwork complete? Will I be denied entry? How easy is it to get furniture, a phone number, power, and a driver’s license? As a Muslim, Arab, international medical graduate (IMG) how I am going to be treated? Am I going to prove myself in the program and show excellent medical knowledge and clinical reasoning? What if I feel lonely or I do not fit in? Dear reader, if you feel heaviness already from all these concerns, this is a sample of how I felt, but please bear with me. After three connecting flights and a total of 18 hours of travel time, I was lucky to have my friend waiting at the airport. Finally, a familiar face!

With the program director and the neurocritical care co-fellows

In the first weeks after my arrival, I realized that America makes it easy to settle in. You can set up your electrical power, renters insurance, and car insurance by phone. You can furnish your apartment by one Ikea trip, and you can get a driver’s license if you know how to drive. All can be done simply! Moving was easier than expected and I quickly realized that I did not need to worry much. I was feeling confident, that is until I learned that I had to self-serve at the gas station! What? I had never done that before. In my country, service station employees do that.

Starting my fellowship did come with another set of worries. I had come from a very familiar environment and had known many in my work environment at the American University of Beirut Medical Center where I had spent six years. I was also used to being a trusted contributor and having my opinion valued. As a pulmonary critical care fellow there, I was a team leader.

Presenting at the Neurocritical Care Society meeting

When I joined my training program at Ohio State University, my colleagues didn’t know me. They may have wondered what I knew, whether it was safe to leave me with patients, and whether they could trust my opinion. Thankfully, I had very supportive program directors, Lebanese friends, and great co-fellows.

Gradually I stopped worrying. I began to really enjoy training, and became focused on learning, teaching, and building trust with all members of the multidisciplinary team. I progressed well and reached the point where people seemed to be happy and relieved when I was on call. Never did I think I would love neurocritical care that much, nor did I know how crucial, broad, and deep the subspecialty is. I gradually came to realize that not only did I enjoy the training, but also the company I was keeping. I enjoyed sharing with people about Lebanon, Islam, my family, food, and culture. It turns out food always brings people together! Watching television series, movies, and documentaries gives you an idea as an IMG about the United States before you land there, but don’t expect people there to know a lot about you. I often had to explain where Lebanon is and clarify, for example, that it is not a desert!

In retrospect, most of my premonitions were not justified—except one, homesickness. Missing family has ebbs and flows, but doesn’t really go away. It can be eased with a video call, a shawarma sandwich, or meeting Lebanese friends. In my case, having my wife with me for three months in the summer helped, but only temporarily. It was hard to miss holidays, birthdays, gatherings, and funerals back home.

Gathering with the work family

As my training year came to an end and I was about to graduate, I found myself reflecting on much I really did love my new family at the Ohio State University Neurocritical Care Unit and I knew how much they loved me. I had such a sense of belonging. I had even become an Ohio State Buckeye fan! Leaving was an emotional time for me and there were many tears. I relive this feeling every time I look at the gifts and souvenirs I received before departing. I quote from my departing message to the team: “I feel I am leaving home to go home; you are family now. I am sad to leave my immigrant Camry car, but I am happy to take with me great memories, and a lot of new friendships in addition to my certificate.”

Gathering with Lebanese and Syrian friends

Now, I am back in Lebanon, not only for my family but also for my country and my people. Despite the economic and political crisis here, I am happily working in a tertiary care center, the Lebanese American University medical center, and I am the first practicing neurointensivist in the country. I see a lot of potential to make an impact, create a difference, educate and raise awareness in the country and the region about neurocritical care. I am thankful for the training I got in the United States.

I was lucky to have a beautiful, fruitful experience. While I am happy to be back in Lebanon, I don’t regret anything about my time in the United States. I have simple advice for anyone who is ready to engage in an exchange visitor program: worry less and enjoy the journey.