As part of an ongoing series of interviews with people who are partnering with the Phoenix Zones Initiative, I had the opportunity to talk with Dr. Amy Zeidan. Amy is a trailblazer inside and outside of medicine. She is an assistant professor at Emory University School of Medicine, and she received her medical degree from The George Washington University School of Medicine and Health Sciences and completed an Emergency Medicine residency at The Hospital of The University of Pennsylvania where she was Chief Resident. Amy is passionate about healthcare delivery and outcomes for refugee, immigrant, and asylum populations. Her research focuses on barriers to acute care for refugees, immigrants, and asylum seekers, and she is a cofounder and director of the Society of Asylum Medicine. Additionally, she holds a national position with The Academy for Women in Academic Emergency Medicine (AWAEM) and serves as Finance Co-Chair of FemInEM, and she is committed to addressing gender inequities in medicine.
HF: You’re trained as an emergency medicine physician but much of your work extends beyond emergency medicine and beyond medicine more generally. Tell me about the balance of professional responsibilities you maintain inside and outside of medicine.
AZ: I was initially drawn to emergency medicine because I view the emergency department as a lens to the social constructs and challenges of our healthcare system and our society. As emergency room (ER) clinicians, we provide a safety net for patients, particularly vulnerable patients who feel they have limited options other than the ER. We see the ugly and the beauty. We see so-called “frequent fliers” who either have multiple comorbidities that require near daily medical support or individuals who have such significant food, housing, employment, or financial insecurities that the emergency department (ED) becomes their most accessible source for social services, food, and safety.
As a result of my “day” job as an ER provider, I feel an urgent need to advocate for patients outside of the emergency department, where many of their health disparities that bring them to the ER start and flourish. My work outside of the ER fuels my ability to engage on shift and it makes me better equipped to support the social needs of patients in the ER. Without my outside work, I think burnout would be inevitable given the challenges we face as physicians navigating the complex healthcare system.
In medical school, I learned about the pathophysiology of disease. In residency, I learned about the pathophysiology of healthcare disparities. Now as an attending physician, I am learning about how structures of racism, sexism, and classism catalyze and perpetuate disease. Since many of the problems I see in the ER start outside of the ER, my responsibilities now push me more toward dismantling structures of injustice and poverty. I think, for me, it is more about integration instead of balance. The ER is a microcosm of our society and connecting the ER to the outside world helps me make sense of things.
HF: How did your early experiences in life influence your career path and your advocacy interests?
AZ: My first month of residency was a one month intensive care unit (ICU) rotation. My first patient was a woman from South America who was five years younger than me. She had a young child, and a concerned family in her home country—none of whom she could see because the sequalae of her disease required her to be isolated. She had spent weeks in the ICU previously and she had showed no signs of improvement. The underlying cause of her illness could have been treated with a lung transplant. When I assumed care for her, I inquired about her status on the transplant list. I learned she was not eligible because of her status as an undocumented immigrant. She wasn’t even on the list. Every day, a new problem would arise and she decompensated rapidly. One morning, she worsened acutely and all interventions had been exhausted except for comfort care (palliative care). The day before, she asked me to take a picture of her without any medical equipment so her son could remember her as close to normal as possible. I told her there was no need as we were planning a surprise for her son to visit the following day….a visit that required multiple hurdles, phone calls, favors, and days of planning. She did not live long enough to see her son. I held her hand and sobbed for hours until she stopped breathing.
While this experience may seem extreme, there are countless other situations in which patients receive inadequate care because of vulnerabilities beyond their control. In this case, citizenship status. We do our best as physicians, but we often don’t truly understand barriers faced by individuals seeking refuge in the United States—individuals who have been displaced and often persecuted because of their gender, religion, sexual preferences, or simply because of where they were born.
There are so many important issues we can and should advocate for as physicians. My advocacy efforts focus on reducing barriers to care that refugees, immigrants, and asylum seekers often face.
HF: Early in your career, you have already become a champion on human rights issues, particularly for individuals seeking asylum. What drives your work in this area and what do you hope to accomplish in this area in the future?
AZ: I am driven by the hope that every asylum seeker has a chance at freedom. That I may play a very small role in an individual obtaining asylum status is beyond incredible. The stories of asylum seekers drive me. I think about how many individuals are currently being persecuted due to factors beyond their control and who do not have the option of asylum. In many of the asylum cases I have assisted with, the fear of return for individuals is debilitating. A forced return is often equivalent to a death sentence. Conversely, the joy of being granted asylum is overwhelming.
Our current asylum process is being threatened unnecessarily and unethically. I hope to not only uphold current asylum standards but expand asylum protections. A lot of great asylum work is possible in progressive states, where communities of advocates are doing great things together. I hope to unite communities in locations where asylum grant rates are less favorable, and to hold elected and appointed officials accountable.
Additionally, I hope to reduce barriers to care faced by asylum seekers and to improve their experiences in seeking acute care. A few years ago, I read a study conducted at an urban ER in New York City in which the authors attempted to identify the prevalence of survivors of torture in their ER. They found that 11.5% of their patients self-reported a history of torture. I suspect this number is much higher given the language barriers and disclosure challenges patients may face when self-reporting. As ER physicians, we are skilled at evaluating victims of acute trauma. But we often forget about how prior trauma affects health and health outcomes of our patients. I think about how potentially traumatizing a visit to the ER may be for patients who are survivors of torture. I suspect that we unknowingly treat survivors of torture frequently in the ED and I push myself to think about a trauma informed approach to care in the ER. My asylum work has helped me think about this approach, and how to identify prior trauma and treat patients with a history plagued by displacement and persecution. I hope to establish standards and best practices in the care of refugees, immigrants, and asylum seekers in the emergency department.
HF: In addition to caring for vulnerable people, you are also concerned about the treatment of animals. How did you come to include animals in your scope of personal concern?
AZ: This is an important question and one I am still figuring out. It finally made sense when I read your book, Phoenix Zones, as you wrote so eloquently about a connection I had been feeling. What I interpreted was an alignment with the mistreatment of animals and mistreatment of humans, and the union of animal rights and human rights. To mistreat a human or an animal suggests the capacity for personal violence with a foundation of structural violence. Only by addressing both can we fundamentally change the pillars of violence that propagate hate. I often think about the existence and development of emotions in species. Do all species feel, and to what extent? How do we know? Our two incredible dogs, Rolo and Bosco, have taught us a lot about both human and animal needs. To be loved and protected, but also to be part of a pack—a community. The community unit seems to be very essential. Rolo was our companion during the long grueling hours of residency. Bosco recently entered our lives and his presence is beyond transformative. He was surrendered at eight years old and experienced terrible anxiety and depression in a shelter. He was rescued and fostered by my incredible best friend and his dignity has returned. He reminds us that the process of recovery is arduous yet joyful and that everyone deserve a chance to recover.
HF: You’re a very calm yet energetic and outwardly optimistic person. It’s a combination of qualities that was apparent even when I first met you years ago. What fuels your optimism?
AZ: I have wondered this as well! The easiest, and maybe somewhat honest response, is I don’t know. Recently I have needed more avenues for recharging my optimism. It is multifactorial but can be broken down into short-term and long-term drivers. In residency, I worked at an amazing clinic, Puentes de Salud. Our patients were primarily under/uninsured, 99.9% spoke Spanish as a first language, and their gratitude was overwhelming. Working at Puentes is what allowed me to return to ER shifts feeling like my tank was full. Many of our patients had significant barriers to care and Puentes gave them a safe and just space built around reaffirming dignity. Along the same lines, my work with individuals seeking asylum restores my optimism. Hearing their stories, witnessing their perseverance amidst pain, and sharing their joyful relief after being granted asylum reveal a real truth that is often overlooked.
But there is more that deeply sustains my drive.
When I was a teenager, my brother died unexpectedly as a result of a hunting accident. While I could write endlessly about personal loss, grief, and long-term sequalae, what comes to mind, in addressing your question, is survivor’s guilt. Survivor’s guilt is the guilt one feels when someone close to them dies because they lived. I remember feeling perplexed for years about why it was my brother and not me. I did in fact feel guilty that he died and I lived. He had so much promise and potential. The manner in which he colored the world was a work of art. So I have tried to transform my guilt into action. To the best of my abilities, I try to do the work he would have wanted to do in the ways I can. Our talents and art forms may be wildly different but I feel a drive every day to live his purpose in addition to mine. It almost seems easy to move forward optimistically when such a purpose is fundamental to my being.
HF: Thanks, Amy, for taking the time to answer my questions and for all you’re now doing for people and animals. I feel privileged to work with you on a variety of projects.