You grew up in Karachi, Pakistan, and attended medical school there before working as a family physician in Abu Dhabi for many years. What inspired you to focus initially on family practice?
I got married soon after medical school and moved to Abu Dhabi (AD), as my husband was an engineer based there. However, I did go back to Pakistan to train in Internal Medicine and Pediatrics. Back in AD, after passing the Ministry of Health Licensing exam, I realized during my job search that there were only a handful of female doctors in the private sector and just a couple of Pakistani female physicians. There was a huge need for a female PCP in the expatriate community not only from Pakistan, but India, Bangladesh, the Arab World, and the African Diaspora.
Additionally, modesty prevented many women from consulting or being examined by a male doctor, even for minor ailments. I felt that I fulfilled a need for a female doctor from a similar ethnic background, who spoke their language and had a better insight into their health concerns. I enjoyed every minute of it as I got tremendous respect, affection, and appreciation from all my patients, irrespective of age, gender, and ethnic origin, including multi-generation families. Those were halcyon days.
You’ve worked in three countries on two continents and speak a wide variety of languages, including – most recently acquired – Spanish. How does being able to communicate with patients in their native language impact your ability to care for them?
To use a cliché, since the world is a global village, it is paramount that physicians learn a few words and phrases of the native languages spoken by the patient populations they serve. For myself it made a huge difference in establishing an effective and beneficial doctor-patient relationship. The patients are more amenable to your advice and concerns if they feel you are truly making an effort to communicate effectively and trying to understand their cultural nuances. I grew up trilingual (Urdu, English, Punjabi) and learned Hindi, Bengali, Arabic, and a smattering of Pashto, Farsi, and Malayalam during my sojourn in AD. In America I learned to conduct a preoperative evaluation and some general conversation in Spanish.
Why did you ultimately decide to specialize in anesthesiology? Where were you practicing at the time and how did you go about switching gears (education, training, etc.)?
Switching specialties from family practice to anesthesiology entailed many challenges, not least of which were moving to a new country in a different continent and having to prepare for the USMLE exams, all while having a busy private practice and raising three children, one of whom was an infant at the time. I really had to burn the midnight oil, as there was no time during the day to hit the books. I had to travel to Singapore to take Steps 1 and 2, as that was the closest center where the exams were conducted (in 1997 at least).
I was really lucky during the application process for residency, as I got 25 interviews and two pre-match offers.
Residency had its own challenges as I had to switch from independent practitioner to undergoing training in a totally new field. My ego took many hits, but I am eternally grateful to all my mentors at Cook County Hospital, Chicago, especially Dr. Eric Pedicini and Dr. Shakuntala Krishna Kutty, for their humor, patience, skill, and forbearance in making me the anesthesiologist that I am today.
I chose anesthesiology as a challenge to myself, as we were not taught any didactics in that specialty and the rotation was only ten days long during medical school. It was the specialty I knew the least about during medical school and subsequently.
The hardest part of moving to America was winding up my practice and saying good bye to my patients. They cried, begged , cajoled, and implored that by leaving AD I was orphaning them. It was gut-wrenching then, and still tugs at my heart strings now.
Somehow in addition to all this travel and training you managed to have three kids along the way! What strategies did you use to stay centered in times of stress?
My children were very young when I moved to the U.S. My husband was still working in AD, so I was a single parent for many years. I might have floundered but for a multilayered circle of support from friends and family who took up unasked – the task of caring for my children when I was not present.
I was close to giving up a couple of times, but The Quran enjoins us, "to seek help through Patience, Prayers, and Perseverance," and I made that my mantra.
Finally, you’ve also published a novel! Uphill features a young Pakistani couple that marries against their parents’ wishes. Do you have a rebellious side and, if so, how do you think that has played out in your own life?
Like anesthesiology, writing is another calling and passion of mine. Uphill flew out of my pen and wrote itself. It's very gratifying to get positive feedback and receive constructive criticism about it from my readers. I have tried to capture the indomitable human spirit. Even though it is based in Karachi, Pakistan, it is a global human story that has resonated with my international clientele and is garnering five-star reviews on Amazon.
My parents were university professors, and they taught me to think independently, to doubt dogma, to have a set of core principles, to stand up for myself, and always to have the courage of my convictions. It's hard for me to see injustice, wrongdoing, or discrimination without raising a voice against it. I have suffered some worldly losses and professional setbacks due to taking a stand and speaking truth to power. In the end I have to live with myself and can truthfully say that I have not blotted the Salahuddin Escutcheon.
Is there anything else you’d like to cover that we haven’t asked you about?
I did my fellowship training in pediatric anesthesia, as I feel that infants and children have an additional layer of vulnerability as they pass through the peri operative course. It is my extreme privilege to take care of all my patients, especially my pediatric patients.
I am currently writing another novel about anesthesia and the OR, as I have not come across much literature narrating from the anesthesiologist's perspective. It is my humble effort to take control of our narrative.
Zohra Salahuddin, MD, is an anesthesiologist with the Lehigh Valley Health Network in Allentown Pennsylvania. She was born and raised in Karachi, Pakistan, where she received her medical degree from The Dow University of Health Sciences. She worked as a family physician in Abu Dhabi, United Arab Emirates, for 14 years before switching to anesthesiology in 1997. She is also author of the novel Uphill, published in 2016.