The Check-in People at the Hospital Make Me Cry


Jimmy Unger, MD1

Perm J 2019;23:18.312 [Full Citation]
E-pub: 08/08/2019


A Somali immigrant describes the painful process of checking in at a medical office in terms that evoke an even more intense emotional response than the traumatic events he experienced in his homeland.


Aden, my son; Ismail, the translator; and I had been waiting in line for a long time. There are some computer check-in machines that nobody is using. I never use those because they’re in English. Even with Ismail helping me, they are hard to use. He’s always a nice guy, like a friend. While we’re waiting, he’s busy on his iPad doing I don’t know what.

“I can help whoever’s (I hear the word) ‘necks’,” says the Check-in Lady, busy at her computer, not looking at me. I think I know what she wants, but I’m hearing something about “necks,” so I take a second to think about what is going on. I have no idea what she’s talking about. In the 8 years I’ve lived in America, I have worked hard at learning English. No way I can figure out why she’s talking about “necks.” We’re here for Aden’s check-up, nothing to do with his neck.

I look back to Ismail for help, but he’s still busy with his iPad. A lady standing in line behind us with her 4 kids understands what the Check-in Lady is saying, because she walks around us in a hurry and goes right to the desk to check in.

I have been bringing my kids to this hospital for check-ups and sicknesses for 5 years. The Check-in People know me. I know what they will want: My Kaiser Permanente card, my driver’s license, and my Oregon Health Card. (The Oregon Health Card is the insurance card they give poor people here.) I am ready. I have seen that almost everybody at this hospital has Oregon Health Cards, but there are some people who don’t have them. They either have their Visa cards or lots of dollars that they pay with. I don’t pay anything when I come here. It seems like the people that pay are always treated better. The Check-in Person smiles at them, calls them by their names, and asks how they’re doing. Me—they don’t smile, they don’t look at me, they look at the translator, always in a hurry. Kind of reminds me of how, in my country, if you bribe the guys with money, they treat you nice. Even if I had the money, I’m not gonna bribe the Check-in People.

The doctors and nurses here—they are nice. They seem to understand me; they listen. They make it so the kids don’t get too scared or cry too much at the doctor. The doctors are like magic sometimes. A couple of years ago, Aden was losing his hair—almost like an old man. I thought maybe spirits were making him lose his hair. The doctor gave us this medicine to drink, and the hair came back!

What I don’t like is the check-in part. I know I’m a grown man. They don’t seem to know that; they treat me like a kid. I’m not stupid, but they treat me like I’m dumb. I’m not deaf, but they talk extra loud, almost yelling at me. I know why; they know I’m not from here. I look different. I’m black, not black like American blacks—I’m really dark. My English is funny. A lot of my clothes are old and come from Somalia. They must think I don’t belong here.

I owned a small store in my country and made enough money. My wife, kids, and I moved to America because it wasn’t safe back there. I took care of my wife and 8 kids, prayed 5 times a day, went to the mosque whenever I could. I come here, and they treat me like a kid. They know I need a translator; my English isn’t that good yet. I know how much I have learned in a short time. I have heard Americans try to speak Somalian. People like me learn a lot faster, let me tell you. Maybe if Americans talked slow and listened to me, I wouldn’t use a translator, but that doesn’t happen.

Finally, it’s our turn. I’ve been practicing in my head, “I’m Mr Mohammed. This is my son, Aden Mohammed, here for his 13-year check-up with Dr ___”. The Check-in Lady knows me and Ismail; we’ve seen her many times. Ismail, the translator; Aden, my son; and I walk up together; I’m ready to speak. She looks up from her computer and looks at Ismail, the translator, and asks him, “What’s he here for today?” Like I’m invisible or deaf or stupid or a little kid. Ismail and she talk quickly, and we get checked in.

While we’re waiting for the doctor to come in the doctor’s room, I start talking to Ismail about how the Check-In Lady made me sad, mad, and feel like a stupid kid. He said maybe I should talk to Dr ___ about it, so I stop talking about it.

The check-up is fine. The doctor says Aden’s healthy, we’re doing a great job, but we need to make sure he sees the dentist soon. He needs a flu shot; that’s it.

The doctor asks, “Is there something else you want to talk about?” I say “no” because I don’t want to bother the doctor with the Check-in People problem. Ismail reminds me that maybe I should bring it up.

I talk to the doctor, telling him the same thing I’m telling you. I’m a little afraid I’m wasting his time. I know he’s a busy guy. Maybe he doesn’t have time to mess with my hurt feelings. He looks kinda mad and stops me after a while. Ismail tells me that he’s saying stuff like, “This is not OK. … Your family is always welcome at this office. … The people here should always make you feel welcome.” He asks if I will talk to one of the bosses of the office. I don’t really want to; I’m starting to want to go home (in Portland, not back to Somalia). I don’t want to talk to some fancy white lady who probably will say the Check-in People didn’t do anything wrong. I look at Aden—he wants to go home. I also know that he wants me not to be a “wimp.” He always is telling me, “Don’t be a wimp, Aabbe” (that means “Papa” in our language.) I say I’ll stay and talk to the office boss. I start crying—hard; it’s hard to stop. Crying like a kid, in front of my son.

I have seen my brothers killed, babies starved, girls raped —never cried with any of that stuff. I don’t know why the Check-in People are making me cry, when all the terrible stuff I lived with in my country didn’t make me cry. I have seen cruelty and many deaths that never made me cry. Came all the way to America, and the Check-in People make me cry.

The boss is not a white lady, but a black guy who seems cool. He listens. I see he’s mad … but not at me. He’s mad at the Check-in People. He asks who checked me in and who talked to me that way. He asks if it happened just this one time or does it happen all the time. I tell him, “Almost every time.” I don’t want to get anyone in trouble, so I tell him, “I can’t remember who did it.” He says he’ll talk to the Check-in People and make sure that I get treated right next time.

As we’re leaving, Dr ___ sees us, thanks us, tells us goodbye. Ismail, the translator, is gone, and Dr ___ says something to Aden. I don’t hear all of what he said, but I hear him say “Dad” and “brave” with a big smile.

I ask Aden what the doctor said.

“Whatever.… Can we go home now? I’m starved.”

He, too, had a smile—you know, the kind teenage boys never want their Aabbe to see.

Disclosure Statement

The author(s) have no conflicts of interest to disclose.


“The Check-in People at the Hospital Make Me Cry” is a slightly fictionalized account of an office visit of one of my patients. The names used here have been changed. The author wishes to express his admiration and gratitude to immigrant families who every day demonstrate courage that allows them to begin to overcome both the trauma from which they have escaped and the new hardships they face in the US. He also thanks the “front-office” and “back-office” staff who take the extra time to help care for these patients daily—often not receiving the praise that they so richly deserve.

Kathleen Louden, ELS, of Louden Health Communications performed a primary copy edit.

How to Cite this Article

Unger J. The check-in people at the hospital make me cry. Perm J 2019;23:18.312. DOI:

Author Affiliations

1 Pediatrics, Northwest Permanente, Portland, OR

Corresponding Author

Jimmy Unger, MD (


Keywords: cultural competence, immigrant experience, immigrant health, Somalia, well-child care


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