"Fine," I replied, "When I finish with the patient I'm seeing now."

It was Monday afternoon and I was in my weekly outpatient clinic. Every week patients come from around the city to my "cardiology" clinic. The fact that I am not a cardiologist but only a medical resident who sits next door to the cardiologist in clinic and consults with him when necessary does not seem to bother the patients, nor, for that matter, the primary care physicians who refer them to me. What is important to these patients and their doctors is the fact that I sit in a university hospital and as such have access to the top levels of academic medicine—including the cardiologist next door.

On this day, the clinic nurse came into my examining room while I was with a patient and said, "There's an old Russian lady outside who came to see you, but she doesn't have a chart here and didn't even bring a referral letter from her doctor. Even though there's someone with her to translate, I can't understand what she wants. I'm going to tell her to reschedule her appointment and come next time with a referral from her family physician."

"Fine," I said.

Since the doors to Jewish emigration from the former Soviet Union opened during the Gorbachev administration, more than 600 000 Jews have arrived in Israel. This emigration has changed the face of Israeli society, with Russian now heard almost everywhere. The health care picture has changed no less dramatically than the rest of society. In addition to an influx of Russian health care providers, there has come a whole population of patients in need of medical treatment. The Russian patients who fill our emergency departments and clinics are mostly elderly and often have stubborn diabetes, hypertension, ischemic heart disease, and the rest of the chronic maladies that affect the population of the Western world.

Caring for these patients has been a considerable challenge, not only because of their illnesses but also because of the language barrier, and, in some cases, because of a reliance on the part of the patients on their "old country" medications, despite the protestations of their doctors to switch to medicines used here.

Although I had not yet seen my prospective patient, I knew that just to interview her would be no small task, especially because she had come without a referring letter from her doctor. But no sooner had the nurse informed me that she would defer the appointment than she was back in the office telling me that I would at least have to talk to her. I surmised that the nurse's attempt to persuade the patient to reschedule had not gone well, and I realized that I would indeed be seeing this patient today. So I inhaled, looked at my watch, and said, "Fine," as I started to prepare my excuse for being late to my clinic across town later that afternoon.

When my patient entered, I had a hard time persuading her and her companion to sit down. They were both visibly upset. Her companion, an elderly gentleman who spoke broken Hebrew with a thick Russian accent, said he thought it was terrible that they had traveled all the way across town only to be turned away. I assured him that nobody was turning them away, and that his companion would be seen. Only then did they sit down.

My patient was an 85-year-old woman who walked slowly into the room, clutching a cane in one hand and her companion's arm in the other. He, it turns out, was not her husband or even a family member, but rather an elderly gentleman, himself an immigrant, who volunteered his time assisting other recent immigrants who needed help with translation. My patient had been in Israel a few years but spoke no Hebrew and had no family in the country.

I began my interview. The story was surprisingly simple. In front of me was a generally healthy but frail woman, whose medical history was significant only for hypertension that was medically controlled. She noted feeling a little "tired" when she climbed stairs or hills. The reason for her visit? About 6 months earlier she had begun to develop difficulty seeing because of bilateral cataracts. Her vision had deteriorated to the point where she could no longer read, and it was this disability that had led her to seek help. She showed me her appointment slip to the eye clinic for the following week. She was hoping they would offer her surgery. She had come to me because she wanted her heart examined before any eye surgery, to make sure it was fit for the operation, and also to get something that would give it a little boost of strength.

I examined my patient, looked at her electrocardiogram, and tried to persuade her that her heart needed no strengthening, and that I wished on all my patients, as well as on myself, a heart as strong as hers at 85 years of age. I started to write out notes to the eye clinic and to her family physician, and I noticed that all the tension that had been in the room when these two people had entered had vanished. Moreover, each began to express a gratitude that I felt was out of proportion to the service I had provided. As I talked to them, I began, I think, to understand why.

I also moved to this country not long ago. I remember, and still sometimes experience, the frustration, difficulty, and sadness of coming up against a system that is foreign and feeling that one does not have the means to master it. I thought of these people before me, two elderly people who changed countries late in life, for whom a visit across town was a whole afternoon's outing, who had to grapple daily with a foreign language and a foreign society, and who genuinely depended on the system to work for them. While even routine activities may become cumbersome ordeals for the elderly, the ordeal is compounded when one is in a foreign land.

I thought of my patient, whose only request was to recover her ability to read. And I thought of her companion, who dedicated his old age to helping others who had an even harder time than himself coping with their new lives. He assumed a role much greater than that of translator. He became her protector, the defender of her interests in a world that did not understand her. That she would be turned away from clinic, after having planned and traveled for so long, was an intolerable blow to her, and thus to him as well.

What dawned on me as I laughed in the office with this elderly pair was the fact that it was not just the medical service I supplied that made them so grateful. Yes, the news I gave was encouraging, but I sensed that there was more to their suddenly uplifted spirits than simply the relief that comes from a favorable medical examination. In their particular case, the mere fact that I was willing to see them validated the legitimacy of their concerns and their right to be there.

I began to feel ashamed that I would have been a party to their being turned away, and I was glad that the translator-protector had not been so easily deferred. I remembered the days after my immigration when all it took was a smile from a clerk at a government office to cheer me up, making me realize that there was a humanity on this side of the ocean as well. I wondered whether I had just become for these people the smiling government clerk. For a moment we had stopped being doctor-patient-patient advocate and had become simply three immigrants brought together in one room.

The elderly pair stood up. Each warmly took my hand and thanked me. I watched them as they left the room, on their way to the hospital exit and the bus: she clutching her cane and his arm, he walking slowly, carefully supporting her and guiding her way. I finished my charts in a hurry, for I still had to get across town to my next clinic. After about 10 minutes I left the hospital, into the Jerusalem afternoon sun. As I looked down the hospital's front driveway I saw my two elderly compatriots, slowly but steadily making their way to the bus stop.