Volume 60, Number 3 - Summer 2009

 

By Nikola Lozanov, MD

I am a son of Bulgaria, a small country in the southeastern corner of Europe, mostly ignored by the media and tourists. I had a long and complicated journey from my obscure homeland to the great land of America. Like all immigrants, I had to venture through time, culture and an ever-changing fate.

My upbringing began in a setting similar to the area I now call home in Petaluma. The Bulgarian countryside is beautiful and green; orchards and groves were my natural surroundings. My roots are in farming on my father’s side of ethnic Bulgarians, and in pastry-making on my mother’s side of ethnic Turks. Both my parents had strong values of hard work, honoring the land, and serving people. I was raised on the outskirts of Sofia, the capital of Bulgaria, by a Christian father and a Muslim mother living in an officially proclaimed atheistic society—one of the many paradoxes of my youth. 

During my youth, Bulgaria was part of the communist bloc, after 500 years of Turkish Islamic rule and a brief period of a “free market” monarchy. The Cold War was underway, and paranoia of Western imperialism made many societies fall victim to their own governments, which in turn severed connections with the outside world. 

After starting school, I had to move from the green paradise of the Bulgarian countryside to a suburban neighborhood of concrete cubicles with central heating. Every day I took the tramway to downtown Sofia to do my schooling, dreaming of all of the places in the world I would like to see. I had deep curiosity and an eagerness to know the world. After graduating from high school, I served my mandatory two years in the Bulgarian Army and then enrolled in the Medical University of Sofia. 

When the Berlin wall finally collapsed with great noise and amazement in 1989, chaos followed in the streets, and a metaphorical earthquake ended the Soviet empire. My parents and sister immigrated to California, leaving me behind to finish medical school, in the care of the most amazing people in my life, my generous and self-sacrificing Turkish grandparents. 

Bulgaria changed while I was in medical school. Under the old socialist system, despite its many shortcomings, we had decent free education and health care. But when socialism was replaced with a market economy, Bulgaria went from a middling system to no system at all. The earthquake of change left the administrative and social structure of society in rubble. A few people became wealthy, but most were destitute, including intellectuals, professors and doctors, who had to find work as taxi drivers and small-business owners to support their families. The widespread corruption forced many young people to flee the country, leaving behind their homes and professions to make a new life. 

The U.S. Immigration and Naturalization Service made it hard for Bulgarians to travel to America or immigrate there. After multiple attempts to join my family and humiliating rejections at the American Consulate in Sofia, a miracle happened and I got the precious visa in my hand. I landed at the Newark, New Jersey, airport in 1997 with almost no English. That was the start of the American chapter of my life. 

Between the immense culture shock and the rapid immersion in English, my head was spinning; but I was happy to be reunited with my family in the Bay Area after almost seven years apart. The next challenge was to start working, but foreign-trained doctors cannot practice without completing a U.S. residency, so I started volunteering in the Oakland Children’s Hospital Emergency Room. The liability system made it impossible for me to even draw blood. (Despite the increasing shortage of physicians in the United States, various administrative and bureaucratic challenges force many foreign-trained physicians to deliver pizza or pump gas.) After passing my medical board exams with the financial help of my parents and various odd jobs, I began applying to residency programs.

Then I met my wonderful wife, Corinna, a true American “mutt” with her roots in Norway, the British Isles, Lithuania and Latvia, to name a few. She became my helper and supporter. We lived in Berkeley while she finished her graduate studies at the university and worked in San Francisco. I started seeing more and more of the world through the eyes of an American and slowly moved toward the hopeful promise of a future as a doctor.

After much sweat and stress, I was accepted into the family medicine residency at SUNY Buffalo. This event was followed one month later by the wonderful news that we would have a child. Months later, that blessing was overshadowed by intense parental fear after the infantile seizures of our daughter, which, ironically for a Bulgarian doctor who grew up in socialized medicine, continues to make her “uninsurable” by private American companies. 

The residency was tough and often humiliating, not unlike my experiences in the Bulgarian Army. Often I was anxious in the morning to face another day of mental torture by the senior residents and hostile nurses. After three long, cold years in Buffalo, our family—which now included both our 2-year-old daughter and an infant son—headed back to California, the land of our dreams, along with its high cost of living and low reimbursements. We wanted to be closer to family, friends and professional contacts, and we loved the Bay Area.

For the first time in my life—after long schooling, two medical diplomas, and immigrant limbo—I could finally see the prize. I didn’t know what opportunities there were for family physicians beyond the federally sponsored health clinic where I did my practicum and the university hospital where I did my training. Nonetheless, I went on several interviews, but I obviously did not fit the typical American physician model. The experience of rejection ultimately made me stronger and helped me refine my goals and interests. During this time, I discovered my passion for private practice, where I continue today.

Nothing, including my residency, could have prepared me for the challenges of private practice. But somehow, like a sailor in the open sea, I find I possess the survival skills I need. I am inspired by my connection to my patients and the smiles on their faces, and by knowing that they trust me with their well-being. I feel that somehow the struggles of my youth and the challenges of immigration prepared me for the difficult job of practicing medicine in this country. 

One day I may reach dry land, but for now I am happy with the opportunity to continue the journey. The hidden rocks and the troubled sea of medicine, coupled with the delight of my family and my patients’ health, are the salt and essence of my Great American Adventure.

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