place of healing or collection of sick?

It has occurred to me recently that a lot of people say they "hate hospitals." I guess people who feel that way see hospitals mainly as a collection of sick people and a reminder that they, too, are mortal. But I firmly believe that hospitals are places of healing and recovery, full of people who are caring and wise. And maybe it's because I work in them day in and day out that I have such a positive view, but I don't think so. Hospitals are devoted to healing. That is their purpose. And healing requires love and collaboration and wisdom. Despite all the sad things that happen here, hospitals don't depress me: they give me hope. Let's bind up the brokenhearted and proclaim freedom for the captives.

what filter are you using?

We were in a tiny room in the emergency department. Or maybe it just felt tiny from being so jam-packed. The stuff alone would have made it seem smaller than it actually was: two computers, a giant bed, some cabinets, an armchair, a sink, a regular chair, not to mention plenty of gadgets poking out from the walls. So having 5 adults and an almost-toddler crammed into corners around the furniture didn't help.

No-one sat on the bed, since the patient was in his mother's arms. I stood on one side of it, backed up to a computer, my presence backing Dad into a corner. Dr. K sat in the armchair, next to Mom, his legs crossed, his gestures confident, reassuring. Her face was like the sun on a windy, cloudy day: now a bright smile for her baby, now drawn and serious with worry. Two other doctors stood at the foot of the bed, on her other side, awkwardly, with their backs to the door, and we talked.

I was in conduit mode: that normal ping-pong from one language to another that we medical interpreters always do. At first I thought I'd only be batting the ball from Spanish to English for Dad, no need to go back from English to Spanish, since seemed to understand what he was being told. But at a questioning look from Mom, I realized it would be a full back-and-forth, so I went for it, all the while trying to play that eye-contact game that doesn't leave the family to stare into space when they hear someone they can understand, but still indicates that the speaker isn't where the words are coming from. Add that to the mental gymnastics.

The room probably wouldn't have felt quite as cramped if emotions on the family's side hadn't been quite so amped. Dad stood, defensive, speaking for both of them, asking if there was no other way. Mom let him speak, her worried face eloquent enough, until they started pleading, toward the end of the encounter, to try medicine for just a little while longer, instead of what the medical team was suggesting.

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If you've ever worked with a speech therapist, you might know that swallowing isn't as easy as it seems. If you've never heard of a speech therapist, don't worry, I don't blame you. I hadn't either until I started hospital work. Apparently, in order to swallow, humans have to coordinate a bunch of different muscles, and this is something that can be hard to do after, say, an illness that affects the nerves, or a stroke. It can also be hard to learn in the first place - babies, especially those who have other problems, often have trouble learning how to swallow.

This isn't just problematic from a nutritional standpoint (although there is that aspect to it, too), it's also a problem because it turns out that letting food or liquid get into your lungs (which is called aspiration) can cause pneumonia. So you can end up hungry, dehydrated AND pretty seriously ill.

Of course, the medical world being what it is, they've come up with ways to help people who can't swallow correctly: basically different ways of bypassing the mouth and putting food directly into the stomach or intestines. One option is to thread a small flexible plastic tube up your nostril, down your throat and esophagus, and into your stomach (or further down into your small intestine). That was what the medical staff wanted to do for this baby so he could rest from the stress of not being able to figure out how to coordinate his insides, and try again later.

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The staff was doing their absolute best to explain to the family that this wouldn't bother the child once it was in, wouldn't hurt him, and would prevent him from getting seriously ill with aspiration pneumonia. That he would, in time, learn to swallow and be able to live a normal life. To them, it really wasn't a big deal. An easy fix, minimally invasive, cost-effective, cheap... and they were doing their best to reassure the parents that it really was nothing to worry about. But the family wasn't having it.



Whenever I tell people that I'm an interpreter, their first reaction is usually "Wow, so you have to know all that medical vocabulary!" And the truth is, as much as the profession's current 40-h training course does teach some vocabulary and concepts, working in the hospital puts you through a necessary, intensely steep learning curve. (Just as an example, everything I explained above about speech therapy, swallowing difficulties, and NG tubes, I learned while working.) Interpreters are not trained as clinicians, but we do work with them every day, and so learn from them. In this way, interpreters become cross-cultural. Our work requires us to perpetually bridge the medical world and the layperson world, and the result is that we no longer truly belonging to either. We are part of the hospital system, work closely with clinicians, and understand much of what goes on from long observation and a healthy dose of inquisitiveness; but our training is in communication rather than medicine, and what medical knowledge we have is gathered, like wild berries on a walk, from random encounters. I've often said it feels like having a backstage pass to the world of medicine. If I had to hazard a guess, I would say that the frustration that results from this tension is one important reason why many of my colleagues choose to go on to become nurses or PAs.


So as usual, in this situation I was straddling the divide. But this time I was inclined to see things more from the medical providers' perspective. I work with lots of very sick children, and often an NG tube (naso-gastric, for "nose to stomach") or some variation of one is just one of many things they have in for weeks at a time. Standard equipment, you might say. And this baby wasn't even ill. The tube WAS the solution, so to my mind, the idea that this and some therapy was all the baby would need was good news.



For this family, though, it was a BIG DEAL. Their dearest wish was to take their child home and keep trying to help him eat. Maybe with some medicine. As I listened to them, I thought about how Hispanic/Latino culture puts a lot of emphasis on eating. For example, "Eating well," or "comer bien" has become a set phrase with connotations of health, correctness, and plenty, and "comer de todo" or, liking/eating all foods is considered a virtue. And I've noticed, working with families where it's come into question, that eating must involve food, chewing, and swallowing. So the idea that their baby might not be able to eat was very distressing for these parents.



In the end, I don't know what agreement the family and the medical staff came to. But it was a good reminder to me to keep both feet firmly in both worlds, to resist the temptation to align myself with the clinicians. I often identify most strongly with the patients, who are transplants not only to American culture, but to medical culture as well. I remember what that feels like, and want to make the interactions as seamless for them as possible: to make it easier. But this time, I found myself almost amused at the intensity of the family's worries. Didn't they know how simple this would be? ...at which point, I had to check myself.


It made me think about just how much I have acculturated to this wacky medical world of inventions and interventions, apparatus and operations. Just because I saw NG tubes on a daily basis doesn't mean that in regular every day life, having one of those tubes in your child's nose and taking him or her to therapies would be easy to deal with, or in any way normal. It would likely end up being one of the family stories, just like the time uncle Bob set a bush on fire when he was 6 and tried to put it out with Dixie cups of water, or that other time aunt Julia jumped off the bed and cracked her head open on the rocking chair, and Grandpa had to sew her up in the bathroom.


And that's kind of how it is, being cross cultural... your perspective fluctuates in and out. If life really looked like instagram, it'd be like having 5 or 8 color filters on all the time, all blending into each other randomly (or as you chose to focus on them). Sometimes one fades slightly as another comes to the fore, changing the scene, and something's always shifting. One minute you're in the patient's shoes, the next you're adding in the nurse's point of view, then layering it with your own as a part of interpreter culture, but by that time the patient's viewpoint has faded a little, so you revisit it... you never quite fully embody any one of them. No one color every fully saturates your lens.

aqui estoy

As we sat in her basement office at the hospital, my aunt looked me straight in the eyes and said in her friendly but challenging way: "Yeah, I bet they didn't prepare you for THAT in interpreter training!" I had paid her a rare visit, the first person to ever mention medical interpreting to me as a profession, to pick up some things she'd brought me, and we ended up chatting about our respective professional lives. She's been an attending MD at a teaching hospital ever since I can remember, and it's been nice, in recent years, to have more access to and understanding of this part of her life.

And she was right. They definitely did NOT prepare me for the experience I'd told her about in interpreter training. Turns out, no one had prepared her for it back in medical school, either. She'd had to stagger from the sheer weight of it too, just like me. "They do it much better now," she said, and I wished my profession had grown as much.

You see, they don't tell you in that ever-so-crammed 40 hour course that sometimes medical professionals won't be able to stop a disease process. Sometimes your patients, despite the team's best efforts, or for reasons they can't explain, will die.

Today, one of my patients died. Right in front of me, effortlessly. Barely discernibly, she closed this chapter of her existence and let go. (I'm sorry to be so cliche. It's just that it was such a big deal that the two-word sentence that states the fact, "She died," is too bare and bald and can't carry the weight of what just happened. There should be poetry.)

Allow me to tell you the story. Or, if you'd rather not read it, you can skip to the end by looking for the * break.

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It was genetic, so we knew it was coming. When I walked into the office this morning, the whiteboard where we put patient updates said "[this child] is dying."  So I looked her up, to see what disease she had, and tried to understand. But since my expertise is in communication and culture, not medicine, it honestly went over my head. Then I got the call, and the dispatcher said, please go to this child's bedside. So I went.

Although I knew that she was sick I didn't know before I went just how bad it was. When I arrived the sounds of distress were already coming from the room. The respiratory therapist sitting outside said, "you can go ahead and go in," so I did. There was a contact precautions sign on the door, so I put on the disposable yellow gown, blue gloves, and teal face mask the hospital provides in order to protect its staff from getting the diseases they're treating for. It feels a little like wearing a costume, and though I'm always glad for the protection, I also can't help feeling a little ridiculous.

When I went in, the sobs had quieted. The child was in her mother's arms, her father standing, pacing, looking utterly lost in the crowded little 6x8 room. My attention closed on that core family focal point, and everything else took several minutes to come into focus for me: the nurse, the tech and MD, grandparents and uncle, chairs, tables, beds, and medical machines. A couple people wore masks, but I was the only one all suited up. Oops. The doc found a chair for Dad, and had him sit next to his wife and child.

"Her oxygen is very low," the doctor said, "and so is her heart rate. I think... I think we only have a little bit of time left with her." "Su oxigeno esta bien bajo, y su ritmo cardiaco tambien," I said, being sure to imitate her intentionally calm voice and the respectful, sorrowful hesitation "Creo... pienso que ya solo nos queda un poquito de tiempo con ella." Dad, who had bowed his head over his little girl with his wife, all three of them together, raised his head. "Minutos?" he asked. "Minutes?" I repeated. "Yes, I think so." "Creo que si." At which there was more sobbing.

We waited. I felt so silly in my yellow paper get-up. I felt almost disrespectful... but taking it off during this solemn encounter would have been far worse. So I waited. We waited. A few minutes passed, as the nurse turned off most of the monitors, leaving just one little one blinking away. Then the doctor motioned for her to hand her the stethoscope, and gestured to ask if she could listen to the child's heart. She listened, heard what she needed, and pronounced this child's death. More sobbing. I kept concentrating on holding back the tears from my voice in every small thing I had to pass back and forth. I kept watching with all my might, thinking how the medical staff was responding to the events of the moment, wondering how they were feeling and how they would handle it themselves later, wondering how they had prepared for this moment.

I watched the family, but not too closely, from respect and for fear of breaking down. They were calling their dead child by every pet name they could think of, a last declaration of love, like roses or desperate lifelines thrown after her retreating consciousness and falling short. I chose not to interpret those names. For one thing, it was clear as day what they were doing, and so needed no translation. For another, it would have been inapproapriate. Those words were so intimate and private; they weren't intended for the medical team, and to interpret them would made them sterile. (Can you imagine repeating the words of freshest parental grief? Could you do them justice?) And in addition to those factors, to repeat those words, to try to take on that role, would have hurt more than I was willing to bear in that moment. If I had felt it necessary, I would have done my best, but I was grateful that it seemed not to be.

We asked if they needed anything, and then gave them some time to themselves. I went on to interpret for the nurse, a couple staff who came by to give condolences, and for a child life specialist who came in to help the family make tangible memories of their baby girl. I watched Dad's pacing become more purposeful as he informed family members of the event, and discussed funeral arrangements. Gradually, they walked out of the intensity of immediate grief and into the practicalities of the moment, as we must. But they kept randomly sobbing, as it would strike them afresh that their baby daughter was no longer with them.

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Today, after this child’s passing, the family wanted to make molds of her feet and imprints of her hands, so a child life specialist was called to the room to help them make these tangible memories. We had a moment to wait outside the room, so we were talking and she said, “I know it sounds weird, but although it’s hard, I like the work I do with bereavements. When I leave, I know I have helped them and done something for them.” I understood what she was saying. I don’t make anything tangible for people, and don’t do anything clinical/medical with the patients, but there is something else I do. I empathize with them.

I have been an interpreter for two and a half years now, and as everyone in the profession will tell you, the hard or sad things are easier to remember than the good or beautiful ones. I've seen a lot of things now that come easily to mind.A woman dying of cancer, fully prepared to face her fate; a mother who fainted dead away because the pressure to emotionally support her son (who was in a coma) overwhelmed her; a newly delivered baby with her organs inside-out and her grieving, half-sedated mother and inarticulate father; a mother who refused to believe her son would suffer any negative side effects from the chemo he needed to prepare him for a bone marrow transplant; a mother who's son was dying declaring she'd give her life for him if she could... those are the hard ones. Not to mention the parents I've seen fight impossibly challenging circumstances to make sure their babies survived. 

I have seen and known these people, and I have spoken their words. Those people, and many more, are part of me now; their voices have shaped who I am and will become. I'm so glad they have. And I'm honored to be with them in those moments. 

In Spanish, when you say, "I am here," or "I'm going to stay with her," it means more than it means when we say it in English. It carries this extra layer of meaning that says, "I am going to make sure you're not alone. I am here to make sure you're not surrounded by strangers. I am here as someone who cares about you." It's this really beautiful thing about Spanish and Latino culture that you always to your best to make sure no one you care about has to face anything alone - whether it's driving to the bank to make a deposit or walking through cancer. I love the opportunity to make it so that people don't have to face healthcare alone, both by being with them myself, as a Spanish speaker, and by helping them form bonds with the rest of the healthcare team. I think probably a lot of interpreters do. 

From what I understand about grief, what people need most in those seasons is for someone to be with them, on a soul level. We need people to say, "I've been there, I get it. It sucks." I don't empathize exactly like that, by expressing my own thoughts; in a lot of ways, I don't get to be an active participant in what happens. But somehow in speaking the words they speak, in transmitting them to the rest of the care team, I do form a bond of empathy with them. When I say their words, transmit their jokes, or their anger, or their confusion, I am in a sense acting them out. It's like being in a play where you get the script in real time (but in the wrong language. Ha.). I get to BE them in English or Spanish, and in so doing I get to be WITH them in a powerful way. To use Christianese, I come alongside them, walk with them. Nothing more, nothing less. I don’t add or take away anything, no meaning originates in me. But in those moments, in the real nitty-gritty bits of life, I am with them in a very profound way: as someone who understands them, and makes a bridge for others to do the same. So I like that. It is satisfying. It’s active love.

And that is what I enjoy the most about my job. I get to love people in that active way every day.