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.

****************************

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.

****************************

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.