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.
* * *
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.
* * *
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.
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