heartstrings

When I tell people that I work in a children's hospital, they will often say, "oh, that must be easier than working in adults." Generally I'll answer back that actually, for me, it's harder. One of the reasons is that, when your patient is a child, you end up spending most of your time interpreting for their family, so you get up close and personal with the deep love of parents and grandparents and aunts and uncles for their children. That love is intensely strong, and intensely vulnerable, and it can wring you in ways an encounter with an adult patient may not. I was reminded of this recently when I met a young man who required a tracheotomy to breathe, though his mind was perfectly clear.

Some quick background information you may need for this story:

1. A tracheotomy is a hole that a surgeon can make in someone's throat to allow them to breathe without the air going through the person's nose or mouth. It's done if you can't breathe the usual way for some reason.
2. Having a trach generally means you can't talk because in order to speak you need to be able to let air flow over your vocal chords on it's way out of your body - which the air can't do after a tracheotomy because it gets out through the trach before it gets to the vocal chords. 
3. People who get a tracheotomy (trach for short, pronounced "trake") may have a lot of what we call "secretions" - i.e. mucous - but because of the trach, when they cough it up, it can't go all the way up to their throat, where they could swallow it like we all do (gross, I know, sorry) so it has to be manually suctioned out with a special device. So when you see someone with a trach there's often a lot of really gross bodily fluid noises, and fluids.

So I was with this patient and his family, interpreting for his speech therapist, who had brought him a new device to try. This device, though, would allow the boy to inhale through his trach, and exhale through his mouth, which meant he'd be able to speak out loud for the first time since he had the trach placed.

Before letting him try it out, the speech therapist explained to the family (through me in Spanish) and the patient (in English) that putting the device on would change how air was flowing, so it would probably feel uncomfortable at first. She said "it's normal not to be able to tolerate it for long at first, maybe not even a minute; but you can get used to it and work up to being able to leave it on and being able to talk for up to several hours."

So, having set the expectations, she let him try it. There was a lot of spluttering, and he couldn't keep it on for long, but he did manage to start forming one word: "ma-"

The next time he tried it, he managed the whole word: "ma..mi..."

He had so much trouble that time, that the speech therapist asked him to try just humming instead of speaking. He did. It was a pitiful, high-pitched whine, and you could tell from his face that it was intensely uncomfortable. More spluttering and spit, and she took it off.

The next time, she said, don't try to talk or hum - just let me count to 10, and we'll take it off. He did. It was clearly still excruciating.

"Do you want to try again?" she asked. He shook his head no. "Do you want to tell your mom anything before we stop?" He nodded his head yes. She put it on. This time, he held on and managed to say "Mami, te quiero!" before gasping and needing it to be taken off.

I sat in shock for a second, my throat tightening with emotion, before I realized only his mom and I knew what he'd said. "Mommy, I love you!" I repeated, in English, for the speech therapist, respiratory therapist, and the newly arrived psychologist, and was gratified to hear a collective "Aww!!"

When asked if he was willing to try one more time, he refused, and we ended the session there. But it was all I could do not to cry right in the middle of the interpretation. Here was a boy who had spent an unknown amount of time unable to speak, and, without hesitation, the second he got the chance, the first thing he wanted to do - without even stopping to learn how or get comfortable with the new way of using his body - was tell his mother that he loved her. I was awestruck.

It is such a privilege to walk with people in deep suffering, because you see beauty like this. It reminded me of the woman who, upon being told she was likely going to lose her grandchild, began to give thanks for the time she had been able to spend with that child, for the joy of having held that child in her arms the day before. Thanks.

And it is in part for this reason that working in the children's hospital is, for me, harder than working with adults: because you go to those raw places with people who love the people who are suffering. When you work with adults, you have more freedom NOT to put yourself in the shoes of someone who really cares about your patient, because they aren't always there, or, in the interpreter's case, because the patient does most of the talking. When you're working with kids, you don't, because they're right in front of you, doing and feeling and saying all the things loving families and friends do and feel and say. And if you're an interpreter... then whatever they say, you repeat, in English, for everyone else to hear. Their bond with the patient, expressed in their words, passes through you. And it can't not touch you on the way.

don't get bogged down

Today begins with pain. Physical and emotional. Physical because I hurt my shoulder last night, emotional because I learned on arriving to work that yet another of the patients my coworkers and I have served over the course of months and years, has died.

There have been several deaths like that this year, and I was talking to an interpreter friend about how that is an aspect of the job she's not familiar with. Interpreting is a pretty diverse field,  you see, and even one hospital can differ greatly from another. I didn't realize, when I began my journey as an interpreter, that I would be a conduit, not just for people's words, but for their grief and pain; that, in joining a group of professions that work with hurting bodies, I would also find hurting people. It should have come as no surprise to me that when someone's body stops working the way that it should, the person feels unhappy, betrayed, aggrieved, etc. But foolishly, it didn't occur to me. In the same way, it didn't occur to me that when a loved one is ill, or needs medical testing, families feel fear, grief, anger, love, and more... and express those things from the smallest to the most heart-wrenching ways.

I have always been what others call "deep," which in reality just means that I go more easily than most to that conceptual level where ideas and our feelings about them turn out to be inescapably entangled. I can't stand a conversation that's intellectual for the sake of intellect, but when there's passion involved, I'm all in. So I have truly enjoyed, in a way, getting to be with people in the most intimate, emotional processes and decisions that humans go through in life. I count it a privilege. But I wish someone had warned me, because it's starting to become difficult to hold all these stories. My arms are too full, and the thought of holding one more makes me afraid of dropping them, tripping, and falling...

My counselor says this is normal for helping professions. She throws out words like "compassion fatigue" and "PTSD" as things that are common experiences. Me, I remember a very smart PR lady I once worked with who said, "it takes six positive experiences to balance out one negative experience." For her, the point was customer service. For me, it means I need to start very intentionally keeping a list of the good things I see. Flecks of light, joy, hope, peace. Because the bad weighs more than the good, those good things tend to fly away on the wind that disappears memories. But if I list them, maybe my day will look more like mica-flecked rock: dark in color, but sparkling when you turn it over in the light.

***
Obviously, there are more ways to practice self-care than making lists of the good things in a day. That has proved a useful tool for me in the past, so as these weeks have been extra difficult, I'm going to pick it up again. But exercise, vacations, and projects where I have control have also proved very helpful. One of the hardest things about interpreting, for me, is that I have so very little control over anything: where I interpret, for whom, for how long, in what type of situation, when I get a break; even to a certain extent whether or not I interpret for someone who, in my professional opinion, needs it or could benefit from it. So another thing that helps me is finding professional projects to work on where I do have control, which for me ends up being teaching and developing continuing education for interpreters.

If you are an interpreter too, I hope that this post helps you. What we do isn't just a workout for the mind, it's hard on the heart as well. I hope this post encourages you to find ways of keeping yourself in balance.

sometimes...

I sat in the hospital chapel, head in my hands, trying to pray but slipping into sleep instead. My phone rang. It was the dispatcher, who wanted me to rush right back to the side of the child I'd just left, in the outpatient clinic. He'd taken a turn for the worse, and the clinic had called rapid response.
My bowed head just earlier had been for him. Sometimes, you just know.

I rushed back toward the elevator. Would it be faster to take the elevator? I tried, but after 15 seconds, decided I'd better just rush up the stairs. Even though I've never said my own words to them, even though this family knows next to nothing about me, I've spent hours of months repeating their words, and have a deep affection for them. I thought of the child's mother, listening and watching without knowing or understanding, and took the stairs two at a time. Sometimes, someone else's emergency is yours, too.