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.