"I think," I said in what I hoped was a very measured tone, "that one of the hardest things about this job is how unpredictabe it is." My coworker agreed without skipping a beat. She had watched me return to the office twice in a row, only to be called right as I walked in, feet away from my desk, and asked to go out to another part of the hospital. In between the first and second, there'd been a third call, but that time I only made it to the stairwell. Which begs the question "Why were you even trying? Why not just stay put?"
The answer is that I was trying because you just never know. Often I'll wait after an encounter ends, hang around in a random hallway and see if I'll get another call. Sometimes I do, other times I don't. Sometimes I wait around for 20 minutes, afraid of looking lazy in comparison to all the busy nurses and techs and maintenance people walking past me. But I'm not lazing about - waiting is just part of my workflow. But you never know how long it's going to be. It's like waiting for the bus and not being sure what the traffic pattern is like at the moment. Or like checking facebook to see if you have any notifications. When, and where, and how intensely I have to work is not under my control. Period. One minute I might be making sure someone explains medication dosing so they can go home, the next moment I might be giving a worried mom an explanation for why her child is suddenly in the ICU. You just never know. And you might have 2 minutes between calls, or you might have 40.
And now I'm starting to wonder if training myself to jump to it when there's a call is bleeding over into the rest of my life. First I realized that it's impossible to do any task that requires lengthy concentration during my breaks at work. I would go in thinking "I'm going to work on building this presentation today!" and leave berating myself for having done exactly nothing. But the reality is that for a creative task like that, you - or at least, I - need time to muster the concentration and mental resources it requires. I can't just dive in for 5 minutes, or 10, and be productive. So I moved to tasks that I don't have to really settle into to get going: looking up places to get good used tires for my car, reading facebook articles I'd saved for later, that kind of thing.
But now I'm also noticing that it's become harder for me to sit down and concentrate. In my free time I've become liable to rushing around, distracted, cleaning things here and there, thinking of things I should be doing, trying to make lists and only half succeeding, thinking of things I could be doing... it's been increasingly difficult to settle down. What a curious thing, no? I'm not sure how much of this I can really blame on the job. For one thing, I'm sure other people feel like this. Moms, and people who keep very busy. And I'm sure lots of different things can make someone more scatterbrained than usual. But me, I really enjoy concentrating, and am craving centeredness. I'm thinking I need to start some practices that will help me concentrate, settle in to something, and do it well.
Wednesday, November 29, 2017
Thursday, November 16, 2017
On the Fruit of Thanksgiving
Sometimes interpreters have to say horrible things. The same horrible things that doctors and nurse practitioners have to say. And when we do, when we as a medical team give bad news, we get to be at to be there in the big, scary moments where people forget themselves - or rather, decide that other people's eyes and opinions don't matter in light of the magnitude of what they're feeling - and react.
One time, I helped tell a matriarch and her family that her grandchild would likely be lost to her. She contained herself until everything had been said, and then let loose her grief. When she did, she began sobbing and praying in the same breath. And where I might have expected her to plead with God for her child's life, as I have seen many people do, she instead began giving heart-wrenching thanks. "Thank you Papito Dios for my children. Thank you Papito Dios for letting me hold him in my arms yesterday. Thank you Papito Dios for the time you gave me with him. Gracias, gracias..." she continued.
Her family rose instantly from their chairs to surround her, and in that clump of sobbing, grieving, praying people I saw the fruit of a long-standing relationship between this woman and her God. It floored me. She must have practiced thanking him for everything she could think of for years. It must be a very routine, normal thing for her to find something to say "thank you" for in the face of difficult, hard circumstances - otherwise how could she have done it in this, her moment of deepest pain?
And the way she addressed God was so familiar and deeply affectionate. A rough English translation would be "Daddy God," but in English, the word "daddy" is mostly used by young children, so it carries a sense of childishness. People pray this way in English too. The idea is that Jesus addressed God in the Biblical text as "Abba," and because through Jesus' sacrifice and resurrection people who choose to follow him have been grafted into God's family as children, they can now call God "Abba" as well. It is translated as "daddy," in English, but it still makes me a little uncomfortable. It sounded even more odd to me in Spanish though, because "papito" in Spanish isn't used in the same context as "Daddy," it isn't used by children. It's actually an affectionate way for parents to refer to children or older women to younger men. She had taken this word "papito" that is usually semi-parental and flipped it. Suddenly it meant "dear daddy God" instead of "little man." Because it's such an everyday word, and because of how easily it rolled off her tongue, it sounded both deeply intimate and well-worn. It sounded like it carried the undercurrent of love you might hear in a pet name used by a couple that's been happily married for 40 years.
For me, hearing her give thanks in such an intimate way to someone she considers to be in control of everything that happens, including this loss, cut me to the heart. And the way she was doing it, too. She was verbalizing the good thing that was being lost and expressing thanks for it in the midst of its being taken away, all toward a being she considers to be in control of both the giving and the loss. She wasn't asking for it back, or asking for the loss not to happen. Not that she won't - this was just her first reaction to the news. But this being her first reaction to her possible loss made her pain more poignant to me, clarified and sharpened it. And I think what shocked me about it was that it displayed such a soft heart, unembittered by the other pains of life thus far. How had she remained so unhardened by cynicism and bitterness, especially toward God, despite surely having already lived through a lot of the usual suffering?
It is almost Thanksgiving here in the United States, a time of year we set aside to be intentionally grateful. Here, my friends, was the fruit of faith that has been mixed with consistent gratitude. I don't fully know what kept this woman's heart soft, but I'm confident that gratitude had a lot to do with it. We take one day each year to focus on being grateful. But in this woman I saw an openness to love and a resilience to pain that can come from making gratitude a consistent habit.
I am grateful for the lesson, and hope to practice it myself.
One time, I helped tell a matriarch and her family that her grandchild would likely be lost to her. She contained herself until everything had been said, and then let loose her grief. When she did, she began sobbing and praying in the same breath. And where I might have expected her to plead with God for her child's life, as I have seen many people do, she instead began giving heart-wrenching thanks. "Thank you Papito Dios for my children. Thank you Papito Dios for letting me hold him in my arms yesterday. Thank you Papito Dios for the time you gave me with him. Gracias, gracias..." she continued.
Her family rose instantly from their chairs to surround her, and in that clump of sobbing, grieving, praying people I saw the fruit of a long-standing relationship between this woman and her God. It floored me. She must have practiced thanking him for everything she could think of for years. It must be a very routine, normal thing for her to find something to say "thank you" for in the face of difficult, hard circumstances - otherwise how could she have done it in this, her moment of deepest pain?
And the way she addressed God was so familiar and deeply affectionate. A rough English translation would be "Daddy God," but in English, the word "daddy" is mostly used by young children, so it carries a sense of childishness. People pray this way in English too. The idea is that Jesus addressed God in the Biblical text as "Abba," and because through Jesus' sacrifice and resurrection people who choose to follow him have been grafted into God's family as children, they can now call God "Abba" as well. It is translated as "daddy," in English, but it still makes me a little uncomfortable. It sounded even more odd to me in Spanish though, because "papito" in Spanish isn't used in the same context as "Daddy," it isn't used by children. It's actually an affectionate way for parents to refer to children or older women to younger men. She had taken this word "papito" that is usually semi-parental and flipped it. Suddenly it meant "dear daddy God" instead of "little man." Because it's such an everyday word, and because of how easily it rolled off her tongue, it sounded both deeply intimate and well-worn. It sounded like it carried the undercurrent of love you might hear in a pet name used by a couple that's been happily married for 40 years.
For me, hearing her give thanks in such an intimate way to someone she considers to be in control of everything that happens, including this loss, cut me to the heart. And the way she was doing it, too. She was verbalizing the good thing that was being lost and expressing thanks for it in the midst of its being taken away, all toward a being she considers to be in control of both the giving and the loss. She wasn't asking for it back, or asking for the loss not to happen. Not that she won't - this was just her first reaction to the news. But this being her first reaction to her possible loss made her pain more poignant to me, clarified and sharpened it. And I think what shocked me about it was that it displayed such a soft heart, unembittered by the other pains of life thus far. How had she remained so unhardened by cynicism and bitterness, especially toward God, despite surely having already lived through a lot of the usual suffering?
It is almost Thanksgiving here in the United States, a time of year we set aside to be intentionally grateful. Here, my friends, was the fruit of faith that has been mixed with consistent gratitude. I don't fully know what kept this woman's heart soft, but I'm confident that gratitude had a lot to do with it. We take one day each year to focus on being grateful. But in this woman I saw an openness to love and a resilience to pain that can come from making gratitude a consistent habit.
I am grateful for the lesson, and hope to practice it myself.
Sunday, September 24, 2017
looking back
One day it occurred to me to ask my Dad what it was like going to the doctor when we lived in Spain:
"Your mother took you to most appointments after a while. Especially the emergency ones. She spoke the language better. I had to have a colonoscopy once, and there was a hospital where there was just one doctor who spoke English. It was really far away, but I went there anyway, because you know, for something that important, you want to be able to understand what they're saying to you."
This, coming from my American, white, middle-class, male father, who spent 3 years in language school when we moved to Spain. I'm not sure what other layer of privilege you could find to add to that list - by any account, he should've had it easy. Plus, my father is a smart man. He now works in think tanks on things that I barely understand, and collaborates with people in his field literally around the globe. Even so, back in Spain he avoided encountering the medical field, and when he did his access to care was severely restricted by language.
We have to quit faulting people for not being able to communicate with us like native speakers when they're not. My Dad learned Spanish. He worked hard, for years. It was literally the main focus of his work week for the first several years we were living in country. But as an adult, there are, simply put, limits to what you can learn, no matter how hard you try. Plus, you learn language based on the context you need it for. So if you're not in and out of the doctor's office all the time, chances are you won't learn the specific language skills you need for that context, so that even if you're "fluent" for the purposes of everyday life, you're flummoxed in clinic.
My Dad didn't have access to an interpreter, so I couldn't ask him what that was like. But to his and my mother's credit, they never tried to make my sister or myself serve as their quasi-interpreters. Just as well, because we weren't learning language for the medical context either.
"Your mother took you to most appointments after a while. Especially the emergency ones. She spoke the language better. I had to have a colonoscopy once, and there was a hospital where there was just one doctor who spoke English. It was really far away, but I went there anyway, because you know, for something that important, you want to be able to understand what they're saying to you."
This, coming from my American, white, middle-class, male father, who spent 3 years in language school when we moved to Spain. I'm not sure what other layer of privilege you could find to add to that list - by any account, he should've had it easy. Plus, my father is a smart man. He now works in think tanks on things that I barely understand, and collaborates with people in his field literally around the globe. Even so, back in Spain he avoided encountering the medical field, and when he did his access to care was severely restricted by language.
We have to quit faulting people for not being able to communicate with us like native speakers when they're not. My Dad learned Spanish. He worked hard, for years. It was literally the main focus of his work week for the first several years we were living in country. But as an adult, there are, simply put, limits to what you can learn, no matter how hard you try. Plus, you learn language based on the context you need it for. So if you're not in and out of the doctor's office all the time, chances are you won't learn the specific language skills you need for that context, so that even if you're "fluent" for the purposes of everyday life, you're flummoxed in clinic.
My Dad didn't have access to an interpreter, so I couldn't ask him what that was like. But to his and my mother's credit, they never tried to make my sister or myself serve as their quasi-interpreters. Just as well, because we weren't learning language for the medical context either.
Thursday, August 24, 2017
the suction valve
I sat in the dentist's chair, waiting for the lidocaine to kick in. Maybe, I thought, it would also numb the dread I was feeling about what was about to happen.
Before he left, the doctor had handed me the little suction valve, and told me to use it whenever I needed. As I used it, I felt worse and worse. In a moment, I realized that the sound was making me flash back to the day before...
I'd been in the room with a chronically ill patient, in the ICU. Once again, we were all gowned up in our banana-colored reverse paper bathrobes, making us look both serious and ridiculous. A doctor was there doing a test where he had to use a long wand with a camera at the end to look into the child's sinuses. Given her condition, it was terribly painful for her. Another doctor, who had just happened to stop by, was in the back giving him advice. The child life specialist and the child's mother both held her hands and kept up a stream of encouraging (and distracting) words to help her through it. He couldn't get the scope up there, and we all dawdled through an agonizing 3 minutes of waiting for the nurse to get some forceps. He extracted a giant booger, and, in a classic "Scalpel!" moment, tried to hand the forceps (and their disgusting prize) to me. I drew back. More than being grossed out (which, YEAH, gross), I had no idea what I was supposed to do with the thing. He looked confused. The RN stepped in to save me. Thank God!
He continued his procedure. I couldn't keep my eyes or my mind off of what it must feel like to be that little kid. But this guy clearly considered everyone in the room to be there for him, because next thing you know he was asking Mom to push a button on his fancy machine. I didn't know if I should be impressed by the way he was drawing us all in, turning us into a team, or angered by his self-absorption.
And all through it, Mom and the CLS are holding the patient's hands, trying to draw her focus:
"No te muevas, no te muevas!" (Don't move, don't move!)
"Just hold my hand. Deep breaths. Think of the beach. Think of being at the beach with your mom, and your baby sister..."
"No te muevas, que si no te va a lastimar." (Don't move, otherwise it will hurt)
In time with their entreaties, the doctor kept using the suction valve. At one point, he couldn't see once he got the camera into the sinuses either, and ended up sticking it up through her nose into her sinus cavities, where it made the terrible squelchy sucking noises suction valves make when they do find a fluid to clean up.
That one encounter took the wind out of me yesterday. It was absurd, and horrible, and chaotic, and so mundane.
She was so sick, and miserable, and there were so many doctors and nurses poking and prodding her, like it was a matter of course. The juxtaposition between Mom's threatening "comfort" and the CLS's attempts to distract and calm the child nearly drove me up a wall. How could I interpret this to the CLS so it would communicate and not just add to the chaos? Was it worth trying? Would it change anything? I tried. Was she even listening? Add in the terrible sucking noises of the suction. The whole scene was frenetic and absurd and terribly serious. I couldn't figure out how, but I know I could've laughed at the whole thing if it hadn't been so gut-wrenching.
So there I am in the dentist's office, listening to the suction and suddenly thinking, "It's good to be in the patient's chair sometimes, to remind me what this feels like. I wish I had some hands to hold, too. Instead I'll try to hug myself with my own arms, my climber's arms that won't reach round my waist, but can hold on to my sides as if they were a medium edge on a wall... Oh WHAT is he doing in there? Be careful!!"
At least she had someone holding her hands.
At least I'm not real sick, just in need of a quick filling.
I guess we all have things to be grateful for.
Before he left, the doctor had handed me the little suction valve, and told me to use it whenever I needed. As I used it, I felt worse and worse. In a moment, I realized that the sound was making me flash back to the day before...
I'd been in the room with a chronically ill patient, in the ICU. Once again, we were all gowned up in our banana-colored reverse paper bathrobes, making us look both serious and ridiculous. A doctor was there doing a test where he had to use a long wand with a camera at the end to look into the child's sinuses. Given her condition, it was terribly painful for her. Another doctor, who had just happened to stop by, was in the back giving him advice. The child life specialist and the child's mother both held her hands and kept up a stream of encouraging (and distracting) words to help her through it. He couldn't get the scope up there, and we all dawdled through an agonizing 3 minutes of waiting for the nurse to get some forceps. He extracted a giant booger, and, in a classic "Scalpel!" moment, tried to hand the forceps (and their disgusting prize) to me. I drew back. More than being grossed out (which, YEAH, gross), I had no idea what I was supposed to do with the thing. He looked confused. The RN stepped in to save me. Thank God!
He continued his procedure. I couldn't keep my eyes or my mind off of what it must feel like to be that little kid. But this guy clearly considered everyone in the room to be there for him, because next thing you know he was asking Mom to push a button on his fancy machine. I didn't know if I should be impressed by the way he was drawing us all in, turning us into a team, or angered by his self-absorption.
And all through it, Mom and the CLS are holding the patient's hands, trying to draw her focus:
"No te muevas, no te muevas!" (Don't move, don't move!)
"Just hold my hand. Deep breaths. Think of the beach. Think of being at the beach with your mom, and your baby sister..."
"No te muevas, que si no te va a lastimar." (Don't move, otherwise it will hurt)
In time with their entreaties, the doctor kept using the suction valve. At one point, he couldn't see once he got the camera into the sinuses either, and ended up sticking it up through her nose into her sinus cavities, where it made the terrible squelchy sucking noises suction valves make when they do find a fluid to clean up.
That one encounter took the wind out of me yesterday. It was absurd, and horrible, and chaotic, and so mundane.
She was so sick, and miserable, and there were so many doctors and nurses poking and prodding her, like it was a matter of course. The juxtaposition between Mom's threatening "comfort" and the CLS's attempts to distract and calm the child nearly drove me up a wall. How could I interpret this to the CLS so it would communicate and not just add to the chaos? Was it worth trying? Would it change anything? I tried. Was she even listening? Add in the terrible sucking noises of the suction. The whole scene was frenetic and absurd and terribly serious. I couldn't figure out how, but I know I could've laughed at the whole thing if it hadn't been so gut-wrenching.
So there I am in the dentist's office, listening to the suction and suddenly thinking, "It's good to be in the patient's chair sometimes, to remind me what this feels like. I wish I had some hands to hold, too. Instead I'll try to hug myself with my own arms, my climber's arms that won't reach round my waist, but can hold on to my sides as if they were a medium edge on a wall... Oh WHAT is he doing in there? Be careful!!"
At least she had someone holding her hands.
At least I'm not real sick, just in need of a quick filling.
I guess we all have things to be grateful for.
Wednesday, July 26, 2017
Informed Consent
It would be my last call of the day. I didn't really want to go - I'd been dispatching all afternoon, when my coworker called me and passive-aggressively asked if I knew that we were now closing dispatch at 3:30 instead of 4. She didn't say so, but knowing her, she wanted me to take the call that had just come in. We had to go in order, and if I didn't get back in the pool, she'd be up next. I fumed in the hallway as I waited for the elevator about how bossy she was, but the second I arrived on scene, I was grateful I'd come.
At the bedside, along with about 3 nurses, was a handsome, strong-looking young surgeon practically shouting at a similarly young, strong-looking brown man in a hospital bed. "USTED PUEDE COMER COSAS COMO CAMARONES, MARISCO?" I was impressed by his decent vocabulary and grammar, but he looked pretty intimidating. I wasn't sure yet if this was my patient, but decided I didn't care. There was a good chance it was, and either way, this man deserved better communication. So I approached the bed and, projecting my voice above the machines, side-conversations, and the loud surgeon said, "Need an interpreter?" One of the nurses turned around and said, "Oh, perfect timing!" - as if I'd arrived by accident. I wondered who had requested an interpreter, and, for the millionth time, why most everyone else seemed to think they could do without one. The surgeon said, with relief on his face, "Oh, great, yeah, here's someone who's trained, let the professional do it." He sped off and I took his place at the head of the bed. Clearly someone had strongarmed him into helping them "get by." Still, I was grateful for his endorsement.
The nurses took him through their usual pre-operative questions: are you allergic to anything? when was the last time you ate or drank anything? etc. The surgeon came by with the signed consent to say that there were "a few things I had to add, and I need you to initial them - unfortunately they make me do that". He was apologetic, I think because the man found it so difficult to use his hands. Obviously, whoever had gone through the consent initially had done a rush job.
In case you're not familiar with consents for surgery, a consent contains several key elements: benefits of, risks of, and alternatives to the procedure are the most basic ones. The forms I've interpreted also often contain a diagnosis, who's performing the procedure, consent to receive blood if necessary, and disclaimers about video/camera recording and student presence in the operating room, among other things. Whoever had filled this consent out with the patient initially had forgotten to write in three things: the benefits of surgery, the name of the surgeon, and under risks, the possible need for further surgery. So we briefly went through the consent again. The doctor explained that the benefits would be to reduce pain and prevent the joint from stiffening, that it would require putting in a plate and some screws to keep the bones in place, and they would stay in for life, and that the patient might need further surgery at some point, but they couldn't predict that. This last is a blanket disclaimer that often gets thrown in as a way of saying, "something might go wrong at some future point, and you might need surgery again for it" It really doesn't mean anything more than "the future is unpredictable".
Our man initialed, painstakingly, in the places he was shown, and we continued to prep for surgery. The nurse stuck a Q-tip with a nasty looking brown substance up his nostrils to disinfect them, and had him brush his teeth with a mysterious liquid from a brown bottle. Finally she bent over him and asked, "Sir, do you have any questions for us?" Maybe it was something about her kind touch, or maybe he'd just had time while he was being disinfected to think about what he'd heard. In any case, he spoke up. "Si. Yo quiero saber porque no me entablillaron la mano, porque la verdad que prefiero que no me hagan esta operacion, pienso que seria mejor regresar a Mejico y encontrar un cura-huesos que me sane." He said more, but that was as far as I got in English before the nurse looked at me sternly and said, "So we need to get the surgeon to come back here." While she did, I took a second to marvel at what he'd said. "Yes. I want to know why they didn't splint my hand, because truthfully, I would rather not have this operation, I think it would be better for me to go back to Mexico and find a bone-healer to cure me."
It has become a fundamental principle of Western medicine that we don't do anything to the patient against their will. When we fill out consent forms, we often say, "but even if you sign this, you can change your mind at any time." Well, this man had.
Another surgeon on his team came to the bedside, and explained that they were planning to put his bones back where they need to be so they can heal. The man said something I've heard many times: "Bueno, si van a hacer lo que el dice, eso esta bien. Pero el otro doctor dijo que me iban a poner una placa y unos tornillos, y que si no queda bien, me van a tener que rajar la mano otra vez, y si hacen eso y queda mal, un cura-huesos ya no me va a poder ayudar, como es normal." I repeated, in English, "Well, if you're going to do what you're saying, that's fine. But the other doctor said you were going to put in a plate and some screws, and that if it doesn't turn out right, you'd have to cut open my hand again, and if you do that and it doesn't work, a bone-healer won't be able to help me the normal way."
"I'm sorry sir," the doctor said, "I didn't mean to confuse you. We will put the bones in their right place, but then we need to put in a plate and some screws to make sure they stay there. So what the other doctor told you is true, too. Would that be ok?" I communicated this to the patient. By this time, the whole surgery team had arrived. The patient gave an uncertain, hesitant "Yeah..."
The doctors conferred "Has he had any medication yet?" one of them asked. The other shook his head. "What about his injuries?" "Well, he didn't hit his head, and there's no sign of a TBI" I knew that stood for traumatic brain injury. In a second I realized they were trying to decide if he was fully in possession of his wits or if they could operate anyway, for his own good, since they had written consent. As it turned out, there was no loophole.
So the head surgeon, who had filled out the consent earlier, clapped him on the shoulder, in a gentle, friendly way and asked, "What are you worried about?"
At that, the man really let loose. He began talking about his employer, and his worries about being out of work but having huge bills to pay, and worry about having to have a second operation and have even more to pay; how he would rather take care of this at home, but there was no money at home; how he'd never hurt his hand this way before, and really, he didn't get it- it didn't look that bad. At this point, he began to take off the brace he'd been wearing and inspected his arm dubiously. He'd seen guys on the farm back home twist their wrists in some terrible ways, and the bone-healer had straightened them out in 5 minutes.
I did my best to keep pace with him, and finally the doctor said, "I think you have some serious concerns about this surgery. My opinion is that operating is what's best for you, but at the end of the day it's your body, and I won't do anything you don't want to have done. So why don't we wait another day or two and we can talk more, and you can think it over. We can wait two days, and if you want the surgery then, I will do it." The patient seemed on the fence still, but after everything he'd said, the team knew they couldn't operate.
They wheeled him away, and I got called away to another patient. But I was amazed and oddly elated. The patient I'd just worked with chose not to have an operation that would assuredly improve his quality of life, and yet, I had a spring in my step. It took me a minute to realize what it was... I had just witnessed true informed consent.
So often the patients I work with have reservations or questions about what the medical team decides to do. So often they don't say them out loud, or are not fully listened to. But today, there was real communication. This man's voice and his worries were really and truly heard, and it filled me with a fierce joy. I really hope that he gets to sit down with someone and really talk about his reservations. I hope he does get the operation, and that his body returns to full functioning as soon as possible. But for that day, in that moment, it amazed me to see the whole machinery and process of the medical system come to a full stop to respect this young man's wishes. This young man, a laborer from the rancho (the backwoods of Mexico), who stood no chance of getting workman's comp from his employer, even though he was hurt on the job; this man who had more faith in the cura-huesos than in a first world medical procedure, the type of person who is so rarely listened to that many they have learned not to raise their voices or their questions - this man was listened to. It felt, just a little bit, like justice.
At the bedside, along with about 3 nurses, was a handsome, strong-looking young surgeon practically shouting at a similarly young, strong-looking brown man in a hospital bed. "USTED PUEDE COMER COSAS COMO CAMARONES, MARISCO?" I was impressed by his decent vocabulary and grammar, but he looked pretty intimidating. I wasn't sure yet if this was my patient, but decided I didn't care. There was a good chance it was, and either way, this man deserved better communication. So I approached the bed and, projecting my voice above the machines, side-conversations, and the loud surgeon said, "Need an interpreter?" One of the nurses turned around and said, "Oh, perfect timing!" - as if I'd arrived by accident. I wondered who had requested an interpreter, and, for the millionth time, why most everyone else seemed to think they could do without one. The surgeon said, with relief on his face, "Oh, great, yeah, here's someone who's trained, let the professional do it." He sped off and I took his place at the head of the bed. Clearly someone had strongarmed him into helping them "get by." Still, I was grateful for his endorsement.
The nurses took him through their usual pre-operative questions: are you allergic to anything? when was the last time you ate or drank anything? etc. The surgeon came by with the signed consent to say that there were "a few things I had to add, and I need you to initial them - unfortunately they make me do that". He was apologetic, I think because the man found it so difficult to use his hands. Obviously, whoever had gone through the consent initially had done a rush job.
In case you're not familiar with consents for surgery, a consent contains several key elements: benefits of, risks of, and alternatives to the procedure are the most basic ones. The forms I've interpreted also often contain a diagnosis, who's performing the procedure, consent to receive blood if necessary, and disclaimers about video/camera recording and student presence in the operating room, among other things. Whoever had filled this consent out with the patient initially had forgotten to write in three things: the benefits of surgery, the name of the surgeon, and under risks, the possible need for further surgery. So we briefly went through the consent again. The doctor explained that the benefits would be to reduce pain and prevent the joint from stiffening, that it would require putting in a plate and some screws to keep the bones in place, and they would stay in for life, and that the patient might need further surgery at some point, but they couldn't predict that. This last is a blanket disclaimer that often gets thrown in as a way of saying, "something might go wrong at some future point, and you might need surgery again for it" It really doesn't mean anything more than "the future is unpredictable".
Our man initialed, painstakingly, in the places he was shown, and we continued to prep for surgery. The nurse stuck a Q-tip with a nasty looking brown substance up his nostrils to disinfect them, and had him brush his teeth with a mysterious liquid from a brown bottle. Finally she bent over him and asked, "Sir, do you have any questions for us?" Maybe it was something about her kind touch, or maybe he'd just had time while he was being disinfected to think about what he'd heard. In any case, he spoke up. "Si. Yo quiero saber porque no me entablillaron la mano, porque la verdad que prefiero que no me hagan esta operacion, pienso que seria mejor regresar a Mejico y encontrar un cura-huesos que me sane." He said more, but that was as far as I got in English before the nurse looked at me sternly and said, "So we need to get the surgeon to come back here." While she did, I took a second to marvel at what he'd said. "Yes. I want to know why they didn't splint my hand, because truthfully, I would rather not have this operation, I think it would be better for me to go back to Mexico and find a bone-healer to cure me."
It has become a fundamental principle of Western medicine that we don't do anything to the patient against their will. When we fill out consent forms, we often say, "but even if you sign this, you can change your mind at any time." Well, this man had.
Another surgeon on his team came to the bedside, and explained that they were planning to put his bones back where they need to be so they can heal. The man said something I've heard many times: "Bueno, si van a hacer lo que el dice, eso esta bien. Pero el otro doctor dijo que me iban a poner una placa y unos tornillos, y que si no queda bien, me van a tener que rajar la mano otra vez, y si hacen eso y queda mal, un cura-huesos ya no me va a poder ayudar, como es normal." I repeated, in English, "Well, if you're going to do what you're saying, that's fine. But the other doctor said you were going to put in a plate and some screws, and that if it doesn't turn out right, you'd have to cut open my hand again, and if you do that and it doesn't work, a bone-healer won't be able to help me the normal way."
"I'm sorry sir," the doctor said, "I didn't mean to confuse you. We will put the bones in their right place, but then we need to put in a plate and some screws to make sure they stay there. So what the other doctor told you is true, too. Would that be ok?" I communicated this to the patient. By this time, the whole surgery team had arrived. The patient gave an uncertain, hesitant "Yeah..."
The doctors conferred "Has he had any medication yet?" one of them asked. The other shook his head. "What about his injuries?" "Well, he didn't hit his head, and there's no sign of a TBI" I knew that stood for traumatic brain injury. In a second I realized they were trying to decide if he was fully in possession of his wits or if they could operate anyway, for his own good, since they had written consent. As it turned out, there was no loophole.
So the head surgeon, who had filled out the consent earlier, clapped him on the shoulder, in a gentle, friendly way and asked, "What are you worried about?"
At that, the man really let loose. He began talking about his employer, and his worries about being out of work but having huge bills to pay, and worry about having to have a second operation and have even more to pay; how he would rather take care of this at home, but there was no money at home; how he'd never hurt his hand this way before, and really, he didn't get it- it didn't look that bad. At this point, he began to take off the brace he'd been wearing and inspected his arm dubiously. He'd seen guys on the farm back home twist their wrists in some terrible ways, and the bone-healer had straightened them out in 5 minutes.
I did my best to keep pace with him, and finally the doctor said, "I think you have some serious concerns about this surgery. My opinion is that operating is what's best for you, but at the end of the day it's your body, and I won't do anything you don't want to have done. So why don't we wait another day or two and we can talk more, and you can think it over. We can wait two days, and if you want the surgery then, I will do it." The patient seemed on the fence still, but after everything he'd said, the team knew they couldn't operate.
They wheeled him away, and I got called away to another patient. But I was amazed and oddly elated. The patient I'd just worked with chose not to have an operation that would assuredly improve his quality of life, and yet, I had a spring in my step. It took me a minute to realize what it was... I had just witnessed true informed consent.
So often the patients I work with have reservations or questions about what the medical team decides to do. So often they don't say them out loud, or are not fully listened to. But today, there was real communication. This man's voice and his worries were really and truly heard, and it filled me with a fierce joy. I really hope that he gets to sit down with someone and really talk about his reservations. I hope he does get the operation, and that his body returns to full functioning as soon as possible. But for that day, in that moment, it amazed me to see the whole machinery and process of the medical system come to a full stop to respect this young man's wishes. This young man, a laborer from the rancho (the backwoods of Mexico), who stood no chance of getting workman's comp from his employer, even though he was hurt on the job; this man who had more faith in the cura-huesos than in a first world medical procedure, the type of person who is so rarely listened to that many they have learned not to raise their voices or their questions - this man was listened to. It felt, just a little bit, like justice.
Tuesday, July 11, 2017
do mi sol
Today I spent time interpreting for a patient of ours who is what we call a "frequent flyer," meaning her condition requires her to be in and out of the hospital quite a bit. She's gearing up for a new treatment, and so there was a good bit of talking to do today. There have been some rough patches with this family: for a while there was some conflict between mother and daughter, complicated by the fact that the daughter has a learning disability, so we spent lots of time interpreting for social workers or psychologists who were trying to mediate, and I personally always walked into those sessions with a good bit of trepidation. It was difficult, too, because the daughter is fully bilingual, and takes pride in being able to speak English with the staff. That puts us as interpreters in the somewhat awkward position of interpreting the daughter's words to her mother - while she's judging us to see if we said what she would want to say. In the midst of a fight, that can be tough. Thankfully that rough patch is over, and today was a simple matter of education: relatively pleasant and straightforward.
Afterward, I went to visit the chapel, as I often do, just to think or play the piano, or pray or sing. I had sat down to the piano and was playing a song when I heard the telltale sounds of someone entering the quiet, green-carpeted space. The door handle clicked, swung open. I didn't turn to look until I'd finished the verse in the song. When I did, I was expecting to see someone random, briefly apologize for disturbing them, and leave. Instead, I saw the same family I'd just interpreted for.
"Toca el piano?" the mother asked me, "Do you play the piano?" "Yes, one or two songs, not much" I said in Spanish, for once not parroting her words in English. This seemed to give her confidence. "Are you a Christian?" she asked, to which I replied that I was. "What church do you go to?" So I told her, and then her daughter piped up:"I want to know how to play the piano," she said. "Oh, yeah? Well, it's here if you ever want to practice," I said, not thinking about her upcoming treatment and how she wouldn't be able to, not sure what to say "it's always here." "Yes. I want to play the piano."
I looked at her and thought. This was the moment of truth. Or the moment where the sh*t hit the fan, depending on how you wanna look at it. It's one thing to exchange a few words, to be polite and not rude. It's something else entirely to actually interact. And then, I just went for it. "Ven," I said, "come on. I'll teach you one thing." I walked over to the piano, she followed, and I sat down on the bench next to her. I showed her how there is a pattern of three black keys, then two, then three, and how your hand goes at the beginning of the sequence of two. She learned to play from C up to E, on both hands, and since she was kinda going for it anyway, I showed her the arpeggio of C too. She was able to play those things, and before I left and went back to work I got to tell her in Spanish, "mira, ya sabes algo en el piano!" "Look, now you know something on the piano!"
Sitting there with her made my heart so happy! I've taught basic piano stuff to several of my cousins, and it was such a delight to do something so normal with her, without the awkwardness of talking over her, or for her mother, or about medical stuff. A relief from all the stressors I'm typically dealing with when I see her. The simple joys of teaching and music and encouragement. As I walked away I couldn't keep the giant smile from my face. It was good just to connect.
Afterward, I went to visit the chapel, as I often do, just to think or play the piano, or pray or sing. I had sat down to the piano and was playing a song when I heard the telltale sounds of someone entering the quiet, green-carpeted space. The door handle clicked, swung open. I didn't turn to look until I'd finished the verse in the song. When I did, I was expecting to see someone random, briefly apologize for disturbing them, and leave. Instead, I saw the same family I'd just interpreted for.
"Toca el piano?" the mother asked me, "Do you play the piano?" "Yes, one or two songs, not much" I said in Spanish, for once not parroting her words in English. This seemed to give her confidence. "Are you a Christian?" she asked, to which I replied that I was. "What church do you go to?" So I told her, and then her daughter piped up:"I want to know how to play the piano," she said. "Oh, yeah? Well, it's here if you ever want to practice," I said, not thinking about her upcoming treatment and how she wouldn't be able to, not sure what to say "it's always here." "Yes. I want to play the piano."
I looked at her and thought. This was the moment of truth. Or the moment where the sh*t hit the fan, depending on how you wanna look at it. It's one thing to exchange a few words, to be polite and not rude. It's something else entirely to actually interact. And then, I just went for it. "Ven," I said, "come on. I'll teach you one thing." I walked over to the piano, she followed, and I sat down on the bench next to her. I showed her how there is a pattern of three black keys, then two, then three, and how your hand goes at the beginning of the sequence of two. She learned to play from C up to E, on both hands, and since she was kinda going for it anyway, I showed her the arpeggio of C too. She was able to play those things, and before I left and went back to work I got to tell her in Spanish, "mira, ya sabes algo en el piano!" "Look, now you know something on the piano!"
Sitting there with her made my heart so happy! I've taught basic piano stuff to several of my cousins, and it was such a delight to do something so normal with her, without the awkwardness of talking over her, or for her mother, or about medical stuff. A relief from all the stressors I'm typically dealing with when I see her. The simple joys of teaching and music and encouragement. As I walked away I couldn't keep the giant smile from my face. It was good just to connect.
Sunday, July 9, 2017
Le Felicito
You'd think that, if you get a call to go interpret in the trauma center in the emergency room, you'd be walking into a crazy, dire situation every time. Turns out that's not necessarily the case. Because of this, I've come to understand the word "trauma" not as "intense dramatic event" but more like "physical ailment that's not a disease process;" in other words, some kind of impact or accident that caused the person harm... like falling from something, or having something fall on you, getting mugged, or shot, or cut, or stabbed, or hit by a car, or sometimes even just having fallen down. One time I interpreted for a guy, a cook, who had shaved off some of his finger with a knife; but another time there was a mother/daughter pair who'd been in a bad car accident and held hands across their stretchers - which I say to point to the fact that, although it's all trauma, how chaotic and scary a case is can vary dramatically. The guy who chopped his finger had rigged his own tourniquet with a rubber band, and the surgeon was super impressed, so half the time I was interpreting compliments. You just never know what you're going to get.
Most recently my favorite encounter in the trauma center was with an older man (a patient) and the younger doctor who was admitting him to the hospital after a bad fall.
I had been bouncing back and forth between interpreting for this same patient and a couple others all afternoon, and they eventually made the decision to admit him. Over the course of several hours, with different technicians and providers, I had discovered him to be decorous, good-humored, and patient. He knew his own health problems well, and was a deliberate, clear storyteller; full of fancy words, jokes and good manners. So when the admitting doctor arrived, I was pleased to realize that he was a clear communicator as well.
He made eye contact with the man on the stretcher. Shook his hand. Asked what had happened to bring him to the hospital. He maintained eye contact and took notes as I first listened to the story (my third time), and then told it to him in English. He paused before asking his next question, then looked the man in the eye and spoke clearly, despite the fact that he was speaking English and couldn't be sure how much the patient would understand. He was even able to use gesture to great effect, something a surprising amount of people don't do well intuitively. As he went through his series of questions, I became gradually less and less of an obvious presence in their communication. It was one of those golden moments, the ones you always angle for, where you've actually faded to the background and the people you're serving have formed their own connection. It was beautiful to see. And the MD continued to ask clear, thorough questions and get clear, well-worded answers.
At the end of the interaction, they shook hands, the MD turned to thank me, and we both began to walk away. Then suddenly, the man on the stretcher said, "Le felicito!" I wasn't sure what he meant, so I looked at him, brow furrowed, and repeated it in English with a questioning tone "Con...gratulations?" He took the hint. "Le felicito, doctor, excelente trabajo. Muy cientifico!" Aha, I thought, that's what he means. "I congratulate you, doctor, excellent work. Very scientific!" At which the MD smiled and said "Thank you very much!" - which the patient understood. He then turned and thanked me, and we said our goodbyes.
The German-English dictionary I use tells me that the German word "sich verabschieden" is "to bid farewell" or "take your leave" or "say goodbye". The Spanish "despedirse" comes to about the same thing, but I wish there were a noun in English for the closing at the end of an interaction. Like "greeting" but for goodbyes. I've noticed that these types of formalities are much more important in hispanic/latinx culture than in US culture (although the US varies a lot, and so do hispanic/latinx cultures). An example, though, would be how when you enter a room, you have to greet every person in it. At a party or gathering, saludar can be quite an ordeal, especially if you're an introvert! But it's equally important when you leave, to take leave of every person. Not to do so can be insulting. But I digress.
The thing that was interesting and beautiful about this despedida interaction between patient and provider was that what the patient really meant with his "Le felicito, muy cientifico!" was "You were very thorough, I feel heard by you, I trust you, and think you'll do a good job of taking care of me." It was proof, to me, that it had really happened for these two: a therapeutic relationship, that bond of trust and mutual respect, had been established - in just minutes! It was a privilege to take part in that.
Most recently my favorite encounter in the trauma center was with an older man (a patient) and the younger doctor who was admitting him to the hospital after a bad fall.
I had been bouncing back and forth between interpreting for this same patient and a couple others all afternoon, and they eventually made the decision to admit him. Over the course of several hours, with different technicians and providers, I had discovered him to be decorous, good-humored, and patient. He knew his own health problems well, and was a deliberate, clear storyteller; full of fancy words, jokes and good manners. So when the admitting doctor arrived, I was pleased to realize that he was a clear communicator as well.
He made eye contact with the man on the stretcher. Shook his hand. Asked what had happened to bring him to the hospital. He maintained eye contact and took notes as I first listened to the story (my third time), and then told it to him in English. He paused before asking his next question, then looked the man in the eye and spoke clearly, despite the fact that he was speaking English and couldn't be sure how much the patient would understand. He was even able to use gesture to great effect, something a surprising amount of people don't do well intuitively. As he went through his series of questions, I became gradually less and less of an obvious presence in their communication. It was one of those golden moments, the ones you always angle for, where you've actually faded to the background and the people you're serving have formed their own connection. It was beautiful to see. And the MD continued to ask clear, thorough questions and get clear, well-worded answers.
At the end of the interaction, they shook hands, the MD turned to thank me, and we both began to walk away. Then suddenly, the man on the stretcher said, "Le felicito!" I wasn't sure what he meant, so I looked at him, brow furrowed, and repeated it in English with a questioning tone "Con...gratulations?" He took the hint. "Le felicito, doctor, excelente trabajo. Muy cientifico!" Aha, I thought, that's what he means. "I congratulate you, doctor, excellent work. Very scientific!" At which the MD smiled and said "Thank you very much!" - which the patient understood. He then turned and thanked me, and we said our goodbyes.
The German-English dictionary I use tells me that the German word "sich verabschieden" is "to bid farewell" or "take your leave" or "say goodbye". The Spanish "despedirse" comes to about the same thing, but I wish there were a noun in English for the closing at the end of an interaction. Like "greeting" but for goodbyes. I've noticed that these types of formalities are much more important in hispanic/latinx culture than in US culture (although the US varies a lot, and so do hispanic/latinx cultures). An example, though, would be how when you enter a room, you have to greet every person in it. At a party or gathering, saludar can be quite an ordeal, especially if you're an introvert! But it's equally important when you leave, to take leave of every person. Not to do so can be insulting. But I digress.
The thing that was interesting and beautiful about this despedida interaction between patient and provider was that what the patient really meant with his "Le felicito, muy cientifico!" was "You were very thorough, I feel heard by you, I trust you, and think you'll do a good job of taking care of me." It was proof, to me, that it had really happened for these two: a therapeutic relationship, that bond of trust and mutual respect, had been established - in just minutes! It was a privilege to take part in that.
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