Reflection: Dial 1 For an Interpreter
The cachectic, elderly man lay in the hospital bed; he looked brittle as glass as his wife carefully tucked in the sheets beneath him. On the other side of the bed, I approached with my resident. Almost instantly, the couple analyzed my face, read my name tag, and joyously recognized a Vietnamese last name. They started a conversation with me in their native tongue. How are you? Are you my doctor? Thank you so much for treating me. I replied cordially and tried to stick to formalities, but their faces lit up with joy for having found someone who could hear them in their own words. The wife bombarded me with her husband’s complaints, but I only understood bits and pieces about vomiting and fatigue. Not quite confident enough in my Vietnamese, I didn’t feel comfortable enough to engage in real conversation, let alone serve as a medical interpreter. This was especially true given what I knew was coming: before the resident and I had walked into the room, we’d looked at the patient’s chest x-ray, a constellation of masses spread across his lungs.
The conversation would be tough. Talking to a patient in your native tongue is like riding a train--it doesn’t take a lot of effort, and you have time to do and process other things naturally while you’re talking. However, talking through an interpreter in the room is like riding a bike down a winding road in all the worst ways--there are frequent slowdowns when phrases don’t translate well. Even worse, talking through an interpreter on the phone is like using a bike that’s been locked up in storage for 10 years.
After politely smiling and apologizing for my limited vocabulary, I hurriedly called a translator on my phone and handed it over to the resident. I took a step back so that the couple could focus their attention on the resident. As the resident interviewed the patient via the translator, I listened to both the patient’s words and the interpretation, mostly satisfied with what I was hearing. The bike was holding up.
The translator said, “The patient said that he had just received dozens of radiation and chemotherapy treatments for Stage IV Lung cancer in Vietnam. His doctor there informed them he was cancer-free. He and his wife were told that he had been cured.”
My heart dropped. I looked at the resident, deferring to him on how I should react. But his expression remained calm and neutral, explaining, “I am not sure what you were told, but I’m afraid your cancer was not cured.”
After hearing the translation, the man’s face sank to the ground, but his voice remained strong. The voice from the phone spoke, “He says he made his peace with death long ago.”
However, his wife’s voice gasped in Vietnamese, No, we aren’t giving up!
“He understands that he may die,” the translator continued, either unable to hear her or choosing not to.
He is cured. Lies. Why? It’s gone, the wife sobbed, looking at me.
“But he does not want to seek further treatment.”
What about me? You can’t die ... Followed by a slew of words I didn’t fully understand. No longer able to stand it, I interrupted the translator to ask, “Hi, can you translate what the wife is saying as well?”
The translator addressed her, “Excuse me, ma’am, could you repeat what you were saying?” She had stopped speaking though; it hurt too much. But I saw it in her eyes, her tears. She did not want to give up on him. She wanted to hear all the available options, why the doctors in Vietnam had lied, how this could ever happen. We were riding the bike through the pouring rain, and I extended an umbrella to her, but she refused, knowing that our deflated tires weren’t the same as a smooth train ride. The look of joy from when she met me replaced by despair. The way we explain our pain, the context of our health, how we function every day--is integral to providing quality health care, and until then, I never fully considered its importance in each and every interaction. Her words painted a richer, more detailed image. The resident looked back and forth between the husband and wife during the interview, but her words hadn’t been translated.
The resident looked at me asking what she said, but I struggled to find the words to say. What is she supposed to do without him? They just came here last month. She thinks he’s-- I was taking too long, so he changed his mind and spoke to the phone, “Tell them we will arrange a consult with the cancer doctor. And after we find out what our options are, we will be back.” He smiled goodbye at the couple and then beckoned me to leave with him. I told him I would be a few more minutes, and I stayed back with the couple.
Every time I speak with someone whose primary language isn’t English, I know some of my words or their words may not be fully understood. Every time I use a translator, I miss nuances in my patients’ inflection and specific vocabulary. Their words no longer belong to them, processed by an unpredictable third party. But that shouldn’t preclude me from trying.
I hopped back on the bike, umbrella in hand. I explained, via the translator in multiple ways with different word combinations, that he and his wife had options for treatment that could extend his time or alleviate his pain. And at the end, I said, I am here. Their faces softened, albeit only a little, and the dark clouds seemed to part above.
