All posts by witch

MAKE A LIST

Yes, this is my third marriage. My first? Well, I was very young and so was he. And then there was the other woman, and that was that. You know our men want to have their cake and eat it too, but I was not going to put up with that, as young as I was. I left him and moved to my mother in the US to work and find a better life. I learned the language, and it was not easy. Then again, when I set my mind to something, I can make it happen, God willing! All things are possible to God, and I have a story about that. But first, some sadness.

My second husband was from here. Very different. Older, more settled, but it turns out he had mistaken ideas about what a woman from my country is. He seemed to think that we would let the men tell us what to do. Haha! He must have been watching the wrong movies. And in fact, it turned out that he had been. To be serious. I couldn’t talk about it for years, because of the pain, but now I can. He was addicted to pornography. I had no idea, no warning. The saddest day of my life was finding him hunched over his computer, looking at someone who could be his daughter, a mere skinny teenager, and touching himself. That was it. I actually vomited, because my whole body and soul immediately rejected him. I still remember the dizzying emptiness, as if I had vomited out my whole marriage in a single cast. I fell in a heap to the ground, but the ground sustained me. I honestly thought I might fall right through it. But I didn’t. I survived.

Some men! What is wrong with them? I really wonder. My first husband tried to tell me that he didn’t really care about the other woman. That she had no value in his eyes, no importance at all. He seemed to think that would comfort me. I found that odd. If he didn’t care about her, why would he risk his marriage and future family for her? Why would he enter a part of his body into hers? What a strange way to think. What a breach, what a disconnection! I let it go, but I really cannot understand it to this day.

My second husband tried to tell me the girl on the screen was not real. Those words haunt me. Not real! I told him she was more real to me than he was. Because he was just an empty shell of a man. And she was most certainly somebody’s daughter. Having to suffer and smile for such as him! What made him think he should have sexual access to this teenager? I demanded an answer. But there was no answer. He just stared at me like a fool. Blinking like a deer in the headlights, frozen – paralyzed. I don’t think he was even in his body at the time I found him. Apart from God he was, that I know. I went to counseling after that, and they called what my second husband did dissociating – when your mind is actually out of your body and your body is abandoned. Such weakness in a grown man infuriates me. I feel the bile rise in my throat even as I speak of it today!

What happens to certain men to lead them into thinking that women are not important – that women are not real? I wonder. What kind of childhood trauma, what kind of abuse? What would make a man think that telling a woman that another woman doesn’t matter or doesn’t even count as a real human would be a nice thing to hear? What sadness there is in that. A deep well, fathomless. I believe these men are banished from God. Outcasts. And as a Christian woman I knew I had to leave him immediately. It was consorting with the devil to stay. If I cleaved onto him still, I would cleave onto his sin. It was my bounden duty to depart, although it cast me back into poverty. Still I left – to redeem my very soul.

Think of me with compassion! In all my youthful innocence, in all my desire to be good, and do good, it just went from bad to worse. First, a man who says a sister of mine in Christ, from the same church, is not important. That he can become one with her in the flesh and it has absolutely no meaning. That it shouldn’t even register for me as a transgression, because of her lack of importance as a human being! What sinful thinking. What a dark underbelly he showed me. Then worse yet, a man, already grown, even middle-aged, who would obliterate the very existence of suffering girls. To deny their humanity. To stand before me and state with conviction that they are not real! They are not fully human! What madness, what sin is this? Slavery was built on these lies. And human trafficking is modern day slavery. Give it a pretty name, and call me a prude if you will. I know what I know. And denying someone’s humanity is the basis for all human suffering. An absolute recipe for sin.

So here I was only 25 and already divorced twice. What could I possibly do but turn my life completely over to God? Like a child. God had never forsaken me, but I had moved away from God in my blind search for partnership and marriage. I was the one who had been out of touch. So I turned back to God and asked forgiveness for my own transgressions. I asked for the gift of clear-sightedness. I prayed to come into alignment with God. I prayed for atonement. I prayed until my heart was clear and strong again. I felt I was ready to try again. So I put up an ad. Optimistically. Third time’s a charm, haha!

Oh, heavens! The devil was in it. I can tell you that! The men I met! I went through some very bizarre first dates. Strange and stranger. I didn’t know what to do, but I was way too young to give up on love. I kept looking, and some dates made me laugh, and some made me shake my head in despair. I cast an ever wider net, hoping to catch my golden fish, but no such luck. Then one day I opened up and I told the ladies at my church prayer circle, and the oldest one gave us this advice. Make a list, ladies. Make a list. And then pray with an open and trusting heart. Pray to God who made you!

She told us, put every single thing you want on that list. Don’t be vague. You don’t make a shopping list that just says “some nourishing food” when you go for groceries. Be specific. State your true desires. She didn’t tell us to do it there at church, of course, because that would be embarrassing, but to do it in the privacy of our homes and to humbly pray over our list. And make sure, she told us, not to settle. If there is one thing on the list that does not match, that man is not God’s gift to you as a faithful servant. Make a list! Be specific! And pray.

The first thing I had to do was pray to God to suspend my disbelief. Could there truly be a man to match me, a twice-married woman, who was still pure of heart? By then I was already running my small business on the internet, mostly cosmetics, so at least I didn’t need a man who could take care of me financially. But I longed for a soul companion, one with his own innate moral sense, a man that I wouldn’t have to guide or shelter… a man that might even protect me in my most vulnerable places. For him, I would gladly offer my life, and use every breath in my body to serve him. To rest in him. The potential joy of it made my heart flutter! So I made my list, and I gave it to God. Let me think what was on it, as best as I can remember.

Strong moral fiber. Thoughtful. Self-aware. Insightful. Clean. Neat. Professional. Nicely dressed. Very hygienic. Because if he may end up kissing me, my dear, he had better be thinking about the quality of his breath! Man of God, of course. Good Christian. Loves his family. Understands family ties. Cleans his shoes. Believe me, I dated a few where it was only the scuffed shoes that warned me off. I decided that mine would have immaculate, shiny shoes. Ambitious, like me. An equal partner. In good shape, because I work out and I care a lot about it. Did I say well-dressed? Well put together? That matters. Not vain, but a man who likes to look his best. Must be able to lead me in dance, vitally important, and appreciate my cooking. I grew up in the kitchen at home! And of course, above all, faithful in word and deed. And not because I am watching! True to himself, and thus trustworthy. A strong man. Someone who can see the humanity in everyone. Who knows himself well.

Perhaps a strange list. Perhaps. But God is great, and thirteen years after my last divorce, guess who I found? Him! Yes, I just got married for the third time a year ago last summer. Yes! We run the internet business and it is expanding like crazy. We go to the gym most mornings, because we have the time. We make our own schedule. And I have time to take care of my mother, and come with her to her appointments, as she grows forgetful. He supports me in this, and is kind to her himself! And my dear, he is tall and clean. Healthy and strong! What do you call those kind of push-ups where you clap your hands underneath you between the push-ups? Yes, he can do those! He cares about staying in shape. And he treats me very well. He sees and appreciates my good qualities. He is pure of heart. He wishes to do good in the world. We help through our church, and we enjoy ourselves immensely, and we pray together!

As to my list? Yes, haha, even down to the shoes it was a match, just as the old auntie at church had advised me, may she rest in peace. I knew it would click when he finally invited me to his home and there was a shoe-shine kit by the shoes at the front entryway. That was the last piece of the puzzle. I saw it, and thought to myself: God’s last detail. A man with clean shoes is a clean man. And so it was, in the most fundamental way.

I feel sure that God is holding us as man and wife in the overwhelming immensity of His Loving Hands. I have felt human love before, this is true. But in giving my love to men who were unworthy, men for whom I merely settled thoughtlessly, without intent, I was sloppy. And I paid for it. Now I finally feel completely safe, in my innermost heart. And my dear husband feels just the same about me, that he can rest in me. What joy, what happiness! And the baby to come… truly God is great. And whatever else God chooses to give me or take from me, I shall praise Him to my dying day.

SHACKLED

Your Honor, I object to the shackling of this defendant! He is here to plead guilty and the recommended sentence is Credit for Time Served. It is ridiculous to have him in shackles!

Marshall, can you explain on the record why the defendant is shackled?

Yes, Your Honor, he is on Ultra Status because he attacked one of our jailhouse nurses this morning.

Counsel?

Your Honor, I object strenuously to my client being shackled and want to go on record stating that he may feel coerced into pleading guilty because of being shackled. He should be afforded basic human decency. I am absolutely objecting to the use of shackles!

Marshall?

Your Honor, the defendant is in for unlawful use of weapon, and he just attacked a nurse. He is on Ultra Status. We are not going to remove his restraints.

And the alleged weapon brandishing incident concluded without any actual harm to any actual human being!

Well, counsel, I will note your objections for the record. Now I need to ask a few questions of the defendant before I can consider his guilty plea.

I see you are in shackles. Do you feel coerced into pleading guilty because you are in shackles?

No, sir!

Pressured?

No, sir!

Do you feel forced in any way?

No, sir!

Do the shackles have any impact whatsoever on your decision to plead guilty today?

No, sir!

Then I am ready to hear your plea, and consider the sentencing recommendation. And the defendant will remain shackled during this proceeding.

SHORTS

I hate shorts. I don’t care if it’s a hundred and five degrees out. I really hate them. I’m never gonna wear shorts again. Because we were so poor. I was the youngest of seven living children, with some ghosts in between us, you know, the babies who didn’t make it. And we had enough clothes for maybe three kids, but there were seven of us living. So when my older brothers wore out their pants and the knees were all ripped out, my Mom would just be like, oh, that’s okay, we can just cut them off and Baby can wear them. And guess who Baby was? Yup. Me. Oh, it was warm enough. The problem was that nobody wore shorts except the poorest of the poor, and that was me. It was a mark of shame, like having no underwear or torn shoes. I’ll never forget it.

I can still look down and see my skinny, knobby little knees. One or the other always had a scab on it, sometimes both of them did. Dusty and dirty and one sock that was falling down because it wasn’t the same size as the other one. When I even had two socks. My wife makes fun of me for being such a Junior now, you know, dressing up nicely with a neatly pressed shirt and a pair of slacks. But honey, at least I iron my own clothes, right? Because it means a lot to me. It means the world. It means I have enough to eat, and a safe place to live, and my kids have enough to eat, and we don’t have to feel ashamed about anything like that. Because God knows I wouldn’t buy myself nice clothes unless my family was already fed, housed and clothed! I still remember exactly how I felt as a poor little guy.

Do I have a little shoe-shine kit? Yes, I do. Do I like to have pants that are a little bit shiny and don’t wrinkle? Yes again. Do you see my knees if I am not wearing a hospital gown? No, Ma’am! Because I have two clean knees and nice pants to cover them. My wife here can giggle all she wants. I know she understands me, even when she jokes about it. Ask her about her one dress and the missing button. Go on, baby, tell the interpreter about the safety pin you had to use. And how you looked all over for that button. For weeks! And then finally figured out it must be three miles down the river from where your Mom washed your clothes. Far out of your reach. You remember. These memories go deep.

We’ve come a long way, not just on the map, you know, but in what we can provide for our family. So if anybody wonders why our kids look like they’re dressed for church just to come to the hospital, now they know the reason. We’re not raising them to be proud, God forbid, but we never want them to feel ashamed of something that’s not their fault, like poverty. I promised my wife I would take good care of her if she joined me here, and so far I have. And that’s a good feeling. That’s something to dress up for.

NOT ENOUGH

I heard the lawyers talking about 160 months – I can’t even believe that. It’s so unfair. It’s not enough. I have to live with what he did for the rest of my life. Why should he have the chance to ever be free? I will never be free. Believe me. I know. It was years ago and I live with it every day. Every day. It took me all this time to even be able to talk about it. It took me years and years even to tell my own mother! I am scarred, Your Honor. I don’t have words for this kind of betrayal. Why? Why did he do it? I want a reason. Can you make him tell me why?

When he moved in, he said he was our Dad. He acted so nice. So loving. Our Dad! We trusted him. But it was all a lie. How could he do that? I never did anything bad to him. I never hurt him. I only tried to help him. He had a baby with my Mom, and now I have that baby brother, with the Dad who is my abuser. How do you think that feels? I used to wonder – what did I do? What did I do to make it happen? But I didn’t do anything. I was ten years old, Your Honor. Just a little girl needing a father. I tried to be a good daughter. I did what he told me to do. He said he was our Dad!

He hurt my whole family. How did we deserve this? My mother fell in love with him. She trusted him. She felt sorry for him. She helped him. She took care of him and cooked for him. She knew he drank too much, but she wouldn’t give up on him. She kept trying to get him help. She let him move in. We had to help him, because he was our Dad now. He said so. He promised. He was our Dad. We encouraged him to go to his meetings. Go to classes. We took care of him. So how could he do that to me? How?

I am here to say what I think about his sentencing. Well, I don’t want him to get out of prison. I don’t want him to have a life. I don’t want him to be free. I see he has a new wife and a new baby and the lawyer says she has kids of her own already besides their new baby. Are any of them girls? Are they? I want to say to his new wife, I don’t wish you any evil, but how do you know – how do you KNOW for SURE that he has not done the same thing to your girls that he did to me? It is in him. It lives in him. He might have done it and they will be too scared to tell you for years and years. They will be too scared of him. Like I was. You don’t know him. Believe me. You think you do, but you don’t. My own mother didn’t know.

Your Honor, 160 months is not enough. It’s not enough. His lawyer was talking about mercy and compassion. Did he show me mercy? No. Did he show me compassion? No. So why should he get a light sentence? That’s like stabbing me in the gut. Please give him the maximum. Please. Because even if you do give him the maximum, it will not be enough. I hope he suffers every day of his life and I hope he dies in prison – the loneliest, most damaged person in the world. Because that is how he made me feel.

I

JOANNA

People who don’t interpret tend to ask how interpreters can “think so fast” and be so ready to pop out what someone just said in a whole different language, just a split second behind the speaker (simultaneous). Or how we can remember what someone said in a paragraph or two of speech and then say it all back (consecutive). One answer is practice, and of course fluency. Another factor that few people consider is that interpreters are doing what all listeners subconsciously do. We are predicting what people will likely say based on context and whatever other knowledge we have of the situation. It is the same skill that close relatives and partners use to drive each other crazy by finishing each other’s sentences.

Of course, we don’t always know what a person is about to say, or even what they are saying once it is being spoken. I had a nurse who was practicing her language skills tells me that our patient was an ex-combatant. She even told me outside of his room that his military experience explained how impatient and controlling he was with the staff. She knew all about it, she told me. She was an army brat! Weeks later, someone asked his visiting wife about it. And it turns out that he never was a soldier at all. He simply comes from the state of his country named “Warrior” in his language, and the nurse has misunderstood him. It didn’t help that the word for “state” in his language is the same word as in the phrase “I have been” so I can see why she had heard him say “I have been a warrior” rather than “I come from the State of Warrior”. She also had preconceived notions about how veterans behave, so it fit into her mental picture nicely. And it led her straight to a false conclusion.

This nurse is no exception to the rule. Interpreters also jump to the wrong conclusions. I was interpreting for a cancer patient who was asked to say what side effects she was noticing with her chemotherapy, specifically headaches or nausea, and she pointed to her nightstand and said it was hard for her to do the “point of the cross” because it would give her a headache. I looked at her nightstand, and the first thing I saw was her rosary. I also knew she came from one of the many speech communities where they don’t pronounce their “s” so I jumped from the singular “point” to the plural “points of the cross” and asked her if she meant she was praying the stations of the cross on her rosary. She smiled politely and reached back to show me the embroidery she was working on – a cross stitch needlepoint. Not what I expected. “Interpreter correction: Not stations of the rosary, but cross stitch needlepoint.”

In a court hearing where a defendant was explaining why he had not followed a court order, he told the judge through an interpreter that Joanna had told him he didn’t have to do that any more. The interpreter presumed that Joanna was the name of the defendant’s probation officer. The interpreter stated, “Joanna told me I don’t have to do that any more”. The judge responded by asking him who this mysterious Joanna was, and his answer came through the interpreter: “You are Joanna, Joanna.” There was a confused pause, and then the interpreter snapped to and added, “Uh- interpreter correction: You are the judge I am talking about, Your Honor.” (Your Honor pronounced with an accent sounds quite like Joanna.) The judge was able to look up the record and see that she had reduced his day reporting to twice a week, so the defendant was not found to be out of compliance. The interpreters all ran around greeting each other as Joanna for a number of weeks because it was somehow so delightful to say, “You are Joanna, Joanna!”

A friend of mine was doing a deposition in a fish processing plant accident, and the person being deposed explained that he was working next to Joaquin about the time the accident happened, and then he slipped and fell just as he was stepping into Joaquin with the next load of frozen fish. The lawyers for the insurance company wished to go on record that the witness was not making any sense, putting into question his credibility. The lawyer for the plaintiff wondered on the record whether the interpreter was really able to understand the defendant. The interpreter asked for permission to get clarification, and asked him who Joaquin was, and what he meant by stepping into him. The injured worker was very surprised and loudly repeated, “Joaquin! Joaquin!” This didn’t clarify much. Eventually they were able to figure out that he was talking about the walk-in freezer where he had slipped and fallen with his tray of flash-frozen fish. Walk-in sounds a lot like Joaquin. If this interpreter had worked on ships like I had, she would likely have guessed it right away. But she had no context for it.

I was once doing a therapy session and my client stated he had seen a wonderful movie called What the Wind Carried Away when he was a child. Presumably some obscure movie from his country of origin. Then he went on to mention someone named “Escarlet” who said she was going to “think about it tomorrow”. This is when I realized I had misstated the film title. So I raised a hand to interrupt, and said: “Interpreter correction: The name of the film is Gone with the Wind”. The psychologist and I both spontaneously giggled, and I immediately asked his permission to clarify for the client that we were laughing about my mistranslation of the title of a very famous movie, and not anything about the client, of course. Then they were able to get back to the client’s procrastination problem, and his underlying perfectionism that makes him put things off rather than risk completing them imperfectly.

Years ago, I was with another client who had a very strong accent, a very short temper, and never pronounced his “s”. The social worker was trying to assist him with housing support along with drug treatment, and needed to know where he lived. There was some question of dual diagnosis, meaning underlying mental or cognitive difficulties. They wanted to get him services close to home. Not the easiest guy to interpret for, and I was not understanding him well. He couldn’t remember his address or the name of his neighborhood, but said he lived near the coconut. I presumed he must live near a coconut palm tree, or a small stand of them, but where would that be? Then he said no, the helmet. I interpreted that, and wondered if he lived near some motorcycle shop that had a big helmet on the roof, or what kind of a landmark that might be. He kept repeating palm tree and helmet, and so did I.

Then he got really angry, and I was able to interpret his next utterance into English, yelling just as he had, as: “The palm tree – the helmet – the palm tree- the helmet – what the f%*k don’t you understand?! This last utterance was directed toward the interpreter.” At that point, I finally got it, to his great relief, and told the social worker, “Interpreter correction: I live nearby Costco.” For the record, coco is coconut and could be a coconut palm tree, and casco is a helmet. And Costco is Costco. When something is unexpected and unpredictable, we are not able to guess our way forward. If I shopped at Costco or drove past it regularly, I would have got it right away. But it was off my radar.

One of my favorite interpreters likes to say that the only time people notice us is when we have messed up. There is some truth to this. As long as interpreters are doing our job well, it can be fairly seamless and we will be mostly invisible. The jurors will be focusing on the witness, and the healthcare providers will be focusing on the patient. The interpreter will be unobtrusively passing ideas, words and phrases back and forth but not holding onto them for long. Having heads swivel toward me when I least expect it is an uncomfortable wake-up call, much like a dash of cold water on the face. It is a sign that I have likely overstepped my mark while making one of the thousands of tiny predictive jumps that we all make every time someone opens their mouth. Then it is time to backtrack, regroup, and stop my predictions from carrying me away.

FEVER OR DOGS?

Yesterday, I was ushered into a room with an elderly woman and a young male resident. He immediately dismissed me as interpreter, telling me that he speaks her language. I told him that I shall stay and interpret for the actual surgeon when she arrives. He repeated that he doesn’t need me. But I stood by anyway. Then he launched into a barrage of complex language, rapid-fire and sprinkled with his own local slang. After all, he is a native speaker. So why is this a problem?

Number one. The patient could clearly not understand him. Number two. The resident did not pick up on the very obvious fact that the patient could not understand him. Number three. The patient felt “put in her place” by the young male doctor’s use of the informal “you” which is NOT how one addresses an elder, and further taken aback by his hurried and confusing speech. Thus, the patient was not made comfortable to ask questions, or even say when she could not understand. The patient was further judged about not working outside the home, and being overweight. On paper, we all speak the same language. Box checked. We even “brought in” an interpreter, who is sitting in the room. So no lawsuit. But really, can we be confident that we have informed consent for the upcoming surgery? I cannot. Because I was not allowed to do my job.

Here is the flavor of the resident’s word choice, in speaking to someone who left school in elementary. In asking what makes her pain worse, he asked, “What starts it on a chain of events?” The patient answers that she doesn’t know (because she doesn’t know what he means). Her answer starts the doctor judging her. Meanwhile, she is having a different experience. She is wondering what chain of whatever he is asking about, and she is feeling anxious. She is wringing her hands and clutching her bag. She is shifting in her seat. Why is the doctor impatient with her already? The doctor is shaking his head while taking notes, and talking quickly.

In saying they were going to have to talk more about her case with his attending doctor, this resident uses the word that in her speech community means to exchange words or to argue. Even more worrisome! He goes on to ask if she can “reduce” the hernia, and she thinks that means to make it smaller, so she says no. He asks if she has noticed any “brusque growth,” and again she says no because she doesn’t know what he means. He uses agile to mean quick. For an allergic reaction, he asks what the allergy “generates” and again not understanding, she again doesn’t know. He asks if she has hyperlipidemia and she says no. He gets impatient and tells her the chart says she has high cholesterol and she takes meds for it. He even asks if she has had any “fever or dogs” lately, because his local word for “chills” happens to be a common word for dog , pooch, or mutt in most places. Virtually every answer she gives is no or I don’t know. All the way to the end: Do you have questions? No. What do you expect from this appointment? I don’t know.

The resident truly had no grasp, not an inkling, that he was doing a poor job. That he was scaring the patient. That he was disrespecting the patient. That he is a horrible communicator. That he was getting “no” and “I don’t know” to all his questions NOT because she is stupid or stubborn or a bad patient or doesn’t care about her own health, but because she didn’t know what the hell he was talking about half the time. He exhibited zero sensitivity or awareness as to how the communication was going, and the appointment is for a surgical consent.

Part of cultural sensitivity is overall awareness and respect for the people we serve and acknowledgment of their humanity. Those of us who work as professional communicators are clear about this. Most staff consider us experts and professionals and thus welcome and integrate any linguistic guidance we can give them to keep open lines of communication. They understand that above and beyond our basic linguistic skills, we can pick up on subtle cues such as facial expression, body language, hesitations, unexpected answers showing confusion, fear, or misunderstanding, and they rely on us to monitor the quality of the communication throughout. This resident just plowed on getting no and I don’t know over and over, without once stopping or adjusting. He had words to deliver and he was checking boxes on the screen. He was doing his job as he views his job, but seemingly unaware of the patient as a real person having her own subjective experience.

Speaking of the patient’s subjective experience, here is an elderly lady who has worked hard to raise eight children and take care of them, and now helps out with her eleven grandchildren. As a matriarch who has dedicated her life to her family, she has earned their respect. She is looked up to as a very important head of her growing clan. This doctor walks in and his first move is to tell the interpreter – that the patient requested – to leave. Then he talks down to her in using the informal address. He is hurried and rushed and he talks over her in every sentence, using words she cannot understand, not explaining anything well, confounding her and limiting her ability to exchange needed medical history and information. Even in asking about her work situation, instead of asking whether she works “outside the home” which would be a standard culturally appropriate question, it goes like this:

“You work?” “No.” “You unemployed?” “No.” “You retired?” “No.” “Then what can’t you do?” “Uh, I don’t know.” He may have been trying to inquire as to the ways in which the hernia impedes her daily activities, but he never directly asked that and he never found out. She looked very confused and mumbled something about mopping, then looked to him for further help, which she did not get. He had already concluded that she was incapable of answering to his satisfaction. On his way out to get the attending, already standing in the doorway, he looked her up and down and asked, “Have you been to bariatrics? Do you even know what that is?” She said no. He walked out. Bariatrics, by the way, is the specialty clinic for weight loss.

While the patient and I were alone waiting for the actual surgeon, she heaved a big sigh and looked up at me for sympathy. I asked her if she had fully understood the young doctor, and she no. That she understood some, but not all, of what he was saying. He spoke so oddly! I apologized on behalf of the hospital for the miscommunication. I went over the list of the few terms I had had time to jot down in the rapid-fire resident interview. For example, I told her that when he asked if she had dogs he wanted to know if she had chills. She was surprised and enlightened by the terms we went over. She asked me questions, and I assured her that once the actual surgeon arrived, she could ask all her questions and get them answered in a way she could understand. I encouraged her that as a hospital, we do like our patients to ask questions and we do want them to understand. I am sorry to say that I assured her that I would be there and help her once the surgeon came, so we could get everything cleared up, because as it turns out, I was not allowed to do my job.

As soon as the doctors returned together, the resident again told me in English to leave, explaining that “I will be translating so you can go ahead and leave.” I did point out to the attending surgeon that their patient had not understood quite a few things and that she had not been able to answer appropriately as she had not understood. That she was having a hard time with his vocabulary and delivery style. I offered some examples. “She cannot understand you very well,” I said in conclusion. The attending surgeon smiled and thanked me, then told me to go ahead and go because she knows “interpreters are busy” and she will be just fine with her resident as her “translator”. I felt compelled to leave.

When I spoke to my boss about it, she asked me to write them up. Knowing it may be investigated along with other unsafe and unethical practices, I felt a little less “moral distress” which is defined as the emotional pain of knowing what should happen and being unable to make it happen. Basically watching something you know is wrong and being helpless to make it right. This patient’s body language and gestures spoke volumes, but nobody was listening. Except me. And when I pointed it out, I was dismissed. My heart is heavy thinking of this patient and her experience. A grandchild had taken the day off work and they had driven several hours for this long-awaited consultation at “the best” hospital with the “best” staff. I wish that she could have felt seen and heard, and been treated with the dignity and respect that she deserves.

FLOPHOUSES

I moved here around 20 years ago now. Maybe 25. Back in the day, we had flophouses, you know what I mean? You could get a cheap room right downtown, with your own bedroom. Or share a room with a couple other guys for even less. You had to go to the end of the hall for a bathroom, but that was okay. No kitchen, no cooking, except a couple big old houses by the university, but the downtown ones, they were reasonable. You could get work for the day and pay for the night’s bed pretty easy. Or pay by the week, whatever. We didn’t worry about sleeping outside. It wasn’t a thing.

I don’t remember people actually camping outside. I don’t remember a single tent in a city park. There was no Jungle under the freeway. There were no Official Encampments, at least that I knew of. There were not a bunch of rows of campers, people in cars, and pretty much somebody in a sleeping bag in every business doorway, it seems. In every green space. In every possible spot. We were poor then, and most of us still are poor, but we were working poor, and we slept inside. I think the owners made a profit, too. I mean, we didn’t demand much. Mostly just a roof over our heads and a locked door. Now these buildings are gone, and it’s just high-rises and condos. Instead of being locked in at night, we are locked out.

You know, I grew up in a poor country, and I grew up seeing beggars. People who had nothing but what somebody might hand them out a car window, or the food someone might give them by the back door. And when I got here, I thought wow! Everybody who works can sleep inside. And everyone can find some kind of work. It’s like a miracle. People talked about how there was money enough for everybody. Now they say the money is gone, but where did it go? The government prints the same amount of money, right? So the money is still around, it’s just changed hands. It’s concentrated. Like in the countries we fled from to come here and have a better chance. Life is funny that way. Not haha funny, but more like food for thought.

I worked for the same guys, small companies, for years. A house remodel here, a clean-up there, a rockery, a fence, some landscaping around town. Basic stuff. A lot of the owners would just pick us up and drive us to the work site, and that was great. But those small businesses seemed to dry up around the same time that our housing got pulled down. Maybe it got too expensive for them, too. Maybe the traffic did it. Who knows. I’m still able-bodied, so I count my blessings there. But I lost my contacts. So now I am just one of a hundred guys standing outside of Home Depot at 5:00 a.m.

I get picked up a couple of times a week, and every once in a while, they will hire me back for a couple days. But a lot of them don’t want to pay you unless it’s something really heavy, something they don’t want to do themselves, like moving concrete and demolitions. More tear-downs than building. Then they decide how much to give you, and you can take or leave it. There used to be more of a standard day wage, but now there’s a guy who’s hungrier than you, louder than you, and younger than you, pushing out in front, so you’d better take it quick or forget it. Just hop in the back of the pickup and shut up.

I never thought – I never even dreamed – that I would be sleeping outside. I’m a hard worker. I’m a good worker. I’m a willing worker. Sleeping outside! Sleeping in doorways and parks. Keeping all my stuff in this backpack, nowhere to put it down. Going to that shared laundry downtown where they let you put on a jumpsuit and wash all your stuff at once. Why do I say all? It’s mostly one outfit with layers. And two pair of pants, in case someone needs you more clean for a job inside. And work boots.

Camping out in the city is not camping out. You think about campfires, and fishing, and starlight. No. Think about rain. Think about cold. Think about concrete. Think about trying to find a doorway where no one will kick you out or hurt you. Your backpack is your pillow and you hold it with both hands. Maybe you put your wallet into the foot end of your sleeping bag, in case someone does grab your backpack and run off. Think about every noise, every rustling. And sorry to say it, the city rats. You gotta wake up, you gotta keep an eye open. You sleep four or five minutes at a time. Then as soon as it gets light, you gotta get that first bus and stand and hope for work. You tired? Too bad. You hungry? Share a can of beans. You sad? Can’t afford it. Don’t even think about it.

The city has to be what the city has to be. I get that. It’s changing. People call it growing pains, and talk about how it will get better later. But let’s face it, it’s not going to get better for people like me. At the end of the month, eating carefully, staying sober, trying to get work every single day, the only way I can put together the couple hundred dollars my family needs to survive, is by sleeping in a doorway. And I will do it as long as I can, because I’m a working man and I’m going to take care of my family the only way I know how, by working. I used to think once my kids were grown I’d get a break, maybe even move home, but my wife has diabetes and needs insulin and now it’s my parents too, you know? I was just gonna say I wish it could be easier but I can’t let myself think that way. I could fall apart. And then where would we be?

HEAD IN SAND

I understand why some people would rather keep their head in the sand and not be aware of what is happening around the world. There is only so much we can do. Does it help anyone for me personally to read details of various wars, human trafficking, environmental disasters, political prison systems, and more? Or do I just traumatize myself to the point that I cannot be as helpful in contributing my little bit to society? Does information overload make it all seem so hopeless that I get paralyzed in despair?

I used to feel obligated to know as much as I could, under an idealistic theory that “if they can live through it, I have to handle knowing about it,” and I sought out information, and really tried to understand so many situations that were so far out of my control. It gave me a certain world view that can be painful to me but keeps me more sensitive to the suffering of others, and in that way, I suppose it has served me well. I am much less likely to wound others where they are already most wounded. I have a sense of where vulnerable people’s sensitivities are.

Not everyone has embraced this process, and I do understand why they wouldn’t want to. But I wish those who work in healthcare and others who interface intimately with vulnerable populations would make some effort to have a general understanding of the people they are likely to meet. A few evenings of reading would give them enough insight to avoid reawakening deep wounds in those they are paid to serve, and they don’t need to delve in deeper than the surface if they would rather not. A few simple tips:

TORTURE: People are really tortured. Don’t give a torture example for your pain scale questions (10 is like being tortured!) And please stop joking about torture or using the term with a sarcastic laugh. It is no more appropriate than joking about rape, which is one form of torture among many. I cannot count the times nurses have joked about not being into torture, or how something is torture. It is not torture to have a blood draw. It is not torture to watch a film about transplant. Find another word. Millions of people in war zones and areas of conflict face torture as part of the power struggle. It is very real and leaves permanent scars on the body and in the psyche. Be respectful. Torture is real. Making light of it hurts.

MURDER: Most people in war zones have lost family members. Sometimes whole families are gutted. In my father’s country, they lost 10% of their population and 18% of their land in the last war. No one in that country had a family that was intact. I remember one older man telling me he didn’t dare marry his childhood sweetheart after the war, because her father had been killed, her older brother had been killed, her two uncles had been killed, her cousin was an amputee, and the farm was going to filled with widows, disabled and orphans. This still goes on. So what seems like small talk, casually asking about family members, how many kids someone has (left) can open deep wounds.

FAMILY SEPARATION: It is extremely rare for a refugee or immigrant family to arrive all at the same time, or even to all arrive. One parent or an adult child is sent here to work, or wins an immigration lottery, or makes it over the border while the rest of the family is caught and deported. Again, the small talk that is so common, how many kids do you have, where are they? Oh, dear, you haven’t seen your daughter in 8 years, that must be hard! Your wife is now with someone else after you sent money for 4 years, too bad. Your Mom died a lingering illness but you couldn’t go back and say goodbye? Oh, gee! Folks, these are not the conversations that your refugee patients need to have during blood draw, with a medical assistant, or at any other time during a routine visit. Be sensitive. Don’t pry. You can open a wound simply by asking someone if their children live nearby.

HOW CAN I BE SENSITIVE? Just remembering that the refugees you hope to serve have likely been through terrible and traumatizing situations will make you more sensitive and respectful. Understanding that their family has huge holes in it, missing people, parents they will not be able to comfort on their deathbeds, children they will not be able to raise themselves, wounds that can open at the slightest touch, will make you kinder and more careful in your speech. Focus on what you are doing with the patient, and let them bring up their families, their lives, and their experiences if they wish. If they find you compassionate, and you have the time, they may wish to have these conversations and talk about their lives, but let it be their choice and in their way. It is the least we can do.

QUESTIONS

Patients are being invited to ask questions and voice their concerns more these days, and it can be eye-opening to the medical providers. I was with a surgeon who was doing her final pre-surgical review with a patient, and the questions the patient’s family asked made her step back and realize she needed to explain the surgery over again from a whole new perspective. The doctor had come in presuming the patient and her family had understood everything just fine at the office visit, but the questions that came up when I was with them told a much different story. It was illuminating for all concerned to share this question and answer session. I am glad to see this happening as a more regular part of healthcare.

When asked if she understood what was going to happen during the surgery, the patient admitted she really didn’t know what her body parts were that were slated for removal. Just that they were “down there”. So the doctor was able to make a simple drawing, and instead of just naming items like ovaries, womb, bladder and bowel, she showed their shapes, and said what each organ does, in a simple way.

The husband’s main concern was whether any men would be in the operating room. He was very concerned about his wife’s modesty. The surgeon was able to reassure both him and the patient that she would be covered up and that everything would be done “decently and respectfully”.

The son said he was really surprised to hear that his mother had two ovaries, because he had always heard that women just have one. The doctor was able to explain that the gonads in both men and women, that is to say, both ovaries and testicles, come as a pair. In men, they descend and hang outside. In women, they stay deep inside. She pointed to her drawing to show where they were. She explained that is not where the baby grows, and we do just have one womb. She pointed to that as well.

The daughter, a college student who is bilingual, asked if after the doctor removes the ovaries and the pathologist looks at them, whether she going to put them back into the mother’s body. Will she be able to clean them up and then reattach them? The doctor was able to explain that the ovaries are very diseased, and have been destroyed or eaten up by the cancer, so there is nothing left to put back. But she assured the patient that beyond the ovaries, they would only take away what was badly diseased, and work with the pathologist during the surgery to decide what could be left and what removed. And reminded them that this may include some bladder and bowel, and showed these items on her drawing again.

It is useful and healthy for patients to get their questions answered where they are at. It is useful and healthy for care providers to have a better sense of their patients’ background knowledge, concerns and worries. Questions, even the kinds of questions we tend to cringe at (like will anyone see my wife’s private parts) need to be answered. Because healthcare providers do not get to decide what is important to the patients and their families. I saw the doctor’s facial expression change from hurried to surprised. Then she stepped back to explain the procedure better, and talk with the patient where she is at. With each well-answered question, the faces around me relaxed and shoulders dropped. They nodded at each other.

At the end, the doctor placed her hand on the patient’s arm, and invited her to ask anything else. The patient admitted she was “too scared” to ask anything else, and just wished it was over. The doctor nodded and thanked her for sharing that. Then she added that the patient is in good hands. She is with experts at a specialty hospital. Her cancer is being diagnosed, and they are going to take out the least amount of tissue possible. Then she can meet with the cancer team and see what else can be done. “One step at a time,” she told the patient. “We will just take one step at a time!”

“We place our trust in God and in you, Doctor!” the patient responded, and her family members nodded in unison with newly earned trust for the healthcare team and the process this patient was facing. Time spent? Probably a total of ten minutes to smooth this patient’s whole cancer journey and create a space for the healing we all hope for. Time well spent for all concerned. Including the doctor, whose life is enriched by getting to know her patients more fully.

These kinds of question and answer sessions bring us much closer to our goal of fully informed consent. They give reassurance. And they help doctors communicate in a way that is more helpful and meaningful for their patients. The more we can move away from our canned presentations into a more fluid and welcoming communication style, the better patients will feel. Because what patients face on the physical front is enough without adding any unnecessary fear and uncertainty. Where we can inform and comfort, we should. I am happy to see this happening more.

OPEN WOUND

As part of a transplant workup, each potential candidate goes through a series of grueling tests, including meeting with a psychiatrist on the team. I wish that one particular psychiatrist were capable of being even mildly sensitive about cultural, gender, and trauma issues. As in, having even a modicum of familiarity with basic psychology and sociology, which should be part of any mental health professional’s development. I was truly dismayed and disturbed in what vicarious trauma experts have now dubbed “moral distress”. Moral distress is the stress that “occurs when one knows the right thing to do, but institutional or other constraints make it difficult [read impossible] to pursue the desired course of action.” That definition hits interpreters very hard, as the limits of what we can do are so incredibly narrow. Yet we are literally first-hand witnesses to every possible manifestation of healthcare, and observe with our hands tied.

This psychiatrist did not give the patient any context for her to understand his role and what was expected of her. He failed to inform the patient that she was not actually under any obligation to answer all his questions or give details that bring up severe trauma as part of the evaluation. He failed to protect her. I believe he had no clue that she would feel absolute compulsion to answer every question he put, even when he delved into what seemed a selfish indulgence of his prurient personal curiosity rather than any part of a transplant workup. I believe he is completely clueless about her culture, her respect for authority figures and men, and how obligated and helpless she would naturally feel under his rapid-fire interrogation. And she had zero context for what he was asking and why.

I would love to have patients receive something like this as an opening: Welcome to my office! Allow me to give you background on why the transplant team has each patient meet with me, a psychiatrist. Studies have shown that something as intense as a transplant can bring up all kinds of feelings besides joy and relief. People who have had depression or anxiety may get those feelings again. People who have had trauma, whether from abuse, growing up in a war zone, car accident, or whatever, which is pretty much all of us, so don’t feel alone, can have our post-traumatic stress come up. That’s okay, as long as we have supports and coping skills in place to help with these things. It’s all a part of normal life. Some people deal with these feelings by self-medicating with drugs or alcohol, but as you can imagine, with a brand new organ, and all the prescribed medications, that would be the worst thing we could do! Luckily, there are so many other ways to deal with sadness, worry, bad memories, and other human feelings.

I am here to help the team, and to help you. For the team, I am evaluating what kind of skills you already have in place to deal with the difficulties you will be facing. I will report on your strengths, your support system, any counseling or meditation, exercise or whatever you already have in place, so the team knows you would be a good caretaker of a donated organ. I may make suggestions as well. I am also here to offer you support and resources. I have lists of support organizations both before and after transplant in your area, and a list of resources for counseling and support in your language. Let me start by asking you some questions. And please understand, although I may ask about specific traumatic events, it is not my job to investigate your past. My focus is on your coping skills. You can always let me know if you would rather not delve into something, as we will not have time to really do healing therapy in this short hour! And I wish to apologize ahead of time, as these sessions can be uncomfortable. I will try to be sensitive. Any questions before we start?

That is what I wish would have happened. Here is what did:

I am a psychiatrist and I need to write a report as part of the transplant workup. Let’s get started. What is your full name? What is your date of birth? Are you married or single? How many children do you have? How old are they? Do they live with you? Do you think they would take care of you? Do they work? How could they take care of you if they work? Can they get time off? Have they asked their bosses? You think so, but can you find out for sure? When can you find out for sure? Who lives with you? Is it really just a roommate, or something more? Do you work? When did you last work? Why did you quit working? But you weren’t on dialysis then, so why did you quit then? Why couldn’t you work then? What did you do? Housecleaning? How long? How many years? How much schooling do you have? Can you read and write? Why did you quit school so young? What did you do then? Was there violence in your home? Did you ever see your Dad hit your Mom? Did he hit you, too? How many siblings did you have? Where do they live? Are you in touch with them? Are you close? Did they quit school, too?

This goes on for half an hour. The patient is clearly distraught, but there is no recognition of that. No acknowledgement. No breather. No time. The psychiatrist is taking calls, texting messages to colleagues about in-patients on his computer screen, between writing into her open chart, and clearly thinking of other things. Time is money. I am sure he considers himself great at multi-tasking, a picture of professional efficiency. The interruptions hardly slow him down. He doesn’t seem to feel it disrespectful, but simply his right. He is important! He is a valuable professional! He has so much to do! So let’s push ahead with this interview so he can wind up his report to the team, which he is typing as we speak. He keeps firing off his questions, rat-a-tat-tat:

So your Mom left your Dad. How old were you? Where did you live? Why did you live with your Grandma? Why didn’t you live with one of your parents? Oh, your mother lived there, too! Okay. Have you ever been sexually abused? By whom? Your stepfather? How old were you? How long did it go on? Pregnant? I am sorry! Did your mother find out? What did she do? She made you marry your stepfather, but stayed with him herself! I am sorry! Oh, I must answer this page, sorry. Where were we? Oh! Your mother made you marry your stepfather and then you had his baby. Is that your older child then? Does she know her father was your stepfather? How is that for you? Do you think about it a lot? When’s the last time you thought about it? That long ago? What brings it up? How do you deal with it? Are you in touch with your stepfather, your husband, or I guess your ex? Oh, he’s dead? What about your other child, was that the same father? A second marriage? What does he know? Oh, the second husband is dead, too? Oh! I see from your chart you used to drink a lot. Why is that? Because your second husband got killed? How old were you then? Did you really only started drinking then, and not before? How did he get killed? I am sorry. How long did you drink? How many years? Did you ever black out? How many drinks could you drink? Did you ever miss work? Did it affect your children? Do you drink now? How did you stop? Did you go to treatment? How long? Why did you quit after two months? It was all men? You mean AA? I see. Okay, well, I think I have enough now.

The patient has been trembling for over half an hour. I am the one who offers her to kleenex because the psychiatrist doesn’t think of it, although she is using her coat sleeves to wipe her face. I place my hand on her arm in support as she stutters out the words of her shameful (to her) life story and the horrible things she had to survive, and faces the excruciating pain of this clinical retelling to an unknown and frankly distracted, possibly dissociating male authority figure. A doctor. A rich man. A white man. A citizen of the country where she lives underground. The kind of person whose house she cleans, when she is well enough. A gatekeeper who potentially will stand between her and the life-saving transplant, if she cannot show that she can deal with her trauma and pain well enough to pass muster. And she cannot, at this moment, after this interview. She gets up still in tears, still trembling, to politely thank him for his time and his business card. He nods with a grimace and dismisses her as he stands up to mark that she is excused and may leave now. I may leave with her.

Well, thanks for coming in. I will send my report to the transplant team., and they will let you know. Here’s my card. You can call me if you need me. Goodbye.

I personally find this as unconscionable as doing surgery on a patient and failing to sew them up properly. A properly trained psychiatrist should surely know something about the psychology of trauma. Can he really not see, does he really not care, that by opening wounds that he cannot close, he is leaving these already very ill, very vulnerable patients to heal themselves as best they can? The gratuitous, completely unnecessary human suffering! It astounds and distresses me to no end. And across these power boundaries, encounters such as this one are carried on in hundreds, thousands, millions of settings, in hospitals, tribunals, war zones, workplaces and in the often dangerous privacy of our family homes. We are created equal, that I do believe, but we are certainly not all in a position to be treated equally. And it is just so damn unfair.