Category Archives: INTERPRETERS

I AM HERE!

Medical interpreters for common languages struggle with doctors, usually residents, wishing to display their spotty “second language skills” to their colleagues. I am consistently fascinated by how little self-aware these highly trained individuals are in assessing their own language skills, and in judging the appropriateness of their taking over someone else’s certified and regulated roll in the hospital. I can only presume they have a deep-seated, unmet need to display non-medical “expertise” that would somehow make up for their Impostor Syndrome feeling of not knowing enough in their chosen field of study. This is my working theory on why it is most painfully prevalent among young and insecure residents.

No doubt many of these doctors would be surprised to hear that their behavior is tainted not only with their personal insecurities, but also with an unhealthy dose of underlying racism and xenophobia: “My second-language skills are good enough for THIS KIND of patient – and it is fun for me to practice (even if the patient may understand a little less, or I may mislead them, the consent for a serious procedure may not be fully informed, and my supervising doctor may not even know what I told them) because THESE KINDS of patients will be quiet and docile, and I want to impress my colleagues! I didn’t spend three months abroad for nothing!”

Some will tell me it is not racist, and not even wrong, but simply friendly. They just want to help! Okay, if you say so. But let’s face it. These simple monolingual mortals with stethoscopes and scrubs have others skills, too. They know how to clean and cook, perhaps even garden, or tinker with repairs around the house. Therefore, I will believe these doctors are not acting on subconscious bias just as soon as I see one of these “helpful” doctors grab a broom or mop from a cleaning staff, because they “know how to clean”. When they shove aside the guy on the riding lawnmower, or grab a rake. When they leap over the cafeteria counter and start flipping burgers. Or when they mount a ladder to work on some pesky wiring in the ceiling of the clinic hall, because they are quite the handyman. But why stop there? They could even shove aside the hospital clergy at a deathbed gathering, announcing to the spiritual care team, “I’ve got this! I know how to pray!” and pop out a childish version of the Lord’s Prayer. A few missing lines, maybe the wrong theology, but close enough. Unless and until any of that happens, I will persist in my belief that the behavior is racist, and the underlying thought is that these patients – our patients – my patients – don’t deserve equal care.

Meanwhile, the interpreters are put into the awkward position of having to argue with the doctor to try and make them stop practicing their second language on the patient, all the while in front of the patient and the doctor’s colleagues, in both languages. Or trying to guess at what the doctor meant to say and give a corrected version of it. Or stand awkwardly by and then try to mitigate the harm by asking if the patient has questions, or has understood. Or announce that as everyone present doesn’t speak that language, the interpreter must now back-translate into English everything that the resident is saying. Or try to apply any spectrum of other gut-twisting remedies for a situation that shouldn’t have happened in the first place. This would include pointing out to these doctors that their language skills are lacking, that they are setting themselves up for personal and institutional liability, by providing sub-standard and inadequate care to a vulnerable patient. Not a conversation ideally held in front of a patient. But what to do? Should we clench our fists and ask them if they want to “take it outside”?

Come video remote, now, during the COVID pandemic, and hand me a sweet solution. Simple. To the point. And fun. When a resident doctor turned to the patient in front of the team yesterday and decided to display his mediocre language skills to a patient who needed serious surgery that was being delayed because of even more serious fluid retention and hypertension in the pulmonary artery, which made the urgent surgery too dangerous to perform immediately as hoped, and they were weighing peritoneal dialysis versus a continued course of intravenous diuretics, or going ahead with surgery by first threading a cardiac catheter through the neck directly into the heart to better monitor the pressure under anesthesia, this interpreter was able to leap into passive-aggressive action.

Imagine a quiet interpreter who has been unobtrusively interpreting for about half an hour to a team of doctors in a patient room. All going smoothly, in spite of masks and equipment, side conversations, and decisions being made and changed on the spot. The patient is comfortable enough to ask questions and get explanations as to why the surgery is being delayed until tomorrow. It is a difficult situation, but things are going smoothly and patient needs are being met, including pain control. Enter: young resident. He starts to say in his second language: “You have a – I don’t know how to say – the lung, the blood…machine come, for looking…” Now, I could guess that he means to say that they are coming in to do an echocardiogram, but it is really not my job to guess. Instead, I call out from a great distance via video remote, in my sweetest and most innocent but now very high volume voice:

“DOCTOR! This is the INTERPRETER! I am STILL HERE! I am still on VIDEO! Can you SEE me? Can you HEAR me, Doctor? I AM HERE TO INTERPRET! CAN YOU HEAR ME OKAY? Hello?!”

Doctor (sheepishly): I guess I should switch back to English, then.

Interpreter (neutrally): That would be handy.

TONGUE-TIED

People tend to ask interpreters if it is hard to “say all that” and to find the words. To speak quickly enough and not leave things out. To remember what someone said, and to switch from consecutive to simultaneous. But for some of us, the hardest part is not how we say what we say, but what we are not allowed to say. We are not allowed to speak in our own voice, except to clarify a linguistic issue. There is an argument that we may be “cultural brokers” as well, but I want to bring up something else today. I understand all the reasons why interpreters must “stay out of it” and mind our business, which is to provide clear and transparent communication for others. Our clear professional duty is to be impartial messengers. And yet at times, it can be painful to be tongue-tied.

The vast majority of interpreters have multiple skill sets, multiple degrees, and even several professions. And we may change hats and take on a different role from one day to the next. Yours truly, for example. I happen to be the first certified doula in the state where I live, and for those who are not familiar, we accompany women on their birth journey, providing support, encouragement, information, and sometimes negotiating on their behalf with staff, something an interpreter is absolutely not allowed to do, according our ethical guidelines. And yet in almost 100% of interpreted sessions, we know that one party is vastly more defenseless, while the other is powerful and competent within the society they serve. So standing by silently when it appears that someone is pressured, overlooked, or disrespected can be quite traumatizing.

Moral distress is defined as the painful gap between how you envision something should go, and how it plays out, while being helpless to make it go the way you want it to, or believe that it should. A very few interpreters tell me they just disconnect (or even dissociate?) and interpret by rote, thinking only of the words, guarding themselves against feeling anything, especially helpless compassion. And all good interpreters make it a practice to “stay in neutrality” and remind ourselves that we cannot possibly know what is best for the patient in any situation, and it is not our job. Yet we are still human, with our full range of emotions and values, and interpreters naturally suffer from moral distress in varying degrees while interpreting in healthcare and other settings.

As we witness the care people receive, whether they get it in a safe and respectful environment, whether they seem to fully understand and truly consent to the care they receive, or even when they are denied needed care, we find ourselves both helpless witnesses to what appears to be avoidable human suffering and at the same time complicit in conveying the communication leading toward less than ideal outcomes. But we cannot do anything about it, because after all, we are just “doing our job” – and what a loaded phrase that is, coming out of all the war trial testimonies. There is a conundrum here that is rarely talked about, well worth pondering and contemplating as we go about our daily tasks at our respective jobs.

To change hats, though, for a moment. Let me share with you the honor, the pleasure, the deep love and gratitude, that I am flooded with, having recently been chosen to be the doula to a wonderful and brave birthing mother. The details I provide here are with the mother’s permission.

As doula, I had the power to encourage at every step where the mother was discouraged. As staff kept warning the mother that she was going to need technical interventions – not for any medical reason – but because the contractions would get “bad” and “painful” and “hurt” and I kept reminding her that they would be “strong, powerful, effective and intense”. They kept telling her she was getting too tired, or looking uncomfortable, while I reminded her that she had the innate strength and endurance to ride out the contractions, one at a time. They kept treating her overall like something was wrong, when nothing objectively was – it was an extremely low-risk, completely healthy mother and full-term baby showing zero signs of distress, and the labor was advancing very typically and normally.

Why does one institution treat childbirth as a terrifying disease, while another treats it like a natural event that most mothers and babies can get through just fine? Why, at last count, did this hospital have the highest cesarean rate in the whole state, a whopping 40%, while another hospital had only 8% cesareans and the state as a whole averaged out at around 25% including all the high-risk pregnancies? This hospital is not particularly high-risk. Mothers were generally coming in very healthy. The nurse told me they were aware of their high cesarean rate, and had instituted a “better communication” policy with a whiteboard in each room that all staff were to read and write upon. The doctor even had a hospital-issued jacket emblazoned with a “use the whiteboard” slogan in large letters. But the communication they were praising was among staff, not with the mother.

I did not hear a single doctor telling the mother that she was doing great. That she was perfectly healthy. That the labor was quite normal. That everything was going fine. That she was going to be able to do this. That her body had its own wisdom and knew what to do. That it was natural for her to feel fear and doubt, but that we were all here to support her, and the doctors could intervene if needed. But no interventions were needed at this time, because this mother was rocking it. This mother was riding the waves of every contraction as it came. This mother’s body knew how to open up for her baby, just as a baby bird pecking it way out of its egg shell already instinctively knows and can sing the melody of its family birdsong.

The overall message was “things can go wrong so we’d better hurry up” rather than “you are doing great, but we’ll keep an eye on you and we’re here if you need us!” Throughout the birth process, staff kept telling Mom that it was going to take so long and be so hard, unfortunately so. They talked about childbirth as if it were some kind of cancer that needed high-tech treatment to relieve Mom – of the baby. The doctors seemed intent on convincing her (against all science) that she was not a live-bearing mammal. That her body would be totally bewildered about how to birth a baby, and thus she would have to rely on their expertise, their interventions, their technology, and at this hospital, for 40% of mothers, their operating room, to get the baby out of her mammalian womb.

How can this be? How did this patient, this first-time mother, this non-staff member, out in the community at large without a stethoscope, miraculously and unwittingly – without studying the matter – manage to grow every fingernail, both eyeballs, and every hair on the baby’s head? How did she quite naturally, in the dark, build a lovely placenta and nourish her baby from a two-cell creature to a full term baby, complete with all its organs and parts, without a doctor micro-managing the process? Well, nature is mysterious and miraculous. And natural.

I remember specifically that this mother spent four hours between exams laboring to fully effaced (the cervix is then paper thin and ready to open quickly!) and very stretchy and soft, all the while the baby was doing just fine and so was mother. But the doctor focused on how she had “only” moved from 5 to 6 centimeters dilation, ignoring what she must, as a doctor, know as well as I do, that labor tends to speed up once the cervix is fully effaced. Instead of any encouragement, the doctor came out with a dire prediction: If you keep taking 4 hours to open each centimeter, it will take you 16 more hours, and then you will have to push for 4 more hours, and you will not be able to do that, so you will need a cesarean! A false premise leading logically to a false conclusion, and for what purpose? Oh, and by the way, the average pushing time for first-time mothers is 1 to 2 hours, not 4.

So here was Mom advancing by thinning the cervix and making it soft and stretchy, as the doctor had noted. She was in a regular, intense pattern of contractions every three minutes, as the monitor displayed. Mom was rocking it like a snowball heading downhill. Mom was absolutely speeding up in the process, as is predictable in a normal, healthy birth, but our births have been taken over by the medical establishment and abnormalized. Even pathologized. And here was a doctor standing in front of this healthy birthing mother, telling her she needs to start her on IV Pitocin, a hormone to speed up labor, right away, although it is carries a risk of stressing the baby and mother out with too frequent, too long, and too painful contractions. When she was already in a great pattern of healthy, active labor, heading close to transition. But on the off-chance that it takes 16-20 more hours, she will be too tired to keep going, so let’s intervene right now!

As interpreter, we all know what we would have to do. Ignore our own voice. Tie our own tongues. Our job is exclusively to be the messenger of other people’s opinions and words, not our own. In this case, the interpreter would tell the patient, because the doctor just did, that her labor is abnormal. That her body will not work. That she is simply incompetent to have a baby without intervention. But I am here as a doula. Blessed hat change! Blessed freedom. I was able to appropriately encourage the patient. It was even my job to do so! I was able to remind her that her body was working, that there no signs of any distress in the baby, and that she was advancing. The baby was tolerating labor just great. That she could change plans if and when she medically needed to.

After thinking it over, the patient told the doctor she would like to keep going without interventions for now. The doctor shook her head in disapproval, then raised her eyebrows and reluctantly agreed that she would “let” us have a “trial” of two hours, but then she would have to insist, because this mother was NOT going to have the baby without the doctor’s help! “Remember, if you don’t get Pitocin soon, you’ll end up laboring all day and all night and then end up with a cesarean tomorrow. I’m trying to help you here! You can’t go on forever!” the doctor ominously warned her.

A doula is not going to leave such a discouraging message hanging over the rest of mom’s labor like a black cloud, so this doula told the doctor with a smile, “Here’s our plan – why don’t you come back when you said, and I predict that you will find this mother fully dilated and ready to push, and she will absolutely NOT push for 4 hours, because she is strong and athletic. So I predict that she will likely push around 57 minutes or so. Besides which, I know this baby, and she is a daytime baby, and her birthday is today, not tomorrow! So this mother doesn’t have to ‘go on forever’ because she is having this baby today! She has the strength she needs, and she is doing a great job!”

The doctor just laughed and said she liked our plan better than hers, but she didn’t think it would happen. We need to be realistic! This mother needs help! “I’ll be coming back in at 2:00 to Pit her,” she concluded, then walked out. Now here is the lovely part. The doula part. When I turned back to the patient, I saw a sparkle in her eyes. She had focused on my encouraging words. I saw renewed confidence, renewed energy, a deep realization that she was able to give birth, and that she was giving birth. She was filled with determination. With sweet hubby on one side, and doula on the other, she was ready to labor on, unless and until she needed an intervention. Which she didn’t end up needing. Woohoo! Yay biology.

When the doctor came in 90 minutes later to “set her up” for Pitocin, guess what? She was already 10 centimeters and pushing! And when doctor gloved up and announced herself “ready to deliver the baby,” this doula reminded us all that it was the mother delivering this baby. Yes, folks. Believe it or not. We have been trained to consider it the exception to the rule, but the mother herself was actually giving birth. The mother, a live-bearing mammal, was delivering a live baby mammal, capable of giving birth in her turn, hopefully in a more natural and more humane setting, a quarter of a century from now. Yay mothers. Yay Mother Nature.

When did the industrial medical complex take over? Was it when they burned the midwives, witches and healers? Was it when we founded a country on the principles of greed and profit, and set up a for-profit medical care system (with a few charity programs to take the edge off and avoid revolution) in which patients are told they need doctors for everything from acid indigestion to constipation? In this birth, my job as doula was to help this mother find the space and tap into her strength and confidence so that her body could do its work unimpeded, within a very distracting and discouraging hospital environment. And I did it, to my absolute delight, by using my own words. Which is absolutely forbidden as a medical interpreter. Sweet, wonderful words!

Let me be clear that I have been to many births as interpreter where it was healing, safe, respectful and appropriate. But I wish to point out that treating the human body as if it cannot eat, poop, birth and die without lying in a hospital bed hooked up to massive amounts of expensive medications and constant monitors, being “rounded” upon by a team of so-called experts who will decide how to treat you, and who believe they have done their job as long as they measure and document every step they take, and treat you more like a helpless, diseased animal needing to be “relieved” of your birth experience and “delivered” of your baby … no. Humans are mammals, and not so surprisingly, most of us are quite able to naturally get pregnant, bear our offspring and breastfeed.

Let me assure any worried readers that never have and never will, whether doula or interpreter, stand in the way of a mother getting the medical care she needs, or even the medical care that she wants. I am certainly no proponent of putting babies or mothers at risk. The ultimate goal of every birth is to have all parties come out of it alive and well! Mothers with complications, diseases, premature labor and unhealthy babies should absolutely have access to the high-tech cutting edge medical care available at teaching hospitals, from fertility treatment to sewing the cervix shut to hormone treatment and even surgeries in the womb. Mothers who want pain meds or anything else that is safe and available to them should get it. Absolutely, and no shame! But let us not forget that childbirth for the vast majority of healthy women is a natural process that interventions, noise, interruptions, constant monitoring, negativity, and technology will only disrupt and complicate rather than serving. And I am glad I could say so, and be a part of welcoming this baby into the world, as only a doula can.

The ancient wisdom encapsulated in the saying that “The person who says it cannot be done should not interrupt the person doing it.” Yes. That. It was so healing and satisfying to be able to remind this mother, over and over, that she has inner knowing. That she has a body capable of birthing her child. That she can trust herself, and trust the process. And seeing her progress through her labor, in spite of constant interruptions and even discouragement, yet stay strong and focused within herself …. What a wonderful testimony to this mother’s courage. And how utterly sweet for me not to be tongue-tied, for this magical, life-affirming moment.

MISS THE JUDGE

Working in both hospitals and courts, I sometimes wish I had a judge to order the doctors about at the hospital. How convenient that would be! I could use an arbiter who could direct the doctors to slow their rate of speech, repeat their last utterance, rephrase a convoluted statement, or pause appropriately for consecutive interpreting for a question and answer session (instead of talking over me and confounding matters!) A judge could issue a general ruling that doctors stop interrupting me while I am doing my job. Or issue an absolute prohibition on doctors trying to do my job when I am so strictly prohibited from encroaching on the practice of medicine. Fair is fair! And a justice would understand the justice. Alas, I am on my own with no one to turn to when doctors behave badly. So I have to do my best under adverse circumstances, and decide in each case when and if to stop the session and attempt on my own to direct the medical staff so we can have more adequate communication and understanding.

Today in court was one of many routine occasions where I enlisted a judge to order a speaker to improve their manner of speech. This time, it was a new prosecutor who spoke very softly while pouring out a veritable gush of staccato words in her rush to present one of her very first cases. It was clear that she was not aware of her speech pattern although everyone else in the courtroom surely was. But thanks to being in court and not the hospital, I didn’t have to stand by wondering how to tactfully guide her into better communication. In court, I had the luxury – and the recognized right – to simply interrupt her by calling out, “Your Honor, the interpreter cannot hear the prosecutor and requests that she repeat her last utterance, speak up, and slow her rate of speech!” The judge so ordered, and we started over. Wouldn’t that be nice in a medical appointment? To have an actual judge in our corner!

In my experience, when doctors go into verbal overdrive, it is not so much nerves as hurry that causes them to squeeze words into small spaces and then either hammer them home or cut them to pieces. One solution is to switch to simultaneous and simply render the doctors’ words while they are still speaking. But for those patients who speak and understand some English, they are apt to reach cognitive overload and cannot parse out the interweaving threads of the two languages spoken at the same time. It can be confusing for doctors as well, some of whom have told me that they “cannot think while you are talking!” The standard for most medical centers is to use consecutive across the board, but for that to happen, the doctors need to pause regularly and cede the floor to the interpreter. In lay terms, the doctors need to “let the interpret interpret”. Sounds elementary, but I would literally need a judge and a court order to make some doctors do it. They are in their own world, and sadly it is one that tends to exclude their patients by obstructing clear communication.

The situation is exacerbated when some care providers understand some – but not all – of the target language, and start interrupting and talking over the interpreter before I can get the words out. Like an eager squirming child raising their hand in school and calling out while the teacher is still talking: “I know the answer!” Some doctors don’t seem to understand that from the patient perspective, when they interrupt me while I am conveying what the patient just said, the patient consequently feels interrupted. Why? Because the patient cannot possibly know how much is understood by the doctor without full interpretation, so the patient naturally feels cut off every time that I am cut off. The patient feel disrespected. Once that happens, the patient grows quiet, disengages, and doesn’t ask any more questions. How could they dare to when the doctor keeps cutting off their words, just as they are about to arrive – just as they are literally in the process of being conveyed into the doctor’s language?

I had a doctor the other day who spoke a language close to the target language and kept guessing ahead, not listening to the interpretation, and cutting me off. The patient had come in hoping to ask questions about the dire things he had read on the internet about the proposed treatment for prostate cancer. To start, he said with great fear in his voice: “I read that my penis could be dead and my kidneys could fail.” Before I could even convey that much, the doctor had raised a hand to interrupt me (but was of course interrupting the patient) while loudly exclaiming, “No, no no! That won’t happen! No!”

The patient was immediately shut down, and could not fully discuss what he cared most about, because the doctor had already moved on. So he just sat and listened resignedly with a deer in the headlights look. At the end, the doctor wondered if he had any questions. What the patient was too uncomfortable to say was: “Uh, no, doc. I just offered two questions but you shut us up by yelling no and waving your hands at us, so no. Never mind me. I can just keep waking up at night in a cold sweat, worrying about the things you didn’t have time to hear me say. Worried sick that I will either lose my life or lose what to me makes life worth living. No questions. I’ll just go back to the internet and try to figure it out myself, thanks.”

Now, I get the doctor. He had other patients waiting. He was feeling rushed. He was frustrated by his own lack of language skills, and he understood the patient to some nebulous extent. But what I also know is that his frustration was only partly due to his scheduling. It was also due to his subconscious resistance to (and shame about) needing an interpreter. And subconscious class prejudice in judging the patient for immigrating from a poor country without any education, and not learning English. Thus he vigorously interrupts me to signal that he already knows the gist of what the patient is trying to say. He knows! He is competent! Let’s skip it and move on! Close enough! He doesn’t take a moment to realize that his patient is having a very different experience. And with all due respect, the patient would love it if the doctor would just shut up for once and listen to the patient, through me. The patient wants carefully considered answers, not an offhand dismissal. His fears remain foremost.

The patient is uttering his deepest concerns and needs clear answers. He is talking about a very central organ, his precious family jewel, and the loss of his male identity. He is talking about becoming disabled, needing dialysis, and other scary, life-changing possibilities. He is being brave and vulnerable. He deeply fears the answer to his high-stakes questions. And the doctor’s manner of response to his questions and concerns is of utmost importance to him. Too bad the doctor, for all his learning, has not yet learned that the very first thing that patients using an interpreter wish to hear is their own question, their own statement, their own words, conveyed safely into the ears of the care provider, in words that the care provider can understand, by yours truly, the humble yet kick-ass interpreter. Getting their fears and doubts across is such an offload of care and worry – such a relief! Seeing it happen, watching the delivery, is hugely important.

Dear interrupting and hurrying medical care providers. God bless your fragile little hearts. Please be aware of the complete lack of respect you show when in your hurry, or in your eagerness to display your knowledge, you cut off your patient’s interpreter. You don’t have to arm-wrestle us for control of the communication. Try to think of it as a shared dance rather than attempting a submission hold in a mixed martial arts contest. The interpreters are not talking simply to display our knowledge and make you feel inadequate. We are conveying what our patient wants to say. Never forget that they have no way of reading your mind as to what you may (or may not) have understood (or misunderstood) before you interrupt and talk over us as we convey their words and thoughts. So let us do our job. Let us get their words across to you, whole, unharmed, and uninterrupted. Your answers will mean so much more to them if you do.

FAMILY HELP

Interpreters sometimes talk about the pros and cons of family members assisting patients in communicating with their healthcare team. We tend to focus on the cons: The relatives take over. They want to interpret, but they don’t say everything, and they create a conflict of interest, among other perils. And even if the family members are simply adding information in English to staff, interpreters then have to switch to simultaneous mode and back-interpret so the patient can know what is being said. Pushy or anxious family members, especially bilingual ones, take attention away from the patient and the patient ends up ignored. The list of cons can be extensive.

But here is a little story of when I was very glad to have a grown daughter to help me in a communication that I could not have effectively completed without her insider information.

Here is what I said, as a direct interpretation of my patient’s speech:

“I didn’t eat, but I drank my malted drink and I had my honey. I was told that was okay before this study. Hey! (directed to the interpreter) What you are doing here?!? Aren’t you my liver doctor’s wife? So tall and gorgeous! Just glorious! Not her? So odd! You look exactly like her! So regal! Just like her! And same hair color! Say, aren’t you my doctor’s wife?”

Now for the daughter’s explanation:

“Dad is confused because of his liver. When he said malted drink, he means his protein shake, because he’s lost a lot of weight. Honey means his lactulose syrup for the brain fog. And Dad is convinced that his doctor’s nurse is really his wife even though we keep telling him she is not, and now apparently Dad is now confusing this interpreter with the nurse!”

I simultaneously interpreted for our confused patient what the daughter was saying in English to the nurse, and the patient was very surprised that this interpreter was not married to his liver doctor, and that even my “double” was not married to the liver doctor. Wait, what? That was really a surprise to him. “Oh dear! Are there three women, then? A wife, a nurse, and another one? Oh dear! I am confused! But say, are you my doctor’s wife?” Of course I dutifully interpreted for the nurse what her patient had just said.

The daughter went on to scold the Dad for thinking the doctor is married to his nurse and that I am the nurse/wife. She told him over and over that he is wrong and that I am the interpreter. The interpreter!! Meanwhile, I was back-interpreting everything she said to her father to the nurse, who thought it was pretty amusing. It was a light moment but with a tinge of melancholy, watching this daughter try to orient her father, and watching him struggle. The nurse and I agreed, though, that it was very helpful to have a family member present and assisting with this communication.

Having a family member explain some things, just as an English-speaking family would do, is not at all the same as recruiting a family member to take on the role of nurse, interpreter, doctor, or any other paid healthcare role at the hospital, especially for free and without certification. Of course I do not advocate that. I just want to make sure that in our eagerness to avoid conflicts of interest, we don’t throw out the baby with the bathwater, and unwittingly exclude family members from their very important and valuable role of – family member. Because family members can offer extra-linguistic information that can be very important, especially for vulnerable patients.

Including family members can get messy. But it is important for interpreters to willingly switch to simultaneous as needed, and back-interpret whatever is being said across languages, so everyone present knows everything that is being said. This serves to bring our patients and staff as close as possible to the experience of sharing a common language. Yes, it is an added burden compared to the “clean and easy” interpreting session with one patient alone with one healthcare provider, each taking their turn and pausing for interpretation. But these family sessions, as sloppy, funny, interrupted, and often frustrating as they can be, are something interpreters need to be well prepared for. Because in most of our immigrant communities, a patient coming to the doctor alone is the exception to the rule, while bilingual, highly involved and opinionated adult children are standard issue.

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.

SUPPORT

As a linguist, I have been an independent solo contractor for most of my working life. Except for jury trials or conferences, interpreters work in solitude. For medical interpreters, we never have an interpreter colleague present to share our experience. And it is fraught with peril to talk about our work because of our code of silence. As far as I know, medical interpreters tend to only discuss their work at a couple of statewide training conferences a year, a few minutes at a time, when the trainer elicits examples of situations we can discuss for best practices. At that point, we are many miles and many months from the situation, and only interpreters are listening, and we aren’t likely to change anything. It can be lonely and frustrating.

As a new employee at a state hospital, I have been overwhelmed by the support that staff medical interpreters have here, and how integral and visible we are as part of the care team. Instead of being considered peripheral, we are actually honored and included, even embraced. I never realized how much I missed the recognition, until I got it. The recognition is not for me, as an individual, but for my profession, my field, language access, and good communication overall. This is a sea change, and a needed one. Because the whole US medical model is built upon “informed consent,” which in turn is built upon good communication.

I was present at the unexpected death of a patient recently. Every member of the team from the surgeon to the staff and even the spiritual care people made a point of thanking me for my service, as did the family members. It was not the outcome anyone wanted or expected, but the fact that everyone was able to communicate their needs and convey information and condolences was very valuable, and recognized as such. I was able to stay with the survivors the rest of my shift and help them through the first few hours, and as staff arrived, they came in saying, “Oh, good! You’re here!”

The next morning, my boss called me in. Uh-oh, right? What have I done now? There is a classic interpreter truism, in case you haven’t heard it. “The only time anybody notices an interpreter is when we screw up.” If we are in the middle of a trial interpreting for a witness and all of a sudden the jurors turn and look at us instead of at the witness, we have probably said something awkward. Not being noticed is a sign we are doing a good job. This explains why when my boss was going to call attention to something I had done, I naturally presumed the worst. Who noticed me, and why?

Here was the surprise: she wanted to touch base with me and see how I was doing. Wait – what? I seriously almost broke into nervous laughter. Had I done something wrong, displayed my weakness, that she thought I needed – help?!? No, not at all. She just wondered how I was doing. How I was feeling. How I was processing the sadness of witnessing the rather traumatic death of a young beloved person surrounded by her shocked family; watching the attempts to revive her and seeing it fail and having the time of death called, all the while calmly interpreting, in a roomful of anxious, tearful people.

I was so unused to anyone asking me how I was after interpreting, I started out dismissively joking. “Well, since I’ve done so much criminal work, I was thinking, hey, at least nobody was stabbed in the head with a screwdriver, right?” I went on more seriously to explain that this was a peaceful death. The surgeon had done his best. The patient had chosen this surgery with open eyes. Everyone had tried in good faith to extend this patient’s life. It hadn’t worked, but everyone had tried and it was a more positive experience than not. She was loved. She was cared for and respected. She was surrounded by family and caregivers, and given pain relief and all possible comfort measures.

I considered it a good death, a positive experience. I can handle it fine, and I really don’t need help, I told her. I am so used to this as to be inured to it. Seriously, I have worked with murderers and the families of murder victims, child victims, and extreme, cruel violence perpetrated by psychopaths. This is no problem for me. But thanks for asking. My boss told me that she was glad for it, but as a hospital, they want to do better about giving their staff the support we need especially after traumatic events. She asked for my permission to have the head of spiritual services contact me to debrief. Because no matter how competent and professional I am, I am still, underneath it all, human.

Spiritual care did contact me and we spoke for a while on the phone. She asked some questions about how I was feeling and talked about how natural and common certain feelings are in this kind of a situation. She asked me what kinds of things I do for self-care, and how I generally process this kind of information. She offered to meet with me, and sent me a follow-up email with dozens of resources, tips on handling trauma and burnout, counseling and support options, a repeated invitation to meet and another offer to make herself available as needed by phone or email.

The next week, my boss pulled me in again. She said the spiritual care leader had told her about our conversation, and how I had suggested we could have some kind of in-house training for interpreters on dealing with trauma and self-care. They thought this was a good idea, and planned to follow up on it. But she also wanted to take the opportunity to invite me to a Quality Improvement meeting, where all available staff who were at the event gather and debrief what went right, and go over any suggestions for streamlining or improvement. Not because it was an adverse event, but simply to improve things, and give staff a chance to debrief in a supportive environment.

I had never been invited to anything like this in my decades of interpreting. We gathered around a large table and talked about our experiences. What happened. How it felt. Our emotional responses. What worked. What people said or did that we worried might have felt abrupt to the grieving family. What we thought was of comfort to them. Delicate matters for best practices, like how and when to request an autopsy. When to bring in the social worker and the funeral arrangement packet. How long to allow family to stay with the body, and how to make these practices more culturally appropriate. The leader who facilitated this meeting was considerate, respectful, and taking copious notes. She genuinely wanted to hear our views, and was going to make use of them.

Throughout the meeting, I was praised for my efforts on behalf of the family and the hospital. I was thanked for staying there. There was acknowledgement that it may have been extra hard on me as interpreter, because the whole large family was relying on me for all communication, and I had no control over the messages. I was able to share how I felt, and give high praise in my turn that no staff practiced their language skills in this situation, and that no young bilingual family members had to get corralled into interpreting for free. And this was heard and considered.

In talking about the interpreter’s integral role in end of life care, the Quality Improvement leader let me know she was making a note to have interpreters invited to the next training that social workers and spiritual care (non-medical) staff get. Specifically, there is a 2-hour “code” training for how to deal with these situations in which the hospital may try to revive a patient and must eventually declare them dead. “We want to invite you so you have more support and information about the context of a code, what may happen, and how to deal with it,” she told me. Because the interpreter’s work is so important to patient-centered care.

For the first time in my long career, I had my place at the table in a roomful of supportive non-interpreter colleagues at a meeting with management, where I had been invited to talk about my perspective and expertise as an interpreter in order to improve processes throughout the institution. This was not a segregated group of isolated, independent contractors, sharing a few stories about what went wrong at a state conference, with no power or voice to change it. This was a staff meeting of a healthcare team with hospital management, and all of our opinions were heard and considered, interpreter included. What a great feeling of support and inclusion.

HAVE IT BOTH WAYS

We are in the middle of a historic snowstorm in what is otherwise classified as a temperate rain forest. Schools and courts along with most businesses are closed. So are a lot of roads. Anyone who can stay home will stay home. Professionals on salary will get their full salaries. Hourly workers will probably not. What about professional contractors, such as court interpreters?

I received two emails in close succession from a local court. The first reminded me that the “pay policy” for court interpreters is that no matter how late a snow closure is announced, we do not get paid for that day, not even the standard minimum two hours for a late cancellation. This could mean we are on our way, fighting the storm and making our best effort to get in, only to then turn around and come back home, with no pay. But if the court does not close, we are expected to be there on time and ready to work. And no time is stated for when that notice will be provided.

So court interpreters are told that a last-minute snow cancellation equals zero pay, under the theory that an emergency releases the court from its obligations to the workers. Okay. But a second email tells us there is a very important exception to the rule: If the court doesn’t give us at least two hours notice, we get paid. Haha! Just kidding. The exception is that any court interpreter who is assigned to jail for in-custody arraignments had better get there and interpret, even when the roads are closed, the courthouses are closed, and most buses are not running. Why? We are told we must fulfill our obligations, because we have contracted to do so. Weather is no exception. “You must report!” the email tells us.

Talk about having it both ways. The court contracts us to work for pay, then cancels us without adequate notice, sometimes when we are on our way in the snow. Yet the workers are told we have to uphold our end of the contract, because we have agreed to be there, even though the paying party “reserves the right” to cancel our work without pay and without reasonable minimum notice. This kind of policy is so common in the US that I wonder how many workers even react to it.

Some courts actually put in the extra time and effort so that as soon as they get their insider notice of closure (at 6:00 a.m.) their schedulers immediately relay the snow closure decision to each scheduled interpreter via email. That gives us two and a half hours notice so we can stay warm at home rather than getting halfway to court before finding out that there is no court. I was very happy to get reasonable notice of today’s cancellation and save the unpaid efforts to walk, hitchhike, and shove my way into overcrowded buses (all of which I did last time it snowed, because that time court was NOT cancelled and I fulfilled my obligation to show up).

As to the in-custody arraignments, there is an easy solution that would be quite reasonable under the circumstances: have scheduled interpreters appear via phone. And pay them. As to the rest of the pay policy, obligations run both ways. Courts who are most considerate of their workers are going to have the goodwill to call upon when emergencies arise. And if we don’t want to rely on goodwill for our treatment at work, it is time to unionize.

GOOD SYSTEMS CREATE GOOD CARE

There is a saying that bad systems defeat good people every time.  I see the truth in that.  But sometimes, good systems are in place.  And good people can do good work, a good amount of the time, thanks to having processes in place to streamline what we do and how we go about it.

This week, a young person with a congenital health problem that had been managed well for years suddenly died a week after surgery, right when things seemed to be going well.  While the patient didn’t need an interpreter, her family certainly did.  Yet calling for an interpreter is not something every medical center would think of during a “code” situation when staff is busy trying to revive the patient whose heart has stopped.  These situations tend to be chaotic and people naturally feel a certain level of panic, even when they are well-trained.  We likely would not have known it was happening, but for our integrated Interpreter Services that has systems in place to maximize patient coverage.

I was enjoying my lunch at the office with one of our long-time schedulers, when she heard the overhead page for the code team to go to a specific room number.  She quickly checked the Interpreter Services list of in-patients, and discovered that indeed it was a patient with a language need.  She sent me to the room immediately, shortly before I had my next assignment, to offer my services. When I arrived, there were several dozen people, staff and family members, surrounding the patient while chest compression was being applied in an attempt to revive the patient. The immediate family were needing to communicate and negotiate whether they could remain in the room, and to hear enough of the doctor’s talk to understand when the patient was declared deceased. They were able to ask many questions and get answers and comfort right away.

At the first opportunity, I reached out to Interpreter Services and simply stated that I would need my afternoon schedule cleared to stay with this family just for these couple of hours. Our scheduler’s response was to the point: “Done.”  This was not the same scheduler, but she had been updated by her colleague. Other interpreter colleagues covered my remaining jobs so I could stay with this family. Everything was streamlined.

These systems and procedures were put into place by staff and management based on years of experience, good working relations, and commitment to patient care.  And like other good systems, they created the opportunity for a healing experience.  Even for this shocked and grieving family who were literally watching their beloved family member died before their very eyes.  Because we did watch her die, unfortunately.  And there was a need for clear communication with the family throughout this process.

I was able to be present when the surgeon talked to the family about what had happened to likely cause this sudden and unexpected death. I was present and interpreting when the nurse gave her words of comfort and encouraged the family to gather around even as she was cleaning the patient. I was present as family members were offered chairs and water. I interpreted while the hospital obtained permission for a post-mortem blood draw to run studies to protect staff who had been splashed in the eyes with blood during the final event. The social worker was able to hear the family’s immediate concerns about funeral arrangements and grieving support. Other staff came in to offer condolences and information. One brought in a memorial quilt to cover the patient for viewing and when through my interpreting she found out there were several children, she brought in more blankets so each child could have one. Staff came in with tea and coffee, and a tray of snacks, and was able to offer these refreshments in to the family in their language. One of the siblings had me ask staff for a phone charger to borrow while she called family members, and this was found and provided. Another asked for a private location to make some calls and it was found for him.  Someone came from spiritual services and had a good conversation about the family’s needs, and then brought in the specific liturgy that matched the patient’s faith. We were able to pray over the body in the patient’s language and in the patient’s tradition.  This was all of great comfort to the patient’s family at a time of such need. What a positive and supportive outcome for this grieving family.

It is important to note that although there were several family members who were clearly fluent in both English and Spanish, because of our quick response and my ongoing presence, none of them was asked to step up and interpret, not even something non-medical, let alone medical. Imagine requiring a close family member to ask her siblings or parents for a post-mortem blood draw or an autopsy!  Remember that most often, the bilingual family members are the youngest ones, sometimes merely children.  These bilingual family members were allowed to grieve with their family instead of being recruited to “work for free” for the hospital.  When they asked questions of staff and doctors in English, I was nearby to back-interpret into Spanish so the whole family could hear both the questions and answers as they were uttered. These conversations became general, as the non-English speakers were able to hear and participate in the discussions as they took place.  All family members were put on an even footing, and none were burdened with taking on the voice of the hospital.

Thanks to my ongoing presence, none of the staff was tempted to use their varying levels of Spanish either. One of the doctors, the one who was obtaining consent for the autopsy, clearly spoke a lot of Spanish and understood me as I was interpreting.  Her face would light up and she said “yes” several times as she heard my renderings.  But as I was there, she was able to communicate through me, rather than struggling with not quite fluent Spanish.  The doctor ended up being very pleased with the way her words were conveyed, and mentioned that while she had understood what I was saying, she would not have been able to say it as well or so thoughtfully herself.  Thus, the family were able to understand and ultimately decide on the autopsy, as well as ask further questions about the surgery, hospitalization, and final event, in clear language. The family was able to get a lot of closure in the few short hours I was with them.

I feel so grateful to be part of a team where teamwork matters.  Where patient care truly is central.  Where systems are in place so that patients and their families are less likely to fall through the cracks, especially at these critical moments.  This sweet patient was born with a serious health problem, and she had a long-term relationship with the doctors and staff.  But not all of her family had this close and trusting relationship, and they were all in shock.  For them, having clear communication about what was happening,  and getting gentle and respectful support during this time, in their own language, was truly valuable.  It was my honor to interpret for them.  But I wouldn’t have been able to without the systems in place and the excellent scheduling staff that it is my pleasure to work with.

DOUBLE OR HALF?

The vast majority of interpreters I know are self-employed.  We pay our own taxes, including double Social Security.  We buy our own insurance, be it life, health, or disability – or more commonly, go without.  We take time off without pay for illness and vacations, and have unpaid holidays.  We spend quite a bit of our “time off” scheduling, billing, doing our taxes, and otherwise documenting our work.  Most of us spend at least part of the time wondering if it is “worth it.”  We worry about getting enough work, and sometimes after we get work, it is taken away.  Most courts have a 24-hour cancellation policy.  We have tenuous economies.  But we cling to the hourly pay rate, and tell ourselves we cannot “make that much” elsewhere.

The word on the street is that the self-employed interpreter makes twice as much (per hour) but that is only part of the story.  We can only get an average of 20 paid hours a week.  Probably another ten hours of that week is spent in taking calls, answering emails, scheduling, billing, bookkeeping, and working on taxes.  Another five more might be additional travel to a second location within a work day, and a few more hours every week are spent waiting without pay between paid jobs.  I don’t know how many hours that makes, but in some weeks, it sure feels like at least 40 of not more.

Employed interpreters get around half as much per hour.  But of the 40 hours paid, she gets half an hour a day in paid breaks, so now it is 37.5 hours.  She is allowed to use her workday to do all her logging and documentation for her interpreting gigs, so that saves her 5 to 10 hours a week at home.  She is paid throughout the day for 8 hours whether traveling between locations, waiting, working on written translations, making reminder calls, standing by, or interpreting.  When she is off the clock, she is not working.  Whenever she is at work, she is on the clock.  She doesn’t come home to more work.  But it’s half the pay!  Or is it?

What else comes with employment?  At one major area hospital, the employer pays an astounding $10,000 a year toward employee health insurance. and the employee pays a nominal $120.  Yes, I wrote $120 per year for excellent insurance coverage.  The hospital also provides life and disability insurance which would cost at least $7,500 on the street .  They pay for an annual bus pass worth $1,200.  They subsidize vision and dental coverage worth another $3,000.  They pay around $5,000 a year into a retirement savings plan.  They provide two weeks paid holidays, two weeks paid vacation, with a value of around another $6,000 a year.  They pay the employer’s half of Social Security tax, which is around another $4,000 a year.  Oh, and a little over $5,000 a year for tuition coverage if you’d like to take some classes.

That adds up to close to $50,000 in added benefits that self-employed people either pay for out of pocket or simply go without.  One area hospital actually allows gym access for a nominal fee, and allows a free visit with a physiologist to set up a routine.  They offer an employee assistance program that gives free counseling and other support.  And they subsidize a myriad of other programs including legal insurance, ID theft coverage, discounted home and car insurance, and even pet insurance.

These are the benefits without even taking into account the “safety net” of actually HAVING things like life insurance, health insurance, disability coverage, and sick leave.  Or the security of knowing that as long as I am doing a good job, I will have a job.  And if I do make mistakes or make someone unhappy, there would be a process in place with meetings and warnings.

Interpreters literally live from hourly or daily job, or weeklong trial, to the next.  They literally have a guaranteed job for the next day only, as the standard is a 24-hour cancellation policy.  At a “real” job, you will never get that call where you are told, hey, we love your work, but we changed our mind and we are taking away the hours we have promised you over the next three months.    We only have to give you 24 hours notice, so you get zero pay for setting aside all those days for us and turning down other work.

Yes of course, employment is not a lifetime guarantee.  Employees can and do get laid off.  But then they can get unemployment, which we who are self-employed are not eligible for.  And if I am injured at my work, I am covered by Labor and Industries workers compensation as an employee.  As a contractor, I am out of luck.

So yes, the gross hourly pay is double.  But when all these moving parts are set out into tables and cross-compared, what used to look like double pay turns out to be more like half pay.  Food for thought, if you are thinking about getting a “real job”.