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.