HOPE SPRINGS ETERNAL

Like a fairy tale movie, imagine a humble and unpretentious young woman who suddenly gets a horrible disease. During her ordeal, her kidneys fail, her liver is affected, and the treatment itself causes the lining of one of her coronary arteries to be eaten away, causing a thinning of the wall. She is now at even higher risk of dying suddenly. But she somehow manages to hang on by a thread of life. She languishes for months in intensive care.

The doctors explain that she is in a race for time. If her organs recover quickly enough, they may be able to operate on the coronary artery before it bursts. If not, well, they are very sorry. It may burst at any time and then she will “bleed out” and die within minutes. She must simply trying and remain calm and let time pass. Try to relax and not panic. Stay strong. A true fairy tale ordeal, calling for the greatest feats of endurance.

Doesn’t sound much like a modern fairy tale, of course, where the ordeals are often quite trivial and last less than an hour on screen. Traditional fairy tales were much more reflective of the human experience. They had more gut-wrenching decision to be made, shifting and confusing scenarios requiring heroic choices and efforts. There were offers of wise or fatal advice from elders and others, often in disguise, to be heeded or ignored at the peril of the explorer. And discernment was required, as things were not as they seemed. Three choices. Two choices. Facing pain and uncertainty. One chance to survive. Fairy tales were life and death warning tales.

In the US especially, we like to pretend that life is safe. If we work hard, and keep our nose to the grindstone, and do our best, we will be rewarded with long life, money, a good partner and healthy children, and probably a house. Yet we, like our fellow humans around the globe, find to our dismay that our life is filled with perils. This young woman went through a long series of painful procedures, with sometimes conflicting and ever shifting high-tech advice pouring in during the daily rounds. She lay there like a boat in harbor, calmly waiting to see whether she might emerge in time, or be destroyed there. Months went by.

Not having grown up in our modern fairy tale rewards-based culture, she never seemed to feel that what was happening was unfair to her in particular. It was nothing personal. It was fate. She simply accepted that she might die, and waited. As the months passed and her health rose and fell in a series of complications, yet not resulting in her death, she quite naturally decided that the doctors, for all their expertise, were ignorant at best. They did not know what her ultimate destiny was to be. They were not, after all, above God. There was something magical, something miraculous even, in her slow and jagged recovery and eventual discharge to her home.

At discharge, she was warned once again that she must always consider her coronary artery and the known fact that it may burst at any moment. It was like a very bad varicose vein. She was not healed! She was still fragile and weak. She was barely well enough to go home. But there was a slight hope. She had made it this far. Over time, if her lab work looked good enough, a cardiologist might decide on her behalf that the risk-benefit analysis made the heart repair a worthwhile endeavor. They would let her know. She should stay in touch and of course see the cardiologist regularly.

She went home and did something that was quite natural if terribly risky. She apparently decided that if she might die so soon, just as her life was beginning, that she should at least produce a child before she goes. Leave something behind her to carry on. Experience the natural progression of events. Apparently. Because she got pregnant. The doctors are dismayed, and they plan to give her a good talking to when she comes to the clinic for her maternal care. I am guessing she will sit and look at them quite seriously, nodding in polite agreement as she did from her hospital bed, knowing that if God wants her baby to survive, then her baby will survive. That her life is in God’s hands and always will be. But the actual words that are to be exchanged at the visit need to be spoken, and adequately interpreted.

As interpreters, we try hard to stay in neutrality. To allow our patients the dignity of applying their own value system to the choices they make. In this kind of a situation, some of us might wish we could advocate for her to live her own life and not feel like the only meaning it could have is through reproducing. Others might support her doing exactly what she wants, even if her choice seems self-destructive or wrong-thinking from our cultural bias. Some might condemn the poor communication skills of the doctors who didn’t make it clear enough for her to process, even during months of hospitalization, and fret about whether she can understand her risk.

The neutrality clause for interpreter ethics is not about not having any feelings or thoughts. It is about being able to put ourselves aside for the moment. Whichever interpreter ends up getting invited to this difficult prenatal appointment for this heart-wrenching discussion, must go into it with a straight face, and allow the parties to communicate without intruding our own values, hopes and fears into the situation. Once we come out of there, we are free to cry or laugh or call a colleague and debrief while protecting patient confidentiality. Meanwhile, the patient gets their care and advice through a clean conduit, and we can lick our wounds, and make up our fairy tale endings, on our own.