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.