ONE DAY

People often ask interpreters what kind of cases we see. And we tend to answer “all kinds”. One day this week:

An injured farmworker comes in with herniated discs after falling out of a tree at an orchard. It took him about a year of multiple trips to the farmworkers clinic, sporadic and painful physical therapy, and spinal injections, before he finally got permission to see the specialists “in the city”. This patient has trouble expressing himself or knowing what information would be relevant to his case, and he confuses the doctor even further by agreeing with whatever is said: You have pain that comes around the right side of the ribs? Yes! But your injury is on the left. Yes! Then the pain cannot be from the injury. Yes? Because the herniated discs are protruding out to the left, so that would impinge the nerves on the left side. Yes! The patient is clearly hoping for a surgical fix, and talks repeatedly about his need to “get back to normal so I can support my family” but in the end, the surgeon does not believe that surgery will help him. As interpreter, I have no way of knowing if any part of the surgeon’s decision is due to the respectful and even fearful manner of the patient, and how much was a foregone conclusion based on his chart.

A young woman comes in and tells the nurse practitioner she has gastritis. She details her current diet. They take a good 40 minutes to go over the myriad of foods and ways of preparing it that have triggered this patient’s symptoms, from diarrhea to cramping to bloating to heartburn to the feeling of getting gut-punched to “the sense that the stomach is gnawing a hole in itself so I am worried I may have an ulcer and I read online that an ulcer can give you cancer so now I am really worried!” The nurse practitioner reassures her that she does not likely have an ulcer, as the antacids she took for it did not help, and the specific foods she has eliminated are not related to ulcers, and in any case, only a very few kinds of ulcers are linked to any cancer risk. Questions? Yes, what can I eat?! The patient is referred to see a nutritionist, and meanwhile, they will do some further studies to see if perhaps the gallbladder is involved. Just kidding on that last point! That is what the interpreter kept expecting to hear, but it was never mentioned.

Sweet elderly lady with diabetes and repeat urinary tract infections comes in to get more antibiotics. Her new young doctor explains to her that when blood sugar is very high, even urine is sweet. And since bacteria live on sugar, it’s like preparing a feast for them. The bacteria multiply and get overgrown and that’s why she keeps getting these bacterial infections. She needs to change her diet, not just take more antibiotics. So let’s get you back to a diabetic specialist, my dear, so they can figure out how to help you get better control of the diabetes. And we will hold off on prescribing more antibiotics until we grow out the urine culture to see what you actually have. For now, watch your diet. The patient is amazed and impressed: “I never knew that my blood sugar would feed the tiny creatures and cause infections! That explains a lot! Thank you for telling me, doctor and thanks interpreter for saying it all so clearly – may God in his almighty mercy rain down a veritable SHOWER of blessings upon you both!” Their two beaming faces smile and wave at me as we disconnect.

Next is a stroke survivor with a speech therapist who specializes in swallowing and cognitive support. Food gets caught and pooled inside the cheek where the patient now has less sensation and less tongue mobility. They talk about things she can do to clear the food, and some safe swallowing tips to make sure she doesn’t aspirate any food or liquid into the lungs. They move on to some cognitive training , and the therapists asks the patient to read aloud about focused, sustained, selected, alternating, and divided attention. But because her left field of vision has become foggy and mysterious, the patient reads to the end of the first line, and gets stuck. Her eyes cannot find their way back to the start of the next line of text. The therapists offers some tricks like following the index finger, and even draws a bright pink line to the left of the text, but it is too difficult.

The therapist switches to verbal teaching, and sets up scenarios like “what could you do, for example, if you were trying to learn something and your attention was divided because there were people talking loudly in the hall?” The patient looks horrified and exclaims! “I could NEVER go out there and tell them to be quiet! God forbid! That would be so RUDE!” The two then argue politely about whether it would seem equally rude to simply shut her door. The patient believes it would be rude. The speech therapists thinks the people in the hall would understand. They stick to their opinions, and finally the interpreter slides in with a question: “The patient may not know, this is the interpreter speaking, is shutting the door something you as therapist could order or suggest to staff yourself?” I back-interpret the question for the patient and she gets so eager about this escape hatch from the pending confrontation:” Yes, yes, you do it! You do it! You don’t have to worry about anyone getting mad at you. You’re not the one trying to convince them to let you order the baked salmon every night when they tell you to try something else!” The therapist laughs and promises to let staff know that the patient will need to hit the call button to have her door closed, as part of her cognitive therapy. The patient shows off her newly crooked and mischievous smile.

Baby in Neonatal Intensive Care Unit – born some weeks early, and having heart trouble. The new doctor is being so vague that even the interpreter is unclear as to the severity of the problem or whether surgery is on the horizon: “As you know, your baby has a hole in its heart. This is very common – it’s called a Ventricular Septal Defect or VSD. They usually close on their own, but not always, and they can be dangerous, but not necessarily – we don’t know if this one will close up or not, so we are still deciding whether to send the baby to Children’s for a procedure, but it could still close up on its own. But usually by his age the heart would have sealed itself, so anyways, it is potentially dangerous and can cause damage to heart and lungs if it stays open, but we don’t know yet that it will stay open, and surgery is an option, but we don’t know if that will be necessary.. any questions?” The Dad bravely stands up and says, “Yes doctor, can you come back and tell me what you DO know and what the plan IS as of now, rather than this wishy washy what the hell scare-us-even-more kind of bullshit presentation?” Haha, no he didn’t. He is not there, and the mom just nods politely and avoids eye contact. No questions, Doctor. Thank you, Doctor.

A pair of twins in which one is getting much more of the blood supply and nutrition, and the other is so tiny and starved that they have to hospitalize the mother and monitor the rest of the pregnancy, in case “things get dangerous” requiring an immediate C-section to extract the tiny little fellow (and his robust brother). Mother gently repeats that she doesn’t understand about percentiles, even after the doctor tries to give her a crash course on higher math and statistics. As interpreter, I ask for permission to restate with less math, and offer to say “Imagine a lineup of a hundred babies in size order, from smallest to biggest. Out of a hundred typical babies, your bigger twin is bigger than 73 of them, so very big, but instead of being up there next to him in the line, your smaller twin is way far apart, at the very beginning of the line. Because the smaller twin is one of the 3 smallest babies out of the whole 100 babies – so very, very small.” This off-the-cuff explanation is allowed. The expectant mother’s eyes get really big and worried, because she finally understands, but the doctor is smiling and enthused, and tells me she is going to use “your way of explaining – I love the lineup!”. Then the bell rings and my day is ending.

Will the injured farmworker get relief for his now chronic backpain? Will the woman who has limited her diet to mostly white rice and boiled chicken with no spices find out she has gallstones? Will the sweet lady with diabetes get it under good control soon? Will the stroke victim learn new ways to eat, focus, and become assertive enough to have her door closed? Will she keep ordering baked salmon for the rest of her hospitalization, while smiling her crooked grin? Will the baby’s heart seal up without surgery? And will the puny little twin make it out okay? It is not given to this interpreter to know. So many stories unfinished and unfolding – all in a day’s work.