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.