TRIGGER

The video turns on, and I am popped into a room with three residents and a gowned patient on a table. A man in a baseball cap hides under its brim in a chair along the distant wall.

“So we will give you the trigger and then you go to the lab by 9:30 tomorrow.”

Interpreter: “Trigger?”

Resident: “Yes.”

Interpreter: “You may not realize but I am given zero context, do I not even know what clinic you are in, and that word can mean a multitude of things.”

Resident: “Lupron trigger.”

Okay, yeah, thanks for that. This interpreter has only interpreted Lupron as a chemotherapy agent – used in the case of prostate cancer, and this is a young woman. A quick online scan of Lupron uses include suppressing puberty, fibroid uterine tumors, and ovarian and breast cancer as part of their chemotherapy protocols.

“What clinic are you in?”

“Oh! Sorry! Fertility!”

“Great. Thanks. So for the interpreter, as this is new, are you using Lupron instead of Human Chorionic Gonadotropin to induce maturation of the ova? I need to choose a word for “trigger” here. I don’t believe the patient would likely understand “agonist”. Would it be appropriate to use “activation”?

“Oh, yeah, thanks.”

I quickly back-interpret that conversation in the patient’s language, and then doctors go on the explain the in-vitro fertilization procedure in technical terms, some of which I ask permission to simplify. I get approval for my word choices and work with the team to maintain accuracy – and comprehension. My checkbacks provide useful feedback for the doctors in understanding what part of their language is less digestible.

When the doctors get to the part about how “your partner will go into a room and provide a sample once you go back into the OR for the egg retrieval,” the baseball cap in the corner pops up and I see a startled face – then the face disappears from sight again. Poor Daddy!

By the end of this session, we have managed to clarify many small misunderstandings, including:

The “sample” that hubby gave before was for analysis, not for fertilization, and so yes, he will need to get his own fresh sperm, all by himself, while his wife is in her egg retrieval procedure.

The Lupron trigger/activation requires a blood sample to check progesterone levels to determine whether implantation would be viable (there are more miscarriages with the new Lupron method, but less potential damage to the ovaries).

With Lupron, the patient will need high quantities of estrogen and progesterone (pregnancy-supporting hormones) because Lupron alone does not prepare the uterine lining to receive the embryo. There may be patches, and shots, and pills, and lots of bloodwork on a tight schedule. All to increase the success rate of a viable (able to live) pregnancy.

The patient to be impregnated showed visible relief to know why and wherefore on all the patches, tests, bloodwork, and schedule. It had been partially understood, with gaps and mysteries within a dark web of words and information.

I understand some interpreters, especially new to the field, may not feel comfortable with this level of requests for clarification, and then having to back-interpret what the dialogue in English was, but as a long-time professional, I determined that it was necessary for basic understanding. The other good thing is that once I asked for clarification, it gave the patient permission to ask her own questions, and she was able to get a lot of things cleared up. I see this happening quite a bit. Once the interpreter asks for a clarification, simplification, or even confirmation, it can open the floodgates. The patient lights up with relief and their face shows me, “Oh, we can ask questions? Cool! Me, too, then!”

As to the poor husband, he was clearly not enjoying talking about masturbation in a room full of young fast-talking, highly technical, and mysteriously uniformed masked women. Perhaps a truly activist (agonist? triggering?) interpreter who goes easily over the line into “cultural brokerage” would have asked the doctors to assure the husband that his activities in the bathroom – without the aid of his wife this time – do not constitute anything sinful, even for Christians of the first water, as the biblical prohibition related to Onan was to avoid “spilling his seed upon the ground” and in this case, it was to be captured in a plastic cup, and duly conveyed to the patient in order to follow God’s command to “be fruitful and multiply”. I did not go that far, of course, but limited myself to obtaining the linguistic context to help the patient get clear information about what she was going through.

We rarely see the outcomes of our patients, but I like to think there will be a little person sitting alongside Dad in a couple of years, bashfully hiding under their own little baseball cap at some family gathering, slowly warming up and then trailing off after the other toddlers, safe in the knowledge that Mom and Dad are nearby. In any case, I am happy that my patient was able to understand the whole procedure and the whys and wherefores of what was being done to her body in this very important attempt to start a family.

One more note for the linguists and philosophers among us: The phenomenon of doctors (and others) presuming that others know what they know (when we don’t) is actually a thing. It even has a name, which I love: The Curse of Knowledge. It is officially known as a cognitive bias, one which leads us to unwittingly (and falsely) presume that others know what we know, because we have become experts in our field. Our knowledge has become so deeply imbedded that it feels like “everybody must know this” but of course, we each have very different life opportunities and areas of expertise. This is why I so highly encourage my colleagues to step in as needed to make sure we have enough context and information to be accurate in our renditions. And to simplify for understanding, as appropriate, in a fully transparent manner. It is vital for our patients, and useful for the doctors to get these wakeup calls, so they can become better communicators.