The One Lost in Translation

I can almost guarantee you this situation is happening in some hospital, somewhere, with some patient: the medical team walks in, asks a few simple questions in English, and gets the correct answers. The team then proceeds to explain the entire treatment plan in English, assuming that if the patient can respond to basic questions, they must have a grasp of the entire language.

My experiences this week have made me acutely aware of how dangerous this situation can actually be. When speaking to Guatemalans, I can demonstrate a reasonable grasp of Spanish, and often receive responses that are far more complex than I can fully understand. Sometimes, I just get the general gist of things. Other times, I make incorrect assumptions and miss the point altogether. Or worse, I may not have even the slightest idea what was said, but don’t feel comfortable enough (or can’t remember the words!) to ask them to slow down. But typically, I’m only trying to buy a bus ticket or understand my host brother’s new job, so a few words lost in translation are usually not a huge deal.

But when explaining a cancer diagnosis or the risks and benefits of a surgery, losing words in translation is not an option we can afford. I have no doubt there are patients for whom English is a struggle, but they may be too embarrassed or respectful to interrupt to remind us that they can only handle the basics. No wonder patients have difficulty complying with treatments, or even articulating what exactly their medical problems are.

Though I came to Guatemala to learn Spanish via cultural immersion, this trip is also a firsthand experience confirming the importance of using interpreters, avoiding assumptions, and checking to ensure patients are understanding their providers, regardless of language.

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The One Where I Joined the Walking Dead

It’s Medical Monday again, so obviously that means I come out of the woodwork to introduce myself. This is me:

Image from The Walking Dead

Okay, so that’s not always me. It’s me when I’m in the midst of my second week of night shift for my pediatric subinternship. If that’s not an excuse for an extended absence, I’m not sure what is. At this point, even coffee gets me to about here:

 And of course, I’m also working on my residency applications right now, which makes me look something like this, even on a good day:

But even among the hustle and bustle, I’ve been hoarding ideas for future blog posts. Like about the time that an elderly veteran in ophthalmology clinic decided to read my palm. Or about how I finally managed to write a personal statement after months of procrastination. Or about my patient who disappeared off the floor at 1 AM. Or about narrowing down which residency I want to pursue (!).

Really, I’m going to write about all of that. Someday.

But right now, all I can think about is sleep.

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MedicalMonday button It’s the first anniversary of Medical Mondays, and I am so grateful for the efforts of Emma and Jane over the past year. It’s been so much fun to connect with other medical student/medical wives/medical professionals in the blogosphere. The posts shared each week remind me that I’m not alone in the hectic world of medicine, enlighten me on the various roles played by different staff in the medical system, and provide advice on everything from raising children as a physician to the latest in interview suit fashion. While I hop on into my bed, I highly recommend you hop on over to their blogs to meet the other fabulous participants of MM.

The One With the Appropriate Gift

During my first year of medical school, a textbook author named Barbara Fadem played a huge role in my education. An expert on behavioral health, Barbara guided us in how to address defense mechanisms, recognize substance abuse, and approach complex ethical issues.

For whatever reason, one particular line from her textbook has always stood out in my mind:

From Fadem, Barbara. Behavioral Science in Medicine. 2007: 26: 493.

From Fadem, Barbara. Behavioral Science in Medicine. 2007: 26: 493.

This concept has always made me chuckle at its seeming absurdity, because who in an urban environment even raises chickens, let alone thinks to package their eggs up for their doctor’s appointment?

But this week, my jaw dropped as I walked into a patient room.

Because there, on the counter, with “Mindy’s Farm” scribbled on top, was this:

“Mindy,” I began, giggling. “You have no idea how appropriate this gift is.”

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Also, I’m taking this opportunity to wish a very happy Father’s Day to the man who always read me countless stories and taught me to ride my bike and to drive, who still washes my car and changes my oil, answers my frantic 6 AM phone calls when my car door freezes shut, and supports me no matter what. Love you, Dad!

Rx: One Boost of Confidence

“Mr. Smith, I know you’ve seen a lot of doctors in the past year. I was wondering if you had any advice on how I can be a good doctor for patients like you.”

“Honestly? Just keep doing what you’re doing. You’re already there.”

 

So grateful for interactions with the Mr. Smiths of the world: those patients who give more to you than you could possibly give to them.

The One With the Bag Full of Pills

“Well, let me tackle the most important thing first. Dr. Family really wants me to figure out what medications you’re on, Ms. Smith, since we weren’t so sure during your last visit,” I explain, settling into a Lazy-Boy recliner situated near the 89 year old woman’s end of the couch. My preceptor had asked me to focus my mandatory geriatric home visit on reconciling the medication regimen of this patient.

Overhearing me, Ms. Smith’s 63 year old daughter emerges from the kitchen to drop two gallon-sized Ziplocs and a weekly pill organizer into my lap before immersing herself back into baking what smells to be apple pie.

I glance down at the bags and struggle to hold in my reaction. One bag is simply a collection of appropriately labeled prescription bottles. The other, however, looks similar to this:“Ms. Smith, do you know what these pills are?” I ask, holding up the bag. Please tell me you don’t take anything out of this mess, I think to myself. My mind wanders to a story my preceptor told me of a woman who would toss all of her medications into one bag and take a handful each morning.

Her blue eyes, blurred by a recent stroke, squint to make out what I’m holding. “Oh, no, dear. That’s why they’re all in there. I don’t think I take any of those.”

“You don’t think you take them?” I prompt.

“No. But my daughter puts my meds out for me. I can’t see all those tiny little pills.” There’s a touch of frustration in her voice. Eighty-nine years of life and several mini strokes had robbed the frail woman of her strength and independence.

I make a mental note to ask the daughter about the hodgepodge of pills and shift my attention to the prescription bottles. I pull them out one-by-one, each time looking to Ms. Smith for confirmation that she takes this medication as prescribed, and she responds each time with a nod.

“How about aspirin? It’s the one to help keep your blood from clotting up and giving you another stroke.” I hold up the bottle.

“Oh, no, I don’t take that stuff. I don’t need thin blood!” Her arms fold across her tiny chest; an act of defiance that exerts some control over her life.

“I see. But what if it’s just thin enough to help you avoid strokes?”

She gazes back at me unconvinced. “I think I’d rather have a stroke.”

“Can we compromise? These are big aspirins, but maybe you can try just a baby aspirin?” I’m tossing out a lifeline. Changing medication doses isn’t exactly within my job description, but I figure my preceptor will agree that any aspirin is better than none in this patient.

She allows me a slight smile. “Okay. I guess that would be all right.”

I smile back, satisfied with my small victory. “What about your sleeping pill? Are you using that each night?”

Ms. Smith shakes her head. “Oh, no. I never take my sleeping pills these days. I’m always sleepy enough.”

I decide to open the bottle to take a look at the pills inside and compare them to the pills sorted into her weekly medication box. I immediately discover a matching white tab in one of the PM slots, but subsequently locate it in almost every AM box as well.

“Ms. Smith, you’re taking these twice a day every day! No wonder you’re sleepy!”

She shrugs her shoulders and laughs. “Oh. How silly. I guess that explains things.”

I start opening the other bottles and comparing the placement of the pills into the pill box with the prescribed dosing. In each bottle, I notice a few rogue pills hiding among the uniformed tabs that I assume are meant to be in that bottle. Where do these other pills come from? I debate.

And then I open her hydralazine bottle. Though I know this to be a blood pressure medication, I find a bottle stuffed with the exact same white pills I’d found in the sleeping pill bottle.

Crap. This cannot be good.

Thankfully, I’m learning to practice in the age of Google, and what would once have required scouring a thick text full of pages and pages of pill images now required simply locating a website on which I could type in “white” “circular” and choose the pill code stamped on top to discover the true identity of the pills.

They are, in fact, hydralazine. Ms. Smith is consuming twice the dose prescribed for her on this medication. Suddenly, her recent history of dizziness makes so much more sense.

“Ms. Smith, I think I know one way to make you better,” I declare, beginning the arduous task of returning the medications to the appropriate bottles.

“Good,” Ms. Smith replies. “Next, I’d really like to be able to see my TV again, okay?”