Tuesday, October 12, 2010

Loose Interpretations.

*patient names, details, and identifiers changed. . .but the message is the same.
There was this exercise I participated in once at some workshop at a medical meeting where we wrote narratives in patients' voices. Kind of like your interpretation of what they might be thinking or feeling.
It was pretty powerful. Man. What a great way to really connect to how a patient might feel and really humanize them. I revisit that little process every now and then to, as my advisee Antoinette and I always say to each other, "keep it human." Most times I just carry out the dialogue in my head, but other times I'll actually put it on paper.
By the way. . .even if you're not a doctor, you should try this sometime. Hospitals aren't the only places where empathy is needed. . . . . .

Mrs. Xie.

There was this sweet octagenarian woman from rural China who had been an inpatient on my hospital service once upon a time. She couldn't speak more than two or three words of English, so would only smile at most things said to her during her entire stay. I hated being unable to communicate with her, but she never seemed to let it ruffle her feathers. She always seemed to have such a sweet and gracious disposition. It pained me to see the confusion in her weathered eyes each time we entered the room. She deserved to be heard.

This trip was on her "bucket list". Family had fulfilled a lifelong dream of hers to visit to the U.S. and she was elated.

That is until she got sick. Headaches on and off. Pain in her leg and really, really high blood pressure. We admitted her for management of a hypertensive emergency, and to further explore the pain in her leg. Years of smoking had done a number on her arteries which decided to give up on sending blood to her right leg. A complete blockage at the femoral artery, right in the groin area, left her with a tender, mottled leg--all the way down to the toe.

To make matters worse, she spoke a Chinese dialect that few people (read: nobody) in the hospital had in common with her. These are the times that you kind of wish you lived in a city like New York or San Francisco, for real. (Interesting sidebar: My friend and former Grady doctor, Natalie L., works at Bellevue Hospital in NYC and they have an entire Chinese-language-speaking medical and psychiatric ward!) But we were in Atlanta, not New York City. Bummer.

We pointed at the sign for interpreter services.

"Mandarin?" Smile.

"Cantonese?" Smile.

It wasn't one of the ones on our in-house interpreter list. Or what if this was a literacy issue? This sucked.

One of the inpatient pharmacists, Val, came to help me out. Val is Chinese and was fortunate enough to learn both Mandarin and Cantonese as a child. In a pinch, she's always gracious about stepping in to interpret for me, despite her busy schedule. If the issue was that my patient could speak but not read Mandarin or Cantonese, this would be money.

Val spoke to the patient. The patient spoke back to her in a wobbly voice that, no matter what language you speak, seemed difficult to follow. Val looked at me and shrugged. Her eyes were apologetic.

"I'm sorry, Dr. Manning. This is some kind of dialect that I just can't make out. Her last name is a Mandarin last name so I thought she'd at least speak some Mandarin. But honestly, it's not unusual for older people from certain areas to only speak dialects other than Mandarin or Cantonese. Sorry I can't help."


To make matters even worse than the worse that I mentioned before, she was sick-sick. That leg pain of hers turned out to be severe peripheral arterial disease. Her right leg was getting no blood supply and the clock was ticking. She needed surgery ASAP to either open up those blocked blood vessels or if that didn't work, an amputation.

But she was almost eighty nine years old. Would she want such aggressive treatment? How did she feel about the possibility of an amputation? Not getting surgery would be life threatening. Getting surgery could also be life threatening. Sometimes when people are sick-sick and well into their eighties, they don't mind life threatening situations. But for her, we didn't know any of that. And that sucked.

She had two family members that worked full time. They would come when they weren't at work (which wasn't often.) They owned a small business and had no choice but go to work each day. Most of the time, the patient was there alone. So there she was. . . . in this mystery land with a mystery language while fighting a mystery illness. I can only imagine how she must have felt. . .. .

6:08 a.m.

Can't sleep.  The television next to me is too loud.  I also think I need to move my bowels. I haven't had one in three days. My leg feels like a tooth that aches.

Lady with brown skin comes in smiling at me. She keeps nodding her head over and over again. I think I do understand that word, "MAM."  Always with two words I know in English: "yes" and "no." I think "mam" means thank you? Or please?

Brown lady shows me a pillow. But I think the pillow here is too itchy. Or something. That television. It is too loud.

"Mam." Thank you for offering, I really want to say, but this thank you will have to do.  I smile and shake my head. I don't want another pillow. I think she understands what I said.

My stomach is hurting. I need to have a bowel movement. Maybe this medicine is making it worse? I don't know. And my foot hurts, but just on my toe.  I move the cover over it softly because it hurts. Ouch.

Brown Lady is smiling at me again. Maybe she is a nurse? What is the word for nurse in English? I don't know. How do I say "excuse me" in English?  Is it "please?"  Oh man. I am not sure.


Brown Nurse Lady just looks at me and smiles.  I squeeze my stomach. I want her to know I need to move my bowels and that my toe hurts. I think this medicine is making it worse. Helps my pain, hurts my bowels.

Brown Nurse Lady looks at me and smiles again. She says words that I do not understand that sound like that loud television next to me.

"Don't worry, they will be coming around shortly with the breakfast trays."

What? Does this mean she understood what I was saying with my hands? I hope so. I nod my head and say "thank you."

"YESMAM." I say. That is, Yes, thank you.

She leaves.  Television still too loud in bed next to me.  I don't even see a patient in there. I think they took her to a test. Maybe nice Brown Nurse Lady will come back and turn off the television for me.  Push the call button. Picture of a nurse lights up and a voice follows.

"How can I help you, Ms. ZEEE?"

Voice comes in saying words I do not know. Except the last part ZEEE which, I'm thinking she thinks is how I pronounce Xie. She speaks again. I still don't understand.

"How can I help you?"

"PLEASE?" Excuse me?


Why is she saying thank you? Never mind.

I hear some voices. Laughing. Speaking in English and I still don't know what they are saying. Voices get closer.

Someone greets me. Then they go to town examining me.

"Mrs. ZYE. . . . "  They said a bunch of other stuff after that that made no sense to me. And they mispronounced my name. Again.

Hands near my groin. Pushing hard with gloved hands. Gloves off. Push again with fingertips. Now on the back of my leg. The top of my foot. Feeling for pulse? They look worried. Doctor in a short jacket runs out and comes back with device to look for my hiding pulse. They squirt clear jelly on my foot and move that thing around. Doctor in short jacket keeps looking scared. Doctor in long coat helps, but nobody can catch my pulse.

They look at each other and talk to each other. They look afraid which makes me afraid. Somebody tries to talk to me but all I can do is smile. I am grateful that they want to take care of me. But I wish I understood.

They wave good bye and prepare to leave.

"MAM." I say. Thank you. Want to ask about my bowel movement, but don't know how.

Brown Nurse Lady comes back. Still smiling. I point at the TV that is still too loud.

"PLEASE," I say to get her attention. Excuse me.

She comes over to me, smiles and squeezes my hand. I like this lady and also like her hair. I want to touch it, but I don't.

She turns my TV on. Not that loud one that isn't getting watched off. NO!  I don't want my television on. I want hers off. I hate the laughing sound from those recorded laughing voices. Why do they have that? Now I get to hear it double.

"PLEASE," I say. I point again. This time she turns it up a little louder.

My stomach hurts. Can I have something for that? She puts something inside the IV. I fall asleep.

I awaken to more hands groping my pulses. Everyone is wearing green uniforms like pajamas. Talking, pointing, nodding to each other. But not to me.

"She needs to go to the OR tonight," one of them said.

"Where is the family? How can we consent her?"

"Wait, is she a full code?"

"How is her cognitive function? Is she decisional?"

I have no idea what they are saying. But I am grateful.

"MAM," I say. Thank you.

Later on my nephew and his wife are there when I wake up. I am so happy. I feel like I've been locked in a tomb and they just arrived with the key. Now they can turn off that television and listen to me.

My foot is hurting like a really, really bad tooth. Tip of my toe looks a funny color to me. The team with the short jacket Doctor and the Green Pajama doctors are all there together. Everyone looks worried. Now I am worried.

Green doctors say a whole, whole bunch of words. Nephew looks to me and says,

You need surgery. There is no blood going to your right leg. So you need surgery. Or you will die.

Surgery? This is something I'm not sure about. I ask can he call my daughter. I know she is in China but I want to talk to her about this.

No, you need surgery, he says. It is an emergency. They said right now or you will die.

Feel sad about dying and not speaking to my daughter first. But otherwise, would rather make a peaceful transition than have surgery. I think my daughter would not object.

I tell my nephew. I don't want this right now. I want to speak to my daughter.

There is no time for that, he says. It is life or death.

They all talk some more. They all look at me.

"MAM," I say.  I am grateful that they are spending so much energy. But my life has been good. I want no leg pain, but surgery, I don't think I want this either. I want to tell my daughter. Can't we call her in China?

It's an emergency, my nephew says. If you were back home, then okay. But I cannot let you die here. You need the surgery. It is an emergency.

So that is that. I am afraid. I am nervous. I want to speak with my daughter. Had not seen this nephew since he was a little boy. Would rather speak to my daughter.

But I am grateful that they want me to feel better, though.

More medicine in the IV and I drift off.

Knuckles on my chest. Pushing in harder and harder.

"Ma'am. . .Ma'am?"

Why is she thanking me?

My eyes flutter open and I see young, young looking doctor with short jacket like that other one. Looks very  new at this. Feel very nervous at the sight of her. Younger than my youngest grandchild.

She says, "SHIH? SHIYE?"

She wants to say my name correctly. She is trying. I like her already. Close enough. I smile. She smiles back.

Short coat green doctor then takes out her phone from her pocket. Makes a phone call. More words I don't understand. Then she hands the phone to me.

I hear a voice through the phone. First I don't understand. Mandarin and then some kind of Cantonese. Then. I understand!

Her friend worked in something he calls Peace Corps. He told me about my leg. I told him that I did not want surgery. I want to call my daughter and tell her. He asked if I understood it could take my life. I tell him my life has been perfect. I ask him can we call my daughter. He says he is only a medical student, but will see if he can help.

Asks a few other questions, but these are silly. Where are you? What day is it? What is your full name? I tell them all of this. Phone-a-friend tells me that they will call me back. Short coat green pajamas young, young doctor leaves really fast.

Comes back with all of the Green Team. Takes out phone again and now it is a speaker. Phone-a-friend asks me the same questions over the speaker phone. I say the same answers. And also, Can I call my daughter? In China?

I also ask him how to say "thank you" in English.

It isn't "MAM."

12:35 a.m.

On a flight back to Beijing "at my own risk" and "against medical advice." Daughter flying to Beijing to meet me. No surgery. Just pain medicine. And pain is there but manageable. But that's okay because  Nice Stewardess keeps checking on me the whole time. She can only speak Mandarin and English, but she is nice and I appreciate the attention. I feel safe.

She puts a cover over me as I feel myself drifting to sleep. Before I do, I look up into her eyes and smile.

"THANK A-YOU," I say.  

 "Yes, ma'am," she replied.

 This time, nothing was lost in translation.


  1. Loving this post. I found you via Smacksy and am hooked! I was a social worker in a teaching hospital for a few years and so many of these stories are painfully familiar!

  2. love this post, very real and funny at the sametime,

  3. Awesome post, thanks for sharing this.

  4. How am I just seeing the wonderful post?? I am not on my J. You are an amazing writer Dr KD.


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