Saturday, September 3, 2011

Time to talk.

It was time to talk to you. And I am so ashamed to admit that I had secretly dreaded this time. Not because of you, but mostly because it would be awkward and lumpy like it always is when the doctors can't speak your language. The thing is that usually even when "the doctors" aren't fluent in someone's native tongue, somebody somewhere in the vastness of the hospital is. A crafty student or resident finds that person and just like a combination lock that finally had the right code entered, everything is opened to us.

But not this day. There isn't that person lurking on the Mother-Baby unit or at some desk down in the Emergency department. No person from your home country willing to change your words from a plume of smoke floating from your lips to crystal clear images that paint a picture and explain why your face has that twisted snarl of pain. Not even someone from your family to rush in after work still in uniform and waiting with anxious eyes on the end of the page the nurse just sent to the team.

Nope. Not even one.

So for this reason, I wasn't looking forward to this time on rounds when I needed to see you. My eyes quickly trampled over the clock hanging on the ward--4:45 p.m. Afterschool care pick up in the horizon and yes, I know, this was my problem not yours. But this problem of mine was making me even less excited to hear about yours. Especially because my 5:20 deadline would unfortunately become yours.

The medical student was perched beside the door waiting.

"You ready, Dr. M?" he asked all bright-eyed and bushy-tailed.

"Yep!" I announced with as much spunk as I could muster. But inside I was saying, No. I am not.

We approach your bed and find you curled in the fetal position. Your eyes squeezed shut and a tsk-ing sound is the first thing you say in response to my pseudo-chipper greeting in English. My patience drains down into my feet and forms into a puddle on the floor. I don't speak "tsk-tsk" and you don't speak "pseudo-chipper."

"We can use the phone interpreter," the student offered.

He must have stepped into that puddle and had decided to have patience for us both. I would need it.

"Oh, that's good," I replied, "so, we have a phone interpreter that speaks this language?"

"Sure do," he answered in a real-chipper that wasn't pseudo like mine. "I used it earlier."

He smiled gently at you and picked up the bedside phone. Looking at a laminated card retrieved from his overstuffed medical student pocket, he dialed a number and entered a few codes. I could hear a muffled voice and he announced your language in response. And then we waited.

"Looks like we're in queue," the student said while still being careful to keep including you. He held your hand and patted it. "There aren't many interpreters speaking this language, so sometimes there's a wait."

Of course. A wait. A wait to have a perforated discussion with you between a tiny voice coming through a hospital telephone, a medical student who already had spoken to you, and me--who still needed to get her two children from school before six p.m. That pool of patience floated out of the door and down the hall.

I rubbed my neck hard which is always what I do when my patience wanes. And then, finally, an interpreter.

"Hello, my name is Dr. Manning and I'm the senior physician that will be caring for you with the team."

I announce this into the telephone and pass the receiver over to you. The muffled voice says a version of my greeting and you mumble something in return.

"She says, 'Good to meet you, madam.'" Which was little surprising because the look on your face didn't seem to say that. It looked angry and tired and like it wasn't down with any pleasantries such as 'glad to meet you' and damn sure not 'madam.'

"Tell me about your pain that you've been having." I extend my arm back toward you with the phone. This time your answer is longer with more "tsks" peppered throughout. I realize that the "tsk" is not a good thing; mostly a sound of frustration. I wanted to "tsk" too.

I learn of your pain. The student interjects and fills in blanks about your very complicated past medical history. We lay the phone receiver down and examine you, picking it up to ask things like, "Right here?" or "What about this?" Between the student, the telephone interpreter, and your tsks it comes together. The diagnosis isn't a good one. In fact, it is a bad one. A really bad one.

Now what next? Tell you of a life-threatening, life-abbreviating diagnosis through a choppy back and forth via telephone? Do I do this, knowing that no matter how nice that tele-interpreter man sounds over the phone that he can't see your facial expressions or know exactly when to soften his intonation? Even in the King's English it's no walk in the park to tell someone that, "Oh this diagnosis that you have? Well it's essentially trying very hard to shorten your life. And we don't have a lot of medicines to stop what it's trying to do to your body." Yes, this sucks. How do I tell you something like this under these circumstances?

I look at the student and he looks at me. And a decision must be made about you. Tell you all of this or no? Right then, right there I decide.

"Do you have any family at all who speak your language here in Atlanta? Any one that you know that can come and help? There are so many complicated things to talk about. Some hard things. We would rather not have this conversation over the phone."

No. This wasn't the time.

I stick my hand in my lab coat pocket and secretly cross my fingers. Someone has to help me with you. Not a mystery man inside of a phone but a real person with warm blood and three dimensions.

I put the phone to my ear and what I hear washes me with relief.

"She says that she has a son. He can come tomorrow. After work to speak with the team."


We exchange a few more words with you, the tiny voice, and your pain. We confirm that you are comfortable right now and make a plan to meet with your son. And you nod when the tiny voice tells you this through the phone.

I turn the ignition in my car at 5:18 p.m. Life goes on and surely I will find kids covered with Georgia dusty red clay and unidentified stickiness on their cheeks. Full of the vigor and joy of life and safety and consistency and familiarity. Then, I think of your frail body, the disjointed communication, and the worst part of it all--the fact that you are dying. In this foreign land with its confusing culture and impatient people whose cell phones play music and whose wall-phones are bilingual, you are dying.

And here I was worried about me and my time.

"Tsk," I say aloud to myself. "Tsk tsk."


Now playing on my mental iPod. . . .


  1. I am always amazed and impressed at your ability to doctor in the truest sense of the word and to tell a story, a narrative -- you are re-humanizing the profession. I hope you know that -- and that we are blessed by it.

  2. Well...that was very moving. really sad for her.

    I've always liked that song since hearing it in "Stricktly ballroom" years ago.

  3. To bad you can't skype with those telephone interpreters. At least then body language and expression wouldn't be lost.

  4. I'm thinking about how scary it would be if I was a patient in that situation. I love how you're so compassionate.

  5. I agree with Elizabeth also


  6. i get it, i've been there, in those moments and my critique of myself and my heart in those moments- and .... i miss you- like fo' reals' like thinking of you saying goodbye in my empty living room is bringing a smile and a tear- hang in- hang in-
    and continue to be an instrument of peace.

  7. Sister Moon -- This is a compliment. I thank you for always getting me.

    Elizabeth-- I am blessed by you. You are an amazing woman. This I know from reading what you write, too.

    Kristin -- I am not familiar with this movie. Will have to check it out! I grew up in the seventies and eighties so early MTV is my point of reference. :)

    Sarah -- You are always so kind. Thank you.

    Emmy -- What a great idea. Bet that's just an iPad app away. . . .

    Lucy -- You're waaay more insightful than I was as a teenager. Waaaay more.

    Poopdeck -- Knowing that you and Mom read my blog always makes me smile. I love you.

    Kris -- Yes, that was a moment wasn't it? Do you know how much I am loving your Uganda posts? Do you? Love. xo


"Tell me something good. . . tell me that you like it, yeah." ~ Chaka Khan

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