Wednesday, March 6, 2013

Los dedos azules.


On that first day I'd popped into the room just before lunch. After a quick knock on your door, I greeted you warmly. "Hello! My name is Dr. Manning. I'm the senior doctor on the team taking care of you while you're in the hospital."

Your hand went up like a stop sign. "No hablo Ingles. I don't speak the English. Justa Spanish solamente." You smiled and shrugged when you told me. Not a shrug that said, It is what it is, but instead a rather apologetic shrug. One that offered regrets for the inconvenience of you not speaking the language of the land you're in. It was obvious that this was something you went through a lot.

"Okay. I mean, Si," I said. I nodded hard and pointed first at my chest and then at the door. "I'll come back. With an in-ter-pre-ter."  I rubbed my forehead with the heel of my hand because I know my slow pronunciation of the word "interpreter" made no sense whatsoever. But lucky for me, you knew what I meant. I could tell by your relieved smile.

I have to say that I was impressed that you advocated for yourself this way. You stopped me before I even passed go to let me know that you didn't understand what I was saying and that smiling really hard and pointing a lot wouldn't be enough.

And even though I knew that, it was good to have you hold me to it.

Okay so the confession is this: I had hoped to see you before lunch. I wanted to come in and chat with you a bit, examine you and tell you our plan once more. Calling an interpreter would take time. It would be the difference between a leisurely lunch over forty-five minutes and wolfing down what was in front of me in ten. Sigh. But you didn't speak English. What else could I do?

I'm ashamed to say that there have been times where, when pressed for time, I came in with big, sweeping hand gestures in the place of an interpreter. Slow, loud, staccato English words landing in sloppy splats all over the room. Tricking myself into believing that I'd saved time when really all I'd done was waste it. I promised myself that I wouldn't do that any more. So you telling me that you only speak Spanish gave me even more incentive to call someone in.


And so I called. I couldn't help but grit my teeth as I waded through all of the prompts on the recorded Interpreter Services menu. "Just get me to Spanish," I huffed inside of my head. I didn't dare utter it aloud. Finally someone came to the phone and told me an interpreter would be up to join me on the ward soon.

And you know what? It was soon.

We returned to your room and the minute you saw that woman behind me in her blue smock, you erupted into a big smile, sparkling with dental crowns of precious metals. That smile said, What a relief to hear my language. What a relief to understand. I pulled up a chair and surrendered to the clock and my growling stomach.

Here's the thing: The patients I'd seen before you had received more than just my clinical acumen. They had received me. You deserved the same.

I owe this to an interpreter at Grady who came to assist me one day with a Spanish speaking patient several years back. She came to the bedside donning her tell-tale blue Interpreter Services smock and offered me a warm and friendly handshake like always. Then, when I started speaking to the patient, I said, "Can you please tell him that our team is treating an infection on the skin of his foot?"

She immediately spoke words that, I'm sure, were directly translated into English of that very statement. Then she made a suggestion to me before I could go on. "Doctor? Might I suggest something?" This rather caught me off guard, but I obliged. "Just talk to the patient and interact exactly as you would with any patient. Simply pause for me to be able to interpret, but do everything as you would in English, okay?"

And honestly? Hearing her say that felt a bit embarrassing because I thought that I did do that mostly. But obviously, that wasn't true. And so. I paused for a moment and asked myself, What would you normally do?

You'd pull up a chair.
You'd hold his hand. 
You'd get to know him.
You'd take your time.
You'd examine him and everything else, of course.
But mostly, you'd bond with him. 

Yes. I'd find a way to give him a piece of me.

And you know what? That is exactly what I did. I asked him about his family. Whether or not it tickled when I examined his foot. And what he thought about the weather in Georgia.

He answered all of those questions initially in the direction of the interpreter, but eventually he settled into our interaction and started talking directly to me. That's when I found out that he was really funny. And that the Georgia weather didn't bother him so much since he was used to the warmth of South American suns.

Then his face became serious and, since we weren't limited only to the basic-basic-basic tell-this-man-this-or-that-so-that-he-knows-the-minimum, I asked him.  "Are you worried about something, senor?"

And he swallowed hard and answered. "I worry about losing my foot. If I did, I wouldn't be able to work or send money to my family."

He was diabetic so that was a reasonable concern. But this infection on his foot was just on the superficial part of his skin--the outer layer. It wasn't a deep ulcer or a non-healing sore. And, from what I could see, it was already improving with antibiotics.

I held his hand and leaned in closer to him. He squeezed mine tighter and his lip started to quiver. "I worry a lot about this. Not having my whole body able to work. I have to work."

I reassured him and talked to him about the things that put people at risk for bad diabetic foot ulcers. I pulled out a monofilament to test his foot sensation and check for signs of diabetic neuropathy. After demonstrating that the feeling in his feet appeared to be normal, we talked about foot care and proper shoes and taking insulin and seeing his primary doctor. And all of that seemed to make him feel better. And empower him, too.

"So my toes and feet are mostly okay?" He released a sigh of relief.

"Well," I responded with my eyebrows raised, "You could use a pedicure, maybe. I take that back. Not maybe. Definitely. But from a diabetes standpoint, your toes and feet are fine."

And the interpreter shared exactly what I said, wise crack and all, and we both laughed out loud.

"I think when I leave here, I'll go and get my toes done. What do you think about me getting my toes painted blue?"

I started laughing before she could even speak the words back to me in English. Not because I fully understood what he said but because I knew, from the mischievous expression on his face, that whatever he'd said was a joke.

"Los dedos azules!" the interpreter exclaimed. And we all broke out into fluffy laughs together.

He got better. I'm not sure if he ever followed through on los dedos azules but the image of him doing so has always made me smile.

And so. That interpreter showed me what I'd been missing. I'd been disqualifying all of my non-English speaking patients from the F.P. (favorite patient) race. But my patient with los dedos azules opened a door for me and let me see the humanity that lies behind those language barrier walls.

The humanity. The person. And the jokes, too.

So. With my stomach protesting and with my sweet Mexican F.P. and his dedos azules in my mind, I decided to offer you the same. Not just the basic things you needed to know, but a piece of me.

"What do you think of this cold weather?" I asked you.

You rolled you eyes and huffed. "You guys can keep it. I like it here but never needed such a heavy coat in Honduras!"

And no. That had nothing to do with why you were in the hospital. Nor would it get me any closer to my lunch break. But it felt so much better than exaggerated hand gestures and also richer than giving you the basic-basic must-know parts only.


Before I left, you spoke to me in English, "Thank you, doctora."

And I spoke back in Spanish, "Gracias, senora. Mucho gusto."

We shook hands and I stood to walk out. Just before I did, you said something to the interpreter that started with, "Como se dice in Ingles. . . "

And so, she answered you and you beamed in my direction with your gold rimmed teeth.

"I like your short hair cut. Very nice."

And you said that compliment en Ingles to me every day for the rest of your hospital stay. You sure did. And every day until the day you were discharged, I'd say the same thing back to you with a pat of my head. "Aaaahhh. . . gracias, senora."

Gracias para todo.

Happy Wednesday. And shout out to the Grady Hospital Interpreter Services. 'Preciate y'all.


  1. As someone who was known in the sorority circles as "Spanish Fly" 20-plus years ago, I must say "Bien hecho mi hermana!

  2. From the deck of the poop,

    What you learned during this visit would probably have gone unappreciated by many Drs, but not Dr. KD. You have a genuine caring about you that makes you the great caregiver that you are. You are the best.


  3. I am constantly amazed at your ability to see, feel and connect with your patients. I would instinctively talk toward the interpreter and what a simple thing to look into the eyes of the person you're communicating with instead. Thanks for the laugh this morning, love that humor transcends the language barrier. Me gusta los dedos azules :)

  4. Communication--the Final Frontier!Kudos to the interpreter for teaching the invaluable lesson and kudos to you for translating it into oh so meaningful action. Your attention to the whole patient is extraordinary...
    Love, Coach B

  5. Interpreters all over Atlanta rock! As we can see from your story, they teach us how to interact, they guide us into relationships. Good for you as well, Dr.M.

  6. I am an interpreter and thank you for this post!

  7. Thank you for taking care of one of my all-time FP's :)

  8. Grady Doctor, are you ok? It's been days since you posted and your fans want to make sure that you are ok!


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

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