Sunday, September 1, 2013

Still listening.

 Would you hold my hand
If I saw you in heaven?
Would you help me stand
If I saw you in heaven?
I'll find my way, through night and day
Cause I know I just can't stay
Here in heaven 

~ Eric Clapton

"Good morning, my friend."

"Buenos dias, mi amigo!"

My sing-songy greeting was interpreted into Spanish as it had been every single day that I cared for you. Complete with the happy intonation.

I was happy to see you. In fact, I was always happy to see you on those days that you were there. Your gentle and brave smile and, especially, the way your eyes danced every time I asked about your wife and son, made every visit a joy. Even under these circumstances.

I took a seat directly in front of you as always. On this day, you were sitting on the bedside chair. You couldn't go too far from the bed with so many things connected to you. I was glad that you didn't let this stop you from getting out of bed.

"How are you?" I asked. I emphasized the word "are" and appreciated it when the interpreter did the same in Spanish.

You shrugged and told me that you were as well as could be expected. "You just try your best to be positive, you know? To get out of bed and tell yourself to keep on going." After that, you pressed your lips together and inhaled through your nose. You gave your right shoulder a tiny flick upward as you focused your eyes on mine. "All I can do is just hope and try."

And this? This is precisely why I always waited those fifteen minutes for an interpreter just about every single time I saw you. Not because you spoke no English. Your more than a decade in the U.S. had helped your conversational use of this second language along quite well, actually. But some things just couldn't be expressed by your basic English skills. Your heart emoted en Espanol. And without someone there to cross that divide, all of that part would be lost in translation.

Or just lost altogether.

It was so tempting to see you without those interpreters, too. Mainly because you understood nearly all of my questions and, with careful thought, could reply in short, logical answers. And sure, if I was just popping in for the umpteenth time during the afternoon to check on your pain management or to see if you'd made it back from some procedure, I was relieved that you could express what you needed and I could help you without much of a delay. But mostly, I called someone when I needed to talk to you. A person to knock down the wall of words standing between the kind of relationship I knew you deserved to have with your doctor.

And so. Day after day, sometimes multiple times in one day, in I walked with a blue-smocked interpreter by my side. And I'm so glad that they didn't just fold my English words over into the language you understood on those days. They put all of the emotion into it, too--a part that I didn't want to get lost in translation either.

Or lost altogether.

"When you have a child, everything that you care about changes. Like, all I can think about is what this means to my son. I've been sick since he was in kindergarten. It's just so much on him. And my wife." When you said that part about your wife, you balled your hand into a fist and pressed it to your lips. Again you sucked in air through your nostrils and this time your eyes squeezed tightly. "She is very, very strong. You know that."

I did know that. I knew it because, on a different day, an interpreter spent nearly an entire hour with me at your bedside as I talked to your wife and you. While your young son sat criss-cross-applesauce in the bedside chair while reading Diary of a Wimpy Kid. 

That hour was a pivotal one. Her English was far more limited but she had this way of smiling and nodding as if it were much better than it was. During that discussion, we got to address all of her concerns--and her concerns were many. And all of that took an hour because the first half of that time was simply spent trying to convince her that I wanted to hear what she had to say and that she wasn't inconveniencing our team by wanting to know what was going on with her husband.

"I really, really want you to feel comfortable asking for an interpreter, okay? Like this is very important," I recall telling her.

"A lot of times my son helps me. I just don't like to bother anyone." This was her response. Her honest response.

"Su hijo?" I said in my rudimentary Spanish. When I said that, I remember your son looking up from his book and resting his brown eyes on me. His expression was so complex that it was impossible to read. I softened my face in his direction and smiled. Then I shook my head hard. "Let your son be your son. He should never be the interpreter."

The interpreter with me that day repeated my words in Spanish. I could hear a tiny bit of emotion in those words that came more from her own feelings than what I said.

"Nunca." I said that part in Spanish for emphasis. And for some reason, that made your wife start crying. I walked over and gave her a big hug. Wrapped my arms around her, still in her housekeeper uniform, and pressed my hands into her back as she wept and wept.

That part required no interpreter for her to understand. Or you either.

So, yes. I knew that your wife was strong. As were you.

"Yeah. Your perspective does change when you have children. I agree."

"So really, that's all I think about. Wondering, like, what is best? Like should I keep taking the treatments? Because, you know, I looked up the word 'palliative' on the computer and I know it means that it's something that can't be cured. So, then I ask myself what's best?" You paused to allow the interpreter to tell me what you said before going on. And I was glad you did--not because I didn't understand what you said, but more because I needed to wrap my mind around it all. "Like, do I go back to my country with my family? Now? And even when I think of this, I feel bad because of my son and his education. Education there is just. . . it's just different."

I nodded because that made sense to me. And that's about all that I did because I knew that these questions were yours to answer, not mine. But I did feel glad that you trusted that moment enough to feel safe sharing them with me.

"What are you thinking that you'll do?"

"I just don't know. I don't. My son is everything in this. I want the whole world for him and I feel afraid that if we take him there he won't come back.  Like, for money reasons, he won't because it will cost too much to make it back here. I worry about that. And that he just won't have the same kind of life that he could have if he gets an education here."


"So this is what I mostly do all day between the procedures and treatments. I think of these things and pray about them. And I ask God what to do."

"You do? So. . . . what has been revealed to you? From God, I mean."

"I'm still listening," you said.

I nodded. "Good."  I narrowed my eyes and repeated that word again. "Good."

And the interpreter behind me said it just the same way. "Bien. Bien."

We finished up the obligatory parts like examining your body and discussing the treatment plan. Then I stood up to leave.

"What questions do you have for me before I go?"

"I'm okay," you responded.

"You sure?"

"I promise. I'm sure."

I nodded hard and then reached out to shake your hand. "Okay. I'll see you later, my friend."

"Okay. And thank you so much for always taking time with me. And my family."

I pressed my palm into my chest and smiled to keep myself from crying. "You know?" I finally said, "I guess I just want you to know that I'm still listening, too."

I glanced over at the Spanish interpreter when I said that part because some part of saying that made me feel like it should include her, too. 



Happy Sunday. Or rather Feliz Domingo. Or Domingo Feliz? Hmmm.

But especially thank you. To Carmen. To Ana. To David. And to our entire interpreter services at Grady Hospital most of whom I know but some of whom have names that escape me at the moment. And also to every single interpreter out there for helping people like me to see more of my non-English-speaking patients for the beautiful human beings that they are.

That just reminded me of something. It isn't always heavy, you know? Like it doesn't have to be heavy or life-threatening to warrant an interpreter. Sometimes it's something as simple and as silly as los dedos azules. Remember that?

Ha ha.

 Now playing on my mental iPod. . . this classic by the great Eric Clapton. . . .for every person who helps to create a little piece of heaven for our patients at Grady Hospital.


  1. The interpreters do such a great job at Grady! Language can be such a barrier in providing treatment and they do a great job of tearing it down. I love working with them!

    1. Me, toooooo! Thank you, Steve, for this comment. I hope one of our interpreters reads this. :)

  2. This is one of my favorites of yours ever, dear Grady Doctor. Communication is powerful and necessary and yet, so often glossed over at the least hint of inconvenience.
    Thank you for being the sort of doctor who listens despite barriers. Of all sorts.
    Your fan...Ms. Moon

    1. Awwww man. I appreciate these kind words, Sister Moon. You would have liked this patient. A man with very kind eyes and a heart for his family. Kind of like Mr. Moon.

      Your fan. . . .Kimberly

  3. You are one awesome human being...not to mention an amazing doctor!

    1. That's super kind of you to say. Thank you, my friend.

  4. Replies
    1. I loved that he said that. I hope you are well, Avery's mama. I think of you often.

  5. May all of us strive to listen better, listen more and listen even when it is hard and time-consuming.

  6. I started reading your blog about a year ago and continue to do so at least once a week. Thank you so much Dr. Manning for not only being an exceptional doctor but for always "KEEPING IT HUMAN." I will make sure to post this blog entry in our office along with your other blog entry "Dedos Azules." I admire and respect you not only for the love you show your patients but Grady too.
    Ana Gamboa
    Spanish Medical Interpreter@GRADY)


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