Barriers to caring.

"She doesn't speak English," my resident said.
"Okay," I replied. "Let's call the interpreter and then go see another patient until they are ready for us."
"We can use the phone line or the video chat interpreters."

That's what the med student said. And honestly, it was a very good suggestion considering how busy we were that morning.

But.

See, I had never met this patient. And though I am deeply appreciative of the technology that affords us easy, prompt ways to close language barriers, whenever I can help it, I like everybody talking on that first meeting to have a pulse that I can feel.

Our Grady interpreters are so amazing. They have this way of melting away during a discussion and allowing you and your patient to really, truly connect. And again--sometimes I have no choice but to use the phone or video interpreter. On this day, though? I had a choice, man. I did.

Yep.

And so. With the help of Maria, one of our exceptional Spanish interpreters, I listened to the story of this patient. And not just the story of her present illness. The story of her life outside of the hospital. Of her six children who make her very, very proud. Of the tiny details of her symptoms that only come out when feeling unhurried. I also loved that her fluent-in-English son and daughter didn't have to interpret but instead got to sit there and just do what every single other family with a matriarch in the hospital l gets to do: Love their mama, ask their questions, and worry as only they can.

Yup.

The next day she felt better. And, again, I called that human-being interpreter even though the technology and bilingual family member options were readily available. And since she didn't feel sick anymore, this time I learned even more about my patient.

Here's what I learned:

We both have a spoiled labradoodle.
We both have danced all night at a wedding in Mexico City.
We both wish we'd worked harder in school to learn the native tongue of the other.
Neither of us like cheese. (Yuck.)

She's never been to my hometown so I told her all about southern California. I've never been to or even heard of hers so I listened to her paint a vibrant picture of her hometown in Mexico--a place with breathtaking waterfalls and rivers so blue they make you want to cry. "Agua turquesa!" she said with closed eyes for emphasis. Her kids nodded in agreement. Then her English-speaking son insisted that me and his mom Google image it right then and there. Which we did. And she was right--words didn't do those turquoise waters justice. No, they did not.

And I want you to know that that human-being interpreter shared everything we said word-for-word. And none of it took long but all of it made my patient feel better. Which made me feel better, too.

Here's what I know for sure:

Barriers to care can create barriers to caring. Every single time I call and wait for an interpreter to come, it honors my patient. Now more than ever, I want to do that. And though I (always) feel slightly annoyed with myself for being a Los Angelino who doesn't hablás español and though I'm (always) impatient with the time (no matter how short) I have to wait for the human-being interpreter to come, not one single time have I ever regretted it after the fact.

Nunca.


I'm really thankful for our interpreters at Grady.
***
#mejortrabajodelahistoria #elamoresloque #bestjobever #loveisthewhat #amazinggrady #iwanttogotosanluispotosinow #herhometownisdope #nowaterfallsininglewood

On second thought.

I saw a man the other day who mostly spoke Spanish, but who also spoke relatively okay English. So I came to see him and, because of his limited vocabulary in English, had a very "business only" encounter with him. Because of his pride, he didn't want me to go off to get an interpreter. And so. I saw him and evaluated him. And that was that.

Another patient on the same floor spoke pretty much only Spanish. So I called the interpreter line and sat quietly at a computer charting while waiting for the interpreter to come to my rescue. After about ten minutes, up comes my blue-smocked comrade Ana, poised and prepared to bridge the gap between his Espanol solamente and my English only.

Ana was great and things went well so all was fine. We prepared to leave and Ana kindly bid me adieu. But just then, someone spoke words to her in Spanish from across the room. She walked a bit closer and we learned that my first patient, upon seeing me with an interpreter, had a change of heart about not communicating through his native tongue. Ana was super gracious and obliged.

And so. I will keep this simple. Here are ten things I learned about my patient today after I'd already evaluated him but then returning to him with an interpreter. Some of the details are changed, of course, to protect anonymity.

1. He has been married for 38 years.
2. The part of Mexico that he is from is right in the center of the country which helps him to not mind about how landlocked Atlanta is.
3. The key to staying married for 38 years is to talk things out and share your feelings. Even if you get into a big argument, listen to each other and don't just walk away. And always stick together.
4. Sons can be trouble. Girls are easier.
5. He has 9 children, 5 of them sons. But fortunately only one is really big trouble. The girls are all angels.
6. He has 29 grandchildren and more on the way. As in literally more on the way.
7. Atlanta has been his home for the last 25 years but since his whole community is Spanish speaking, he hasn't fully mastered English. But he has come a really long way.
8. Even though his daughters are easier, the child that takes care of him the most and is the most helpful is one of his sons. (Who has 3 kids of his own and one on the way.)
9. Dialysis is frustrating.
10. Family gatherings at his house never have any less than 100 people.

And for the record? Not a single thing changed about my assessment and plan. But I know for certain that coming back to him and truly humanizing him was therapeutic for us both. 

Yeah.

***

Happy Thursday.

What I sent my ward team after that encounter. I wanted them to understand why it's important to get an interpreter for the human connection.

"Read this to understand my feelings about the power of getting interpreters. It explains better than I could today on rounds. 

http://www.gradydoctor.com/2013/03/los-dedos-azules.html

Dr. M."

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."

"Hmmm."

"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. 

Bien.

Bien.

***
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.

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.

Sigh.

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.

Yeah.

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.

Loose Interpretations.

*patient names, details, and identifiers changed. . .but the message is the same.

image credit

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. . . . . .

 photo credit

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."

Dang.

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.

"Please."

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?

"Ma'am?"

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.