Can I give him mine?

They called me from the Pediatrics Eye Center. Ugh, I thought. I hate it when they prescribe glasses to small children.

Outside my assigned examination room, the doctor, nurse, and social worker were gathered- a little unusual for an ophthalmology appointment. As soon as I arrived, they broke: “She is here, lets do this.” We went inside the room. I saw mom walking back and forth with her 3 month-old baby in arms, dad was sitting on a bench against the wall. The doctor, social worker and myself stood across both of them.

The family was there for an evaluation of baby Joni’s vision. His pediatrician had some concerns that the baby’s eyes were not responding to light and this appointment was to check if that was true, and see what type of surgery would be necessary. A concerning, but overall positive and hopeful visit.

Immediately after walking in, I noticed that Mom looked worried. She spoke some English and was able to gather that something wasn’t right during the examination, when there was no interpreter. She suspected there was bad news, but remained quiet, hanging tight to her baby in prayer. Dad had no idea.

“You have a very healthy, strong boy.” The doctor began. “Unfortunately, the concerns about his vision were correct – he is unable to see. At this point in time, there is nothing we can do about his condition. Your baby is permanently blind.”

I took a deep breath before I started talking, to keep my voice from cracking. As I repeated the doctor’s words in Spanish, mom and dad’s eyes are fixed on me, begging for relief. Painfully, I looked straight back at them with the most compassionate expression I could put together after hearing such shocking news for the first time. As I finished interpreting, mom burst into tears and held even more tightly onto her baby. Dad turned red and looked down, holding back. Baby Joni was awake, his eyes wide-open, looking as happy as any child his age.

The doctor kept on talking, trying to convey some hope and explain that this was not the end, that the baby was otherwise healthy and would be able to develop normally; that he would “see” the world in different ways.

But the family was not listening. They were dazed, not knowing what to do, what to think, what to expect.

At some point, the doctor asked: “do you have any questions for me, about your baby’s eyes?”

Dad, a robust man who had been quiet the entire time, suffering in silence, burst:

“Can I give him mine?!”

Tears finally started rushing down, tears everyone in the room had been able to control until this point. There was a brief moment of silence as the doctor tried to find the least painful way to answer his question. I took another deep breath:

“No, you can’t…”

So you DIDN'T want your tubes tied?

Not too long ago, I was called to the Mother-Baby unit. Mrs. Gonzalez had given birth to a healthy boy and required post-c-section instructions before going home.

We began as usual, asking how the patient is feeling, and giving a summary of the patient’s current state. We talked about her incision and the steps to take to avoid infection or hurting herself. No bending over, no heavy lifting, lots of rest, blah blah blah. It was actually a pleasant interpretation – c-section was smooth, baby is healthy, tubes were tied, mom can go home. Until…

“What do you mean my tubes were tied?”

Oh oh – the nurse looks at me in shock as I repeat the patient’s words in English.

In very simple terms, the nurse explains this is a semi-permanent procedure to prevent future pregnancies. Conveniently, it is offered to women scheduled to have a c-section since doctors are going to “be in the area” already. The nurse emphasizes that consent is required for this to be performed and that the patient signed it before the surgery.

Mrs. Gonzalez, still in disbelief, says in Spanish: “so you are saying I cannot have any more children?” The nurse rushed out the room to get a doctor.

Minutes later, a doctor the patient had never seen before came in with the nurse. While fully aware of the situation, he looked fresh and calm… a little too casual for the occasion. A defense mechanism, I would say.

“So, how are you feeling? I understand you have some questions for me!” He says energetically.

“The nurse is telling me I cannot have any more babies because of a surgery. I don’t understand…” The patient said worriedly, hoping the nurse had confused her with a different patient.

The doctor’s tone became sober and his smile disappeared as he explained to Mrs. Gonzalez that she did get her tubes tied, that her insurance would not cover its retraction, and that even if it were to be reversed, there was no guarantee she could have a baby again. As I finished repeating his words in Spanish, the woman broke into tears. Having just delivered her second baby, she looked forward to having three more, as is accustomed in her culture.  “Por qué, por qué?” she sobbed. “Why, why?” I asked the doctor. The doctor apologized and slowly drifted out of the room.

Under what circumstances did Mrs. Gonzalez sign the consent form? Who explained the procedure to her? Did someone confirm she understood? Did the medical interpreter screw up? Did the surgeon? The anesthesiologist? The residents? The nurses?

At this point, it is not about who to blame, but about recognizing that there is a gap that goes beyond the language barrier. Being in a hospital and not understanding the language of your providers is a huge risk despite the availability of medical interpreters. Some providers would rather not wait for the interpreter to arrive, others choose to practice the little foreign language that they know, others prefer not to waste time waiting for the interpreter and “wing it” by speaking louder/slower English with a touch of improvised sign language.

Communication between Limited English Proficient patients and health care providers is a real challenge, with real consequences to people’s lives. This is just one of the several “misunderstandings” that take place on a daily basis. And just as they are in the hospital, the patients remain voiceless about these injustices when they go home. What rights do they have anyway?

Please, Just Give Me Some Water...

I was supervising the medical interpreters that day. It was early in the morning, and the first call came from the Emergency Department – they needed a Spanish Interpreter ASAP.

The interpreter and I ran to room 36, expecting to see it full of clinical staff given the urgency of the requester. Instead, we found a Hispanic man in his 30s, lying in bed, suffocating. He had difficulty breathing despite the oxygen going thru his nose, and moved from side to side, desperately changing positions, complaining about how exhausted and thirsty he felt. His lips were completely white from dehydration, his skin pale, and his look confused and powerless: why is no one trying to help me?

When we walked into the room, he was alone. By protocol, the interpreter should not be alone with the patient, so we were supposed to leave. But it was impossible, his eyes cried for help, or company at least. A few seconds later, a nurse walked in very calmly and injected something in his IV without saying a word.

“I am thirsty, I am so thirsty. Please give me some water” the patient panted.  The interpreter relayed the message to the nurse, who responded: “The doctor said you cannot have any water. You are very very sick, OK?” as if her condescending baby talk would make the patient understand English. The interpreter relayed the message to the patient, who continued his struggle to breathe.

The patient had dangerously high levels of blood glucose. His diabetes was out of control and he was actually pretty close to dying. We spent about three hours in that room, waiting for a space to open up in the ICU so that Mr. Jesus could get the care he needed. The entire time, he pleaded for water, but no one gave him a single drop…

Once in the ICU, he asked for water once again, and a kind doctor ordered a nurse to wet a sponge and rub it on his lips. If he drank water, he might vomit and make his already delicate state worse. His hydration needed to be directly through the IV.

When Mr. Jesus felt the sponge on his lips, his eyes widened and his lips almost smiled. His problem was solved! He impatiently bit the tiny sponge and squeezed it with his lips, trying to suck out the minimal amount of water in it. A profoundly sad scene, his joy for a few drops of water after hours of begging for it.

This experience made me realize the huge discrepancy between health care providers’ approach to illness, and the perception of the patient experiencing it. Providers usually concern themselves with the biological dictates of disease, a mechanic view of the broken human body that needs to be fixed. Patients, on the other hand, experience the consequences of such brokenness, which should be reduced with mechanical fixing, but may also require another level of attention and care.

In Mr. Jesus’s case, yes, he was in a very critical condition and needed his internal body to be fixed. Hence all the IV medication, the oxygen, blood tests, etc. But what Mr. Jesus was complaining about was not how much his blood glucose levels hurt – he could not feel that directly. His primary concern was thirst, a thirst that was making him delirious and could be appeased with a few drops of water in a sponge, with no significant risk to his health.

I am not saying that the medical team should have stopped everything taking place to give the man some water. But I do believe that health care providers need to be aware of what patients experience and not ignore those concerns. The three hours we spent in the Emergency Department would have been entirely different for Jesus if only someone in that department had listened to him, had some compassion, and given him a drop of water to reduce his suffering.

Biologically speaking, the feeling of thirst and exhaustion is connected with the high blood glucose level and blood pressure. If those “bigger concerns” are addressed, technically the lesser ones (like the thirst) should decrease eventually. But why not try to empathize with the patient and do what is possible to make his experience of illness a little less terrible?

Professionals in the medical field need compassion, not just knowledge. There is a big difference between fixing a patient and caring for one.

When I Thought Was a Huslter

I just got back from a fabulous work trip with my fabulous boss. We drove to a beach town in North Carolina, for about 5.5 hours each way for a 2-hour-long meeting. The meeting was quite successful and the ride rather enjoyable. Beyond lacking sensitivity on my bottom due to sitting in a car for so long, I couldn’t complain…

However, on the way back to my house (now alone in my car), I started feeling tired, and thinking about the work ahead of me despite it being Friday. I have another work assignment out of town that will take all weekend and for which I have to wake up tomorrow at 5am. I also have an avalanche of time-sensitive emails that I need to respond to, and a load of responsibilities that only gets heavier the more time I spend out of the office.  As any dramatic young lady would, I took pity on myself and started thinking about how all I do is work and study and work some more. Such is the life of a hustler.

On my way home at 9:30pm, I passed by the local Hispanic supermarket to pick up my cousin Ronny from work. He got in the car and immediately started to tell me about this new guy that started working with him today. “He is Dominican, just moved to North Carolina from Florida. He had a car accident there, got laid off his job, has two children to raise, and his mother recently passed away. Man, he is having a hard time! He did not even have money to buy water today. I heard the manager is only letting him work this week, but I hope he can stay. Some people have it so rough…”

My cousin’s story shook me up and down and all around. Here I am, complaining about a fun trip to the beach and having too much work at a job that I love. Exhausted from all the hustling, heading home in my new car, to spend time with my loving family, and go to bed in my air-conditioned room. Real rough.  

Next time I get even remotely close to feeling sorry for myself, I hope I can think of this guy. Not for the purpose of comparison, or realizing “how good I have it.” But for inspiration, as despite his pain, burden, and hardship, the man tirelessly strives for success. “He was so energetic! Kept finishing the jobs really quickly and asking me what to do next. When he was telling me his story, he said ‘I will do any job, I will clean human shit if I have to. I need to support my family. I hope they let me stay…”

On our way back home, we saw Jose walking to his place – fast pace, long strides. In a hurry to get home, and out the empty and crime-ridden streets. I hope they let him stay.