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?