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?
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