[lg policy] The Danger of Knowing ‘Just Enough’ Spanish

[Fierman, William]

The Danger of Knowing ‘Just Enough’ Spanish
By Daniela J. Lamas, M.D. November 12, 2015 10:00 am November 12, 2015 10:00 am
New York Times

I speak just enough Spanish to be dangerous.

It is intern year, and one day at 2 a.m., and I am summoned by a terse page about a patient I have never met. “Patient reporting abdominal pain. Please come assess.”

I rub sleep from my eyes and fumble for my white coat and stethoscope. The patient is not one of my own; I am covering him overnight for a fellow intern. As I leave the call room, I flip through the sign-out, the sheet of paper that promises to tell me all I will need to know overnight. There is nothing on it about belly pain.

The patient’s room is dark and still, and I speak quietly, still half-asleep myself.

“Hi, I’m the doctor on overnight,” I say as I turn on the light. “How are you? Are you having pain?”

The patient frowns. “No English,” he tells me. “Español?”

My father was born in Cuba. I vacation in Miami and lived for two months in Spain before medical school, but I am not fluent. I can manage conversational Spanish on a good day, but I have seen disappointment flash across the faces of my clinic patients when “Doctora Lamas” reveals her clumsy American accent. I am surely not an expert in rapid, whispered dialects at 2 a.m. I know this. But I am exhausted and the patient does not look ill, and so I gamble that my Spanish is enough.

Not sure what words to use to warn him, I flip on the light and he blinks, startled, in the brightness. “Dolor?” I ask, employing the Spanish word for pain while mashing into his stomach with my hands. My eyes are trained on his face, attuned to the flicker that might alert me to an insidious process within his abdomen. “Lo siento,” I apologize under my breath, more for my Spanish than for my exam.

“It’s O.K., doctor,” he reassures me.

What luck! He speaks some English after all, I tell myself. Of course, I could call an interpreter. It would not be hard. There is a two-way phone I could fetch from the nurse’s station, and I could call the number for a Spanish translator, and we could have a conversation in his native language. But my pager is already going off, telling me about a patient with shortness of breath some three floors away. Besides, my patient’s abdomen, soft and not appreciably tender, feels normal. I push in again, lift my hand up quickly and he hardly flinches.

So there in the middle of the night, in this tertiary care center in New York City, we persevere – a patient with sparse English, a doctor with almost-good-enough Spanish. At times, I am not quite certain what is being said, but I can tell that he is medically stable, and assure myself this is all I need to know.

“Estas bien,” I tell him.

He seems to understand that the exam is over, and that I am trying to tell him that he’s O.K. Out of words, I give him a “thumbs up” and leave the room.

Of course, had he spoken Cambodian, or Japanese, or Creole, I never would have thought to pretend. You cannot fake a language you have never learned. But, for better or worse, Spanish is different. Many of us know just enough. And so it is tempting, alone in a dark room in the depth of exhaustion, to make do.

But good medical care relies on understanding, and understanding is all about language. Words compel our patients to fill a prescription, to stop smoking, to keep a follow-up appointment. Illness itself has its own local culture, idioms and colloquialisms. At its core, medicine strives to bridge sickness and health. And I wonder how – if I could not truly communicate with my patients in their own language – how I could ever hope to connect in the foreign territory of disease.

In a story of doctor-patient misunderstanding that I heard in my training, a patient comes to an outpatient appointment to address her diabetes. A doctor tells her she needs insulin and teaches her how to inject the medication, using an orange to simulate skin. “Do you understand?” the doctor asks. The patient nods. She comes back for follow-up a month later, and her sugar is still under terrible control. The doctor asks, “What have you been doing? Show me how you’ve been injecting the insulin.” The patient reaches into her bag and brings out the orange, bruised and scarred now from a month of careful daily injections.

I finally manage a few hours of sleep. In the morning, I stop by the patient’s room to make sure he is still doing all right.

“Hola,” I say.

He nods. I press on his stomach again, wordlessly. There is no pain. He will be discharged in the next day or two, to finish a course of oral antibiotics for pneumonia. I had not missed an acute appendicitis, abdominal perforation or other surgical emergency. But there might have been some other nuance, some anxiety or fear that called me to his room at 2 a.m. and that is something that, without the benefit of shared language, I did not appreciate.

I do not know what I might have missed that night. And what scares me now, looking back at this and countless other similar stories, is that I will most likely never know.

Daniela Lamas is a pulmonary and critical care fellow at Brigham & Women’s Hospital in Boston.
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