I'm wasn't trained for this

I’m not a doctor. I’m not even a nurse. Sure, I work in the healthcare field, but public health is quite different from patient care, my job is to keep people out of the hospital. This last week I had the chance to go outside my comfort zone and go into the patient care setting. We had a visit from a doctor from Yale University, (her specialty is geriatrics) and I translated for her while she saw patients in the clinic. My first thought:  I'm not trained to translate for a doctor, what if I mess up?  My second thought: of course you're going to mess up, just man up and do it! So I did and it was fun.  The elderly are funny, intentionally or not. They just seem so much more genuine and gracious than younger adults, and they tend to be much less inhibited and have no concern whatsoever for time. Today I’m going to share some of my favorite clinical moments.

A 82 year-old woman comes in for a free consultation. I ask her the reason for coming to the hospital today. She said that her daughter forced her to come, but she doesn’t know why because she is in perfect health. Apparently, the lady is losing her balance and refuses to use a cane, she claims than an umbrella works just fine, thank you very much. We ask her if she has fallen in the last 6 months. Now that we mention it, yes, she has fallen. She was walking one day, and sees a pretty mango tree. Then she starts thinking how she’d like to make a nice pot of tea with the mango leaves, and starts to wonder if the owner of the tree is home so she can ask to take some leaves, and as she’s looking up admiring the graceful tree, boom, she falls. “But it wasn’t my fault, there were rocks. And it was raining. And I had stuff in my hands. And it was dark… I think.”  Turns out the woman has a balance problem and weak leg muscles. We prescribe physical therapy and make her promise to use a cane, not an umbrella, but a real cane that’s adjusted for her height. She didn’t like that idea very much.

A 60 year-old woman comes in for a free geriatric consultation. “And what brings you here today?” I ask.  “Oh, well I’m going to be elderly soon, so I just thought I’d come by and see how I’m doing”, she responds. “Well, you’re too young to be considered a geriatric patient, do you have any current health problems?” Yes, I have high blood pressure. And my back hurts. And my wrist hurts. And I get headaches sometimes. And I just feel… anxious.” As the consultation continues, we find that this woman is depressed. We even tell her this. “I know exactly why that is,” she says. “3 of my cats died.” We give our condolences and try to continue with the consultation. The doctor suggests she buys a new cat. “I can’t just replace them! I feel like I should have done more to save them, like it’s my fault they died.” The doctor, a bit agitated, makes me translate that cats have short life spans and that it’s normal they die. The woman then says to me, “ask the doctor if she think I’m crazy because I live alone and have 10 cats”  It suddenly becomes very hard for me to control my facial expression, I have to turn away. The doctor doesn’t do such a good of job. She lifts her eyebrows and murmurs something that I shouldn’t translate,  but ultimately gives a diplomatic answer. “Well, um, there are lots of people with several pets, the important thing is that you don’t put their needs before yours and that you remember to take care of your own health.” After this, the consultation drags on and on. The woman doesn’t want to leave. “I think I’m addicted to attention,” she says,  “I feel so much better just talking to you two and knowing that you’re listening to me.” Finally, the doctor and I can’t take it anymore, we have 6 more patients to see and we haven’t eaten lunch yet. I know that translators should only translate what is said, or the general idea, but I have to stray from that rule, I stand up and tell the patient thank you for coming to see us, to please get her prescription filled and to take care of herself. As she finally leaves, the doctor and I let out a sigh of relief and just start to chuckle.

Another patient comes in with his wife. He has come prepared. He has a stack of folders 8 inches high. These are his medical records and copies of every examination known to man. “I know your time is precious” he says as he hands us a typed list of all the medication he’s on, alphabetized by health condition. “Wow,” says the doctor. The man is there because all the medication (about a dozen) are making him feel “cloudy” and not himself.  Duh!, I think to myself.  The doctor says she’s going to try to wean him off some medication, when she suggests the Lorazepam, which he uses for his insomnia, he refuses. “No, not that one! I need to sleep!” The doctor laughs, “Well sir, you’ve been on this medication for 5 years now, I don’t think you’re benefiting from it anymore, but you are psychologically and physically addicted to it, so we’ll have to do this slowly…”

In staunch comparison to this man that has spent the equivalent of thousands of dollars on medical exams, another elderly patient comes in complaining of pain in her hands. She makes tortillas for a living and can’t do that with the pain. We try and convince her to take an X-Ray. She immediately asks how much that will cost. The cost is 130 lempiras, $6.50. She has to think it over with her husband first. After about 15 minutes, her husband gives her some money and she puts her hand inside her blouse and pulls out another small sum. She then hands me a wad of money and with trust in her eyes says, “Okay, I’ll take the X-Ray.”  Her livelihood depends on it.

Lastly, though not related to patient care, I had a strange encounter yesterday.  As I was running to my office yesterday morning, I noticed 2 maintenance men carrying a man on a gurney. Many things crossed my mind: Why is there someone on a gurney in the middle of the hall? Why are they putting him in a closet? Hmm, I’ve never seen the closet open before. Maybe he’s drunk and they’re sticking him there until he sobers up. Wait, shouldn’t they be taking him to the emergency room instead? Where are the doctors?

This made absolutely no sense to me, but I was in a rush and didn’t have time to worry about it. Later on last night, I had a conversation with Carla about this.

Carla: Did you hear someone died this morning. 

Tina: What? Someone died? Where?

Carla: Well, he came to the hospital and he was already dead so they just put him in the morgue.

Tina: Whoa, we have a morgue?

Carla: Umm, yeah. It’s right next to the side exit.

Tina: Gasp! What?! Yes! I saw him! Oh my gosh, I saw him. I WALKED RIGHT BY A DEAD GUY AND I DIDN’T EVEN KNOW IT?!! Holy smokes! I thought he was drunk or taking a nap or something, I was trying to figure out why they were putting him in that closet. THAT'S that morgue?? That explains why I’ve never seen that door open before…

Even though we live in a hospital, deaths are not terribly common in here, neither are births. To make a long story short, I was completely horrified. For being a relatively calm hospital, there is never a shortage of excitement, especially at night.  Like when I discovered one of the patients living in the hospital is a suicidal schizophrenic, or like last week when we saw a mouse running through the in-patient ward. The nurses freaked out, until one of them killed it. And I thought nurses were supposed to heal…

Healing is a matter of time, but it is sometimes also a matter of opportunity. – Hippocrates

t-bird, over and out.