Skip to main content

Medicine In Translation



“But what will you be doing to cure my disease?” the interpreter said, relaying the words of our patient.

Was there an error in translation? Perhaps there weren’t clear equivalents of “cancer” and “metastatic” in Mandarin? Perhaps the patient somehow didn’t know her diagnosis after 5 years of illness?

The possibilities of confusion were endless. But it was a frigid December night, and Mrs. Liang (not her real name) sat with us in her hospital room, gripping the telephone that connected us together via a far-off Mandarin-English interpreter.

We didn’t know why Mrs. Liang had been admitted to the hospital. She had a remarkable performance status for some who’d just been through breast cancer and was now battling widely-metastatic colon cancer. She was 51, alone in this country, somehow managing to climb two flights of stairs in her walk-up apartment every day, despite the “too numerous to count” mets in her liver and the “too numerous to count” mets in her lung. The cancer was in her spine, and had progressed despite chemotherapy.

Yet here she was, asking us about “cure” via the dutiful, business-like interpreter who was probably sitting in an office thousands of miles away from our hospital.

Much later, I sat down to write about Mrs. Liang for my book “Medicine in Translation: Journeys with my Patients.” When I finally had the time and space to process, I tried to tease out the multiple layers of confusion. There were language barriers and cultural barriers with Mrs. Liang, issues of disease knowledge and social isolation. There was the awkwardness of handling sensitive subjects such as metastatic disease (and, ultimately, advance directives) with a disembodied interpreter via telephone. Was Ms. Liang in frank denial? Did she have cognitive impairments? Had no one ever told her the prognosis?

Medicine is its own world. Becoming ill is like emigrating from a land of the healthy to a land of the sick. People with illness face a new language, a new culture, new mores. Patients who have actually emigrated from other countries and then become ill are confronted with even more barriers and challenges. Physicians and other caregivers become the interpreters of the culture of medicine. In these roles, we often end up on unusual and moving journeys with out patients.

Here’s a short journey I took with another of my patients, one that involves a confusion of languages and translations. I invite you to share your thoughts.

___________________________________



Danielle Ofri is a writer and practicing internist at New York City’s Bellevue Hospital. She is the editor-in-chief of the Bellevue Literary Review. Her newest book is Medicine in Translation: Journeys with my Patients. View the YouTube book trailer.
Danielle will be visiting San Francisco and reading at City Lights Bookstore
on Tuesday Feb 23 at 7 pm
She is also giving Grand Rounds at the following institutions: (full details here)
  • SFGH Dept of Medicine, Tues Feb 23 at 12 pm
  • SFGH Dept of Pediatrics, Wed Feb 24 at 8 am
  • CPMC (Pacific Campus), Wed Feb 24 at 12 pm
  • Contra Costa Med Center, Thurs Feb 25 at 9 am
  • Moffit Hospital, Thurs Feb 25 at 12 pm

You can follow Danielle on Twitter and Facebook, or visit her homepage.

Her blog, Medicine in Translation, appears on Psychology Today’s website.


 

Comments

CyndiC, RN said…
Wonderful quote on what illness is...
Mrs Liang may have never been told her prognosis. If she had only gone to health practitioner's only within her culture, they may have not wanted to take away her "hope". It's very difficult to work within cultures that are not our own. It's hard enough communicating well within our own cultures!

Popular posts from this blog

Lost in Translation: Google’s Translation of Palliative Care to ‘Do-Nothing Care’

by: Cynthia X. Pan, MD, FACP, AGSF (@Cxpan5X)

My colleagues often ask me: “Why are Chinese patients so resistant to hospice and palliative care?” “Why are they so unrealistic?” “Don’t they understand that death is part of life?” “Is it true that with Chinese patients you cannot discuss advance directives?”

As a Chinese speaking geriatrician and palliative care physician practicing in Flushing, NY, I have cared for countless Chinese patients with serious illnesses or at end of life.  Invariably, when Chinese patients or families see me, they ask me if I speak Chinese. When I reply “I do” in Mandarin, the relief and instant trust I see on their faces make my day meaningful and worthwhile.

At my hospital, the patient population is about 30% Asian, with the majority of these being Chinese. Most of these patients require language interpretation.  It becomes an interesting challenge and opportunity, as we often need to discuss advance directives, goals of care, and end of life care options…

Delirium: A podcast with Sharon Inouye

In this week's GeriPal podcast we discuss delirium, with a focus on prevention. We are joined by internationally acclaimed delirium researcher Sharon Inouye, MD, MPH. Dr Inouye is Professor of Medicine at Harvard Medical School and Director of the Aging Brain Center in the Institute for Aging Research at Hebrew SeniorLife.

Dr. Inouye's research focuses on delirium and functional decline in hospitalized older patients, resulting in more than 200 peer-reviewed original articles to date. She has developed and validated a widely used tool to identify delirium called the Confusion Assessment Method (CAM), and she founded the Hospital Elder Life Program (HELP) to prevent delirium in hospitalized patients.

We are also joined by guest host Lindsey Haddock, MD, a geriatrics fellow at UCSF who asks a great question about how to implement a HELP program, or aspects of the program, in a hospital with limited resources.  


You can also find us on Youtube!


Listen to GeriPal Podcasts on:
iTunes…

Are Palliative Care Providers Better Prognosticators? A Podcast with Bob Gramling

Estimating prognosis is hard and clinicians get very little training on how to do it.  Maybe that is one of the reasons that clinicians are more likely to be optimistic and tend to overestimate patient survival by a factor of between 3 and 5.  The question is, aren't we better as palliative care clinicians than others in estimating prognosis?  This is part of our training and we do it daily.   We got to be better, right? 

Well, on todays podcast we have Bob Gramling from the Holly and Bob Miller Chair of Palliative Medicine at the University of Vermont to talk about his paper in Journal of Pain and Symptom Management (JPSM) titled “Palliative Care Clinician Overestimation of Survival in Advanced Cancer: Disparities and Association with End of Life Care”.

Big findings from this JPSM paper include that we, like all other clinicians, are an optimistic bunch and that it actually does impact outcomes.   In particular, the people whose survival was overestimated by a palliative care c…