Medicine In Translation

February 12, 2010
GeriPal
All Posts, Cancer, Communication, Culture, Language, Medications, Relationships

“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.

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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)