This is my October column in Emergency Medicine News.  It isn’t posted yet at their website, but is in print.



Medicine would be so much easier if we could understand everyone’s language.  Our hospital cares for many Hispanics.  Typically, they bring a friend, neighbor or brilliant 12-year-old child (who is now bilingual) to translate.  Sometimes, we have the blessing of an employee who is fluent in Spanish.  Failing that, it’s off to the ATT language line where, for a fee, we have access to almost any modern language on the planet.  It comes in handy in other situations, as well.  For example, we occasionally have Clemson University students who, while exceptional chemists, speak assorted exotic languages.  ATT to the rescue again!

In other cities, in other lands, the problems are the same.  I once did a disaster exercise in Omaha, where one of the major language groups among immigrants was Sudanese.  I mean, I can stumble my way through Spanish without calling someone an egg-crate or prostitute, and I even boast a smidgen of French, but Sudanese?  My hat is off to those fearless ER docs.

Of course, not all languages are even, well, languages.  I remember the night I called the language line to help with a Hispanic gentleman who had been in an altercation.  The problem was two-fold:  he was intoxicated on Tequila (that great leveler of all men and women); and he spoke an obscure native dialect mixed in with his drunken Spanish.  The translator was frustrated.  ‘Doctor, he’s drunk.’  ‘Really?  I hadn’t noticed.’  ‘Doctor, I don’t understand his dialect very well.’  ‘That makes two of us.  Thanks for trying.’

He sang a lot, I know that.  Maybe I should have asked for a translator like this:  ‘Hello, I need someone who can translate enthusiastic Mexican-Indian dialects interspersed with grammatically incorrect Spanish, set to music but slightly off-key.  Please.’  He ended up being fine.  We closed a scalp wound, did a CT of his head, let him sober up and he was off.  So much for the need to understand someone else’s language!

But even as I joke about language, I realized recently that there are languages spoken in our hospitals that are much harder to translate than we realize.  In fact, we miss many nuances of our patients’ lives because we just don’t understand the tongues that they are speaking.

See, we care for patients whose language is self-loathing, depression, crushing anxiety, alcoholism, drug-addiction, loneliness, dementia, abuse, and untold dozens of other dialects of the human heart.

This is why we sometimes are frustrated with them.  They come back over and over for anxiety or suicidality; they’re brought by family members because they dwell in the maddening isolation of aphasic strokes, Cerebral Palsy or Alzheimer’s.  They can’t tell us with any clarity what they need, and we can’t tell them with any certainty what we want to do for them or why it’s important.

And it isn’t so much that we’re uncaring; it’s that after a while, humans become separated by wide gulfs of experience.  We usually don’t know what they feel; they have drifted so far into misery, sadness or confusion that they no longer understand what it is to feel normal, accepted and hopeful.  The language of the heart can fail in both directions.

We can’t ask for a translator.  We can’t call up the dementia hotline and have another demented individual speak to our patient and calm them.  There are abused women and assaulted men, rape victims and drug addicts who will ultimately speak the same language as our patients if they seek them out.  But in the dark of the night or the press of the day, we’re usually stuck, stumbling through our patients’ stories, trying to offer some halting comfort or hope that too often sounds like gibberish to the suffering; or worse, sounds like we come from another planet altogether.

Maybe it’s why they drive us crazy; as they try to convey their pain and we fail to grasp it, as we try to offer healing and they can’t hear normality anymore, we all become angry and annoyed.

We can learn a bit of it their language by experience, since we all ultimately suffer.  Furthermore, all the years we spend among the suffering sharpen our ability to grasp what they’re trying to say to us.  Just as one may learn a language best by living where it is spoken, or loving someone who speaks it, when we work in hospitals, and especially emergency departments, we are immersed in all the languages human expression.

Fortunately, there is a parallel language we can speak as early as we desire.  It’s cliché to say that love is the universal language.  But I’ve seen compassion work wonders.  Kindness and smiles, touches and looks of concern, calming words and simple interventions like food or drink, a pillow or blanket, a little bit of (as we Southerners say) ‘petting.’  These are words and acts that cross all languages, which are always understood, that have never in all human history required linguistic translation.

If you aren’t a Protestant Christian, you may not know how we debate one of the spiritual gifts called ‘speaking in tongues,’ mentioned in the Bible.  Some people think it means speaking or understanding unknown, spiritual languages.  Some think it refers to a gift for an earthly language without ever having studied one.

But as I write this piece, I realize that there may be another meaning.  Maybe, those tongues are the tongues of the heart.  Maybe it means the gift of seeing into the heart of another who is otherwise powerless to convey their suffering or need, or the cause of it, or the thing they hope most to cure it.  If so, that would be a gift indeed.

Still, I have to say I’d also love for God to let me speak and understanding musical, ‘Mexican-Indian-Spanish-Tequila.’  It was a happy language that could only enhance our mundane medical lives.

I hope that we all learn to speak and understand the languages we need.  Because frankly, all our science and studies are worthless if we can’t grasp what our patients (or even our colleagues) are saying; with or without words.

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