Patients love my broken Spanish

February 15, 2008

This determined ER physician taught himself a second language so he could communicate with all his patients.

Without a doubt, the worst educational advice I ever received came from my high school guidance counselor 40 years ago.

"You're college material, Harold," Mrs. Huckstep told me. "You need to take a foreign language."

Our rural high school offered two. "Which one?" I asked.

I can't blame Mrs. Huckstep for not foreseeing today's demographic tidal wave. But as an ED physician at a hospital in Virginia's Shenandoah Valley, I'm constantly reminded that heeding her advice was not a savvy move. Nobody speaks French here; Spanish is the primary language of 22 percent of our patients.

Little by little, I'm speaking it with them.

It began as a New Year's resolution, born of the frustration of being unable to converse with one-fifth of my patients. Either Spanish-speaking staffers or a telephone translation service bailed me out, but neither option felt right. That January, I purchased a Spanish medical textbook and launched into a self-study program-with no syllabi, deadlines, or exams, and no one to show me the next step or insist that I take it.

Every day, I jotted vocabulary words on index cards and studied them before each shift. Commuting to work, I recited road signs and license plate numbers in Spanish. I even rolled my Rs.

By March, I was struck by the impossibility of the whole thing. I should quit now, I told Ysabel, a Spanish-speaking aide who'd beamed when I told her about my studies.

"Nunca," Ysabel said, her jaw jutting out. "Speak Spanish more, to every patient, si?"

So I took her advice. I paused outside of exam rooms, scanned my cue cards, and chose canned lines I hoped would work. Usually they did; sometimes they didn't.

"Aspire profundo," I said, listening to the lungs of a young man.

"No, no!" Ysabel whispered. "Respire, not aspire. You just told him to vacuum deeply," she giggled.

I blushed. The patient took it in stride.

In August, Ysabel made an announcement. She would no longer interpret.

Fortunately, I've had only a few problems, which given my limited Spanish is surprising. While I have a respectable vocabulary, I'm fluent only in the present tense. I carefully structure my sentences to elicit Yes or No answers. Open-ended questions invite fusillades that blow me away.

Mostly, I do okay

When a situation calls for more empathy than I'm able to express-a teenager is miscarrying, say, or a grandfather is dying-I recruit Ysabel. But most of the time, my encounters work out well.

Such as this one with Mr. Lopez, who cut his thumb on the deboner at the turkey processing plant.

"No speak English," he says when I walk in.

"No problema," I say. "Hablo poquito Español."

His shoulders relax, and he grins, pleased at the prospect of being understood. I numb his laceration, and we talk. He tolerates my Spanish, and tries out some English.