Medicine in Translation: Journeys With My Patients

Nursing Book Club

Medicine in Translation: Journeys With My Patients

Bridging the language barrier for the sake of adequate care

By By Danielle Ofri (Beacon Press, 2010)
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Reviewed By Elizabeth Hanink, RN, PHN, BSN

For a long time, New York’s Bellevue Hospital was for me the epicenter of the medical and nursing universe. The distinctive Bellevue cap, a delicate soufflé pouf contrasted with the tough person wearing it; the nurses who survived the grueling course were excellent. Patients, too, needed their own toughness. Coping with the rigors of the hospital’s system was a triumph in itself, never mind the demands of their particular illness.

Now, after decades in Los Angeles, I know that New York does not have a monopoly on great nurses or interesting patients. That’s why I think this book will intriguepeople in all kinds of places.

Medicine in Translation comes from a physician Danielle Ofri, who works at Bellevue. Although Ofri is not a nurse, she contends with the same array of problems. To begin with, many times she can’t understand what patients are saying. Often they are multilingual (just not in English); and yet here she is, struggling with simple Spanish. Translators, just a phone call away, help, but nuances get trampled — along with any privacy. Questions pop up everywhere. For example, what about head coverings and Ramadan — are they mandatory or optional, like her own practice of Judaism?

Having the confidence of those in her care is a privilege, yet Ofri needs to maintain limits. No, she doesn’t want to leave loose ends at clinic closing time; but she needs to pick up her children, doesn’t she? But if you maintain too high a guardrail, everybody loses. And periodic clinic appointments can offer just so much. Unfortunately, some patients need much more.

The glimpses she has into her patients’ lives invoke in her pity, anger and even bewilderment. They come to this country seeking refuge, yet someone like Julia Barquero can’t get optimal care because she is in the country illegally. Emergency and clinic care, yes; but there will be no transplant list in her future.

It is agonizing for Ofri to realize that Julia has never received a clear explanation of why — but even she doesn’t want to tell her. At the same time, Ofri’s own ambivalence about resource rationing troubles her.

The stream of people in need is endless. Samuel Nwanko, his face disfigured by acid, misunderstands what the clinic provides. As part of a special program at Bellevue, Nwanko wants help with school and employment. Initially, his persistence bewilders Ofri, even while she redirects his search. What stays with her is admiration for such tenacity.

Another patient, Chan, is an enigma. A minor crisis causes him to return to China because, as a doctor, he knows the care will be better. He has to leave his wife in New York, and her wails, her refusal to go with him — influenced by the cloud of Alzheimer’s — do not dissuade him. How can he do it? Is it grit or selfishness? Self-preservation, perhaps? You will have to decide.

In the midst of this, Ofri and her family decamp to Central America for a year of language immersion. There, during the birth of her third child, she experiences medical care that is personal and informal, and she desires to bring it back to New York. Nevertheless, Costa Rica is a different place, and soon enough she is back to struggling with the unrelenting demands of sick people.

Ofri captures her patients’ personalities and quirks with the deft hand of a gifted writer. Like the life she leads, her chronicle is fast-paced. The stories will ring true with any nurses who struggle to understand and care for patients who in many ways remain elusively unknown.  

Elizabeth Hanink, RN, PHN, BSN, is a freelance writer with extensive hospital and community-based nursing experience.

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