Writing Resources from Fifteen Minutes of Fiction

Through a Child's Eyes

Through A Child's Eyes

I've often wondered how children see the world, recalling myself only foggy memories of being eye level with seas of pants like a forest of smooth, black trees, and that wonderful sensation that I was all alone in my play, happily lost, and that moment was everything. I got a glimpse of that simple world again thanks to a little fix or six-year-old child I interpreted for as he took his vision test.

The nurse began the usual routine, and once his medical history, weight, and height were logged away safely in his manila folder, she stood him on the line and pointed to the eye chart ahead. He didn't know his letters well enough to identify them, so she pointed to the shapes section, rows of what looked like circles, squares, and apples marching in ever-shrinking lines down the shiny plastic page. We explained what he should do, and then she began.

"What's this one?" she asked, pointing to the first, a large circle. He caught me by surprise when he answered, "Una pelota" - a ball. Not a circle, a ball. "And this one?" she pointed to the square, one row down. He paused shyly, thinking, then answered, "Una ventana" - a window. My smile got bigger. The apple was last, an even smaller shape and very hard to identify with it's quirky lines. But my little friend didn't hesitate even a moment. He knew exactly what that was. "Un corazón," he said, smiling up at the nurse - a heart.

I thought what it must be like to live in a world where cold, black lines weren't simple squares and circles, but balls, windows, and hearts. I couldn't help but wonder how he saw other things, and what vivid pictures must color his imagination. Life can be so simple. And I thought again how it isn't what we're given that really matters - it's how we see it.

Por mi vida

"Excuse me, excuse me!" He kept saying that, the only little bit of English he seemed to know. I stood up and leaned close to him, shutting out the multitude of beeping monitors, shuffling feet, and rumble of pitched discussions floating through the SRU, our trauma unit in the ground floor emergency room. He was looking around wildly, like a trapped animal, and had been since I'd arrived, his dark eyes taking in all the bustle and the many intimidating machines around him. He'd been in a car accident, and as he described it to me I could see how shaken he still was. Over and over he painted it for me: how the two cars hit, and how the car he was in was 'dancing' all over the road before he lost consciousness. His body trembled, reacting to his broken leg, and a few minutes later, he began describing it all over again, the panic written in the paleness of his face and those searching eyes. A nurse was using a piece of tape to gently remove the minuscule glass shards from his face, and as he worked, tears began squeezing themselves out and down the patient's cheeks.

Why are you crying?
Por mi vida. For my life.
Everything's gonna be OK.
Will I get better? Will this bone heal?
You're alive. You're safe. You'll get better, I promise.

Later I found out he'd been equally scared the hospital would find out he was illegal. We finally got his real name after he'd been patched up and was waiting for his ride home. He told it to me when we explained how much we really needed to know his true name for his record, not for the police, and his whole manner changed. It was over - he'd told us. Come what may, he had told us. I overheard him on the phone with his friend coming to get him - Ya les he dado mi nombre verdadero. I've given them my real name. I could hear the resignation in his voice, I couldn't imagine what he was going through - hurt, scared, alone in a country that didn't want illegals, didn't want him.

Why are you crying?
Por mi vida. For my life.

An almost faint

Long before I ever set foot in a hospital, I asked myself curiously just how strong a stomach I had. I wondered if I could take the spattering of blood, the smell of oozing infection, or the deformed sight of broken bones. I can tell you now comfortably that none of those bother me, but there is one thing I cannot stand - dental work.

My dislike for all things dental branches back to my childhood I suppose - I imagine there's some psychological term for that, but I simply classify it as a case of familiarity breeding contempt. After the baby teeth that refused to fall out and their forcible extraction, the adult teeth that then refused to come in and their forcible coaxing down into place, the 4 wisdom teeth out and what seemed like endless years of braces, shaping devices and retainers - dental and I simply do not get along.

I was abruptly reminded of just how much we dislike each other one very long afternoon on the third floor of our surgery building, tucked away on the corner of campus and bearing a cornerstone from the 1920s. My patient was in for a pre-operation check - we were escorted to a typical dental room, and I had no idea why my patient was even there until the doctor came in to check him over. It's amazing how very little interpreters know and how much we figure out by just being present at the appointments. Questions that make absolutely no sense to me usually make perfect sense to my patients and doctors, and I suppose that's why it's so important for us to stick to exactly what is said and play that machine-like roll of simply interpreting. But I digress.

Apparently my patient, who we will call José for anonymity's sake, was a security guard of sorts at a factory, and had gotten himself into a fight which left his upper teeth hanging on by threads. The ER had patched up what they could, attaching a metal bracket to keep the teeth in place until he could get an appointment to have surgery. The doctor was adamant - those brackets had to come off, now, and they'd put something temporary back on to keep the teeth in place.

I was standing across the room, doing my normal interpreting, when it started. Click, click, twist. Wire clippers clashing on wire brackets; snips, slips, and little tugging sounds. I could feel him pulling on the teeth, fighting with the stubborn metal. My stomach started protesting, and I could feel it rising against my lungs, pushing on my chest and making it hard to breathe. I turned slightly and saw a picture in pastels close by. I'm sure it was a lovely picture, but to this day, I couldn't tell you if those were flowers or triangles scattered across the canvass. Focus on the picture...flowers, they look like flowers. I like flowers. I could hear my brain trying to convince my stomach that this wasn't a big deal. Click, snip, twist. My, those are gorgeous pastels. José doesn't seem to mind, I thought ruefully, why should I? It was one painful thought at a time, forcing my ears to forget what they were hearing. Memories of every wheezing, whining drill I'd ever dreaded, every screaming whir of electric toothbrushes, every nails-on-glass scraping of instruments on my metal mouth, came pouring in like floodwater over a broken levee. Breathe. Concentrate on the picture. Good.

"You can sit down if you need to." I snapped out of my forced reverie to find the doctor looking at me curiously. I must have been very white, because he continued, "I don't want you to faint." I've promised myself I shall NEVER faint from mental weakness, so I smiled and told him I was fine. Back to one painful thought pushing the next forced thought through my brain.

I had a good laugh at myself afterwards. I imagine there are very few people who almost faint watching a dentist, and even fewer who are stubborn enough to refuse a chair and admit they're queasy. I did learn the real strength of mind over matter, and I suppose as long as I got the lesson well ingrained, it doesn't matter how silly I was getting there.

Little guy in a big world

"Manuel," she answered when I asked what her little two-and-a-half-foot ball of energy's name was. I looked down at a three year old inquisitively wandering all over the cold, painfully white exam room. I studied his face as he cocked his head to look up at me and mutter something in perfect Spanglish - he reminded me of a little squirrel monkey. A long, oval face, with high, flat cheekbones and a short, snub nose; black, black, black eyes like lopsided teardrops; smooth, lightly copper skin, and thick, erect hair bristling around his head. He was a looker, no mistake, in more ways than one. I glanced at the thin, withdrawn woman beside me (his aunt, apparently) and suddenly sensed how overwhelmed she must be by his constant energy and curiosity. It was clear nobody curbed him at home, but then I'm not sure you can curb the kind of intense motion this little boy had. It was touch, touch, touch, one thing after another, expressions and mimicked expressions flashing across his pointy-chinned face in quick succession. And then that constant needed to share what he discovered - showing, pointing, babbling away to both of us in a hybrid language neither could understand. He wasn't the first child I'd seen that was linguistically confused - a number of the Hispanic children in our clinics grew up mixing Spanish and English to such an extent that they switch as often as every couple words, making understanding challenging at best.

Suddenly, Manuel froze. The nurse was taking aunty's blood pressure. He watched, eyes fixed on the cuff, face unreadable, then skittered over to her arm as as the cuff came off, to touch it and see what had happened, what might be different. Then froze again. Nurse was taking aunty's pulse. I tried to show him on my own wrist what she was doing, pressing his fingers first to my pulse, then his. "Pulse," I said, "pulso," trying to get my meaning, or least a general idea, across that confused language connection of a young child in a bilingual world. He touched my pulse, touched his, parroted both words, and was off. There were so many other things to see.

A Newbie Moment

(Written 6-8 months ago)

Oh the adventure of being new to something! I have so many 'ah-ha!' moments as I figure out this whole interpreting career - even now, almost a year after interpreting for the first time, I'm learning new things every day, understanding things a little better with every appointment.

My latest self-chuckle was a pretty typical, human reaction I think...I'd just stepped off the labor and delivery ward, leaving my patient heavily contracting but not anywhere near having her baby yet. Heading back to the office for a quick break, I found myself in step behind one of the many nurses always out and about in a hospital of any size. Her pale, rosy pink scrub caught my eye, and I noticed she was carrying one of those Styrofoam containers from our cafeteria. My instant reaction was, Oh my gosh - how can she eat at a time like this when we're about to have a baby?! And then I almost laughed aloud as I realized A) I didn't even know if she was an OB nurse, B) of course she wouldn't know anything about my patient, and C) even if she did, that was her career, delivering babies! And even as exciting as that was, she still definitely needed her lunch.

A time like this...times like this happen every day. According to statistics, there are 4.2 babies born every second, 250 babies born every minute and 15,008 babies born every hour. And I expected the whole world to hold its breath while my patient experienced the miracle of birth. I realized how narrow our personal view of the world is, but I also realized something wonderful. Every person in that patient's room with me was dedicated to this patient, this baby, this moment. We all focused all our energies on bringing this child into the world, and so truly, for us, she WAS the only person for the moment. Nothing else mattered.

She delivered without me because by then my world had shifted - I had another patient in another part of the hospital to be engrossed in, and she had another interpreter. But I smiled, knowing the detailed attention she was getting, and when I think that this kind of engrossment happens every day, that millions of doctors, nurses, receptionists, staff and interpreters like myself spend their days in MOMENTS dedicated to others, I still smile.

Me, Myself, and I

The happy-go-lucky Nokia tone started ringing in my pocket, and I began to wish that the evening December 12, 2010, had never existed. I hadn’t had a night this busy in a long time, and although clichés are worn out excuses for tired minds, I’m the first to admit that it never rains but it pours. I didn’t want to be here. I really, really didn’t want to be here in the middle of all this. It was an interpreting nightmare, with all my least favorite appointments playing out in the space of three hours. It started in the pregnancy diabetes clinic, running late as usual, with a drawn-out diet teaching to a very tired, very pregnant, and very diabetic mom. She didn’t want to be here either, and I can’t blame her since we were the only ones left in the place. I was starting to think she was only catching every fifth word I interpreted when the educator caught on and let her go home. Then the Emergency Department exploded in all ways but actual physical combustion, and I found myself next to another very pregnant and very sad mother whose husband’s cheating had thrust her into tears and depression. I really hate those; it’s hard enough to watch my patients’ physical struggles. It’s almost more than I can bear sometimes to watch their emotional, real-world, kicked-around-and-let-down moments. We were just about to take Social Work in when the Nokia started singing again and “This is Labor and Delivery and they’re requesting you in Operating Room 2, and STAT.” That was the quickest G to 3 I’ve done since I started at this hospital, and I walked into a weakly crying baby, a drugged up and passed out mom, and a dad waiting in tears in a dimly lit labor room, not knowing what was really going on or why his wife was suddenly whisked away with 20 masked people. My one happy moment was walking in with the nurse’s message that mom is alright. 29 week old baby girl is doing very well, and everything’s going to be OK. It was their first baby. Mom came out the anesthesia crying – I wondered as I watched her wake up if the teardrops hugging her eyelid were the tears she’d gone to sleep with, trapped under the plastic eye covers from her surgery. I stood there with Dad as we watched her wake, fielding his questions, expressing his concerns, living the spoken life of a father who, as far as he knew, almost lost his two girls. He was too close to being right – baby girl’s heart rate had dropped dangerously low for too long, and another few minutes would have brought the chaplain and grievance counselor instead of the pediatrician and the nurse.

Interpreting is a strange profession bordering on schizophrenia. I was a swollen, frustrated mother who couldn’t get my diabetes or my growing belly under control; I was a shattered, discarded wife picking up the pieces of what used to be along with my teardrops; I was a scared, 20 year old girl who went to sleep with a tummy and woke up without my baby and wondering if she even survived. And then I stepped into my office, and I was ME. I looked back and saw what I had done, saw the little piece of Awful I’d chopped off the traumatic by making my patients heard, the doctors understood, and some of the barriers eased. I breathed a prayer for that, and suddenly, I was very glad to be here, in December 12, 2010.

Angel of God, my guardian dear...

It would seem I have angels on the brain. But not those angels-in-people's-clothing this time...I mean angels. Halos, wings and all.

I stood behind our sea-green polyester curtain in the women's clinic, interpreting for a painful procedure happening on the other side. As often happens when I know my patients are in pain, I breathed a quick prayer for her. For strength, for God to hold her close, and bring her through as comfortably as possible. And suddenly - I knew they were there. Five angels, guardians of the five people in the room. Real. Present. Watching. Helping.

"Perhaps the most significant continuing activity of the good angels is to be the agents of God's particular providence for mankind. Thus, the Church teaches that everyone has a guardian angel, based on references to them throughout the Bible."

Catholics are very attached to their guardian angels, and it isn't a figure of speech when I say they were here with us. They were as present as the doctor, the MA, or myself. When I was little and had nightmares, Mom would sit on my bed and remind me of the strong angel who was always with me, my protector. As she tiptoed back down the hallway to her own bed (often for the second or third time that night), I would park my angel on whichever side of the bed was scarier, roll over, and go to sleep. Forgive the casual assignment, Angel; I'm sure you always chuckled at this tiny little girl trying to decide which side you should be on - as if you couldn't guard both.

I realized there in the clinic room that even though I couldn't be next to my patient (privacy screens keep the patient comfortable when there are already too many people in the room), she was not alone. I thought I could almost feel the presence of those silent guardians there with us, and even though I knew that for what it was, just imagination, I still shivered. I could see them in my mind's eye - next to the doctor, guiding her hands; next to the patient's mother, as she watched anxiously; next to the patient, a strong and steady companion. And knowing they were there filled me joy. Our world and theirs are so distant and different, but here we share a middle space. I've become more and more aware of that as I move through the hospital. It's amazing to think of them as I move through the crowded hallways; past the trauma bays; by the newborn unit. What a beautiful thing that is. We're not alone - we're never alone.

Perspective

It may be prejudiced of me to say, but I'm saying it anyway - I really have the best patients in the hospital.

I remember being a patient in our Radiology department myself, coming in for a back X-ray that would tell me what we already knew - my bones were fine, I just needed muscle therapy and a way to rid myself of the Eichlers' bad back jinx. It was strange to be a patient in my own facility; I remember looking at all the machinery a little differently as I slid onto the cold table in my gown. That memory surfaces every time I go down to Radiology with my patients.

Today was no different. My X-ray flitted through my mind and disappeared as I followed my petite, Guatemalan patient into the room. She was the cutest little mother of two I'd ever seen, with her dark, slanted eyes and the halting Spanish that made me suspect she was more comfortable in a native language. It was a standard X-ray - breathe, blow it out, hold, adjust, repeat. But as we stepped out from behind the lead wall to do a second image, she shyly asked me, "Y esa cosa no me va caer encima?" "And that thing isn't going to fall down on me?" She was motioning to the giant, boxy X-ray machine hanging from the ceiling, connected by tubing, sliding grooves, and other intimidating gizmos. In the dimly lit room I was suddenly aware of how big it was. I interpreted the question and the tech quickly assured her that no, no it wouldn't. Out of the broken Spanish that followed, I gathered that she thought it was all part of the test - that this big plastic and metal monster had to engulf her, press up against her, to do its job. She laughed in nervous relief, and while I chuckled on the outside, I was a little shocked inside. She was going to take it - whatever happened, without knowing what was going to be (literally) thrown at her.

It's so easy to forget what being a patient is like, and so hard to imagine navigating a medical system so foreign to your own, isolated by even your own language. Medicine tries so hard to predict a patient's every question, answering it before it ever comes up - a worthy goal, but hardly realistic in a world of 6,998,975,769 individual people. What else can we do then? The most important thing I took away that day was the need to create an area of trust, that rapport everyone always talks about - a horribly ugly word but very accurate concept. I've watched it growing throughout hospitals, as medical staff come to the same conclusion I did - we need that open field of communication. A place where patients can ask questions, even silly ones, even unrelated ones. A place which opens the way for us to tell them, no; no, the sky won't be falling down on you. Not today.

Medicine in the Kitchen

Imagine if everything in life was subject to the cautionary measures of medicine...

Good morning, I'm Stove. We will be working together today. I'd also like to introduce Sink, Counter, Frying Pan, and Spatula. You should know that Spoon, Fork, and Whisk could also be part of your team today. Do you have any questions?

Before we get started, I'd like to ask you to sign this privacy notice, informing you that while we will never voluntarily share any kitchen failures without your permission, we are not responsible for any accidental disclosure as a result of wafting odors or observation by thru-traffic in the kitchen. Do you have any questions?

I'll be helping you make scrambled eggs today, but I must first warn you of the risks and benefits of using my services. Common risks include minor scrapes, overheating due to standing too close, disillusionment with the finished product, and occasionally a minor burn. More serious but very rare risks include possible heat damage to other utensils, a lingering odor of carbon or sulfur due to overcooking, and catching your hair or other local products on fire. This risk is less than 1 in 1 million, and primarily occurs in members of the male sex. Do you have any questions? Are you sure you don't have any questions? We must also ask for your permission to dial 911 in case of a house fire or a severe burn emergency. Sign here.

Benefits of using my services are an increased efficiency, more even cooking when compared to the more traditional campfire, and quicker results. Depending on your own experiences and skills, benefits can also include a delicious meal. On the flip side, we take no responsibility for the risk of obesity that is the result of continued use if the meal proves to be too delicious.

Do you have any questions? Are you sure? Sign and print, date and time, and have a witness also sign, here.

Privacy - it ain't about HIPPA.

If you asked the regular Joe Shmoe on the street to let you accompany him into his doctor visits, chances are he'd think you're crazy. Nobody wants a stranger in their business; nobody.

Welcome to the delicate role of the interpreter.

I was interpreting for a young Guatemalan gentleman last month, in dermatology, for severe acne on his upper chest and abdomen. We were well into the doctor's interview when I realized either my communication was breaking down, or something was wrong. No matter how many gentle requests and hints the doctor dropped about unbuttoning his shirt to see the acne, he never got more than two buttons undone. She'd peek, and he'd button right back up. It took me a minute, but I realized that my presence must be embarrassing him. The next time we tried that number, I pulled the curtain, stepped a foot or two behind it - and what do you know, the shirt came off and stayed off! What was more interesting was the fact that a troop of about 10 medical students came in a few minutes later (with his permission) to examine the case with an attending, and I was the only one he needed behind the curtain. I think it's the lay clothes - I have no white coat.

Custody of the eyes is part of an interpreter's unwritten code of behavior. As we are not medical staff, and usually have no clinical reason to be looking at the patient, vision often become superfluous. I should probably be able to tell you the wall colors of most hospital clinic rooms - we spend a lot of time looking at each other. The ceiling and floor get a fair amount of attention, but the wall, particularly the one right behind a patient's head, is the usual center of focus. Day after day, appointment after appointment, I stare at them, either for the patient's comfort during a procedure or exam, or simply to get the patient and doctor to look at each other and build that rapport. I should know them all, every tone across half a dozen buildings. Funny though - I only remember a few. Labor & Delivery is a cool, light lavender; OB GYN has purple curtains and gorgeous light covers over the exam tables, depicting flowers, ocean scenes, or clouds; and depending on which room you get in the Outpatient building, they're either a rather mustardy yellow or a faded tan. But I don't remember the rest - mostly because no matter where my eyes are, I usually am not seeing. I am thinking, switching words, listening to patient hints in their tones and word choices. Processing, waiting for the silence that lets me know I need to look up for a facial cue to work with. So sometimes, a patient's embarrassment catches me by surprise. I don't really SEE their bodies, you understand - just their words.

I got gently (but definitely) kicked out of a room for the first time yesterday. A middle-aged Dominican came in with his English-speaking adult son, who was very fluent, but they opted to still use my services. Although patients do have a right to waive an interpreter's service by signing a form, choosing to utilize it is actually a really smart choice, and not because interpreters want job security. Fluent doesn't always mean bilingual, nor does it mean that the family member (who is suddenly thrust into the spotlight) is comfortable with medical terminology. Me, that's my specialty. I may not joke around very fluidly in Spanish sometimes, but I can sure interpret the ins and outs of just about any -ectomy or -itis there is. The son was more than happy to step back and let me help them. I keenly feel the privilege of a family member entrusting their father, mother, aunt, daughter, to my care, and while it makes me a little nervous to have them listening in, I'm glad for the opportunity.

We'd skirted around the issue of a prostate enlargement earlier in the visit, and the doctor finally let the patient know that yes, he needed a quick exam. I was getting ready, out of habit, to head behind the curtain, when this big, burly man turned, looked at his son and said, "Entonces, ella necesita salir, si?" "So then she needs to step out, right?" She clearly being me. The poor patient actually looked nervous, and very apologetic. I didn't even offer to stay behind the curtain - this man, who was a perfect gentleman and extremely friendly, just didn't need to be put in that uncomfortable situation. We agreed that he would be OK with the son giving him any positional instructions that may be needed, just during the exam, and I would be right outside the door when the doctor was ready to talk to him again. I could only smile to myself as I thought, If you only knew how many much more uncomfortable situations I've been in... But he hadn't been, and that was they key. While I was extremely used to talking about normally touchy subjects, my patient was not. For him, it may have even been a first.

Privacy isn't about HIPPA. We hear 'privacy rights' and everyone quickly scrambles through their brain files, looking for the rules and the right words, just in case an administrator asks. While that's all find and good, it isn't nearly a complete picture of what patient privacy means.

pri·va·cy
noun:
The state or condition of being free from being observed or disturbed by other people.
The state of being free from public attention.

Privacy is about making the patient comfortable - whether that's averting the eyes, turning slightly, or sometimes just ignoring behaviors in the room or untimely comments. To my mind, privacy is simply courtesy. Sometimes, I think we as medical professionals get so comfortable with the human body, so nonchalant about what is private, and sacred, and almost taboo. Thank goodness for it, as that calm air of experience can put a patient at ease, and actually more often takes the embarrassment out of a tough situation. But perhaps we forget sometimes that our patients haven't always had the advantage of that experience. Yes, we may have had this discussion a million times - but for a patient, there is always inevitably a first.

I'll never get tired of L&D.

People-watching is always an interesting pasttime, but in the delivery room, it reaches a whole new level. I see many couples come to the unit, deliver, and head back out to the floor, and they are all so different. It's a stressful place - I've witnessed a whole gamut of reactions and it's quite interesting what we human beings will do under pressure. I haven't a clue what non-Hispanics do, obviously - but my patients are fairly fascinating.

There's the adorable couple - the ones you find holding hands down the long hallway as she is rolled back to a labor room; the one husband we found actually snuggled up on the bed by his tiny wife before it got too terrible and she needed her space; the worried pacer who stops every few minutes to feed his wife ice chips or wipe her forehead with a cool cloth; the antsy, hand-patting, cheerleading husband to whom every push is an amazing feat. (He's right, you know.)

There's the we've-been-through-this-before couple - dad sits on the couch, calmly, or has run the kids home, because we all know there's plenty of time. By looking at mom, you'd think this was a routine clinic visit - no stress, no worries, just a let's-get-this-done look on her happy face. No surprises, no complaints, just happiness.

There's the missing couple - conspicuous by the fact that they aren't there together. The relationship didn't outlast the pregnancy - mom is alone in a quiet labor room, with only the interpreter and medical staff for support. They break my heart, those shattered couples. I always wonder how the coming child will feel about and deal with it all.

There's the freaked-out couple. Always the most interesting by far. Millions of questions, afraid of needles (I'm not sure how you get to the end of a pregnancy and still fear needles after the billions of blood draws), afraid of the sounds, not really sure why baby isn't coming NOW. The ones you can't even say 'C-section' in front of for fear of sending them into a panic (but of course in a sue-happy, paperwork-loving world, we have to say it at least 2 or 3 times AND sign a consent, just in case). These couples aren't necessarily noisy about their freaking out, but you can see it on their face all the same. They tend to break into sobs when it's all over, which is very cathartic for everyone in the room.

One little couple caught me completely by surprise - I have a bad habit of attaching the adjective 'little' to all adorable or short people. Maybe it has something to do with the suffix -ito in Spanish, which technically makes something 'smaller' but can actually just be an endearment. Hmmm. Anyway - they couldn't have been more than 19 years old, 'babies' everyone called them. Babies having babies - the world will go round. I didn't peg them as the freaking-out type; Dad was very, very quiet through the whole ordeal. But once his little girl finally made it into the world, he turned around and faced the wall, perfectly still, perfectly silent. We've had plenty of fainting dads, so the staff quickly rushed over to make sure he was OK. He waved us off, and I realized he was crying. It was adorable - he couldn't hold the tension inside anymore, but darn if he was gonna let anyone see it!

They are all great patients, and I've seen staff handle each one carefully and wonderfully. Every baby is different, yes - and so is every family. Beautifully and delightfully different.

What I can't help but wonder is if patients don't see staff the same way - and in all the same groups. What an article THAT would be.

You don't think I'm crazy, do you?

Language gets so much harder when it's altered by psychological problems.

Psych is such an interesting field, but I'd rather keep it at arms length if at all possible. I've brushed up against a handful of cases during my time here at the hospital - we have a Psych Emergency center, and you never quite know what's coming in. Every time I get ready to walk into one of the tiny rooms, I take a second to readjust my brain. As an interpreter, I constantly search for meaning, using context, body language, whatever can help me get the proper meaning transferred. But Psych changes all of that. Body language doesn't have to match words, words don't even have to match language structures. But it all has to get through.

The implications of proper interpreting are huge. I step into a world where every precious word counts, where every inference, second meaning, and cultural sideline must be ushered safely across the language barrier. It doesn't have to make sense to me - that's the job of the psychiatrist sitting next to me, and I am so glad of it. But I do have to catch the undercurrents - the tones behind the word choices, the difference between choosing one word and the next, the silent cries for help in the way the words are put together. I have to say what the patient says so the provider hears not only the words, but the meanings, and the possible meanings, all without tainting any of it by my impressions. I have to enable the psychiatrist to do what he does best, across a language barrier. It's an awesome responsibility.

Strangely enough, I'm never scared in Psych Emergency - I'm not sure if that's good or bad. I remember standing in the hallway with the doctor, trying to usher a patient back in his room. He kept squinting up the ceiling, and twitching as if he'd had hot water sprinkled on his face - 'He won't stop...he keeps spitting at me," the patient said, pointing up to the empty ceiling. Another patient, thin, bony, defensive, wouldn't even speak to me, because she was indigenous Mexican and I had a cara blanca. A white face, and of course we the white faces stole all their land, all of it, theirs, all of it, stolen, and that was unforgivable. Her mind crawled into a shell harder than her body and refused to come out. Then there was the schizophrenic-off-his-meds who came in with two self-inflicted abdominal stabs from a butter knife. He wanted to know where the doctors kept all the patient brains. Nothing we could say would change his mind.

Most cases aren't so spectacular though - they're simply depression (if depression can ever be called simple) or patients who've never really been 'off' enough to seek psychiatric help until suddenly something triggers them into isolating themselves and ignoring the world. I remember one lady in particular. I sat very still as we talked, focusing on her words, letting the psychiatrist try to engage her attention without seeming rude myself. Tu crees que soy loca? Do you think I'm crazy? she kept asking. Her poor brain was crammed full of so many bad things that she couldn't let go of. Anger, loneliness, fear of being thought insane, pride - yo nunca pido disculpas de nadie, she said - I never apologize to anyone. Guilt over an accident of an epileptic brother who fell off a horse at age 4 and was never the same. It was my fault, it was, it was! A veces mi abuela me viene - sometimes my grandmother comes to me - soy loca? Am I crazy? Thoughts of dying, thoughts of ending, too many thoughts.

We try to leave hope behind us in our patients, giving them something to look for and live for. We connect them to resources, give them medication if that will help, send them to counselling, and even keep some admitted to our psych unit. Sometimes just having someone to talk to is all they need, a kind of bad-bloodletting, getting it off your chest. Everything about it is so very different from clinical medicine - I almost feel myself undergo a mental change when I step through the door.

What an interesting job I have.

Because I could not stop for Death...

Death isn't something you expect to rub elbows with at 25 ... or at 75 for that matter. But then again, Death isn't a something; it's a nothing. It's a gone, disappeared, vacuum, hole, missing. It's a negative, a taking away. And lately it's been putting a lot of holes in my world.

There's the obvious kind. He was in his late 30s, and when I walked in, I didn't realize he was there at first. You see, I've never seen a body bag. Covered up to his neck, his face looked normal, except for a yellowish tint I'd like to attribute to the lighting but couldn't. So that's it. You're declared...passed over...gone. He wasn't there. I couldn't get over the fact that he, this man with the thick dark hair and young face, wasn't actually...here. Just his body. Empty.

It's a little easier somehow and yet much harder when you're patient is 29 weeks old - gestational. Easier to know he never suffered and won't have a life in Children's Hospital as he surely would have, had he survived. Harder, because he was the boy Mamá had wanted so badly after 3 girls. Easier to see his sweet, peaceful face and curly hair; harder to see his little organs and heart outside his abdominal cavity and his misshapen legs. Harder because he wasn't here anymore either and Mom wanted to know why. Harder than I expected.

Little baby girls born full term shouldn't be perfect and purple. Little baby girls shouldn't look like they're breathing because their body is expelling the air that tried to save their life. Little baby girls shouldn't survive a pregnancy to be killed in the last 10 minutes by a silent, rupturing placenta.

Then there's the not so obvious kind. I watched her breathe, in and out, rise and fall. I saw her warm, rosy skin. Her long, healthy, inky black hair. And I interpreted the term 'brain dead' to her family. She wasn't there either, you see. It seemed like it, but SHE wasn't there anymore. It was time to let go.

The phone call to Mexico for the family of a young man who came in half gone and was now a living shell - that wasn't easy either. He's not really here, they wanted me to say. He's just a remnant now. It's time to disconnect. I wanted to stamp my foot as I took the phone receiver, and stop them - he's still alive, the body still works, don't turn him off! but in my heart, I knew they were right. Death was already here and he'd left us. He wasn't coming back.

And of course there are what I call perimeter deaths. I watched them working on the young Asian boy two beds over in the trauma bay. I wondered how his surgery went. Then two hours later, I passed the residents, and heard snatches. "He didn't make it out." "Traffic accident..." "..tragic..."

There was our 30s something patient sent home on hospice, Raul, having fought the best we could against his HIV and stomach cancer. We heard four weeks later that they didn't need to visit anymore. Another hole.

I didn't get 'death' as a kid - it was just grief to me. I left the dying part out and saw only the grief. But now I see it eating away, taking away, people I have known. It's just something that happens. And maybe that's what's so scary. Even here, in a hospital, it just happens. I always had this fuzzy, comforting feeling in the back of my mind, that no matter how sick someone got, you could just hook them up to the right machines and ride them through it until they could start recovering. I knew it wasn't true, but I think it was one of those protective mechanisms - my head knew it was impossible, but my heart really wanted to believe it. It's what we hear in the media, it's what we debate about in the newspapers, the line between living on a ventilator and extending dying by using one. Surely, now, in the 21st century, we can keep people alive! But we can't. And we shouldn't.

Tides are such a cliche, but I suddenly understand why they are appropriate for describing life. My world is filled with patients and they rise and fall like the tides, one moment full of familiar waters and the next bringing up new treasures. You can't stop it, I can't stop it - I shouldn't. But somehow, it's always a little sore, like rubbing over an old wound...more of a ... molestia, a trouble, a bothering. Yes, la molestia de la muerte.

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