Spanglish

In the office, I have my good days and bad days in Spanish.  Sometimes, the words come so effortlessly. Other times,  I stumble through my sentences and everything seems (at least to me)  forced.   I really don’t know what contributes to these ups and downs. I’ve just come to the conclusion that some days, I’m afflicted with a sort of ‘Broca’s aphasia’ of the Spanish part of my mind, and I just muddle through the best I can.

Today in particular was one of those days.  A young woman came in complaining of red eyes:

Me: ¿Por qué está Ud. aquí hoy?

Patient: (pointing to her left eye):  Estoy aquí por esto, un ojo rojo. Dos semanas atrás tuve la misma cosa en el otro (points to the right) y ahora este ojo.

She has one of the few diagnoses in ophthalmology that you can diagnose from across the room: a subconjunctival hemorrhage.  I proceeded to ask her questions:

Me: ¿Ha estado enferma?  ¿Está tosiendo? ¿Tiene presión alta?

Patient: No, no.

Me: ¿Está esforzando en el baño?

Patient: No.

Me: ¿Qué tipo de trabajo hace? Por ejemplo, ¿está levantando cosas de peso en la casa o en su trabajo?

Patient: No. Pero en mi trabajo hay mucho polvo, ¿tal vez lo puede causar ojos rojos?

Me: No en este caso. Bueno, ¿toma aspirina o Ibuprofeno?

Patient: Sí—ibuprofeno. Tengo migrañas, y uso ibuprofeno de vez en cuando.

Me:  ¿Cuánto? ¿doscientos miligramas, tresciento…más?

Patient: No. Sólo una píldora, no más.

Me: ¿Tiene un neurólogo o médico de familia?

Patient: Tengo médico de familia, Dr.--. Él me refiere a un especialista—un neurólogo, pero no he le visto todavía.  

All in all, here we have a conversation that 1) reveals to me enough information to make a diagnosis and 2) a dialogue that the patient understands and leaves her feeling confident enough that I can address her concerns.    Fine.   But I commonly review interactions like this in my mind long after the patient has gone home and my work day is over, thinking about how I could have sounded less elementary and choppy and, instead, more sophisticated and urbane.  

Take the phrase “¿Está esforzando en el baño ?”   lit. : Are you forcing in the bathroom?

This is my attempt at asking the patient if she is constipated, when in fact, I’ve forgotten the word for constipated (estreñido) and have to improvise at the meaning.

And, “¿Está levantando cosas de peso en la casa o en su trabajo?”  lit. : Are you lifting things of weight at home or at work?

Here I want to ask if she’s picking heavy things up at home or at her job. Again, my translation is a little sloppy sounding, but some would argue - so what? The patient understands. But I think to myself:    I’m a professional so….. shouldn’t I sound professional?

This was the remainder of the encounter:

Me: (after examining the eye) Ud. tiene ojos sanos. El nervio óptico, la retina, el lente y la presión del ojo—todo está bien.  Ud. tiene algo que es muy común—sangre debajo de la piel blanca del ojo. Significa a veces, que subió la presión de sangre—lo puede pasar particularmente cuando una persona tiene dolor—por ejemplo, en su caso—migrañas.  La arteria en el ojo explota y, aunque parece mala, la visión y la salud del ojo no son afectados.  Y recuerda, Ud. está tomando Ibuprofeno ahora para el dolor de cabeza.  Ibuprofeno, como aspirina “thins” la sangre. Entonces, lo puede sangrar más—un poco más que es normal para Usted.

I basically tell her the eyes are healthy, and that she has a common eye problem: subconjunctival hemorrhage. I relate that the origin of such a hemorrhage can be a rise in blood pressure, and this often  happens when a patient is in pain (as is this patient because she suffers from migraines).  I mention how the burst artery may look bad, but vision and eye health are unaffected.  Finally, I remind her that because she uses Ibuprofen for migraines, she may bleed more than average, as Ibuprofen effects the clotting ability.  

During my explanation to her, I resorted to using the English word “ thins “ because frankly, at the time, I didn’t know the Spanish equivalent (anticoagulación).  The patient understood me just fine.  In the end, if you can’t think of the vocabulary word, my advice is: say it in English.   

Incidentally, one of the unique things, I feel, about practicing medicine in Spanish in the United States, especially here in the New York area, is that American Spanish has evolved as a new Spanish, a sort of  ‘Spanglish’. Even if you’re a true Castilian Spanish speaker,  all bets are off here in the United States.  Native fluency doesn’t guarantee that you’ll be able to communicate in the clearest way with patients. A Spanish speaking doctor or health care worker needs to be more versatile in a Spanish influenced by American English.  

And isn’t that one of the beautiful things about language communication? It’s always changing, growing and adapting—and it requires us to do the same!

Courtesy: D. Hromin