Lenguaje “Llano” – Common Words & Plain Language

I wanted to review a common list of terms I come across frequently when discussing eye problems/conditions with my Spanish-speaking patients. I have mentioned a few of these previously in my blog, notably in my October 2013 entry “A Rose by any other name...well, except for ischemia”.  As I have said before and as any physician knows (usually through personal experience), in any language, speaking to the patient only using medical terminology is not beneficial.  For anyone not medically trained, such words are foreign, scary and often misunderstood. People have common ways to refer to medical conditions, diseases, the human body and to fully know a language you need to be intimate with all of these manners of expression.

Now, Spanish language has the added issue of varying its dialect depending on country of origin. So, a Puerto Rican patient may have a different way of expressing an eye “floater” than someone from the Dominican Republic. I have not yet reached a level in my own Spanish knowledge and experience where I can differentiate terms based on national origin, or vice versa. What I do instead is repeat all the forms of the word that I know to the patient, until I reach one that the patient understands and identifies with. For example:

1 )  Mole, or any skin growth

You could try saying  nevo for nevus, but likely that won’t be understood, just as the word nevus usually isn’t! The equivalent Spanish word for mole is lunar. Now, what term to use for a generic growth of the skin is a different story.

Years ago I looked up the word growth in an on-line English-Spanish dictionary. The supposed equivalent Spanish word it gave me was protuberancia, apparently similar to the English word protuberance. So, I started using this word anytime someone had a growth I wanted to describe. Well, I can tell you I received many a strange look from the patients when I used this word! In fact, when I shared this experience with my Puerto Rican technician, she practically guffawed, and we had a hearty laugh at my expense!

The problem was resolved when a patient came in one day pointing to and describing what were actually small chalazia on his lower lids. He used the word bolita: ¿Qué es esta bolita?  Since then I have been using bolita for growth and the patients understand me, so it must be a valid and universal description.

2) Lazy eye

When I was studying Spanish during my high school days,  I learned the word for lazy to be perezoso. During my residency, it made sense, therefore, to refer to a lazy eye as an ojo perezoso.  No patient ever questioned it or seemed to misunderstand. Sometimes I will introduce the patient to the medical term, amblyopia, or ambliopía in Spanish.

But many patients don’t really understand what constitutes making the eye “lazy”. In my experience, I have found that patients think that lazy eyes are eyes that drift, ie. a strabismic eye. Knowing this, I will sometimes refer to a lazy eye as ojo cruzado or crossed eye if I know that strabismus is the reason for the amblyopia.  Obviously I cannot use this term in all cases of amblyopia.

A description that a Puerto Rican patient may use to indicate lazy eye is ojo vago, but according a technician I work with, this is a very base way to describe a lazy eye. Per the Spanish-English translator, vago means slouch, lazybones or slacker. Can you imagine? “Hey, your eye is slacking off!” If you visit the website www.ojossanos.org, you will find the term ojo perezoso, which appears to be the acceptable way to express a lazy eye in Spanish.

3) Eyelid “crusts” and discharge

One complaint I hear about often from patients is that when they wake up in the morning, they have crust buildup on the eyelids/lashes. In English, they refer to this as crust, or flakes or “eye sleep”.  I’ve heard even more unflattering terms to describe it, but I won’t go into that right now.  But how does a patient refer to this in Spanish? Some common words are: legaña, lagaña or pinchas.  But I have asked, “¿Tiene algo como una costra en el ojo cuando se despierta?” and they do understand what I mean by costra = crust.

Incidentally, to ask about eye discharge, I often used the word descarga. “¿Tiene Usted una descarga del ojo?”, but I found I was stared at quizzically more often than not. Instead, now I use lagrimeo which is closer to the English for tearing. I do recall one patient describing her eye discharge as flujo, but I do not hear this word used too often.

4) Pterygium/ Pingueculum

Un pterigio or una pingüécula are words I will introduce to the patient just so they know the medical word for this lesion growing conspicuously over or near their cornea. However, Spanish-speaking patients have many colorful terms to describe these lesions: una carne, una carnosidad, and una uña, which are meat, fleshiness and fingernail, respectively.

I often start out: “Esta cosa que Usted tiene en el rincón del ojo, esta carnosidad/carne/uña, es algo se llama un pterigio.” English speakers typically refer to it as “this thing growing”, “this growth”or “lump”on the eye.

5) Blue Eyes

I remember when I was studying Spanish in college, my professor—wow, I just remembered her name now, just this moment! La Profesora Marques. I haven’t said it or thought it for years! Perhaps the old brain is still retaining and not simply leaking words, phrases and experiences like water through a sieve (as previously thought!).  

La Profesora Marques told my class one day that blue eyes are not referred to as blue eyes or ojos azules in Spanish. This is because, as she said, blue eyes are very rare among the Latino people. Instead, she said, that blue eyes are actually referred to as ojos blancos which literally translated means white eyes. I have never had the opportunity to use this expression with my patients.  The majority of them are from Central and South America, and the Caribbean islands. Their eyes are almost always a dark brown or marrón, rarely I will see even a hazel eye.

6) Flashes / Floaters

Patients coming in with potential PVD or retinal tear complain of destellos (flashes of light) or puntitas de luz (points of light). Sometimes they will describe the flashing lights as lightening or relámpago. Floaters I have heard called by different names:  manchitas (literally ‘little stains’), manchas (stains), pajaritos (little birds), moscas (flies) or líneas en la vista (lines in the vision).

I almost always will refer to the American Academy of Ophthalmology’s website www.ojossanos.org (an informational site for patients describing various eye conditions written in Spanish) to expand my vocabulary of medical ophthalmological Spanish. There, floaters are called flotantes.  However, I have used the word floaters / flotantes with my patients, and many do not know what I am referring to. It is easier to get across the following sentiment whether in English or Spanish: ¿Ve Usted puntitos negros que se mueven en su campo visual? Once people hear ‘black spots’or ‘moving spots’ and understand, then I introduce other ways to refer to them.

7) Black Eye /ojo morado

Not everything can be literally translated from English to Spanish. If you describe someone as having an “ojo negro” literally ‘black eye’, it is interpreted as simply a dark brown eye in Spanish. It doesn’t have the same meaning as in English, where a black eye is an eye that is bruised as the result of a punch. Instead, you have to use the words ojo morado which literally means purple eye.

8) Blind Eye /ojo ciego

Any reference to blindness brings us to the word ciego in Spanish. Many patients, particularly those with eye problems like glaucoma or diabetic retinopathy, truly fear that they will lose the vision completely and go blind. Often I will hear, “Voy a ser ciego?” The answer is almost always no. So far in my >10 years in private practice, I have not heard of any slang (jerga) for a blind eye. Maybe the closest thing I have heard is bad eye (ojo malo) or weak eye (ojo debíl).

9) Prosthetic Eye

I have been using the most direct tranlation of these terms: prótesis ocular or ojo artificial.  Another description that is a little more basic would be ojo falso, or false eye.

10) Pink Eye – Viral Conjunctivitis

Pink eye is also another expression in English that is not necessarily literally translated into Spanish.In Central America, this condition is referred to as mal de ojo or ojos rojos, not rosados. You can also use the medical term conjunctivitis or conjuntivitis. However, conjunctivitis is a broad term and not always understood. If I use that word I preface it with: “La piel que cubre la frente del ojo se llama ‘conjuntiva’. Cuando esta piel se vuelve inflamada, se llama ‘conjuntivitis’”.

There are times, however, when I will interject the English words pink eye when explaining the diagnosis to a Spanish speaking patient. Why? Again, it takes me back to an earlier blog entry of mine “Spanglish” http://www.eyesayinspanish.blogspot.com/2013/10/spanglish.html when I talk about how Spanish in the Americas has been influenced by English. Because of this, sometimes the English slang equivalent is the jerga that Spanish speakers here will use and understand.

Universal Signs

La Jerga

Doctora: “Díme, ¿ qué son los síntomas Usted tiene?

Paciente: “Es como, veo un’ moca, un’ moca.”  

<me mira, con duda>

Paciente: “¿Sabes qué es, un’ moca?”

Doctora: “¿Usted ve ‘un moca’? No, no lo sé. ¿ Qué es un moca?”

Paciente: <mucha risa>

Later in the day long after the patients had gone home, I asked one of the ophthalmic technicians in the practice who is Puerto Rican and Spanish-speaking, what IS a ‘moca’? What was this patient talking about?

She laughed and told me he was saying “mosca” which right away I recognized as a fly. Because the patient left out the “s” sound when saying ‘mosca’, I had no idea what word he was trying to communicate. When people don’t fully pronounce words, or slur their speech, it can be very difficult to figure out what they’re saying. But, usually if this happens in English, I can figure it out. In a language non-native to me, however, I rely on every sound, every inflection, to get the meaning right. And if the sound I’m expecting isn’t there, then I feel very much like someone lost in the woods without a compass. I have no idea where I’m going. Or where the speaker is coming from.

Recently, I came across an interesting article on the American Translator Association website entitled, “La jerga de los médicos y de los pacientes” (Doctor and Patient Jargon). The article’s authors, Becky Katz and Rudy Heller, attended the Congress Division in Orlando during which physician Dr. Fernando Navarro presented euphemisms doctors and patients use to describe otherwise unpleasant or intimidating medical conditions and/or bodily functions. Dr. Navarro went on to describe vocabulary that doctors use with their patients that may be misinterpreted or misunderstood based on pronunciation alone or how the pronunciation is perceived. He goes on to give examples first in English:

Varicose veins = very close veins

Very high electrolytes = very high electric lights

Superficial phlebitis = superstitious fleabites     <hahaha, I can’t help but chuckle at that one!>

(I even remember one such misinterpretation from my medical school days:

Cystic fibrosis = sixty-five roses)!

Dr. Navarro then presented similar problems (referred to as ‘barbarismos’) in the Spanish language:

Otorrino = Doctor Rino

Cesárea = necesaria

Ataque de insulina = ataque de ursulina <chuckle>

And the list goes on and on...Something is being said, but is not necessarily heard as was intended. Inevitably, it leads to good-natured humor and a hearty laugh. From there continues a conversation of clarification, as I experienced during another patient conversation:

Doctora: “Bueno. Tengo que decirle, que Usted tiene ojos muy sanos.”

Paciente: <me mira confundido>  “¿’Sano’? ¿Qué es ‘sano’?”

Doctora: “Saludable. Usted tiene ojos saludables – sanos.”

Paciente: “Ahhh...(relajado)”

I’m still not quite sure why the patient didn’t understand me when I used the word ‘sano’for 'healthy'. No one else ever had a problem understanding me. But then again, maybe he heard something different. A little clarification was all that was needed to do the trick. Oh, and by the way, because of my experience confusing ‘moca’ and ‘mosca’, my mind is now keyed into that sound variation. Just yesterday a patient came to the office as an emergency visit, again with similar symptoms of floaters in the eye:

Doctora: "Se dice aquí que ¿Usted ve un cambio en la visión?"

Paciente: "No hay un cambio en la visión, es sólo que, ahora, en el ojo derecho, veo pajaritos – es como un’ moca."

Doctora: "Ajj, Usted ve moscas, ¿ o manchitas en su campo visual?"

Paciente: <muy profundo> "¡Sí! Sí, veo manchitas, hace más o menos tres días ahora..."

And the dialogue continued, unperturbed by a dropped syllable.

For more information on Becky Katz & Rudy Heller’s article, you can find it here at:

http://ataspd.org/2012/09/27/la-jerga-de-los-medicos-y-de-los-pacientes/

Bryce Canyon, Utah

"Tu español es muy bueno."

“Tu español es muy bueno. ¿Eres latina?”

“No. Nací aquí en los Estados Unidos. Soy una mezcla de nacionalidades: polaca y italiana.”

<me mira con duda>

“Bueno, las lenguas de italiana y español son semejantes. Entonces, ¿hablas italiana?”

“No.”

<más duda>

“Y no hablo polaco tampoco. Pero hablo y entiendo un poco de la lengua de mi esposo: croata.”

<ahora, confusión extrema>

***

This is a conversation I have with patients several times a week. I always feel complimented when my Spanish-speaking patients tell me that my Spanish is good, especially since I know I have much to learn, and I cringe sometimes at the thought of all the grammatical mistakes I must be making when I talk with them! But inevitably, after the compliment about my Spanish skills comes the question about how I know it so well. I must be Latina, right? Or at the very least, I must have travelled  outside the U.S. at some point and spent several years living in a Central or South American community of people. This is what my patients think! And truly, I am complimented they feel my Spanish is that good. 

But the simple answer is, no. I’m not Latina. I grew up in a two-family house with my parents and my mother’s parents. My grandparents were first generation Italian Americans who got married and raised a family during the WWII era. Based on their stories of what it was like living in the United States back then, everyone was fiercely patriotic. In their minds, to be American was to jump feet first into this ‘melting pot’ of a society. This meant learning the English language and adopting American customs, unfortunately, to the detriment of the mother tongue and traditions.  My grandparents spoke Italian as children growing up in Brooklyn, but that language was gradually lost during their years to adulthood. Eventually, when they had children of their own, there was no language to teach them but English and this, of course, carried on to my generation.

I was a child in the 1980s and back then, television programming was not like it is today. It did not introduce children to any languages other than English. Even Sesame Street, which I probably watched for the majority of my young childhood, introduced me only to the basics of ‘gracias’, ‘hola’ and numbers up to ten in Spanish. I remember hearing once when I was growing up, I’m not sure if I heard it on the news or in school or elsewhere, but I remember hearing someone saying, “What do you call a person who speaks two languages? Bilingual. What do you all a person who speaks three languages? Trilingual. What do you call a person who speaks one language? American.” And when I heard this joke, it bothered me. I would have loved to have learned something other than English as a young child. That opportunity wasn’t given to me.  My grandparents touted many times how proud they were to be of Italian origin. Then why did they give up on the Italian language? 

Fast forward to my junior high years of 7^th and 8^th grade and my school finally introduced me to another language: Spanish. I loved it! It was fun to learn, but something that unfortunately could only be learned in the confines of a classroom. At home, my family – namingly my grandparents- flip-flopped between being proud of me for being such a good student, and being angry at me for speaking a language they didn’t understand and didn’t want to understand. It was a tough situation. But I continued my Spanish studies through high school and college and eventually got real practice using it in my medical school and residency years. It took many many years to accustom my ears to the different sounds of Spanish, enough to understand someone speaking it. I still struggle at times with that today, especially if someone’s using slang or speaking with a heavy accent or dropping syllables from the words. But I have come a long way. And I am proud of what I’ve accomplished.

Because I speak Spanish, and because I can understand Spanish, windows into patients’ lives have been opened to me that I would never have been able to peer through before.   It’s a real gift, this gift of communication, and one that I work hard to maintain everyday.

***

In this same vein, I came across an article title recently that caught my attention: “Non-Spanish Fluent Latinas: ‘Don’t Judge Us.’” written by Tracy López for the website NewLatina. The article mentions that, though it is predicted that the United States will be home to the largest population of Spanish speakers in the world forty years from now, many Latinos born and raised in the U.S. do not speak Spanish. It goes on to talk about the history of Spanish language in this country, which most interestingly parallels my time-line of Americans’ attitude toward foreign language learning from the 1930’s to present –this time seen from the perspective of the Spanish-speaking immigrant. Those whose mother tongue was Spanish during the WW II era here did not dare speak the language outside the home because they received discrimination if they did. And often times that translated to them not even using the language in the home for fear their children would not be able to learn English properly enough to “blend in” with American society. Hence, a generation of Latinos was born that, upon reaching adulthood, could not teach the Spanish language to their children even if they wanted to because they themselves had no exposure to it.

Ms. López goes on to say that for these non-Spanish fluent Latinos, there is a sense of judgment from other Latinos in the community who do speak the language. They are regarded as “fake Latinos” because not speaking Spanish is viewed as shameful. Several Latina women are quoted remarking on their experiences with this in the U.S., all of which have the common thread of feeling less-than or left out because they do not know Spanish fluently. These even include stories of famous Latinas such as Jennifer Lopez and the late Selena Quintanilla who struggled with having a strong Latin identity and yet weak Spanish-language skills.

The article ends on a positive note, saying that among the Latina community, people should embrace each other for their similarities and differences.  Latinos come from a rich variety of countries of origin, cultures and backgrounds, and therefore should not be held to a standard that says they should all act and sound the same way. There is certainly a lesson we can all learn from this.

...Which brings me back to the conversation I had with my patient.  I speak Spanish, but I am not Latina. There are many Latinas out there, proud of their heritage, who don’t speak Spanish. 

Because I am not Latina, should it be assumed that I don’t speak or understand Spanish?

Because  a woman is Latina, should it be assumed that she does speak Spanish and if she doesn’t, she is ‘fake’?

No and no to both counts. Preposterous!

How about this: We live in a country of which we are proud to be a part. We come from various origins we are proud make us who we are, and we respect and embrace each other for our similarities and our differences.

***

“¿Dónde aprendiste español?”

“En la escuela.”

“¿En los Estados Unidos?”

“Sí. Desde mi escuela primeria.”

“Ohh.”

“Tengo mucho más que aprender.”

“Bueno, está bien. Lo hablas bien.”

***

To read more of Tracy López’s article “Non-Spanish Fluent Latinas: ‘Don’t Judge Us.’”, you can find it with this link http://newlatina.net/non-fluent-latinas-dont-judge-us/ 

Arches Nat'l Park, Utah. "As far as the eye can see..."