Office Space

I have asked this question many times before in this blog: what exactly constitutes fluency? When do you really know a language? I ask this question often because, at the end of the day when I return home from work at the office, I feel like I’m fluent in Spanish. I speak it all day with the patients. I hear it all day. I use it all day. And then I write this blog about Spanish in medicine, and I use it more. And then I tweet about it. I even have a facebook page dedicated to ophthalmology in Spanish.

So I must be fluent, right? Well, yes, if we’re talking about medical Spanish. Specifically, if we’re talking about ophthalmology-related medical Spanish. Then, yes, fluent it is. But take me out of that context – remove me from talking about cataracts all day and how they form. Remove me from answering questions about dry eye or explaining which drug store drops are best for allergic conjunctivitis. Take me away from describing what a PVD is and what to expect from it, and instead, plop me in the nearest Spanish-speaking auto body shop with a car engine that goes pop-pop-pop and ask me to explain that, in Spanish. How long it’s been doing that, where the sound is coming from, when I last had the transmission fluid changed. Suddenly my great medical fluency turns into an auto body Spanish 101.

I guess fluency all depends on the context. When I’m in the office, I’m repeating various phrases and questions over and over, until they become rote. I already know what questions to anticipate, and how those questions are asked of me in Spanish. I know what to listen for. I know how to answer. And it’s comfortable. Maybe too comfortable.

¿Hola, soy Doctora Hromin, cómo está usted?

¿Qué problemas tiene con la visión?

¿Ha cambiado la visión desde la última visita?

¿Prefiere bifocales o progresivos?

¿Tiene una historia de glaucoma en su familia?

Aquí está la receta. Puede regresar en uno o dos años por otro examen, o más pronto si tiene un problema o cambio de la visión.

I get a false sense of security in Spanish, because the same Spanish is being used everyday and in the same instances. I’m rarely, if ever, pushed to grow.  But, the only way to grow is to be led outside the comfort zone of rote context.

Recently, the office that I’ve been working in for the last two years moved to a new space. The lease was up, and the doctors, the owners of the practice, decided they wanted a bigger space with better amenities. So they moved to a relatively new office building just down the road. And like most medical practices, they did very little to limit their patient schedule during the time of the move. ??? So, amid hammers and nails, window shade installment,  drilling and sawing, the patient day started as usual at 8:30am.  I was working out of a completely new exam room, just orienting myself to where everything was. My first patient of the day happened to be an emergency walk-in. Metallic corneal foreign body. Spanish-speaking only. He came with a friend who was also Spanish-speaking only. And the tech plopped him in my exam chair and left before I had a chance to say, “Where are the TB syringes? The 30G needles? The alcaine?...Where are the alcohol pads??”

I went through my usual ‘introduction, how are you, what’s wrong, when did this happen’ in Spanish. But I pride myself in keeping my patients relaxed and letting them feel that they’re in good hands. How do I project confidence when I don’t know where half my equipment is? How do I look competent when I’m opening and closing drawers half-heartedly, and coming up empty-handed every time? I can’t rely on my usual confident Spanish shtick when the shtick changes. I never had to apologize for not being familiar with the office space I’m working in, that we just moved, that I had to find where the technicians hid my instruments – certainly not in Spanish.  But now I have to, and I’ll have to fish for new vocabulary:

Perdóname, Señor. Esta es nuestra oficina nueva. Tengo que acostumbrarme al cuarto nuevo. Ahora, no sé donde la enfermera puso las almohadillas de alcohol. Déme un momento para encontrarlas, entonces empezamos el examen.

Maybe it wasn’t the most technical Spanish, or the most articulate. But it made sense. It got the point across. It was different than my usual banter, and it forced me to talk about something other than hordeola and corneal abrasions. The exam continued, I removed the foreign body, gave the patient antibiotic drops and instructions and told him I’d see him for a follow-up visit in 1 week.  I must not have done so badly in my new-office-move-Spanish-101, because the patient’s friend said:

Su español es bueno. ¿De dónde es? ¿Aquí?

I smiled, knowing it wasn’t my best Spanish. But maybe it doesn’t need to be the best. Maybe it just needs to be taken out of context now and again. Maybe it needs just a little airing out.

Lo cree o no, aquí. Lo aprendía en la escuela.

Oh, la escuela.  <smiles all-around>

Comfort Zone, Courtesy: D. Hromin