The Thinker

Sometimes when I’m speaking to a patient in Spanish, I’ll think of something that I want to say to him that I could easily say in English, but I do not know exactly how to convey in Spanish. Especially if it’s a colloquialism, there is usually not a direct English to Spanish translation. You simply have to know the Spanish language-way to express it. In these instances,  I have to make a quick decision: either abandon the phrase altogether or attempt my own Spanish version.  The latter may result in a complete butchering of the language—oftentimes, it does! So, after the patient leaves, I typically write these phrases down on paper and save them for investigation later.  By the end of the week, I’m left with random phrases on little pieces of paper that add up to quite a collection. For this blog entry, I’m going to list some of these phrases below, translate them the way I would if I had a patient in front of me, but then research to see how the phrase really should be expressed by a native Spanish-speaker for comparison. Here we go!

“The disease has to run its course.”

My translation:  Esta enfermedad requiere más tiempo para curar.

Actual: Esta enfermedad tiene que seguir su curso.

             Esta enfermedad debe tener su curso.

             Esta enfermedad tiene que completar su evolución.

“When your medication runs low, please call the office.”

My translation:  Cuando casi ha acabado los medicamentos, por favor, llame la oficina.

Actual: Cuando quedan pocos los medicamentos, por favor, llame la oficina.

             Por favor, llame la oficina antes de se terminen los medicamentos.

“When you hit your eye, what were your symptoms?”

My translation: Cuando le golpeó el ojo, ¿qué fueron los síntomas?

Actual: Cuando le ha dado un golpeo al ojo, ¿qué fueron los síntomas?

             Cuando se golpeó el ojo,...

             Cuando se ha golpeado el ojo,...

“It is important that you keep your follow-ups with your doctor, so that he monitors for any changes in blood pressure.”

My translation: Es importante que mantenga usted las citas de seguimiento con su médico, por eso, él le pueda vigilar para cambios en la presión de la sangre.

Actual: Es importante que cumpla con sus citas médicas, para que el médico mantenga una observación de los cambios en la presión de la sangre.

             Es importante que asista a sus citas médicas, para que el médico pueda averiguar para cambios en la presión arterial.

             Es importante que usted vaya a la cita de seguimiento, para que el médico pueda vigilar para cambios en la presión sanguínea.

“He thought that you had these symptoms for many years.”

My translation: Él pensó de que tuviera usted los síntomas para muchos años.

Actual: Él pensaba que usted hubiera tenido los síntomas por muchos años.

 Él pensaba que usted tuviera los síntomas durante muchos años.

“Let’s say, for example, the test was normal. I would not start those drops you are using.”

My translation: Vamos a decir, por ejemplo, que el examen fuera normal. Yo no empezaría los colirios que está utilizando.

Actual: Se podría decir, por ejemplo, que fuera* normal la prueba. Yo no tendría que empezar los colirios que está utilizando.

            Digamos, por ejemplo, si la prueba fuera normal. Yo no habría empezado las gotas que utiliza usted.

            Pongamos en caso, que el examen fuera normal. Yo no iniciaría las gotas que utiliza usted.

(*Even with my research, I am still not fully clear on the proper expression of this sentence. To me, by beginning the phrase with, “let’s say, for example”, I’m creating a hypothetical situation that is uncertain.  Therefore, any uncertainty is expressed in subjunctive. If you use subjunctive, ie fuera, then you follow it with the conditional tense, tendría.)

“It depends on the insurance. They dictate where you have to go (for the treatment).”

My translation: Depende del seguro. El seguro dirige a donde tiene que ir (para el tratamiento).

Actual: Depende de la compañía aseguradora. El seguro le indicará donde tiene que ir.

             Depende del seguro médico. El seguro le exige donde va usted.

             Depende del seguro médico. El seguro le aconseja donde puede ir usted.

There are many ways to express any one particular thought in a language. As you can clearly see, some of my translations above came very close to what I found in parallel texts (aka Spanish reference texts) online. Others deviated from the Spanish “norm”.  However, the question remains, will the patient understand me, even if I don’t say my phrases according to the RAE (Real Academía Española- the governing body for all things Spanish language-related)? The answer is yes.

Think about it, when a non-native English speaker has said something to you in an “unnatural” aka "non-native" way, you can still understand him. You still get the gist of what is being said. Why? Well, we don’t need precisely correct grammar to convey understanding. Ideally we strive for correct grammar, but it is not always necessary to get the point across. My advice is to keep practicing. When a phrase pops into your head that you want to try to express in your non-native language, go for it! But write these phrases down for later investigation, to see how close you are to what a native speaker would say to convey the same idea. In this way, your command of any language will continue to improve day by day.

References

Phrases. 2017. In Linguee.es. Retrieved July 25, 2017, from http://www.linguee.es/  

The Thinker, The Gates of Hell, Musée Rodin

Trata

“Usted habla el español bien.”

“Bueno, gracias, tengo más practica para hacer, para mejorarme...y tengo—“

“Pues, trata.”

                                                                   *

For anyone who has been reading my blog entries regarding my experiences using Spanish, my second language, throughout my medical career, you will note that they follow a sinusoidal-shaped curve of emotion. There are very positive entries, which focus on powerful learning moments, both linguistically and culturally.

Then there are the frustrations that I feel when I am racing to perform an exam (because of minimal time allotted me) and diagnose a patient and explain all this in detail to the patient in a language that is not my native one. Today’s entry represents another such frustrating dip in the curve. However, I remind myself and my readers that the point of my blog is to show the experience of practicing medicine in a non-native language in its entirety: the good and the bad.  I hope my readers can understand that even in my moments of anger or frustration or exhaustion, I always work to provide the best experience possible for my patients.

I was examining a patient recently. He only spoke Spanish, so I performed the exam in Spanish. As I was finishing up my notes and printing his eyeglass prescription at the conclusion of the exam, he took a moment to compliment me, telling me that I speak Spanish well. This is not unusual, and I’ve mentioned many times before in this blog, that the majority of my Spanish-speaking patients are grateful that I conduct the eye exam in their language. Because they are grateful, most will overlook the occasional grammar mistakes that I inevitably make: the wrong verb, the wrong conjugation. Incorrect use of subjunctive. Wrong choice of the verb “to be”. 

Because I’ve become accustomed to hearing these compliments, I lapsed into my usual response in Spanish, “Thank you, yes, of course I have much more practice to do if I want to improve...”, or something to this effect. But this time it was different. The patient interrupted me with a curt, “Well, you’re trying,” in Spanish.

You’re trying.

And suddenly in my mind, the compliment ceased to be a compliment, and transformed into a criticism instead.  And listen, maybe he really  did mean it as a compliment. But I see it from a different perspective. Think about it:  when you tell someone “they’re trying” at something, what you are saying is that, although they are making a good effort, and you applaud that effort, the end result is poor. Through that one word, trata, this patient touched a nerve within me because I don’t think most patients – make that, I don’t think most people—realize the amount of work that goes into conducting a medical exam in a non-native language. And then, having to do it under a time constraint makes the situation even more stressful.

Of course, I didn’t show him how I felt. I finished my notes and handed him the prescription, and wished him well and told him that he should return for a complete eye exam again in one year. It was business as usual. However, when something someone says bothers us, we have to ask ourselves why that person’s words hit a trigger point. I don’t have to think very long or hard to know why his trata bothered me. I’m sure there are individuals out there, maybe even readers of this blog, who wouldn’t think twice about it! But the root of my frustration comes from the following:

When I was interviewing for the ophthalmology position in the practice where I work, of course I talked about my ability to conduct an eye exam in Spanish and regarded it as a selling point. Why not? I had worked over a 15-year period to build a professional fluency. And I knew that the area where this office is situated has a fairly large Spanish-speaking population. I thought to myself,  I’m being hired as an ophthalmologist, but if I can use my language skills here and there for the patients that need it, all the better. This, in my mind, would make me a better fit for the practice and would also render me an invaluable team member.

However, within the first few years of working there, the office manager began swiftly altering my patient schedule, very rapidly replacing all my English-speaking patients with Spanish-only speaking patients. The English –speakers were moved to the schedules of the other doctors in the practice. These doctors are all monolingual. This means the majority of time I spend in that office, I am only speaking Spanish from the moment I walk in the door at 8:30am until I leave at 7pm at night. That’s anywhere from 30-40 patients a day with whom I am speaking only in Spanish. This is a very different work scenario than that which was posed to me by the practice owners when I was initially interviewed. I was hired to be an ophthalmologist first and foremost.  I was hired for my medical skills, not my linguistic ones.

For anyone performing her job in more than one language, there is no denying that the work load is greater. This is because it takes tremendously more mental effort to express things clearly in another language, in addition to addressing cultural issues which also affect the interaction. I recently had to perform risk management training with my malpractice carrier, PRI. The training course, entitled Clinical Reasoning, Resilience and Teamwork, addressed this issue of speaking non-native languages in the medical setting:

                ...language barriers may create a time burden for physicians...physicians felt

            that they had spent more time with non-English-speaking patients, the actual

            duration of the encounters was no different from those with English speakers.

            The study concluded that the physicians’ perceptions that encounters with non-

            English-speaking patients were longer may have been due to the increased

            effort involved in overcoming language and cultural barriers.

After doing some additional online research, I discovered that the medical industry is not the only one where people with bilingual or multilingual skills are taken advantage of in the work setting.  Nurses, customer service representatives, administrative assistants, etc. have had similar experiences of being hired to perform a certain job task, but later told they had to do that job task in two (or more) languages, just because they have the ability to do so. These people, like me, have become very frustrated, working twice as hard as fellow monolingual coworkers, and for the same pay scale.  And the worst part is, legally, employers have the right to exploit their workers like this.  If employees are being overworked and not compensated appropriately, their only recourse is to quit.

Going back to the patient that started this conversation, the one who told me (while I was working in two languages under a time constraint)  I was only trying, am I angry at him? No. Do I think he said something offensive? No. But his words brought to the fore an injustice I have been struggling with working at this practice. It's a struggle that affects many, and if not addressed appropriately, will have a negative impact on workplace morale and employee well-being.

"When the well runs dry, we shall know the value of water." -Benjamin Franklin

Benjamin Franklin oil painting, Michael J Deas

Una conversación con un paciente

Doctora: Leí la información de la enfermera...se dice aquí que tiene usted síntomas de “destellos de luces” en la vista periférica?

Paciente: Sí. Para arriba, en este rincón de la vista (me muestra con movimientos de la mano) veo destellos, como un relámpago, de vez en cuando, y, como moscas que vuelan.

D: ¿Sabe usted en qué lado están los destellos- el ojo derecho o el ojo izquierdo?

P: Cuando me lo cubro, el ojo izquierdo, no los veo. Pero, cuando cubro el derecho, sí, veo los destellos.

D: ¿Desde cuando, más o menos, tiene usted los síntomas?

P: Hace un año, tal vez diez meses, ahora.

D: OK. Usted sabe que se le dilataron los ojos. Voy a examinar la retina—

P: Está bien.

(algunos minutos más tarde)

D: Pues, hay una explicación por qué tiene los síntomas visuales que describe.  Usted tiene en la retina periférica del ojo izquierdo un desprendimiento superficial de la retina. Está ubicado en la retina inferior, al lado nasal. Gracias a Dios, porque está ubicado en la retina inferior, usted no tiene un desprendimiento de la macula, o la retina central. Con un desprendimiento de la macula, se vuelve ciego.

P: Yo sabía que algo estaba mal. Antes de vine aquí, les he consultado con muchos otros médicos. Todo me dijo que no tenía yo problemas con la retina. Me dijeron los médicos que los síntomas indicaban solo sequedad, y que yo necesitaba las gotas artificiales para resolver el problema. Entonces, ¿qué es lo que tenemos que hacer ahora?

D: Va a necesitar un especialista de la retina, para reparar el desgarro en la retina, y para aplanar el tejido retinal.

P: Está bien. ¿A dónde voy?

D: (le doy un pedazo de papel) Aquí he escrito el apellido de un especialista de la retina con una oficina local. La dirección está ahí también.

P: ¿Él acepta el seguro que tengo?

D: Sí. Voy a decirle a la secretaria a llamar la oficina para informarle al médico que viene usted ahora mismo.  No coma ni beba nada después se va de aquí. Es posible que el médico tenga que hacer cirugía, y necesita usted dejar de comer y beber para esto.

P: (al irse) Gracias otra vez, Doctora. Como le dije antes, yo sabía que algo estaba mal. Estoy aliviado a saber la respuesta que estaba buscando.

D: De nada. Me alegra que haya venido aquí. Pase un buen día.

P: Dios le bendiga.

D: Igual.

                                                                        *

D: I read the information from the nurse...it says here that you have symptoms of  “light flashes” in your peripheral vision?

P: Yes. Above, in this corner of my vision (he shows me with hand motions) I see flashes, like lightening, once in a while, and like bugs flying.

D: Do you know which side the flashes are coming from? –the right eye or the left eye?

P: When I cover my left eye, I don’t see them. But when I cover the right, yes, I see the flashes.

D: Since when, more or less, do you have these symptoms?

P: It’s been a year, maybe ten months now.

D: OK. You know that your eyes are dilated. I’m going to examine your retina.

P: It’s OK.

(some minutes later)

D: Well, there is an explanation why you have these visual symptoms.  You have in the peripheral retina of the left eye a shallow retinal detachment.  It’s located in the inferior retina, on the nasal side.  Thank God –because it is located in the inferior retina, you do not have a detachment of the macula, or the central retina. With this, you become blind.

P: I knew something was wrong. I have consulted many other doctors before you. Everyone told me that I didn’t have retinal problems. They told me that my symptoms indicated dry eye, and that I needed artificial tears to resolve the problem.  Then, what is it that we have to do now?

D: You are going to need a retinal specialist, to repair the tear in the retina and flatten the retinal tissue.

P: OK, where do I go?

D: (I give him a piece of paper) Here I have written the last name of a retinal specialist with a local office. The address is there, too.

P: Does he accept my medical insurance?

D: Yes. I’m going to tell my secretary to call his office and let the doctor know you’re coming now. Don’t eat or drink anything after you leave here. He may need to do surgery, and you have to fast for this.

P: (upon leaving) Thank you again, doctor. Like I told you before, I knew something was wrong. I am relieved to know the answer for which I was looking.

D: You are welcome. I’m glad that you came here. Have a good day.

P: God bless you.

D: And you as well.

Una conversación. Courtesy: ClipArt Panda

Adaptations

Have you ever had the experience of sitting down and reading an article about a particular topic, only to find as you’re reading it that the subject at hand parallels almost identically the issues of a completely different topic? Recently I read a very interesting article in the magazine Living Bird entitled, “Flying in Thin Air: How do birds meet their oxygen demands at high elevation?”.  The title drew my attention because, A) as I said before in this blog, I like birds and B) my husband and I are amateur climbers with a fascination for how people handle oxygen demand at various elevations of the climb. Anyway, the article goes on to focus on the birds that survive and thrive living among the highest mountain peaks in the world.  We’re talking living at elevations of 8,800 meters (29,000 feet) or more, where the air contains less than one third the oxygen available at sea level.

Cornell PhD student Sahas Barve chose to study the survival abilities of birds among the peaks of the Himalayan Mountains. Interestingly, he discovered that the adaptations for living in such oxygen-deplete areas differed among the birds native to that area (birds that live there year-round and do not migrate) versus migratory birds (those that live there only certain times of the year).

By collecting blood samples from resident and migratory birds, he found the following information. Migratory birds produce more red blood cells, the oxygen-carrying cell in the blood, to make up for the low oxygen levels of the air. More red cells means more oxygen transport in the body. This is evidenced by a higher hematocrit on blood testing.  It is indeed an efficient way to tolerate the tenuousness of oxygen at these heights. Red blood cells can be produced relatively quickly and easily, readily adapting the birds to this environment.

However, higher hematocrit has its draw-backs.  More red blood cells means thicker blood, which has a propensity to clot. Thicker blood also moves slowly through the blood vessels, reducing speed of oxygen delivery to the body’s organs. But this short-term adaptation works well enough to get these birds through the nesting season, just long enough until they move on from these elevations.

Resident birds have developed a very different technique which allows them to survive year-round in this oxygen-deplete environment.  Instead of increasing red blood cell number, they increase the amount of hemoglobin (the actual oxygen-carrying protein) of each red blood cell.  This means each red blood cell of a resident bird carries much more oxygen than individual red cells of the migratory birds. There is no thickening of the blood, and therefore, no risk of clotting.

These highly interesting findings got me to thinking about the different language adaptations of native (aka resident) versus secondary (aka migrant) language learners/speakers. I’m thinking specifically about a trip to Croatia I took with my husband some years back.  The Croatian language is different than any language I had previously studied, so I knew I would have to give myself a crash-course in the language if I had any hope of communicating with my husband’s friends and family there. Much like the migratory birds of the Himalayas, I chose the quickest method possible to adapt myself: a traveler’s book of common Croatian phrases/vocabulary. I memorized as much as I could. I repeated phrases over and over. I taught myself the most common verb conjugations, and then I went on the trip. When I got there, these well-known phrases served me well. In Croatian I could introduce myself, order in a restaurant, thank people politely, tell them I was glad to make their acquaintance. And my husband’s family noticed: “She speaks Croatian well!”, “She understands the language!”, and I felt good about myself. A true cosmopolitan. A traveler. A multi-lingual.

However, this adaptation had its draw-backs. Rapidly, I ran out of common phrases to use. When it came to communicating anything beyond basic needs, I was lost. And native speakers don’t stick to a script. Their conversations deepened, their words became complex. Pretty soon I stopped opening my mouth because I ran out of things to say. And I stopped listening because I didn’t understand what was being said. My short-term adaptations carried me through most of my trip there—about two weeks—at which point I headed back home to my native speaking grounds.  I was relieved, and could finally breathe again.

The native Croatian speakers had a more efficient, long-term adaptation to their language. They didn’t memorize phrases for survival - they were raised in these phrases. They lived their lives in these words. They were familiar with the nuances. From infancy on up, vocabulary took up residence in a permanent part of their brain.

As a native English speaker who has spent well over half my life learning Spanish, I personally understand the struggle of transitioning from short-term to long-term adaptations in a language. Rote memorization of common phrases or vocabulary certainly help us when we start out learning a language. But memorization without practical and everyday usage will never make those words a permanent part of who we are. My daily clinical work in Spanish and my writing about those experiences help do that for me. What are you doing to help ensure permanent second (or third, or fourth, etc) language acquisition in your everyday life?

“I’m an ophthalmologist making the most of my high school Spanish. Mr. Jondee would be proud.” –BH

Bar-headed Geese, 9,000m

Those with ears ought to hear

“Somewhere, always, the sun is rising, and somewhere, always, the birds are singing.”

-Donald Kroodsma, PhD

I don’t believe I’ve mentioned this in my blog before, but, I like birds. I just really like them. There, I said it. So much so, that I sought out and found an outlet for my bird passion and became a member of Cornell University’s Lab of Ornithology. It’s a great organization dedicated to bird research as well as conservation and protection of the environment to preserve species habitat.  Planet Earth has so many beautiful, natural marvels; so many beautiful creatures and yet most people don’t notice or pay attention to any of it. People are too busy with their agendas. Their eyes are open, but they’re not seeing.  They’re driving, reading, and scrolling on their phone. They’re looking down. Their gaze is fixated on the computer screen. Few people actually look up. And fewer listen.

If you open yourself up to your surroundings,  you might be walking along one day and hear a familiar “teek-teek-teek-teek!” of an alarmed Black-capped Chickadee. Or, you may hear the answering caw of a far-away American Crow. You may awaken one spring morning to the mating song of a White-Throated Sparrow. Or, when you settle in to sleep some cold winter night, you might hear the haunting territorial hoot of the Great-Horned Owl. Try it some time. Listen. You’re not alone in this life.

As part of my membership to the Cornell Lab of Ornithology, I receive their monthly magazine Living Bird. It is filled with articles on the latest scientific research into bird behavior, conservation efforts, migration studies etc. Recently, one particular article piqued my interest because I found in it great similarity to my experiences in language learning. Birdspeak is language, is it not? Just because we don’t understand it, doesn’t mean there isn’t a significant amount of communication going on.

Insert here Dr. Donald Kroodsma, university professor (now retired), with numerous publications and accolades to his name in the field of ornithogical research. He has dedicated his post-university life entirely to birdsong, and to efforts in teaching everyday, non-scientist people how to recognize bird species based on their song. In my recent copy of Living Bird, authors conducted an interview with Dr. Kroodsma, asking him how one can become familiar with a particular bird’s song. His answers, in my opinion, truly mimic how learners of a second language begin to familiarize themselves with the speech and meaning of words spoken in a language foreign to them.

He says we can familiarize ourselves with a bird’s song in, “...the same way we get to know people.”  He uses an example of a person who moves to a new town. That person starts to get to know those around him one by one, starting with, say, the next-door neighbor. Once you keep listening to and talking to that person, it is unlikely you would mistake him for any other person when next you hear his voice speaking. Once you know him, you move on to the next person and speak with him and get to know him individually, and so on and so forth. You realize that everyone has a unique voice pattern and speech, a unique dialect. Once you know it, there is no mistaking it.

He goes on to say that any given bird species has multiple songs in its repertoire. For example, “..a Song Sparrow has about eight different songs...sit an listen to an individual and hear him sing one particular song over and over...after...10 to 20 repetitions...he’ll switch to another song.”  In this way, “..you learn...how an individual bird expresses itself.” He goes on to say that once you know the several songs unique to Song Sparrows as a whole, you will never confuse the Song Sparrow with any other species.

I can certainly attest to this mode of learning as it applies to the Spanish language. Yes, there is the generic, universal Spanish language you learn in school. But not everyone speaks that Spanish. Few people are “generic”.  During my years working at Bellevue Hospital in Manhattan and my post-residency years working in the community, I have, unbeknownst to me, been applying Dr. Kroodsma’s birdsong technique to my Spanish-speaking patients. I have spoken to and listened to many Dominican patients, for example. I have gotten to know them individually. I’ve gotten to know their Spanish individually. After a time, I couldn’t confuse one Dominican’s  Spanish with any other Dominican’s Spanish. And, after a time, I couldn’t confuse Dominican Spanish as a whole with any other country’s Spanish. Obviously, this level of learning takes time. It takes patience, and it takes a willingness to listen and interact with many different people in varying scenarios.

A final question posed to Dr. Kroodsma in this article is of particular importance: “How can birders improve their auditory memory?” He talks about 1) recording the song, so that you can hear it over and over again. In addition, he talks about making 2) spectrograms of the song. Spectrograms are line drawings of the song on paper, which visually highlight the various parts of the song: the long, drawn-out whistles, the short, quick chirps, the even shorter quicker trills. He says, “when I see the song and hear the song simultaneously, the eyes teach the ears how to listen.”

Insert here my long-held belief in the importance of reading a language to strengthen understanding and memory of that language. This is why I strongly support written language dialogue as a major means of learning and growth in language. Dr. Kroodsma’s life-long seminal work has at its focus the communication of birds. But the end result of that work is much more profound. It is communication-- among and in between individuals and then among individuals as they connect to the whole. To communicate effectively, we only need to take the time. We only have to look and listen.

References

“Get to Know Your Neighbors First: Q&A with Birdsong Expert Don Kroodsma.” Living Bird 36.2 (Spring 2017): 9.

Kroodsma, Donald. “Biography.” Donald Kroodsma: The art and science of listening to birdsong.” Wordpress. Web. Accessed 26, May 2017.

Courtesy: Totally Owls Website

Finding the Right Ritmo

Me acerco a la paciente, una mujer de 85 años, y su hija que está aquí para acompañarla.

Doctora: Hola,¿Sra. López*? Soy Dra. Hromin (sonrie,mira a su hija)– vengan Uds. conmigo por favor, vamos a empezar el examen ahora.

Sra. L: Mucho gusto (apoyada en el brazo de su hija)

D: Aquí estamos. Sra. L, usted puede sentarse ahí (le muestra la silla de examen). Y usted puede sentarse en el lado, gracias (le muestra a la hija otra silla).

(se enfrenta a la Sra. López)

Se dice aquí que tiene problemas con los lentes – no funcionan para usted—que quiere usted lentes nuevos para leer.

Sra. L: (con expresión confusa-le mira a su hija con cejas fruncidas) ¿Qué dice ella?

D: (habla con la hija) ¿Ella no comprende mi español? ¿Por qué?

La hija: No, ella la comprende, es solo, ella es vieja....(a su madre) Mama, ella le pregunta si tiene 

problemas con los lentes. Me dijo que ellos no funcionan para leer, ¿no?

                                                                          *

(Translation:

I’m approaching the patient, a woman 85 years of age, and her daughter who is here to accompany her.

Doctor: Hello, Mrs. Lopez? I am Dr. Hromin (smiling, looking at the daughter)-come with me, please, we are going to start the exam now.

Mrs. L: Pleased to meet you (leaning on the arm of her daughter).

D: Here we are. Mrs. Lopez, you can sit there (shows her the examination chair). And you can sit on the side, thank you (shows the daughter the other chair).

D: (faces Mrs. Lopez) It says here that you have problems with your glasses – they are not working for you – that you want new glasses for reading.

Mrs. Lopez: (with a confused expression – she looks at her daughter with furrowed brows) What is she saying?

D: (talking with the daughter) She doesn’t understand my Spanish? Why?

The daughter: No, she understands you, it’s just, she is old...(addressing her mother) Mama, she is asking you if you have problems with the glasses. You told me they are not working for you for reading, right?

                                                                        *         

When I was first learning how to communicate in Spanish, through real, live, conversations with patients during my medical school days, it was very rough-going for some time.  I tend to advance quickly in reading and writing language skills, but speaking and listening are a unique and different skill set.  Unlike written text, which can only appear one way on paper, spoken dialogue varies from person to person, based on accent, rapidity of speech, dialect. Does this person slur his speech when he talks? Does he drop the final consonant? Does he talk so quickly that a sentence becomes one, long, continuous word? Native speakers of a language know the various ways something can be pronounced and still make sense of it. They know the inflections, the accents, the slang, the dialect. They know when to listen, and how to listen. And they know how to speak.

In the beginning, when my Spanish vocabulary was poor, my understanding of grammar was limited and I had minimal previous interaction with native speakers-- talking in full sentences was painfully slow and choppy. It took tremendous time and effort to spit out one complete thought in the language, and it required a listener who was willing to wait to hear what I had to say-- not get frustrated and complete my sentence for me. Understandably, because my practice in the language was minimal, my pronunciation of words more often than not, was incorrect. I would put the emphasis on the wrong syllable, and native Spanish speakers listening to me would look at me curiously, with one brow raised.

That’s how it was in the beginning. But now, fast forward almost 15 years later, and I’ve worked with many Spanish-speaking patients. Their countries of origin vary, but have included a rich mix of Dominican, Puerto Rican, Chilean, Guatemalan, Mexican, Salvadoran and Peruvian patients. As a result, I’ve been exposed to various ways of speaking the language, including lenguaje llano (plain language) typical of the regions the speakers are from (known as localization in translation circles). I know what to listen for now, and I judge myself a pretty good mimic of the correct pronunciation. I don’t sound like a typical “English speaker learning Spanish” anymore. I’m proud of that.  Most patients now mistake me for someone of, say, Puerto Rican, descent, based on my Spanish. I am thrilled. I feel accomplished.  

So that is why when I come across a patient like this older woman in the above dialogue, who needs to look to her daughter to interpret my Spanish to her Spanish, I am dumbstruck. I listen carefully to the daughter to see if she’s using any special vocabulary or colloquial phrasing. She’s not! In fact, oftentimes the daughter says verbatim in Spanish what I already said- and somehow the mother understands better. ??? In these scenarios I have no answers to give on what to do when this happens. I only try to speak more slowly, loudly (if I suspect a senior patient has a hearing problem) and place more emphasis on proper accent pronunciation.

Out of curiosity, I attempted to look online to see if anyone else in the healthcare field or elsewhere, wrote about a similar experience. Not many useful hits came to light, except for one messaging site where a native Spanish-speaker wrote that when someone non-native speaks Spanish, if she doesn’t have the right “ritmo”, or rhythm, to her speech, then he has difficulty understanding her.

It seems the reality of language learning is this:  you may have built quite an arsenal of vocabulary. You may be following all of the grammar rules. You may have excellent reading, writing and listening skills.  But when you open your mouth and speak,  if you don’t have the right ritmo, then all of that knowledge is for naught. Your listener won’t understand you. You’re missing a key component in oral communication. Getting the rhythm right only comes over time, from interactions with many different native speakers. This is yet another argument I have against these “be fluent in 3 months” language programs. It took you a lifetime to get your native language’s ritmo right, why would you expect anything less from any other language?