Monday, October 24, 2016

Language Without Borders

“The limits of language mean the limits of my world.” – Ludwig Wittgenstein


El paciente regresa a la oficina hoy para realizarse una visita de seguimiento conmigo.  Después de nuestra última visita, le pide un examen con el cirujano de cataratas.  Años atrás, el paciente perdió la visión en el ojo derecho, tras de un accidente al ojo.  Sucedió una catarata traumática, pero, no sabía yo el alcance del daño por la razón de él no vino con una copia de su médico historial. Sin esta información, no sabía el estado de salud de la retina y, por eso,  no sabía si fuera posible mejorar la visión con cirugía para sacar la catarata.

Doctora (Dra.).: Leí el informe del cirujano de cataratas. Se dice aquí que él ha decidido no hacer la cirugía.

Paciente (P):Sí, lo sé.

Dra.: ¿Comprende usted la razón para la decisión no hacer la cirugía para sacar la catarata?

P: Sí, pero pensé yo que, si existe la posibilidad, no importa cuán remota, de que podamos mejorar la visión con cirugía, entonces, me gustaría tomar el riesgo. ¿Me entiendes?

Dra.: Sí, pero quiero explicarle la razón para la decisión.

P: Está bien.

Dra.: El cirujano recibió el médico historial de su oftalmólogo en su país. Tengo el informe en frente de mí. Se dice <leer las letras en la pantalla> ‘...sufrió el accidente de un clavo dentro del ojo derecho, sucedió una ruptura del globo del ojo y un desprendimiento de la retina’, él añade ‘...el paciente no tuvo cirugía para reparar la retina..’

P: Sí, eso es lo que sucedió.

Dra.: Aunque no hay una agudeza visual escrita aquí, puedo decirle que, con un desprendimiento completo de la retina años atrás, desafortunadamente, no existe la posibilidad de visión viable en ese ojo.

P: ¿Cómo es eso?

Dra.:  Dentro del ojo, las estructuras que son las más importantes son el nervio óptico y la retina. Es por la razón de que ellos transmiten información visual del ojo al cerebro. Si uno de ellos no funciona, no importa lo que hagamos con las otras partes del ojo. Podemos reemplazar la córnea, el cristalino natural (que es la catarata) –pero eso no va a cambiar la visión, porque la línea de vida del ojo, la retina, no funciona.

P: Sí, la entiendo. Pero tengo una pregunta. ¿Es posible, un trasplante de la retina?

Dra.: <pensar, pensativo> Hmm. Bueno, hay experimentos ahora...los médicos están trabajando a encontrar un proceso para crecer de nuevo o reemplazar la retina. Pero ahora, desafortunadamente, son solo eso: experimentos, en las etapas tempranas. Tengo la esperanza de que, en el futuro, vamos a ver la posibilidad muy real de un trasplante de la retina.

P: Entonces, voy a continuar a esperar, a tener esperanza. Mientras hay esperanza, hay también la posibilidad de que, algún día, utilizaré el ojo otra vez.

Dra.: <sonreír> Sí, hay siempre la esperanza, y el trabajo para realizarse los resultados de la esperanza.

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As you have noticed, many times when I write my blog entries in Spanish, I leave them in Spanish, sans translation in English. I choose to do this because it represents my everyday experiences in the office. There is no interpreter when I talk to patients. There is no translation for their words or my instructions. What happens is very real, raw, and always represents a learning experience.

However, I want to translate this particular conversation I had with a patient one day to emphasize a point. I work with other doctors in the medical community at large who do not share my same passion for learning to communicate in Spanish with patients. Sadly, it’s easier for many of these monolingual English-speaking physicians to examine Spanish-speaking patients because they don’t talk to them (because they can’t, there’s a language barrier). This means they can get through the exam faster and they don’t have to bother answering patient questions because the patients can’t ask any – they won’t be understood. Exams are completed in mere minutes and very sadly, many patient concerns go unanswered and unaddressed because there is no communication. The patient may feel embarrassed to push to be understood because they don’t know English or have a rudimentary understanding of it. And there are some doctors who take advantage of this.  These doctors are not only not providing the standard of care for these patients, but at a very basic level, they are missing out on truly hearing these people: what they have to say, their thoughts and fears. This is a grave loss for everyone involved in this patient’s care.

In the above scenario, I had referred my patient to a cataract surgeon, not yet knowing the historical details of the accident the patient had in his eye years ago. I thought, if there is a possibility of vision improvement by removing the traumatic cataract, then I wanted the patient to have the opportunity to explore this option. By the time the patient’s appointment with this cataract surgeon (who does not speak Spanish) came to be, the ocular records were finally received from the patient’s ophthalmologist in his home country.  The cataract surgeon learned that the patient’s eye trauma included a completely detached retina in the right eye, which was never repaired. Knowing there was no chance for visual potential in that eye, the surgeon opted not to perform surgery. This is entirely acceptable, but what bothered me was the extreme brevity and detachment in this surgeon’s note:

  (of importance, the following lines are me paraphrasing the gist of the note, I am not transcribing verbatim here the actual patient note!):

A/P:  h/o ruptured globe right eye, with complete retinal detachment, unrepaired, and  traumatic cataract.
No visual potential. Not amenable to surgery.
Interpreter explained to patient.

The surgeon didn’t take patient questions, there was no explanation to the patient why such a retinal detachment can’t be repaired now, so many years later, and the surgeon didn’t have to break the bad news himself at all- an interpreter did. A quick 3 minute exam, 5 minutes tops, but all the patient’s hopes were riding on this exam.

After speaking myself with the patient, I could see he didn’t understand why this type of trauma could not be repaired and I explained this to him in Spanish. The patient was then able to pose well thought-out  questions to me such as, whether or not retinal transplants exist and if that would be an option for him. You can read my continued explanations to him in my translation, but my point is simply that this patient deserved more attention from the surgeon.  Now, it is possible that this surgeon is short and gruff with all his patients, English-speaking, Spanish-speaking or otherwise. 
However, I have seen this many times before, particularly when a doctor does not speak the patient’s language, it is easier for the exam to be done in minutes and pass any explanations off to an interpreter.

In my opinion, you, as a doctor, can’t avoid the tough questions by claiming not to understand the questions. If you are treating a patient population that speaks a language other than your own, then you are obligated to understand and be understood, and to take whatever extra time is needed to ensure that.

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The patient returns to the office today for a follow-up exam with me. After our last visit, I had requested for him an exam with a cataract surgeon.  Years ago, the patient lost the vision in his right eye after sustaining an accident to the eye.  A traumatic cataract resulted, but, I didn’t know the extent of the damage because the patient did not come with copies of his medical ocular history.  Without this information, I didn’t know the state of health of the retina, and as a result, I didn’t know if it was possible to improve the vision in that eye with cataract surgery.

Doctor (D): I read the cataract surgeon’s report. It says here that he has decided not to do the surgery.

Patient (P): Yes, I know.

D: Do you understand the reason for this decision not to do surgery to remove the cataract?

P: Yes, but I thought that, if there is the possibility, no matter how remote it may be, that we can improve the vision with surgery, then, I would like to take that risk. You understand me?

D: Yes, but I want to explain to you the reason for this decision.

P: Fine.

D: The surgeon received your medical record from your ophthalmologist back in your home country.  I have the report in front of me.  It says <reading from the screen> ‘...he suffered an accident of a nail to the right eye, resulting in a ruptured globe and a retinal detachment’,  he adds, ‘...the patient did not have surgery to repair the retina...’.

P: Yes, that is what occurred.

D: Although there is no visual acuity written here, I can tell you that, with a complete retinal 
detachment so many years ago, unfortunately, there is no possibility of viable vision in that eye.

P: Why is that?

D: Inside the eye, the structures that are the most important are the optic nerve and the retina.  It’s because they transmit visual information from the eye to the brain.  If one of them doesn’t function, it doesn’t matter what we do with the other parts of the eye.  We can replace the cornea, the natural crystalline lens (which is the cataract) –but we are not going to change the vision because the lifeline of the eye, the retina, isn’t functioning.

P: Yes, I understand. But I have a question.  Is a retinal transplant possible?

D: <thinking, pensively> Hmm. Well, there are experiments now...doctors are working to find a process to grow a new retina or replace the retina.  But for now, unfortunately, they are only that: experiments, in the early stages.  I have hope that, in the future, we are going to see the very real possibility of a retinal transplant.

P: Then, I am going to continue to hope, to have hope.  While there is hope, there is also the possibility that, one day, I will use the eye again.

Dr: <smiling> Yes, there is always hope, and the work to bring about the results of that hope.

Adirondack Balloon Festival 2016
'Without Limits'



Saturday, October 8, 2016

The Wow! Signal

Every now and then I enjoy reading about a good mystery. We live in a day and age when very little is left to the imagination. Most questions in life are answered. Most problems, solved. And I think that because we are privileged to live in such a scientifically advanced time, we’ve become used to having the solutions to various problems seemingly at the tips of our fingers. Therefore, when a topic comes to the fore every now and again that we don’t understand and don’t have a solid explanation for, it can indeed be a scary, brow-raising (if not hair-raising) enterprise. I recently read about one such event that I’ll share with you right now.

Humanity has always been curious about space: what’s out there, how far it goes and the inevitable question: does life exist anywhere outside planet Earth in far-away galaxies? Over the years, there seemed little evidence of this potential extraterrestrial life. Mostly hoaxes or elaborate stories, time and again disputed and disproven. However, something wonderful and fantastic occurred that truly piqued everyone’s interest in the possibility of alien life.  In 1977, astronomers were using a radio telescope called Big Ear at Ohio State University to scan radio waves coming into Earth’s atmosphere from space. Most of what filtered in was hum-drum: expected low –frequency blips collected on the recording tape, leading to reams and reams of useless mundane information.  But on one fateful night that year, the telescope picked up 72 seconds worth of high-burst radio waves from the night sky.  Astronomer Jerry Ehman, who found and was analyzing the signal at that time, was so excited by this finding that he circled the radio wave read-out on the recording paper and wrote the word “ Wow !” on it.  This signal (thereafter referred to as ‘the Wow!’ signal) was definitely emanating from interstellar space, from Chi Sagittarii - a group of stars that are a part of the constellation Sagittarius.

The finding was especially exciting because over a decade prior to this, Cornell physicists has speculated that, if alien life truly existed and wanted to send a communication signal out into space, they might choose to utilize a frequency of 1420 megahertz. This is because this frequency is naturally emitted from the element hydrogen, the most common element in the universe and therefore familiar to all living inhabitants. The exact frequency of the Wow! signal was recorded as 1420.46 MHz.

Jerry Ehman and other astronomers worked vigorously to try and detect the signal again. They made countless attempts over the years, but to no avail. No such signal or anything similar was ever recorded again. If someone was trying to communicate with Earth, why wasn’t another attempt made? Over the years, more sophisticated and sensitive radio telescopes were employed, but no new information was found. In 2012, which marked the 35th anniversary of the Wow! signal, a radio telescope in Arecibo, Puerto Rico, was used to send over 10,000 Twitter messages to the same location in Chi Sagittarii where the signal originated.

Because no other signals have been detected since that fateful night in 1977, several theories emerged as to what, other than extraterrestrial life, could have caused such a high frequency wave.  Perhaps the signal really originated from Earth but pinged back after hitting space junk? Could the source be military in origin? Due to various physics explanations beyond the scope of this blog entry, no theory seems to fully explain the phenomenon. Therefore, the origin of the Wow! signal remains a mystery...

...until now, maybe?

In this year 2016, a former analyst with the U.S. Dept. of Defense and astrophysicist Professor Antonio Paris has proposed an interesting and exciting theory that he is prepared to test. When analyzing star charts going back to the 1970’s, two comets happened to be passing through the area of space from which the Wow! signal originated. Their names are  266P/Christensen and 335P/Gibbs and were only themselves discovered in 2006 and 2008, respectively. 

This is an important observation because comets, as it turns out, are surrounded by clouds of hydrogen gas millions of kilometers in diameter. This hydrogen gas could have been the source of the signal detected that night in 1977 by Ehman.  Professor Paris has raised enough funds to build his own radio telescope. Mapping out the comets’ paths, comet Christensen will pass through Chi Sagittarii again on 1/25/17 and Gibbs will return there on 1/7/18.  Should the telescope detect a signal similar to Wow! on either of those dates, then that proves that a comet, and not alien life, is the origin of the signal.

I personally find this extremely fascinating. It is now October 8, 2016. In a few short months, we could potentially have the answer to a 40-year-old mystery!

So what does this all have to do with my blog: Spanish language in medicine? Well, nothing really! Other than this, perhaps: the Wow! signal mystery and its investigations underscore the never-ending curiosity and endurance of the human spirit. We are always looking for answers. We don’t want to leave any stone unturned. We want to believe as the great Marie Curie once said, that “ Nothing in this life is to be feared, only to be  understood.” I have spoken many times before in this blog, about how there are days in my Spanish language learning that I feel fulfilled and unstoppable. And there are days when I get tripped-up trying to express some grammar concept, like past subjunctive or the conditional--uh, how abhorred!--concepts which at times I feel I'll never fully grasp.

But then I read stories like this one and I think, the road may be long and full of twists and turns, but anything is possible. With imagination, a desire and a drive to learn, maybe there really aren’t any such things as mysteries in this life. Maybe all the answers are already out there. They are simply waiting to be found.

References

Clark, Stuart. “Alien ‘Wow!’ Signal Could Be Explained After Almost 40 Years.” The Guardian. https://www.theguardian.com/science/across-the-universe/2016/apr/14/alien-wow-signal-could-be-explained-after-almost-40-years (Accessed October 7, 2016).


“Wow! Signal.” Wikipedia: The Free Encyclopedia. Wikimedia Foundation, Inc. Web. 7 October 2016.