Are you still wondering how language
barriers impact real people in health care? On this page, you
will find a bank of real-life stories of people who have experienced
language barriers to health care firsthand. Feel free to draw
upon these when writing about Hablamos Juntos.
collected personal vignettes of experiences interpreters had
with patients and physicians. Most encounters affirm the important
role that interpreters have in improving communication for patients
- En Español, Birmingham, AL:
- TeleSalud Nurse Advice Service, CA
- Su Salud, Rhode Island
- MedVerse, Greenville, SC
- Temple, Philadelphia, PA
- Inova, Fairfax, VA
The patient was a 6-year-old girl accompanied by both parents 2 brothers and an older sister. The family was from Mexico had been living in the States for about 10 years. The parents spoke little English and the children of school age spoke English fluently. The patient was in for a routine follow up appointment with her gastroenterologist.
The interpreter joined the family in the room to wait for the doctor. After they had been waiting for almost an hour, the father began to ask the older sister, who had talked to the receptionist when they got there, what the receptionist had told her about a piece of paper she gave them. The older sister said it was something about lab work. The interpreter went out and asked the receptionist what needed to be done with the piece of paper, and found out that they were supposed to have taken the patient to the lab to get a test done before going back into the room. Apparently the doctor was waiting for the results before seeing the patient. When the interpreter explained this to the parents, the father got angry with the sister who had interpreted and began to scold her and call her stupid, among other things. The family went with the interpreter to the lab to get the test done and returned to their room to wait for the doctor again.
In this case, the use of a child as an interpreter caused a misunderstanding that resulted in the family waiting an excessive amount of time. If the interpreter had not gone to ask about the piece of paper the family received, they might have been waiting even longer.
A Mexican woman, 23 years old, arrived to her prenatal check up appointment at the local health department. The OB-GYN physician that works there speaks some Spanish, so she does not routinely use an interpreter. The OB-GYN doctor asked in Spanish to the patient ďAre you still having vaginal burning or itching?Ē The patient explained in Spanish that she still had some itching; but the physician didnít understand that- she understood that the patient had no more itching.
After the appointment, the patient went to schedule her next appointment with an interpreter. This is the regular procedure for Spanish speaking patients at this local health department. The patient asked the interpreter if she could ask the OB-GYN physician for the prescription for the cream she was using. The interpreter asked the physician but she would not give her the prescription because she understood that the patient was no longer having symptoms.
The interpreter facilitated another interaction between the patient and the physician and they were able to understand each other, so the patient got the prescription for the cream.
Mr. M is a 52 year old, illegal alien from Mexico who lives in the USA with a nephew. Neither Mr. M nor his family speaks English. He has diabetes and needs dialysis every other day.
Mr. M was in dialysis in another clinic when he suffered an adverse reaction because of an infection. Because of this occurrence, Mr. M was inpatient in the hospital. He was receiving care for the infection, and the doctors were discussing the need to change his catheter for a new one. Mr. M had been inpatient since Saturday morning and this encounter was the next Monday.
Mr. M usually comes to the hospital for different appointments because he suffers from a variety of medical problems. Because of his frequent visits to the hospital, Mr. M knows the interpreter. He decided to leave a message in the interpreterís answer machine telling her that he had been inpatient since Saturday.
Language is an important issue for Mr. M because the providers need to know all the details of his medical history. Also, he needs a lot of medical and laboratory tests each time he comes to the hospital. Normally, the medical clerks in the clinics make a request for an interpreter, but sometimes a Spanish-speaking doctor ĖDoctor P- takes care of Mr. M. In this specific encounter (Monday morning) Dr. P was in the room with other physicians, but all of them spoke only English.
Since Dr. P is proficient in Spanish and he knows Mr. M, the interpreter decided to stay in the room, but not participate in the doctor-patient discussion. Dr. P spoke to Mr. M in Spanish the whole time, without interpreting the patientís statements for the other physicians in the room. At some point in the conversation, the interpreter noticed that Dr. P was not aware of the problem that Mr. M had had the last Saturday because of an infection. Dr. P also didnít mention the result of the tests that Mr. M relayed to the interpreter earlier that morning, and, additionally, Dr. P paid no attention to Mr. Mís worries about his infection. Dr P even suggested that Mr. M could go home that day because he seemed to be okay.
The interpreter decided to be a patient advocate. First, the interpreter asked for Mr. Mís permission to talk with the doctors; she then requested to talk to the doctors in both Spanish and English. Both parties agreed. The interpreter summarized Ėin English and in Spanish- what had happened to Mr. M the last Saturday when he was in dialysis and had problems with an infection in his catheter. The other physicians understood the whole situation, and Dr. P discovered that the lab tests done showed that Mr. M had a serious infection. Also, Dr P. discovered that the surgeon had decided to remove the old catheter and put a new one in the left arm that week, a fact that the patient had previously tried to explain to him. Finally, all the doctors decided that Mr. M needed to stay inpatient for a couple of days until the infection subsided.
The patient was a three-month old baby who had been born premature. He was brought in by his parents; a couple from Mexico in their mid 20’s who had been living in a rural area of Alabama for about a year. The parents and the baby went to the Emergency Room because the baby was very lethargic. Interpreter was called to the ER because neither of the parents could speak English.
The doctor arrived quickly to attend this very sick baby. The mother told the doctor the baby’s history. After birth, the premature baby stayed in the neonatal intensive care unit for 15 days and there the doctor heard a murmur. The doctor had some concerns about the murmur he heard, so he scheduled the baby for a cardiac appointment two days after discharge at another hospital because this hospital does not have pediatric cardiology. The appointment was at a different hospital down the street. The mother went to the other hospital for the appointment and tried very hard to find the building and the office where the appointment was. She couldn’t find it, so she asked one of the staff for an interpreter but nobody understood what she was saying and she was not able to communicate what she needed. So she left the hospital and went home. She continued to go to her regular check-ups with her pediatrician, but was unable to get another referral to the cardiologist.
Upon arrival to the ER the baby was examined and he had a serious cardio-respiratory problem due to a heart murmur. At this stage, it was too late to give the baby the treatment he needed because too much brain damage had already occurred. In this sad case, the baby died because he did not receive the proper medical attention and interventions early in life.
Though the hospital where the baby had the appointment with the cardiologist has interpreters, in this case either no one was available or the staff did not know how to access their services. This breakdown in communication caused the woman to miss an appointment where the baby’s heart murmur could have been detected and treated.
After the baby was admitted to the hospital, the same interpreter followed the patient and he also had a Spanish-speaking doctor during his hospitalization. So there was no longer a language barrier and the interpreter and doctor were able to communicate with the parents and help them cope with this difficult situation.
A baby was born in a local Hospital. The parents were undocumented and they arrived to the USA a year and half ago from Guatemala. They had before two children that died when they where born and they did not know why. When the baby was discharged from the hospital, the doctor told the parents that she was waiting for some exams results, so she need them to call her in the next three days, because they did not have any telephone number to reach them. The parents did not call. Five days later, the father called for a follow-up appointment with the pediatrician for the baby. The father spoke to an interpreter because he did not speak English.
The interpreter told him that the first follow-up appointment for a normal newborn is two weeks after delivery and she asked if everything was going ok with the baby. He told her that the doctor at the Hospital told them that they need to know about some exam. After she knew this, she asked if the baby looks ok, and the man told her that the baby was a little yellow. The interpreter thought it could be a bilirubin problem so she asked the pediatrician what she should do. The pediatrician encouraged them to come to the clinic the same day. He told the interpreter that they had lost two babies before so they did not want to take this baby out of the home so early. After a long talk the interpreter convinced him.
When the parents with the baby arrived to the clinic, the interpreter was waiting for them and introduced them to the pediatrician, who asked for more details about the exam results that they needed to know about. The pediatrician decided to call to the hospital to find out more details and the physician there told her that they were waiting for this call because the baby had a problem with the thyroid gland.
The baby was immediately put on medications for life. The parents did not understand how critical it was to call the hospital about the exam results and they also were hesitant to call because of their language barrier limitation. Because the family knew the number for the interpreters’ office at the public health clinic, they were able to speak to someone in Spanish who relayed their message to the pediatrician. If they had waited until the regular first newborn follow-up several days later the thyroid problem could have affected the baby’s brain development.
An anxious and worried mom placed a call to the Spanish nurse advice line, asking advice on what to do with her 10 month old son who had diarrhea. She took her son to his pediatrician on Monday of last week and her son was given antibiotics. She asked what she should do because during the past 24 hours her son had severe diarrhea. Though the child was well hydrated and tolerating fluids well she did not know what to do. The nurse instructed the mother treat the diarrhea according to advice protocols. The mom was educated on home measures for symptoms relief of diarrhea and to continue given the antibiotic the doctor prescribed the patient. The nurse informed the mom that she would follow-up with her in one hour.
An hour passed and the nurse called the mother and asked how the baby was doing. The mother stated that the baby had one bowel movement and he continues drinking fluids and producing tears and wet diapers. The nurse continues to sense a little uncertainty in the mother’s voice and she instructed her that she would call her in the afternoon around 2 pm. The nurse called the mother at 2 pm in the afternoon and mother was extremely happy and thanked the nurse for providing her with the education and advice. The mother was relieved that she did not have to wait hours in the emergency room and therefore, and unnecessary ER visit was prevented.
A fifty-year-old man called our dedicated Spanish nurse advice line at mid-morning after suffering with a fever and sore throat for three days. He was relieved to get a live answer instead of a recording, speak to a dedicated member specialist, and ask for a nurse in Spanish. He could not read English at all, and his spoken English was very limited. Even though he could not communicate well in English, he was ready to go to the emergency room and try to get help. He was promptly transferred to a Spanish speaking nurse, who determined that the patient had not even taken over-the-counter medications for symptom relief because he could not read the labels at the pharmacy. The nurse was able to recommend over the counter medications, spell the label names for the patient, and instruct him on how to use each one. The patient was relieved he would not have to wait hours to get help, and an unnecessary trip to the ER was prevented.
An anxious Spanish-speaking father called the Spanish nurse advice line, after doctor office hours on a Friday evening, regarding his 10-year-old son. The medical history was that his son had a high fever and earache for 1 day, and a sore throat for 2 days. The patient had a history, since his toddler years, of recurring throat and ear infections. The father stated his son returned from school today “very hot and red”, and complaining of a sore throat. He did not have a thermometer, but gave his son one tablespoon of Tylenol elixir, which brought down the fever. Although the patient was refusing to eat food, he was drinking fluids.
The father was considering taking his son to the ER, since the doctor’s office was closed until Monday, so that his son could be given an “injection” to treat the problem. The father also expressed concern that his son was not receiving appropriate treatment since he wasn’t able to dialogue with the doctor and office staff, since they all spoke English. Following the Sore Throat and Fever protocol guidelines, the Advice Nurse directed the father to an Urgent Care this evening. The father was also educated regarding the importance of follow-up with the doctor for possible referral to a specialist for further evaluation of the recurring throat and ear infections. The father was given home care instructions per the Guidelines, especially on the importance of a thermometer and use of antipyretic treatment. The father was also instructed on the process of changing the patient’s doctor to one that spoke Spanish. The father was thankful that there was an alternative to the ER, and that he had options for appropriate treatment for his son.
A nervous mother placed a call to the Spanish nurse advice line, wondering if she needed to take her 11 month daughter to urgent care. She had taken the baby to the doctor two days earlier who prescribed antibiotics. The child had broken out in a rash, and even though she was not in any distress, the mom didn’t know what might cause the rash or what to do about it. The next medication dose wasn’t due until the next morning. Following protocols, the nurse advised the mom that the rash was most likely a reaction to the antibiotics, and to discontinue the medication for now. The mom was educated on home measures for symptom relief of the rash, including over the counter antihistamine with the correct dose. Since the mom didn’t have transportation, she was grateful to not have to go to the hospital and take care of her daughter at home instead. She would take her daughter back to the primary physician in the morning for re-evaluation.
Spanish speaking mother of a 15 year old contacted the telephone advice nurse concerned that her daughter may have been assaulted after passing out at a party, possibly due to intoxication. She nervously reported what her daughter informed her about what she remembered of the events that evening. She was uncertain what her next actions should be, since her daughter had refused to go to the ER or to the police department. Following the “STDS” & “Sexual Abuse – Suspected” guidelines, the advice nurse assisted the mother in arranging an immediate appointment with her daughter’s primary doctor, and introduced the option of emotional support services. The mother was appreciative for the assistance, guidance and reassurance.
A worried mother called the Spanish nurse advice line, requesting advice regarding her 14 month old son who was unable to move right arm. Mother was at the store and she pulled her son by the arm and the child was crying in a lot of pain and she did not know what to do. The nurse advice in a caring, sensitive and non-judgmental manner requested further information of the incidence and instructed the mother to take her son to the nearest emergency room. Mother was crying and informed nurse that she never hits her son that the pulling of the arm was an accident. The nurse in a soft calming voice informed the mother that accidents happen, and that her son needed to be seen by a physician immediately. The mother was more calmed and stated to the nurse that she felt better and was very pleased with the nurse’s advice. She thanked the nurse for not judging her. She also stated that the services Molina Healthcare is providing are great and she hopes this program continues.
Spanish speaking mother contacted the telephone advice nurse concerning her 3 year old daughter. She reported that her daughter complained of the physician requested she collect a urine specimen from her daughter to rule out an infection. She informed the advice nurse that the physician’s office did not have any Spanish speaking staff available and therefore she was not given instructions on how to correctly collect the specimen. Following the “Urination Pain – Female” guideline, the advice nurse instructed the mother on specimen collection and home care advice. The mother was thankful for the assistance, education and reassurance.
A pregnant woman in her middle twenties had recently arrived in this country from Guatemala. The women had lived in a village in the mountain area of Guatemala. The patient had come to the hospital with labor pains. The charge nurse on the labor & delivery floor then paged the interpreter overnight. This interpreter remained with the patient throughout the delivery. The next day she was paged again because the women was screaming out of control, and the nurses did not know what to do or what was going on. The woman was in distress because in her village, the cultural belief is to not brush the babies hair until the child is a year old. In this women’s village the cultural belief is that when a baby’s hair is brushed to the side it means the child will be mute. The interpreter in this case bridged the cultural gap, and educated this mother that all the children had their hair brushed to the side, and none were mute.
A married woman in her middle thirties from the Dominican Republic was at the hospital for pre admission testing before surgery. Her husband, who usually accompanied her for medical visits and served as her interpreter, accompanied her on this day. The interpreter had happened to go by and heard commotion. The patient was yelling in Spanish that she was having chest pains. The interpreter stopped in to see if she could be of assistance hearing the women screaming in Spanish. When the husband went to the bathroom she held the interpreter hands and told her that she had a hysterectomy when she went back to the Dominican Republic, and that her husband did not know. The women had pretended that she was having chest pains because she did not want her husband to know about her hysterectomy. Her husband had told her that a woman who had a hysterectomy is not a women and she feared that her husband would not want anything to do with her. She was also scared because she did not want to go through with surgery without letting the doctor know all of her health information, but she couldn’t because her husband was interpreting for her. After the interpreter was involved she escorted her husband out, and interpreted for her to complete the pre surgery interview.
For this Colombian, female patient the interpreter was not booked because she had a daughter over the age of 18 who spoke Spanish and the patient had wanted her daughter to interpret. This interpreter was there for another patient and then became involved. This was a scheduled appointment on this patient’s day of surgery. The doctor’s office lets central scheduling know when a patient has an appointment for pre admission and surgery that is LEP. Central scheduling then schedules the interpreter. The daughter had interpreted for the patient on the preadmission for the surgery. Patient did not answer truthfully about having children. The patient of the day of preadmission had said she had children, but in reality, she never had a child, her daughter was adopted, but did not know she was adopted. On the day of surgery, she heard interpreter and asked her for help. Luckily, the physician was made aware of this crucial piece of health information.
A forty nine year old woman from the Dominican Republic had an appointment with the doctor to obtain results from a biopsy done on her left breast. The patient had breast cancer.
The doctor requested the interpreter so that he could communicate to the patient the results of the biopsy taken from her left breast. This patient was scheduled to have a mastectomy. The physician had found a lump in her left breast that was not palpable, and after an ultrasound, it was confirmed that the lump was malignant. The patient was late for this appointment so the nurse asked the interpreter if she could call the patient. When the interpreter called the patient her sister answered and told the interpreter that they were going to be late for her appointment because they were praying, but ensured the interpreter that they would go to the clinic that day. The patient’s sister was a traditional healer. The interpreter passed on the information to the doctor letting him know she would be in today, but would be late. When the patient and her sister arrived, the sister stated to the nurse and doctor that they did not need an interpreter because she would interpret for her sister. The doctor explained that it was hospital protocol to have an interpreter present regardless and that he needed the interpreter for his own sense of comfort knowing the interpreter and her qualifications. The sister went on to explain to the doctor that after much praying, as a healer, she determined that her sister would not need the surgery because she had felt her breast and the lump was gone. The doctor then explained the patient’s sister that there never was a lump to be felt because it was palpable. The sister of the patient had insisted that she had indeed felt a lump, but through her prayer and healing it was gone now, and surgery was not needed. The patient and her sister began arguing because the patient had seen the x-ray of her breast with the lump. The doctor then asked the interpreter to ask the patient if she wanted to continue her visit with her sister in the room, the patient requested her sister leave the room. In the end, the patient agreed to have the surgery. Without an interpreter this patient may have never had her surgery allowing the cancer to spread.
An 81-year-old male from the Dominican Republic was a patient in this hospital’s inpatient psychiatric unit. The patient had been admitted to inpatient psych for being a danger to other patients.
The nurse at this unit requested the interpreter because she was having a difficult time with the patient who was continually exposing himself. This patient had a history of impulsive behaviors. He was refusing to take his medication, not take a shower, and did not allow the nurses to get blood samples from him. The interpreter helped communicate this information from the nurse to the patient. The interpreter learned that the patient thought that staff wanted to kill him. The interpreter helped explain to the patient the nurse’s role, why he was there, the purpose of taking the medications, and why blood samples were needed.
I was sent to The Breast Imaging Center to serve as an interpreter to a young female patient. When I arrived, I noticed she was accompanied by her husband, but also was pale and nervous.
I quickly introduced myself and I asked her what she was going to have done. I always take 10 minutes of my time to get to know a little bit about the patient’s history in order to develop a better intercultural and medical understanding.
She was asked to have an ultrasound performed followed by a biopsy after finding a lump on both her left and right breasts. We were finally called by the doctor, but only she and I were allowed to go into the room. As soon as she realized her husband was left behind, she started crying and I held her hand and told her, “Let’s see what the doctor has to say. Everything will be alright.” We both went in and she was having difficulty breathing, and then she said, “My mom and grandmother died of breast cancer…not too long ago.” The she continued saying, “I was living my only sister and suddenly she became very ill. When we went to the doctor, it was already too late. She died ten months later of breast cancer.”
I was silent for a few seconds. She looked at me and asked me for a hug. I hugged her while I was explaining to the doctor and technician what was going on. She was asking so desperately for her husband to be there. The room was so small and the doctor was becoming impatient.
I took a few seconds and explained to the doctor how important in the Latino community is the presence and opinion of our family members, especially during a critical medical situation.
The doctor relaxed almost immediately and was very understanding. She hugged Maria as well and after a big smile, let her husband come in.
It made a huge difference that was sensed right away. She asked me when the procedure was over to be with her for the results, which were going to be given four days later. I did go four days later, and I served again as an interpreter to find out about the results. It was a pleasant answer and she started crying with happiness and thanked God. After a few seconds, she thanked me and the doctor, and then the doctor thanked me for helping her understand better a little part of our culture. It was such a beautiful experience.
A woman came into the hospital to have her baby. Being unable to communicate with her, the staff in the Labor and Delivery called me to provide interpretation services. Unbeknownst to all of us, the woman’s husband had left her the day before. Being upset as well as afraid, she begged me to stay with her during the birth. The next morning after my shift was over; I went home, never to see her again…so I thought. Several months ago, I encountered the same woman again, this time in Wal-Mart. She introduced me to her son James. She had named her son after me.
I was called by the Department of Endocrinology. When I arrived, there was a very young mother, Maria, with her child, Jose. It happened that after speaking with Maria, we found out that we are both Venezuelan and what’s more, the doctor who was doing the assessment did part of his residency in Venezuela.
When the doctor finished examining Jose, he sort of said in Spanish, “Maria, le debes dar una pastilla de esta medicina a José una vez al día. Como puedes ver es muy pequeña y él puede tragar.” (Maria, you have to give Jose one pill of this medication once a day. As you can see, it is very small and he will be able to swallow it.”) Then he said he remembered once that he, thinking he did not need an interpreter, told a patient in Spanish, “You have to take one patilla once a day. It is very small and you will be able to swallow it.” The patient turned red and left very upset. He approached the nurse and asked her what was so wrong and the nurse was laughing. She finally told him, “You said ‘patilla’ which means ‘watermelon.’ You just asked the patient to swallow a watermelon!” Since then the doctor understood the importance of a good interpreter while examining a limited English proficiency patient.
That day Maria was properly instructed to give one very small pill to her son, and despite her baby’s illness, we all shared a good moment together.
I was sent to the Radiology department to meet Mrs. Lopez, a 68-year old Mexican lady. When we met, I introduced myself and after the greetings and the registration, we went to the waiting room. I noticed she was nervous, I asked, “Excuse me Mrs. Lopez, are you ok?” She responded, “Do you know, Mrs. Maria, about one and a half years ago, I went to my hometown hospital to do the same procedure. They didn’t have interpreters there, so I took my nephew to interpret. When we were in the room, I saw large needles and big machines. I asked my nephew, ‘What were they for?’ He got up and asked the nurse. She said, ‘Because of her severe condition, we will put her to sleep.’ The nurse left, and then my nephew translated , ‘Tia te van a poner a dormir.’ When I heard that they were going to put me asleep, I said, ‘I’m old but I’m not going to let them kill me.’ When they were filing out the papers for the procedure, I left as fast as I could. I don’t know, but in seconds I was out of the hospital. I was so scared my heart was beating hard, I couldn’t feel my legs! I saw a patient arrive in a taxi. When she got out of the taxi, I got in, gave him my address and we left right away. Now since that day, I have been so nervous that every time I come to the hospital it frightens me. I told her I understood. I put my hand on her shoulder and said, “Mrs. Lopez, don’t worry that was a misunderstanding.” I explained to her what “Put you to sleep” means. When the nurse came, I asked her to explain to Mrs. Lopez the whole procedure. When everything finished, Mrs. Lopez came out from the procedure very calm and said very thankfully, “Thank you Mrs. Maria for all your help!” she left with a big smile.
One afternoon, I was called to the pediatric intensive care unit because of a critical situation: a young Puerto Rican girl named Maria with Down syndrome had severe problems in her lungs. Her mother was very concerned because she saw the oxygen level changing from 45 to 25. She tried to call the nurses with the little English she knew. When the nurses came to see what was happening, they immediately called Dr. Smith to see the situation. By that time, I was already there.
Dr. Smith examined the girl. She was in real danger – the oxygen level was going down. He suggested putting her on a ventilator, but her mom denied because her brother had stayed on one for 10 years and then died. She repeated, “Please don’t do it!” The situation turned extremely difficult. Dr. Smith called his colleagues Dr. Big, Dr. Heart, and Dr. Baron, and all of them explained the procedure to the mother and the positive things that the procedure will bring her daughter. Later, two new female doctors came and told her about many examples of other similar situations. The mother refused, saying she didn’t want her daughter on the ventilator. We stepped out of the room for a little bit. Doctors arrived and they explained again the need for the procedure. Maria’s mom was upset, scared, worried, and tired. She started to cry. Dr. Ann hugged her and comforted her. I felt better after she was ok. They commented to the mom again that her daughter needed to be on the ventilator in order to survive. Dr. Ann and the rest of the doctors repeated this in many different ways. At the end, she decided to give permission to put her daughter on the ventilator. After everything was clear, Dr. Ann and Dr. Paris in fluent Spanish told me , “Muy buena interpretación Anita, nosotros hablamos español pero, en estas situaciones nos sentimos mas seguros con el interprete profesional. Muchas gracias.”
Jose was ready to have his port inserted to start his chemotherapy treatment. I asked him if he understood what the procedure was and why he needed it, and he answered, “Yes, I have anemia.” In this moment, I confirmed the importance of an interpreter. The reality in this case was that Jose misunderstood and didn’t have anemia; his actual diagnoses was really LEUKEMIA.
I was working the night shift at the hospital when a young man arrived in the ER via EMS. He had been in a car accident and had multiple injuries. The ER doctor spoke some Spanish and did the initial assessment without an interpreter. Once the doctor was done, the nurse called me to fill in the gaps on the patient’s history. The patient answered all of the questions and the nurse left. As I was getting ready to leave, the patient asked me to come closer and said he has something to tell me. He has AIDS and for some reason that was not asked at any time during the interview. I told the nurse what he has said and to inform the doctor that had done the assessment. Without an interpreter, it is my opinion that this particular patient would have waited a long time before revealing his chronic health condition.
The patient is a 3-year old male scheduled to have a tonsillectomy.
The nurse specialist interviews the parents to confirm the clinical history. The parents are Hispanic and the interpreter is present to keep the lines of communication open between them, the nurse specialist, and the physicians.
The surgeon arrives to greet the patient and family, and asks the parents if they have any questions before he performs the tonsillectomy. The parents have several questions which are all answered by the surgeon. All throughout the interpreter keeps doing her job by keeping the parents and the surgeon understanding each other.
The anesthesiologist arrives to greet the patient and family and also asks questions. The parents are starting to feel a little nervous, but the anesthesiologist reassures them that he will take care of their baby boy. The interpreter keeps explaining to the parents step by step what is taking place.
The time comes to take the little boy to the Operating Room. All the nurses are very professional and reassure the parents that they will take good care of the baby. After one hour, the surgeon is ready to speak with the parents. The interpreter is present and carefully explains the surgeon’s findings to the parents. The parents are happy and ask a few questions. The surgeon answers their questions, and the interpreter keeps doing her job by maintaining the flow of communication.
The parents are asked to go to the recovery room with the interpreter. There they find their little boy pale, sill sleeping, and using oxygen. They are scared; they expected to see their little boy looking better. The nurse specialist explains that the little boy is doing fine, and all that he needs is time to recover and wake up. She asks the parents to speak to the baby so he can hear their voices and feel secure. The interpreter keeps telling the parents all the information that ht ensure specialist is giving. The parents are still not completely convinced, but the nurse specialist and the interpreter keep reassuring the parents, and in about an hour, the little boy is doing much better.
One hour later, the little boy is transferred to the discharge area with the parents and the interpreter. This step is for observation and instructions. The interpreter translates the instructions to be followed at home and make sure that they understand the signs for infections, keep taking his temperature, what to do if bleeding occurs. This is a crucial step and the interpreter has to very sure that the parents really understand how to handle the days ahead ad how to handle emergencies. When it is time to go home, the little boy is doing great and the family is happy.
The nurses and the family are thankful to have the interpreter present during the long hours. It made things a lot easier, they said.
The patient (Mrs. Y) is a 23 year old, Puerto Rican woman who speaks very little English. She had given birth to a healthy baby boy 1 day prior. Mrs. Y already has 2 healthy children at home, ages 5 and 3, who were both born in Puerto Rico. Mrs. Y was brought to the operating room for a tubal ligation one day after the birth of her third child.
The interpreter was called by the nurse to communicate with the patient about the surgery, its risks, and the consequences. The interpreter explained that a tubal ligation is a permanent procedure that cannot be reversed. Due to her age, the doctor wanted to make sure that Mrs. Y understood the procedure and was 100% sure of her decision. The doctor spoke through the interpreter to explain the various types of contraception, including birth control pills, the patch, Depo-Provera, and the IUD.
Mrs. Y has a history of 3 uncomplicated, healthy pregnancies. After the birth of her second child, Mrs. Y began receiving the Depo-Provera injection as her form of birth control. The Depo-Provera caused her many negative side effects including fatigue, heavy vaginal bleeding, and an episode of severe depression which lasted almost one year. As a result, Mrs. Y decided that after her 3 rd pregnancy she would get a tubal ligation, rather than having to use the Depo-Provera again.
Mrs. Y received her prenatal care at a clinic where English was primarily spoken. During her prenatal visits, Mrs. Y struggled to speak English, while the providers struggled to communicate in Spanish. She had signed the required consent form 3 months in advance for the tubal ligation and was now waiting on the operating table.
After months of never fully understanding the consequences of the tubal ligation and the options that were available to her, Mrs. Y was happy to finally be able to communicate with the doctor in her own native language. The doctor asked Mrs. Y why she was getting a tubal ligation at such a young age (23 y/o). The patient explained to the doctor the horrible side effects she suffered while on the Depo shot. She was concerned that all forms of contraception would cause the same negative side effects as the Depo-Provera. With the interpreter, the doctor was able to assure her that the other forms of contraception would not have the same side effects as the Depo-Provera. The doctor encouraged Mrs. Y to try another form of birth control before getting the tubal ligation.
Mrs. Y was relieved to hear that she had other options. In reality, Mrs. Y admitted that she was not certain that she would never want another child again. She believed that the tubal ligation would have to be performed immediately following the birth of a child. The doctor explained that the procedure can be done at any point in time, when the woman is ready and 100% sure she does not want any more children. Mrs. Y decided not to have the tubal ligation, but rather to meet with her doctor to discuss other birth control options.
Thanks to the interpreter, Mrs. Y was able to make a more educated decision about her medical treatment. A decision that would have changed her life.
The patient is a 24-year-old woman from Puerto Rico. She has an 11 month old son at home and first came to the Fetal Center at 15 weeks of pregnancy with her second child. Neither she nor her significant other speaks English.
This patient suffers from a rare disease called Takayasu Arthritis, which will be further discussed below. Her doctors in Puerto Rico told the patient that becoming pregnant again could be fatal for both her and her unborn child. When the patient realized she was pregnant again, she immediately made an appointment at her local clinic. The clinic referred her directly to the high-risk clinic and fetal center for follow-up.
The sonographer originally called the interpreter at the patient’s first visit to the high-risk clinic. Once her conditions were assessed, the high-risk obstetrician decided that the patient would need to report to the fetal center every week for an ultrasound, non-stress test, and possibly a monthly amniocentesis to assess the baby’s progress. With the help of the interpreter, the obstetrician was able to thoroughly explain the patient’s plan of care throughout the rest of her pregnancy. Appointments were set up with a cardiologist, a rheumatologist, a genetic counselor, and, of course, the high risk OB/GYN staff.
The patient has suffered from hyperthyroidism since she was a child. When she was eight years old, she was diagnosed with the rare inflammatory disease known as Takayasu Arthritis. As a result of this disease, the patient has no blood flow through her carotid arteries. In other words, the only way that her brain receives blood is through the spinal column. The Takayasu is associated with other symptoms including rheumatoid arthritis and cardiac conditions. The disease is extremely rare and little is known about the treatment of pregnant women with Takayasu. The doctors immediately began to do research and create a plan for delivery. The interpreter was included in many of the doctors’ discussion and did some research on her own of the proper medical terminology in Spanish associated with this case.
After months of closely monitoring the pregnancy, the patient and her family became quite friendly with the staff, especially the interpreter, who was present at all weekly appointments. By the seventh month of pregnancy, the doctors decided that a C-section would be necessary at 35 weeks of pregnancy. On the day of the C-section, the interpreter arrived early enough to be with the patient from beginning to end. A team of over 10 doctors was present in the delivery and the interpreter stayed by the patient and her spouse’s side the entire time to allow for communication during the entire surgery.
Although the baby boy was born premature, both mom and baby recovered well from the delivery. The patient was kept in the intensive care unit under close observation for 1 week following the delivery and then discharged. The baby was kept in the Infant Intensive care nursery to gain weight and receive oxygen. During their stay, the interpreter reported to the patient and her doctors daily to allow for easy communication. The interpreter also delivered news of the baby’s status to mom, took pictures of the baby for mom, and eventually accompanied mom to see the baby in the nursery. After 3 weeks in the nursery the baby was ready to go home. All instructions for baby’s care were communicated through the interpreter. The interpreter also helped mom to set up her subsequent appointments. The patient and her family were so grateful for everything that had been done for the mom and her baby. Thanks to the interpreter, the patient and her family clearly understood everything that occurred throughout the pregnancy and delivery. More importantly, the doctor’s were able to assess her condition, keep the patient informed, and treat the patient safely.
The patient is a 16-year-old woman from Mexico. She was 9 months pregnant with her first baby. The patient received adequate prenatal care and was looking forward to having a healthy baby boy.
The Mexican woman came to the hospital in labor and stayed for 3 additional days after giving birth to recover. Unfortunately, the baby boy was born with cleft lip and cleft palate. As a result, the baby remained in the Infant Intensive Care Unit for 2 more weeks. The mother and her husband came every day to visit their baby, but were obviously distraught by their baby’s condition.
The interpreter was called for the first time by the pediatrician in the Intensive Care nursery to explain more about cleft lip and cleft palate. Also, with the interpreter, the doctor was able to explain the plan of care for the baby: including a feeding tube to be placed, an artificial palate to be made, and a meeting with the plastic surgeon. Although cleft lip and cleft palate can sometimes be diagnosed by an ultrasound, the patient was not forewarned of the condition. The patient and her spouse came to the U.S.A. less than 6 months ago, and have no relatives with cleft lip or cleft palate.
The interpreter was called to the nursery on a daily basis during the newborn’s 2-week stay. At first, the interpreter played an active role and educating the patients on their son’s condition and special needs. Eventually, an artificial palate was created and the interpreter helped the nurse with teaching the mother how to breastfeed her son.
Eventually the results of the chromosome test showed that the cleft lip and cleft palate were a symptom of a very rare chromosomal disorder called “18q Deletion” syndrome. The parents set up a meeting with the genetic counselor to discuss the diagnosis. Prior to the meeting, the interpreter requested to meet with the genetic counselor to better understand the diagnosis and make sure that the syndrome could be properly interpreted in a way the parents could understand. Although, much of the terminology used was new to the parents, the interpreter took the time to explain the situation slowly, using various terms in Spanish to ensure proper understanding.
To the parents’ dismay, the 18q Deletion syndrome is a chromosomal disorder more severe than Down syndrome. It is associated with severe mental retardation, cardiac problems, and immune system defects. While this is very difficult news to hear about your child, the patient and her spouse were fortunate to have an interpreter available to fully explain the situation in their own language.
The patient is a 62-year-old Puerto Rican male. He speaks very little English and was brought to the Emergency room by his son who is bilingual. The patient has been complaining over the past two weeks of tingling and numbness in his left arm that sometimes spread to his neck and back. This morning he called his son, but could barely talk on the phone. When his son arrived at the house, his father was weak and scared and unable to talk without slurring.
The nurse originally called the interpreter. At first, she asked to son to interpret. The son was visibly upset and unable to interpret without getting emotional.
The patient admitted that he had not seen a doctor in over 10 years and was deadly afraid of hospitals. Although he had been feeling “strange” for a couple of weeks, he preferred to use natural remedies than visit a doctor. The patient does not have a family history of major medical problems; however he has smoked for over 40 years and suffers from severe psoriasis on his arms and legs.
To rule out heart attack and stroke, the patient would need to be examined quickly. The interpreter allowed the doctor to ask many very important questions clearly and without delay. The interpreter worked with the patient’s son to understand his slurred speech. Both father and son were overwhelmed with fear and emotions. The interpreter spoke slowly and calmly, trying to sooth the patient so that he could think clearly and answer the doctor’s questions. As the doctor’s and specialists came in and out of the room, the interpreter reminded the patient of his plan of care: X-rays, an EKG, a CAT scan, and some blood tests.
Although the son spoke English, he admitted to not being familiar with the medical terminology. Also, the son preferred to console his father and stay by his side. Having an interpreter present took a lot of responsibility off of the son. He was able to concentrate on comforting his father, rather than being bombarded with translations.
Eventually, the doctors told the patient that he had suffered a stroke. Through the interpreter, the doctor explained exactly what a stroke is and how it had affected his brain. The patient was admitted to the bilingual unit in the hospital where he will begin his rehabilitation. Thanks to the interpreter he fully understood his diagnosis and his future plan of care.
Ms. R is 19 years old comes for allergic reaction. She and her parents recently moved to Philadelphia from Puerto Rico two years ago. Ms. R. came to the emergency room because she had an allergic reaction to thyroid medication. Ms. R. speaks no English. Her 16-year-old cousin, who speaks limited English, accompanied her to assist the patient during the visit.
The interpreter was not called during the patient’s assessment in triage. The triage nurse used the cousin of Ms. R. Via the interpretation of the 16-year-old cousin; the triage nurse understood that after taking a Tylenol, given to the patient by a neighbor, the patient developed some sort of allergic reaction including dizziness and headache.
The triage nurse called the interpreter because it was very unlikely that any individual would have an allergic reaction to Tylenol. After numerous attempts to make sense of the situation, the nurse finally paged the interpreter for clarification. It seems that the language barrier did not affect previous encounter/communication with the provider, because they were talking in her native language.
Once the interpreter arrived, Ms. R. spoke directly to the interpreter and informed that she suffers from a thyroid condition for which she normally takes Zynthroid. Ms. R. had recently finished her medication and began to suffer from dizzy spells and headaches. Her neighbor also suffers from a thyroid condition and offered Ms. R. one of her pills. Ms. R. took the unknown medication and began to like her tongue was swelling and immediately came to the emergency room.
The patient was treated with beardy and given a prescription for Zynthroid. She was also advised never to self-medicate any condition without consulting a physician.
Thanks to the use of a qualified interpreter, the patient could be properly treated. The health provider said that Tylenol usually is not a dangerous drug unless it is taken in large doses. Therefore, if it was believed that two Tylenol only is what the patient had taken, the nurse may not have immediately taken the patient to a room. The patient may have been sent to the waiting room, allowing her allergic reaction to worsen.
Mr. O is 78 years old. He is originally from Puerto Rico. He and his wife have been living in Philadelphia for 25 years. Mr. O suffers from COPD (chronic obstructive pulmonary disease). For the past three days he has been having much difficulty at breathing. Although his condition is a result of his smoking addiction, Mr. O and his wife are active smokers.
The treating physician called the interpreter after receiving the results of Mr. O’s blood gases. After reviewing the numbers of Mr. O’s blood gasses, the physician realized that Mr. O’s condition was life threatening and decided he needed to be intubated or he could die in less than an hour. The physician was attempting to explain the situation to the patient but it was obvious to the physician that Mr. O did not understand it. The response Mr. O continued to give the physician was that he had an oxygen tank back at his house. After numerous attempts to convince Mr. O to sign the consent to be intubated, the physician finally paged the interpreter for clarification.
It seems that the language barrier affected previous encounter/communication with the provider, because of the lack of interpreter. Besides that,the patient did not understand that his oxygen level could be fatal and that what was required to save his life was sedation and intubation for an undetermined amount of time.
Once the interpreter arrived, Ms. O. spoke directly to the interpreter and informed that he has an oxygen tank at home and it is not necessary for him to be admitted to the hospital for oxygen.
Via the interpreter, the physician was able to fully explain to Mr. O the severity of his condition and was ultimately able to save Mr. O’s life. Mr. O was very afraid, as was his wife. However, I could see the some small comfort in their eyes when I explained to them, per the physician, that the intubation was not necessarily permanent but rather important at this point in order to even keep him alive.
Thanks to the use of a qualified interpreter, the patient understood the severity of the required procedure and was able to, in a sense, to save his own life. If the patient is alert and oriented and able to make this decision, the physician cannot give the order to intubate the patient without the patient’s consent.
The parents of a five-month-old Mexican-American infant who has never left the Newborn intensive care unit visit often. They are deeply troubled to see their baby in this unhealthy state. However, it seems that they don’t understand the severity of her condition.
The Physician called the interpreter to interpret a very important discussion she needed to have with the parents of this child. The doctor had to talk to the parents about their baby’s condition and the fact that their baby unfortunately was never going to be a healthy baby, able to sustain life without machines. The Doctor explained to the interpreter that she planned to call Language Line to use a phone interpreter, but she felt more comfortable discussing these vital issues with the parents face to face with an interpreter present.
The baby has a liver that does not function correctly, she frequently has infections for which she is given antibiotics, she receives blood transfusions daily, she is blind but it has not been said a known reason why she is blind. She is intubated because she cannot breathe on her own, and she is in so much pain that the she receives frequent doses of morphine. The baby also has a feeding tube because her intestines can’t digest due to a malformation, which the Physicians have tried to repair in a previous surgery .
As an interpreter, this was definitely the most difficult and saddening interpretation case that I’ve been called to do. During this intervention the Dr. was asking the parents to consent for not having the baby revived if her air tube fell out, or she stopped breathing on her own. The task was difficult for the Dr. because she had to explain that their baby would not be living if medicine were not so advanced. She had to tell them that their baby would not live if she didn’t have breathing assistance, blood transfusions and a feeding tube. She also explained that the infant was in tremendous pain and that no one should have to suffer the way she is. The parents were hesitant because they did not want their baby to have an agonizing death. To clarify, the Doctor explained that if her breathing tube were to fall out, they would immediately give her an elevated dose of morphine and she would pass away peacefully without any pain. After much discussion, the parents decided that indeed if her tube fell out they would agree not to have her resuscitated.
This situation was difficult for everyone involved. However, having an interpreter present not only facilitated communication, but also made the family and doctor for me comfortable and able to express emotions freely without a telephone making things complicated and less intimate.
A 63-year-old Puerto Rican female came to the E.R. due to a recent painful problem that appeared on her face. The woman’s right eye appeared puffy, swollen and red. The woman complained of pain and itching where the swelling and redness was located.
The main reason for the patient to come to the hospital was that a bee had stung the woman one day prior to her visit to the E.R. Her eye was very swollen and although it looked like an allergic reaction, the symptoms and pain had gotten worse in the last 24 hours. This had led the medical staff to believe that a trauma had occurred on her face.
The E.R nurse paged the Interpreter when she discovered the woman was Spanish speaking. However, the interpreter had not been called when the patient was being evaluated in triage. The nurse, while reading the patient’s chart, explained to the interpreter that the woman had suffered a fall yesterday. (This information was completely incorrect). Apparently the diagnostic impression was gotten only from the painful complaints of the patient, which did not speak Spanish fluently, and the patient had not received help until then, by an interpreter.
The woman came from Puerto Rico recently and has been enjoying very good health until this problem presented in the last 24 hours. The patient speaks very little English and was not able to make herself understood, or express the real cause of her painful face.
Had the interpreter not been present the providers would not have known that the woman suffered 2 bee stings on the previous day. During the initial triage period the health provider either assumed the woman had fallen, or misinterpreted what the patient was saying. During this intervention it was critical that and interpreter be present. After the interpreter conveyed that a bee had stung the woman the health provider was aware that she was having an allergic reaction to the sting. Allergic reactions can be very serious and the outcome could have been traumatic if not treated properly. The physician later prescribed and antihistamine to help with the allergy. This was a perfect case that demonstrated that an interpreter was necessary from the beginning. If the health care provider had believed the woman had fallen, they might have preformed unnecessary tests (MRI etc.), which would have been a waste of time and money. Worst of all, the treatment might have been useless, or even dangerous for the patient.
Mr. J is a 38 year old male patient from El Salvador. The patient was very weak and had difficulty breathing. He had been diagnosed with HIV. The patient came to the Emergency Department because he had gone to an Urgent Clinic in Manassas and they had told him that he needed to go to the hospital to get treated.
The interpreter was called by the Nurse in Triage to find the reason that he had come to the hospital and the symptoms that he was having. The interpreter was also called by the physician several times.
The patient stated that he had gone to the doctor about 3 months ago because he was feeling very weak and had no energy. At that time, the doctor ordered some blood work and told him that he had a virus. Because he continued to feel sick, he went back to the doctor about 20 days ago. Some tests were repeated and he was also tested for HIV. He was called by the urgent care and told that he was positive for HIV. They also told him that because he was having difficulty breathing and had diarrhea for over a month he needed to go to the hospital. The patient was confused. He stated that he did not understand whether he had AIDS or not. He said that the doctor at the clinic had not explained the difference between being HIV positive and having AIDS. He was very scared and his brother said that he had lost all his hope in life.
The interpreter helped the physician to clarify the difference between having been diagnosed with HIV and having AIDS. In the emergency room, the physician explained to the patient that he was very sick with a possibility of different infections including tuberculosis. The physician explained that they could not say at this time if he had AIDS or not, but that with the right treatment and medication, he could live a normal life. The patient was relieved to have some one that spoke his language and that could give him some hope. That patient was admitted to the hospital for treatment.
A patient was scheduled to do an operation on her right shoulder. She was calling because the previous day the doctor did not use an interpreter because he felt he was capable of explaining to the patient what procedures would be done. The patient did not understand and felt very unsatisfied with the explanation the doctor gave her. She decided to cancel her operation. She felt upset that she was not given the choice to decide if she wanted an interpreter or not. The worst part was that there was an interpreter available for her.
A 40-year-old woman visiting from Bolivia was brought in by her sister. The patient complained of abdominal pain. The doctor called the interpreter because even with the patient’s sister that spoke some English, they were still having communication problems. The problem the physician had with the family member interpreting was that she was answering the questions without asking the patient.
After the interpreter was called, a medical history was established and the doctor was able to explain to the patient the treatment and test that needed to be done. The patient was admitted to the hospital with appendicitis.
A 6-month baby was brought in to the emergency room from another hospital with an extremely high fever. She was treated in the emergency room, but the baby’s brain was already damaged.
The interpreter was called to help the pediatrician explain to the parents that the baby was brain dead; even thought it seemed that baby was alive, it was the machines that were helping the heart beat and the lungs receive oxygen. The parents could not understand that the brain was dead. To them their baby looked like she was sleeping. They wanted her to stay like that forever and not be disconnected. It took a couple of hours of the interpreter and the social worker to help them understand their loss and not blame the hospital for disconnecting their baby from the machines. Medical terms were explained in plain Spanish to make sure the parents comprehended.
The parents brought the baby to the hospital because she had a cold and she was having difficulty breathing. The baby’s parents were immigrants from EI Salvador with limited English.
The interpreter was called by the Nurse to help her understand how long the baby had been sick and if they have given the baby any medication. Later the interpreter was called by the Nurse again to help the Respiratory Therapist with the teaching of an inhaler use.
When the interpreter got to the room, the Respiratory Therapist had finished the teaching with the limited Spanish that she spoke. She told the interpreter that the parents stated that they understood the use of the inhaler. Later the Nurse called the interpreter for the discharge instructions and she wanted to make sure the baby’s parents knew how to use the inhaler and at that time was established that the parents had understood ten puffs instead of two puffs every four hours.
The word “ten” and “two” in Spanish could sound similar if someone that does not speak the language fluently is saying it, and could lead to a very dangerous situation especially when dosage for medication is involved. When they were discharged the parents were very glad that they had clarified what they learned.
A 30-year-old female came in with her husband with abdominal pain. She told me that she had bladder surgery 1 week before and she was very concerned because of all of the pain she was having and was very concerned about her prognosis. She was afraid that she was going to die since she didn’t have a bladder anymore. Right then, I looked at her and asked where her incision was. “I don’t have an incision. I just have 3 cuts on my stomach,” she said. The surgery that was performed was the removal of her Gallbladder, not her bladder. I explained the difference. It was amazing how grateful they were to me for explaining something that should have been explained by the doctor before the surgery.
At the heart of excellent healthcare is the ability of doctors and nurses to communicate effectively. It is crucial patients understand their condition, treatment options and potential side effects. When language barriers threaten to impede the flow of accurate information, Inova’s interpreters step in to provide a vital service.
Interpretation is both art and science. These professionals are well-versed in medical terminology in both languages, sensitive to cultural differences and aware of the nuances of dialects. Specific techniques aid the encounter. A good interpreter is present but invisible, standing back so the patient and the provider can make eye contact. At the beginning of the discussion, he or she tells the involved parties that everything said will be repeated—no editing, additions or deletions. Comments are stated in the first person (e.g. “I have a pain in my stomach.” vs. “She has a pain in her stomach.”).
With the fast pace of healthcare, interpreters are frequently requested in multiple locations. They must be able to triage their clients and attend to the most urgent cases quickly. Additionally, interpreters serve as navigators, helping patients and families through triage, treatment and discharge and aiding with financial discussions.
Here is a glimpse of how the first two hours of one busy morning might look:
- Labor and Delivery: A 28-year-old woman is about to have a Caesarean section to deliver twins. The babies have a rare condition that requires immediate treatment. Through the interpreter, the mother describes the babies’ condition and the anesthesiologist explains the benefits and risks of anesthesia during the procedure.
- Emergency Department: A 31-year-old man arrives via ambulance after a workplace accident. Paramedics understand he fell from seven feet but the nurse soon learns with the interpreter's assistance that it was twenty-seven feet and the man is quickly triaged as a trauma victim.
- Antenatal Department : The interpreter is called in to assist in communicating with a 22-year-old woman who is referred by a clinic for pre-term labor. The physician wants to admit the patient, monitor and perhaps deliver the baby.
- Oncology: A 52-year-old woman needs to be told she has breast cancer. In addition to learning the potentially devastating news, she must be informed about treatment options, available resources and decisions she needs to make.
- Labor and Delivery: A 22-year-old woman has delivered her first child. The baby ingested meconium and the nurse must explain what that means, with the assistance of the interpreter. The woman is frightened and reluctant to allow the doctor to complete the exams necessary to determine the baby’s condition.
- Emergency Department: A 19-year-old man is confused and unable to communicate clearly. After talking with the gentleman through the interpreter, the nurse discovers he suffered electric shock while trimming branches that touched a power line. He was thrown from the tree and had several fractures.
- Pre-op: A 36-year-old woman is scheduled for a tubal ligation. The patient is ambivalent about the procedure and also under the false assumption it could be reversed. Time is spent interpreting for the physician, explaining the operation and helping the patient understand that the procedure is permanent.
- Emergency Department: A 49-year-old car accident victim has had several tests and is waiting for results. The nurse calls in the interpreter, who assists the nurse in discovering that the man is diabetic and feels like fainting. His blood sugar is immediately tested.