Monday, January 12, 2009

Language is Power II (but know your limits!)

Last week I talked about language, and how making the effort to use it can create bonds and help to seal off deeply running cultural fissures. I find that for the most part, my faltering Arabic is met with endearment, and, as I said in my last post, provides much needed comedic relief within a mostly sober environment. Often, words are used that I know aren’t exactly right in a particular context, however the patients are usually…well…patient, and their forbearing is generally rewarded with better understanding of their care (after they think about it for a second!).

I still like to be fairly certain of the meaning of the word I am using before trying it out on a patient - thanks once again to my Arabic speaking friends whom are constantly being forced to listen and give feedback as I try and twist my tongue and my throat around the unfamiliar sounds and syllables.

HOWEVER. I am also aware that in certain situations, it is not appropriate to have any ambiguity around what is being said. In some instances (usually those which are more emotionally charged), the necessary explanation or command of the language goes far beyond what I am capable of. I have also learned that sometimes, just staying quiet completely and doing your job quickly and expertly speaks louder and more articulately than the most intelligent and thought provoking exchange in any language...

A story to share:

This story is about a nurse (RN) and a doctor (MD) whose identities will remain anonymous (though I am sure many of you will have your suspicions after reading the story).

A patient on a particular hospital word is slotted for a bone marrow biopsy. Any of you who have ever experienced (either receiving, observing, or assisting with) a bone marrow biopsy know well that “barbaric” is a gross understatement in describing the procedure: The patient lies in a semi prone position while the doctor drives a needle (see above picture) roughly the width of a chopstick and the length of your hand from wrist to tip of your middle finger through layers of dermis and muscle, and into the pelvis. The intention is to collect a corkscrew-like sample of bone marrow to analyze for blood cancer (as blood cancers are characterized and can occur at any stage of cell maturation, samples must be obtained not only from the peripheral blood, but also from the early-stage undifferentiated stem cells). I say “with the intention of” because often, it takes more than one trip boring through the fleshy tunnel, and pulling it out to check if the sample attempt was successful. This procedure is done under local anesthetic (a needle as long as your middle finger is driven into the flesh and alternatively eased forward and backwards to ensure that an adequately wide area has been “frozen”). The patient gets some pre-medications for pain and for anxiety, but I liken this to offering someone a Tylenol and a pull of Mary-J before looping the noose around their necks in a lynching ceremony. Get the point? It sucks.

Anyway, this patient has a history of chronic pain and depression, and was particularly anxious and teary prior to and during the procedure. RN had pulled up a chair beside her bed, and was holding both her hands, speaking in her best soothing voice, and trying her best to pass on strength and will to the distraught woman. The woman is crying out in pain as the needle is driven into her pelvis.

The doctor is an incredibly smart man, meticulously conscious of minute details “behind the scenes”, however his bedside manner would no doubt turn Florence Nightengale to the sauce. He is not a native Arabic speaker, but seems to truly believe that knowing how to say “is there pain here”, “you are not feeling pain”, and what is the problem?” in Arabic is an acceptable range of vernacular to competently perform this procedure. As these questions were being delivered in his signature manner with a harsh accusatory “HUH?!” after every question, RNs jaw clenched tighter and tighter as her patient’s cries grew louder. The third “THERE IS NO PAIN, WHAT IS THE PROBLEM, HUH?!” was cut short by an urgent, even statement by RN “With all due respect doctor, I think the crying and the yelling is fairly indicative of the pain, and the problem is that she has an 8 inch needle the size of a pencil stuck into her pelvis…can we just get this over with as quick as possible please?”.

Well, the room was suddenly silent except for the whimpered Koran verses escaping the pursed lips of the young woman. You could have cut the tension with surgery shears. RN calmly met MD’s patronizing stare despite the creeping fingers of crimson slowly making their way up her neck in her signature blush. Just when RN was certain MD was going to stalk out of the room leaving the biopsy needle protruding out of the patient’s pelvis like a Saudi oil rig, MD broke the gaze muttering something about protocol, and the remainder of the procedure was slightly tense, but thankfully quick, quiet, and relatively uneventful.

My point here is that though it is important to know the language, it is also just as important to know your limitations, and to be honest about the range of your abilities both with yourself and others.




Kerry said...

Well I am impressed at both the level of insight and the bravery of 'RN'! =)

Very interesting and important story I think!

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Messydesk said...


I've always been proud of the ability of a certain Saudi based RN to speak her mind when necessary. It's an enviable characteristic that most will never have!