Three knocks, no answer. “Good morning Mr. Adams!” I call as I peek into his room, flicking the lights on. I am wheeling a small, flailing tablet and it unstably spins left and right, back and forth, until I park it by my patient’s bed.
Mr. Adams yawns and offers me a quiet smile before replacing his mask over his mouth — he knows that our conversation will not begin for a few minutes. The tablet is whirring, waiting for our Polish interpreter to join us on screen. While I know Mr. Adams may not understand me, I still apologize for the slow internet connection, and ask how he is doing. He quietly nods at me, but appears distracted, looking towards the screen until a young woman with sleek, brunette hair and golden, thin-framed glasses appears on the monitor.
“Hello. I will be your interpreter today. Can I please have the patient’s identification number?”
I quickly read off the numbers I scrawled onto the corner of my patient list, allowing Mr. Adams and me to officially begin our conversation. Mr. Adams is a tall man with rounded cheeks and graying hair. While his daughter has told me that Mr. Adams has a lively personality at home, during the time I have known him, he has been fatigued and somber, even with our interpreters.
This is unsurprising — he has been my patient for almost the entirety of my month on service, his health waxing and waning over the weeks. At his worst, his skin pales and his arms thin, his eyes protrude from his face. Of all the patients on our service, I worry the most about him, perhaps in part because of our communication barrier. The majority of our conversations have been with the assistance of virtual video interpreters on wheeled tablets.
When I first used video interpretative services, I thought they were miraculous. Compared to other interpretation services, the tablets were especially useful because of how easy they were to use. Phone interpretations could be difficult to hear for our elderly patients, and now that everyone was masked and spread apart, a disembodied voice seemed to add even more distance to our interactions.
Even the in-person interpreter services presented challenges. It could take days to weeks to book an interpreter, and they would often only be available at very specific times of the day, requiring teams to time their rounds exactly. Video interpreters seemed like a compromise — ensuring both flexibility and accessibility for these much desired services.
Of course, this did not mean that video communication was always smooth. We had two tablets on each floor, and with all the teams rounding roughly at the same time, it often felt like a race to get one in the morning. I would leave for the hospital extra early, toss my bag into the team room and immediately seek out a tablet to converse with my patients. More pressingly, as excited as I was about the technology, oftentimes the interactions I had with patients still left me worried about whether these services were doing our patients justice.
While video and phone interpreters allowed literal interpretation, having someone in the room who understood the patient culturally and linguistically felt necessary to allow them to truly feel heard. It was in these situations, with in-person interpreters, or providers with a shared a language, that I felt that I had a true glimpse into my patients’ personalities and wishes.
For example, at the start of my rotation we had treated a patient with heart failure, Mr. Vick, and we used the video interpreter almost daily. His responses were always curt and brief as I probed into his symptoms, the interpreter echoing our words.
“How are you feeling today, Mr. Vick?”
“Is there anything you want to chat about, or anything you have questions about?”
The day before he left, we had wanted to more thoroughly review his treatment course and medications, so we arranged for an in-person interpreter. I stepped in. “Hello again, Mr. Vick. We have an interpreter here today!”
The interpreter, a tall woman with curly brown hair, stepped forward and repeated my words in Bulgarian. Mr. Vick paused and turned towards us, his eyes widened. “Hello! It’s so nice to meet you — please, please sit down!” he gestured at the interpreter. For the next 15 minutes, he rolled through almost nonstop conversation, telling us stories of his daughters, his hometown and his favorite foods. It was as if one week of conversation was bursting out of him. As he told stories, he laughed so hard the corners of his mouth peeked out past his mask.
While our conversation did not reveal anything new medically, I saw a spark in Mr. Vick for the first time in the seven days we had spoken. I gained a new insight into who he was, beyond the strains of his heart and lungs. A part of me was glad that we got to meet this side of him before he left the hospital, but I was left wondering what had been lost during the rest of his stay without the in-person interpreter. I yearned to speak every language, to understand all of the jokes and whispers and frustrations of everyone I worked with.
I wondered how the necessary act of translation altered our conversations. So much of medical communication happens in small moments, built on trust — seemingly trivial differences in conversations can make a world of difference in care. Over time, physicians build and learn many scripts in order to communicate clearly. We learn the words to say when a loved one has died, or how to communicate the nuances of a prognosis and the unknowns of treatment. Even with these scripts, we must rely on our own judgment to sense when something has been lost in communication.
Perhaps speaking with a third party between us, weaving our words back and forth, created an unfortunate efficiency in clinical interactions that required interpretations. I knew the symptoms of my patients, but I missed the little moments when they would joke about their families, or the hesitation in their answers that meant I should probe further. I lost the afternoons where I could pop into their room and check in on them more casually, without depending on the availability of tablets or other people.
For my Polish speaking patient, Mr. Adams, I tried to stop and say hello during the afternoons to at least let him know I was checking on him when the tablets were not around. Once a week, we were able to get an in-person interpreter to visit, and as we left his room, I would ask her about common, simple phrases in Polish.
“Dzień dobry? Good morning!” I would call in the morning, as I pushed the tablet in the room, my pronunciation stilted.
“Dzień dobry,” Mr. Adams would reply, in confirmation, his eyes twinkling.
On my last week of the rotation, Mr. Adams finally reaches a point of relative stability. He is ready to transfer his care and work towards rehabilitation to go home. After a month of his health swaying in almost every direction, I feel ecstatic and relieved for him. We bring his in-person interpreter to speak with him in the morning. We review his plan and instructions with him; his daughter will arrive in the afternoon, he will wait in his room until then.
When we get word that it is time for him to leave, I do a quick sweep of our floor for the tablets. Nothing outside. I poke my head into the utility closets and snack rooms. Nothing. Somewhat disheartened, I knock on Mr. Adams’ door one more time.
“Sorry Mr. Adams! Just wanted to say goodbye.” He looks renewed. There is light in his eyes, and he has brushed his graying hair. I feel hopeful for him.
“Do widzenia — goodbye — and thank you,” I say.
“Do widzenia and thank you,” he smiles.
Author’s note: Names have been changed to protect patient privacy.