Before I arrived at medical school, I imagined I would learn many things. I would study physiology and pathophysiology, treatment and etiology, the realities of clinical practice: decision making, professionalism, and communication skills. What I hadn’t anticipated learning, though perhaps I should have, was a new language altogether.
Medicine is a funny thing; a jury-rigged amalgam of centuries of knowledge and of countless specialties and subspecialties working toward what is ultimately the same goal: preventing sickness, treating disease, and fostering health. It is perhaps no surprise then that its language is just as confused: a creole of Greek and Latin, French and German, English and other languages besides. Its nouns named via countless conventions: after their discoverer or their place of discovery, after anatomical position or physiological function, after order of detection or order of action, after etiology or prognosis, or after some unintelligible allusion. Nevertheless, medicine is a language, and while this truth should be clear from texts and lectures, it was only through clinical experience and reflection that I understood what this truly meant.
This past week was my first block of electives, my first full-time experience in the hospital, and so I was exposed to far more patients than ever before. It was this time in pediatrics that made me realize how much I love the human part of medicine, the rapport building and storytelling that underlie any patient interview. In pediatrics you communicate not just with the patient, but also with their families, and this provides a further gloss to the conversation, particularly when the children are too young to advocate for themselves. This nuance was eloquently demonstrated earlier this week as I watched my staff physician speak with an infant’s parents, neither of whom spoke perfect English. They nodded along, acting out a simulacrum of understanding until, looking at another member of our team, they asked in their own language if that team member could translate. What was it they were understanding before, I wondered, and what were they understanding now, listening to an imperfect translation (as all translations are) of the staff’s original words?
This idea was rekindled that night as I stumbled across an article in the New Yorker by Dr. Lisa Rosenbaum(Rosenbaum, 2013). In it, the narrator was told that her mother had suffered an injury and was given two options for treatment, both with varying chances of failure, success, and disability. The narrator’s only response—knowing technically, medically what the different side effects entailed—was to ask what any of it meant. What does it feel like, what does it cost, what does it mean to lose the use of one’s arm or one’s sight? What is it like to live and suffer with a condition one has read about, perhaps even seen patients face, but never experienced oneself? And how, if even a fellow speaker of our lingua medica cannot understand, do you even begin to convey this reality to someone else: a patient, a caregiver, a family member?
This week I have seen children present so classically with the symptoms and signs of chronic diseases that follow-up investigations were practically perfunctory. I have seen worried parents told, “we think we know what it is,” and have seen them smile as they watch this great medical miracle whirl into action for their children. They imagine, I suppose, that we will be able to fix them. They haven’t been given a diagnosis yet, but even when they are, I wonder if they will hear in those words what I have already understood: that their child has just been handed a shorter life expectancy, a life of complications and likely hospitalizations. It seems wrong that through our lingua medica a lowly medical student such as I should know their new reality before they do. Yet now is not the right time to tell them, not the right time at all. When the diagnosis is confirmed, that moment will arrive and I know that my preceptor will inform them absolutely admirably. But still, I wonder.
Words to me are bundles of intentions and impressions, attempts to pin down with a sound or scribble an idea, a meaning, a sliver of “objective reality” that we can communicate to someone else whose perspective we can never assume. In this sense, medicine does indeed have its own language, but so does every individual. Translation is always a two-way street. Just as I struggle with the best ways to communicate with a patient, so too must they struggle with me, for even if we share a first language, the meaning of any given word may be coloured differently for them. How then does one go about refining what is and forever will be an imperfect translation?
I don’t yet know the answer to this question but I have my suspicions. The first is that I need to spend all the time I can with a patient listening to what they say, attempting as best I can to understand their lives, what gives them meaning, what being sick does to them and how being better would make them feel. The second is that I must always reflect upon my own preconceptions, how my tacit assumptions can alter what a patient means into something my mind understands. These seem like simple prescriptions and doubtless they aren’t entirely enough, but until I have a better answer, I can only keep listening and learning as I work toward a less imperfect translation.