I gowned up in the doorway, studying her. She quietly stood at the head of Carlos’ bed, alone. One light in the room that was shining over his bed and bouncing off her face. Dark bags under her eyes. A worried, yet equally pained look on her face. A slightly distended postpartum abdomen, as she had just delivered Carlos via C-section 6 days prior.
I walked in, and on asking how everything had been overnight since admission, quickly realized she spoke only Spanish. I did not speak Spanish….though I guess I could understand it. Or use my French to deduce what she was saying. As it was 6am, and I couldn’t get a translator to come in fast enough for me to comfortably see my other patients and get my notes done before rounds, I decided I’d point and use French words in order to try my best to communicate with her while I did a quick physical exam on Carlos.
Once I knew he was stable, and could safely assume that nothing had changed overnight, I walked toward the door, motioning toward the clock on the wall that I would be back with the team later. Around “diez” o’clock. That was 10, right? I repeated “diez,” as she silently nodded her head, and walked out.
As I sat there during my half hour of free time after prepping my notes, I thought about this mom and her son. What kind of care was I providing them with? I couldn’t be bothered to get a translator because I theoretically couldn’t comfortably finish pre-rounding in time. I hadn’t even bothered to learn her name, so how did I even really know what was going on?
On rounds, I ensured that we got a translator. Not an iPad translator, but someone who could physically sit with us. Someone who could help her explain her story, her desires, her concerns. Someone who could ask her name.
Her name was Alma. She looked like a Alma. Carlos was Alma’s first child, and she was concerned. She was concerned that he wasn’t breastfeeding, and would only drink formula. She was concerned that this rash could be a serious infection from a peripheral IV that had been placed in his scalp in the NICU. She had questions about the medications we were giving him, about his vitals, about the plan, about how much this would cost. She did not have insurance. She was worried that she would not be able to provide him with the care he needed, both financially and physically.
I reassured her that we’d find a way to pay for the care Carlos was receiving, and that she need not worry about it. However, I probed her about the inability to physically care for him. She brushed it off, thanking us for answering her questions and saying that she’d have the nurses call us if she needed anything else. As we got up to leave, I heard her whispering to the translator, and I turned around after hearing the word “dolor.” Having originally grouped the pained look that I had noticed that morning with her worry surrounding Carlos, I did not expect to hear what came out of the translator’s mouth. Alma’s pain medications after her C-section had been sent to the wrong pharmacy, and she had been controlling her pain with Advil and ice for 6 days.
Alma had become used to remaining silent. We, as healthcare providers, had trained her to pick and choose what concerns of hers were worth our time. We would approach her with pointing, with pre-translated inquiries, with one word questions such as “dolor?,”. Never thinking to acknowledge her as a person, let alone ask her name. By silencing her concerns as a caregiver, her concerns as a matriarch, were we silencing her as a person?