CATEGORY: MEDICAL INTERPRETING, DOCTORS, INTERPRETING It’s three o'clock in the morning. A message appears on my beeper, "Labor & Delivery," accompanied with a high pitched "eeee!" It is the second labor and delivery service call I receive in my brief, new story as a Spanish medical interpreter, and I'm hoping this time I actually get to see a delivery.
The first call I received from that department had taken me to the bedside of a young Mexican woman in her late twenties. She was suffering through the pains of contractions when I first saw her. And I would see her again, but only after she had successfully delivered a beautiful and healthy baby girl. I would not be there for all that happened during the two hours in between -- the push, the sweat, the baby's cries. Had I been there, I would have witnessed one of the approximately 2.4 births of fellow human beings that occur every second, according to the “2010 World Vital Events” table published by the U.S. Census Bureau. As a curious fact, the table also shows that, on average, about 1.8 people die within the same range of time. It's funny how as common an occurrence as both events are, human beings seem to undergo both transitions rather privately.
I am inside of the Spanish interpreter’s office. I drop the book I have been reading for the past three hours, waiting to be called, I reach for the door, and run out, all the way to the main building up to the fifth floor where a family from Guatemala needs my assistance. The nurse is there already -- a nice, fifty-something lady with a very sweet, maternal demeanor. The doctor enters the room after me. A young woman in her thirties, the obstetrician is visibly miserable, dragging herself, and slurring her tongue as she speaks. Behind her stands a young, wide awake medical student noticeably eager to get her practice for the night.
"I'm doctor So-and-So," the doctor says. And even though I have already introduced myself to the family as the medical interpreter, informing them as I do that I will be translating in first person, when I repeat, "I'm doctor So-and-So," to the patient, in Spanish, the patient, a young girl I'll call *Felicia,* smiles at me and utters, "Doctor," clearly referring to me. The physician says, "No! I'm the doctor!" almost too loud to hide her frustration.
I repeat my information to the patient. "I'm the Spanish interpreter,” I say, “And I'm here to help you communicate with your doctor in English. When I speak to the doctor,” I say, pointing with my hand at the obstetrician, “I'll be repeating in English what you say in Spanish, just as if I were you. Then, when the doctor speaks to you, I'll translate what she is telling you, speaking to you as if I were her." The young woman nods as expected, like she understands the information I have relayed now for the second time.
Though her gestures are what is expected, something about them seems a bit odd to me. I cannot quite tell what makes them be so, and at least for a few seconds I remain almost fooled. I would have continued in such state for a while longer had the woman’s husband not interrupted me to declare: "She doesn't know a lot of Spanish.” Ah! I think, and suddenly remember a conversation I had had with a fellow interpreter just a few days before. The majority of the population that has emigrated from Guatemala during the last few years doesn't speak Spanish. "Where are you from?" I ask. "Guatemala," the husband answers. The young woman speaks Mam.
My colleague had told me about what she called, the "trend." For Mam, a Mayan dialect spoken in different regions of Guatemala, there are hardly any interpreters currently available. At the hospital where I work, one of the best equipped hospitals in the state when it comes to interpreter resources, there is but a single Mam interpreter.
According to the Columbia Encyclopedia, about 60% of the population in Guatemala, (gwätəmä'lə), officially Republic of Guatemala, is of mixed Mayan and Spanish descent, or Ladinos (individuals from mixed heritage).
The remaining 40% of the population is of purely Mayan origin. Just like in many places in Latin America, these indigenous people in Guatemala have suffered from discrimination, poverty, and relative geographical isolation throughout history. Although Spanish is the language spoken by approximately 60% of the people, the rest speak several indigenous languages, Mam being one of them. Some sources, such as the Ethnologue, say that about 56 dialects are spoken in Guatemala, 53 of which are “living” languages and three of which are no longer spoken.
As soon as I learn that the young woman speaks Mam, I know I am about to get a bit of my own medicine. If I often interpret for a physician who cannot tell the difference between Spanish and Portuguese, isn’t knowledgeable of my culture, and probably feels lost or seems somewhat removed from the interaction (or worse, impatient), this time there will be at least two members of the team feeling that way -- the physician and myself. This time I am afraid. I know I am not going to be in complete control of the interpretation, and for the first time, I begin to understand what a physician might be feeling under the same circumstances.
What ensues is a humbling lesson in teamwork and communication. When the doctor finds out that instead of two languages required during the interaction, there would be three, I swear I could see a narrow vein on her forehead begin swelling up. “I’m sorry,” I say to the physician, attempting, with a smile, to let her know that I sympathize with her. “I’m afraid this will be a three-language affair. The patient does not speak Spanish either.”
The only communicator between the young woman and the physician, besides me, the interpreter, is an idle husband taking care of a relentless three-year old child who persists in crying. It all goes a bit like this:
"When did her contractions start?" the physician asks. "When did the contractions start?" I repeat in Spanish, both to the young woman and to her husband. "This afternoon," the husband says, answering for the young woman.
Physician: "How was the fluid that came out before? Did it have blood? Was it white? Yellow?”
Interpreter: “How was the fluid that came out? Did it have blood? What color was it? White? Yellow?”
Husband: “No.”
Interpreter: “Well, can you ask her, just in case she has information you don't know.
The husband hesitates. He translates something. He brings back, “No blood.”
Interpreter: “…but was it white? Or yellow?
Husband hesitates. He doesn’t want to translate any further. “She just wants her pain medicine,” he says. I translate back to the obstetrician who is increasingly looking as if she were on the verge of losing it. I say, "But was it white? Was it yellow? Was there blood? “ I ask again, having the sense that the husband hasn’t really been relaying the questions to his wife. “This is team work, you know, Mr. Feliciano?” I feel the need to add. “We have to do this together,” I tell him. “The doctor needs all this information to be able to help your wife better and faster. Let’s just do this so they can help her. We have to work together Don Feliciano. Let's do it, you and I, come on. Can you ask her please señor Feliciano? Was there blood in her fluid? Was it yellow? White?”
The husband translates. The answer comes white. The doctor is tired. The husband is exhausted. The girl is in terrible pain. She now trembles --- visibly suffering the frequency of her contractions. She mumbles constantly in Mam.
"Can you give something for the pain?" the husband says. I translate. The nurse explains the options: a shot in the buttocks, an intravenous line, or an epidural. "What's an epidural?" asks the husband. "It basically numbs the body from the waist down. You won't feel the contractions." He translates immediately. The woman nods with desperation. She mumbles something else in Mam ending with “epidural.” She needs to hear no more. "Epidural," says the husband.
The nurse tells them that she will first need to get the results from the blood test, and only then will the team be able to give her the medication to stop the pain. It’s an arrangement the couple does not enjoy, but there’s nothing else they can do. The nurse leaves the room. The clock starts ticking.
The husband waits for the baby to be born. The little girl waits for the attention of her mother who cannot possibly pay any attention to her amongst the increasing pain she’s experiencing. The mother-to-be waits for the pain medication. The medical team? Nobody has spoken to the family for the last twenty minutes. I begin feeling as impatient as the family. Also, I feel helpless: I don't really know how to interpret these gaps filled with time. I can only look at the mother and the father and smile shyly as if telling them, "I'm sorry," feeling guilty despite knowing it isn't my fault.
Eventually, we will all find out that the medical team has only been waiting for the mother to dilate more – the last two centimeters. Birth could happen soon. Any medication now and everybody would have to wait for another two hours. The medical staff cannot afford this -- but nobody tells the parents. The family is only told to wait for an anesthesiologist that they will see walk by their room, but that will never cross the threshold.
For the mother, it's been thirty-five minutes of pain. She is ready to give birth. Her body shakes like a volcano about to erupt. The husband has caught the exasperation. The medical team – nurses, obstetrician and medical students – are ready.
It's time to push.
"You can go behind that curtain," the doctor tells the man. Carrying their three year old in his arms, he hides with his daughter behind the curtains as told. "We just don't want the little girl to be too impressed," explains the nurse.
The mother receives instructions to push hard during each forthcoming contraction. Each time, the man emerges behind the curtain to help translate. I have positioned myself to the right of the patient’s stretcher around which the doctors work to the right of the drape that hides the husband. I translate and interpret back to the doctor, and for the first time I look. I've never seen images like these except through the filter of a television screen. And right now, even standing before them, there is still a surreal quality about them. I can't really believe the little round thing I see slowly emerging through the labia of the vagina is really a human being.
The mother pushes. The medical student begins assisting but her inexperienced hands are rapidly replaced by those of the physician. "Push harder!” the nurse says. “You have to really push now,” the obstetrician yells. “Open your legs!” Abra sus piernas mucho más, por favor. “Wide.” Más. ”Open.” Abra. “More!" yells the doctor in English. “Más,” I interpret in Spanish, and the husband yells in Mam from behind the curtain. The baby’s head is now out, and so is my almost inaudible gasp. “That’s a head!” I catch myself thinking. “A human head!” Of course it’s a human head, but it’s the first human baby head I have ever seen emerge from such a private place.
A few more pushes and the baby is finally, wholly, part of the outside world! I squeak a little. The father emerges from behind the curtains with his daughter. The newborn is a boy. He is been cleaned up by the nurse and wrapped up into a small bundle placed on top of the mother's belly. With the three-year old in one arm and a disposable camera in another, the father snaps pictures all over the place. "Do you want me to take the pictures?" I offer. I take many pictures with his camera. I begin applauding softly. A feeling of elation transits my entire body. Although it goes away fast, and I am aware as it passes, it leaves something behind.
No. I’m not crying. I’m not feeling emotional. I’m not even wondering how it will feel when it’s my turn. I’m just happy. And it’s a different kind of happiness. I had never seen a human life emerge into the world until today, and I’m shocked. The last picture I take, before there's no more film on the device, is a great image. Taking it makes me feel as I felt when I was a kid and my entire group of friends and I had just achieved something we could not have achieved each by themselves, something that we intuited was important, that perhaps nobody else could do as well as we could; something that always made me wish for somebody – an Other – to be watching, in complete awe of us.
Of all the sensations I'm experiencing, this is what I don't feel: that I am Puerto Rican, that I am in the United States or Malaysia; that anybody is Guatemalan or American.
[Note: details about people have been changed to protect people's identities.]
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