Connecting with Patients Despite Barriers

tobi_thaller_wht by Tobi Thaller

Residency is hard. Sometimes, it is really, really hard. So when you have a meaningful interaction with a patient, it reminds you why you are putting yourself through all of this. And it is priceless.

That was the type of experience I had with Juana. At her first appointment with me, I had been a resident for all of 4 weeks. Juana is from Mexico and does not speak a word of English.  In a similar manner, I am very Spanish-impaired.  I bought a Spanish pocket guide, eager to better connect with patients at the clinic where I work as a resident.

I looked at her weight and other vital signs in the electronic medical record and said, “Juana, usted es un puerco normal.” I smiled and looked up clumsily from the computer and the book I had propped open, the “Survival Spanish for the Medical Professional.”  At first she looked shocked, then she began laughing so hard it rumbled through her entire body.  With a warm smile, she leaned forward and put her hand on my shoulder and said, “Peso. Usted es un peso normal.”  I smiled and nodded, completely clueless as to what she was saying. Later, I found out that I had told her, “You are a normal pig”—something every woman loves to hear about her weight at her doctor’s office.

Luckily, Juana’s interpreter arrived in time to translate the remainder of the exchange and examination.  During this time, Juana covered her face with her hands in embarrassment as she talked about her depression. It was obvious that her symptoms were as excruciating to talk about as they were to experience. She cried as she talked about her feelings of guilt and shame that she was struggling so hard to function. She felt like life was not worth living, but when asked if she ever felt like hurting herself, she looked shocked again. She said she would never do that because she is a devout Catholic and God would punish her. She was resistant to starting an antidepressant medication or psychotherapy.  However, she said she would think about it.

I did not think she would be back. But two weeks later, she showed up for her appointment. And the interpreter was on time, so we did not have any linguistic complications like our first meeting. She was still in deep, apparent pain. She wanted to try the medication. We talked for a bit, and she left with a tear-stained face and a prescription in hand.

She started the medication, and at her follow up visits, I saw her psychological pain become gradually more manageable. These visits gave me the opportunity to learn a little more about Juana and her life.  She explained to me, that after first arriving in America, her first home was a shed in Texas with a dirt floor and an outhouse that was tipping over.  Juana worked cleaning motel rooms to support her family.  Her five grandkids were now the highlight of her life, and they kept trying to teach her English, but it did not stick, she said.  I learned to more deeply appreciate her warm, diverse culture.  She told me that since taking the medication and coming to her appointments, she had started to smile again. She was full of gratitude for the ways in which I had helped her. As she learned to trust me more, I felt humbled and in awe that medicine and human connection had made such a difference in another person’s life. I could not help but be touched by her deep spirituality and respect for life.

At our most recent follow-up appointment, she said, “Usted ha cambiado mi vida.”  Her eyes were teary and she beamed a big smile.  I did not know exactly what her words meant, but I understood that I had made a difference in her life.  But Juana had touched my life as much as I had touched hers. She didn’t know that every time she came to see me, I was exhausted and struggling to keep going. It reminded me that caring and curing transcend language.  She leaned in to hug me and planted double-sided, Spanish kisses on my cheeks. I looked in the mirror to see pink lipstick on both of my cheeks. Who would have thought someone I had initially called a “normal pig” would be kissing me now. Needless to say, I still have a long way to go with my Spanish.

Tobi Thaller, MD is just finishing her intern year at the University of Utah Family Medicine Residency.

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