Friday, March 30, 2012

Is There a Translator In the House??

We had a very sick patient who spoke very little English. He presented to the emergency department acutely short of breath with oxygen saturations in the 70's (a.k.a badness). He needed a chest tube but we couldn't get a proper consent since we couldn't explain to him what we were going to do. We also didn't know his resuscitation status. No next of kin. Fingertips blue, lips blue, respirations labored, shallow and >30 per min. Not good.

The hospital is small, as is the town. There is no translation service on site. I asked one of the nurses what I could to do help and was handed the phone book, "Start calling restaurants to see if anyone speaks his language". 

So I did. The waitress answered the phone, I explained the situation and asked if they had any staff that spoke Vietnamese. The receiver was placed down and I could hear muffled voices:

There is an emergency at the hospital....Vietnamese...they'll pay for a cab...yeah...but I'm no go then...OK. 

Then a man's voice into the phone, "I am on my way".

Soon after our improvised translator approached the desk, within minutes the anesthetist was explaining to our patient what was going on, what needed to be done, and what the risks and benefits were. The chest tube was inserted, his fingertips became skin colored again and he stopped using his entire body to breathe. Today I walked by and saw him sitting up in bed tackling a plateful of peas.

Little hospital medicine: where we make pediatric armboards from tongue depressors and find medical translators in restaurant kitchens.


EMT GFP said...

I love this story because it speaks to the resourcefulness of medicine of any kind. We we don't have it on hand or readily available, we find a way to make it available. Nice going! :)

Christie Critters said...

I LOVE this story. This is how medicine should work...people doing what needs to be done to get the job done. Kudos to the nurse for the suggestion, the restaurant for taking you seriously, and the translator for being willing to do his best for a fellow human being...
Eyes moist from joy and hope for humanity right now...feels good.

Albinoblackbear said...

Thanks guys, yes. I loved how it all worked out.

It is stories like that which reaffirm my love of Small Hospital work (and why I know I'll spend my life doing it).

Scrub Ninja said...

Neat solution. But couldn't you have just used a phone translation service? That would have been a whole lot faster.

Grumpy, M.D. said...

My hospital just dials the phone translation line. Any language in the world, in a few seconds.

Grumpy, M.D. said...

But I agree, it's a really great story.

Absentbabinski said...

We used to have a lot of portuguese-only patients and would have to rely on the portuguese speaking cleaning staff to bridge the gap on more than one occasion :/

Justin said...

Great post!! Dilemmas of communication and language barriers are always particularly interesting to me. What are your thoughts on using a smartphone-based app in cases like this when there is no paid telephone translation service set up and no one nearby who speaks the language? Obviously complex translations would not be possible, but in cases where all that is needed is simple informed consent, it seems like it could be sufficient.

For example, the free Google Translate app on my phone allows voice input and output in multiple languages. There is even a "Conversation Mode," where you speak the text in English, it prints out what it understood and will translate (so you can be sure it's not messing up), prints out the translated text, and then reads it aloud with a pretty smooth accent in the destination language.

For simple things like, "You need an operation on your stomach. If you do not have this operation, we think you will die. Do you want the operation?." it does a very good job. Obviously, when you start getting complicated with statements like "Your health is extremely unstable at the moment, and we might end up needing to proceed with an emergency operation, should your status decline and an exigent situation arise... Could you give use your permission to proceed with the operation, should we deem it necessary?" the app doesn't do a good job.

Any thoughts on the use of such a device in an emergency situation when no other options are available?

Rogue Medic said...

I guess the people working that night have a new favorite restaurant.

I thought only EMS had a food-related solution to everything.


kevel88 said...

Working in a small clinic, in a multilingual community- we use a phone service. AT&T has an interpreter service, we use to use for years. Now we use Pacific interpreters. . . . I just use the speaker phone. Works better than ordering an interpreter. . . they are always late or some excuse.