Communication is the buzzword for today
May. 19th, 2005 12:15 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
osodecanelaI stopped at the hospital on my way home to see a patient that had been hospitalized the day before. It's a patient with a rather complicated medical history, and who‘s also rather elderly. I hadn't seen the patient in six or seven months, when the ER called to tell me the patient needed hospitalization. For some reason this time they called me, when on all her previous hospitalizations, one of several of the specialists involved with the patient's care had been called to take responsibility for care in the acute setting. Seeing the notes of hospitalization after hospitalization, I was struck by the need to discuss quality-of-life issues with the patient and their family. A call to the cardiologist involved with this person, revealed his suspicion that there’s likely little we can do to improve this individual's cardiac function. In short, this elder has end-stage heart disease and is not likely to be with us much longer.
I had a difficult discussion with the patient's daughter and granddaughter, unfortunately, only two of a large number of family members who’ve been caring for this patient, about the need to discuss with the specialists in particular, what they realistically have to offer this patient and at what point a hospice referral would be appropriate. In any event, when I arrived to see the patient today, I found that said cardiologist had been by the see the patient earlier in the day and had sent them home, and then neglected to call me to let me know. So, I made an unnecessary trip, and have no idea of what kind of discussion he had (or more importantly, may not have had) with the family. Tomorrow will be another day for phone tag.
A couple days ago, James was up to visit. As I was speaking at the front desk with my last patient of the day , a lovely American born Latina who grew up in L.A. (and who is pretty fluently bilingual, although she and I speak almost exclusively in English), Jaime (a.k.a. James) said something to me in Spanish as often he does, to which I responded, "Manday?" A few more comments went back and forth in Spanish and I suddenly realized that my patient was watching us, the way a spectator watches a tennis match. Finally, she said, "wait a minute!" James smiled. He bemused smile already told her he knew her surprise at watching two very Caucasian appearing men (one long-haired blond, one long-haired redhead) speaking fairly decent Mexicano Spanish with one another. He knew it tweaked her mind just a little bit. He explained to her he'd been raised in El Paso, directly across the border from Ciudad Juarez and had grown up listening to and speaking Spanish.
The usual assumption is if you are a typical American, you speak nothing other than English. Unfortunately, unless you're of some ethnic minority background, this often is the case. Speak two languages, you're bilingual. Three, you're trilingual. Only one? You're an American. When I went in yesterday morning to admit that patient at the hospital, after telling me where I could find the patient, the nurse hastened to tell me that there was an English-speaking family member at the bedside, to translate for me. I told her (in Spanish), that wouldn't be necessary, as I could speak the language. When she asked me what I had just said, I repeated myself in English. Without missing a beat, she said, "well then, can you translate for me in room 464?" Good recovery, I thought. She'd said it with a smile. Intonation, context and facial expression, make all the difference between an insult and good humor.
I’m reminded however, how much our socialization affects the style of communication. Although I was raised in this country, a large part of my ethnic roots go directly back to Eastern Europe. Traditionally, my ancestors were a superstitious people. Praise something directly, and it was temptation to the ‘evil eye’ to take it away from you. Praise is often indirect, or downright hidden. A beautiful child is called ’misekite’ which means 'my little ugly one'. I'm two generations removed from the shtetls of Eastern Europe, but like my parents before me, and their parents before them, I'm hesitant to tell you, just how wonderful something is. It's the social custom I was raised with.
When I got my first Mercedes, I was absolutely thrilled. I told my younger sister about the car in subdued vocal tones as I recounted every potential problem with the car. It needed paint. It needed new tires. It had 178,000 miles on the engine (a diesel engine mind you, and Mercedes diesel at that. If taken care of, they last practically forever.). My sister understood and responded, "that sounds pretty good. You must be very pleased." We both however knew the 'dance'. Half an hour later, when talking to my friend Michelle, I recounted the same tale about the car in the same manner and to my surprise she responded, "good Lord! You don't sound very happy. Why on earth did you buy this car?" I sputtered, “What made you think I'm not happy?" To which she said, "you sound miserable." It was then that I realized I was talking across cultures. We both thought we were speaking English, but our contexts were passing by each other by. Michelle didn't realize prior to this discussion, that my verbal style had originated two generations earlier and half a world away. T'was an early opener for both of us.
I had a difficult discussion with the patient's daughter and granddaughter, unfortunately, only two of a large number of family members who’ve been caring for this patient, about the need to discuss with the specialists in particular, what they realistically have to offer this patient and at what point a hospice referral would be appropriate. In any event, when I arrived to see the patient today, I found that said cardiologist had been by the see the patient earlier in the day and had sent them home, and then neglected to call me to let me know. So, I made an unnecessary trip, and have no idea of what kind of discussion he had (or more importantly, may not have had) with the family. Tomorrow will be another day for phone tag.
A couple days ago, James was up to visit. As I was speaking at the front desk with my last patient of the day , a lovely American born Latina who grew up in L.A. (and who is pretty fluently bilingual, although she and I speak almost exclusively in English), Jaime (a.k.a. James) said something to me in Spanish as often he does, to which I responded, "Manday?" A few more comments went back and forth in Spanish and I suddenly realized that my patient was watching us, the way a spectator watches a tennis match. Finally, she said, "wait a minute!" James smiled. He bemused smile already told her he knew her surprise at watching two very Caucasian appearing men (one long-haired blond, one long-haired redhead) speaking fairly decent Mexicano Spanish with one another. He knew it tweaked her mind just a little bit. He explained to her he'd been raised in El Paso, directly across the border from Ciudad Juarez and had grown up listening to and speaking Spanish.
The usual assumption is if you are a typical American, you speak nothing other than English. Unfortunately, unless you're of some ethnic minority background, this often is the case. Speak two languages, you're bilingual. Three, you're trilingual. Only one? You're an American. When I went in yesterday morning to admit that patient at the hospital, after telling me where I could find the patient, the nurse hastened to tell me that there was an English-speaking family member at the bedside, to translate for me. I told her (in Spanish), that wouldn't be necessary, as I could speak the language. When she asked me what I had just said, I repeated myself in English. Without missing a beat, she said, "well then, can you translate for me in room 464?" Good recovery, I thought. She'd said it with a smile. Intonation, context and facial expression, make all the difference between an insult and good humor.
I’m reminded however, how much our socialization affects the style of communication. Although I was raised in this country, a large part of my ethnic roots go directly back to Eastern Europe. Traditionally, my ancestors were a superstitious people. Praise something directly, and it was temptation to the ‘evil eye’ to take it away from you. Praise is often indirect, or downright hidden. A beautiful child is called ’misekite’ which means 'my little ugly one'. I'm two generations removed from the shtetls of Eastern Europe, but like my parents before me, and their parents before them, I'm hesitant to tell you, just how wonderful something is. It's the social custom I was raised with.
When I got my first Mercedes, I was absolutely thrilled. I told my younger sister about the car in subdued vocal tones as I recounted every potential problem with the car. It needed paint. It needed new tires. It had 178,000 miles on the engine (a diesel engine mind you, and Mercedes diesel at that. If taken care of, they last practically forever.). My sister understood and responded, "that sounds pretty good. You must be very pleased." We both however knew the 'dance'. Half an hour later, when talking to my friend Michelle, I recounted the same tale about the car in the same manner and to my surprise she responded, "good Lord! You don't sound very happy. Why on earth did you buy this car?" I sputtered, “What made you think I'm not happy?" To which she said, "you sound miserable." It was then that I realized I was talking across cultures. We both thought we were speaking English, but our contexts were passing by each other by. Michelle didn't realize prior to this discussion, that my verbal style had originated two generations earlier and half a world away. T'was an early opener for both of us.
