There was a time when I'd achieved just enough mastery of the Spanish language that I could decently interview a patient who spoke Spanish, and comfortably guide her through her birth experience and hospital stay. A subsequent track working for the Indian Health Service lead me deep into the heart of the Navajo Nation Indian Reservation. I emerged years later with the ability to say "Ya'at'eeh" -- hello, in Navajo -- but could barely retrieve any appreciable memory of Spanish. And such brings me to my current story...
Not too long ago my day began with the care of a young woman from Mexico. She was transported to our hospital from a small facility in a bordering town that didn't perform deliveries. She was in her early 20s, with a petite frame, spoke very little English and was alone. I could easily detect feelings of apprehension, uncertainty and vulnerability. Despite that, she carried a memorable smile tucked between intensifying layers of labor pain.
She was braver than I when it came to the exchange of native nomenclature. Short bursts of barely decipherable English were clearer than my own strained Spanish response. I yielded to the "blue Phone" next to the bed, which was the language translation line equipped with two handsets. While clearly helpful, it still felt like a cumbersome modality for communicating. By a 3rd voice from the blue phone I stood by her bed and quickly obtained more history. Circumstances were not as straight forward as originally anticipated. She'd had few visits with a doctor, no prenatal records and her last birth was by cesarean section in Mexico because of a "too narrow" pelvis. Through the translation line, she described a long and painful labor course for an infant that didn't quite weigh six and a half pounds.
Following evaluation, recommendations were made for a repeat cesarean section. I could sense the return of apprehension and uncertainty. As with all surgeries, I reviewed the risks of bleeding, infection and injury through a process called informed consent. Perhaps a cultural factor, but "infection" rather than bleeding or injury seemed to have elicited the greater fear. In the world of obstetrics, we heed more the risk of bleeding, as hemorrhage -- worldwide -- is the most common reason why women die at birth. She looked at me with a genuine sense of worry and asked with a nervous voice, "What kind of infection will [you] give me?" My heart sank. For as long as time would permit, I tried my best to instill a sense of comfort. I assured her with sincere confidence that "everything would be alright." I had no reason to believe it wouldn't. I was accustomed to doing several cesarean sections a day under much more medically complex circumstances. Holding her hand as we moved to the operating room seemed as routine to me, as any other part of the work day.
The surgery itself progressed uneventfully. Less than an hour later, amidst a peaceful smile and a beautiful newborn, her newly established place of joy and security came crashing apart. She was hemorrhaging. It seemed so surreal, like a scene from a horror film. How could something so scary so quickly penetrate a scenario so beautiful? Emergency measures were initiated and the room was promptly populated by a well prepared, fast-moving team of nurses and other doctors. What occurred was a condition known as atony, where the muscles of the womb fail to contract and thus, continue to bleed. To save her life, she required multiple blood transfusions and a special procedure called uterine artery embolization which slowed blood flow to the womb. Her blood loss was equivalent to someone who'd suffered major injuries in a car accident or in active combat.
Appreciably, there was a Spanish interpreter present when things became emergent. But under such frightening conditions, spoken language provided minimal comfort. Against a backdrop of people, medications, IV lines, and exams, I desperately sought to communicate a language of compassion and reassurance. To re-establish "assurance" under such circumstances was a humbling challenge. Prior to that day we were strangers to one another. I was a young doctor from the South, and she a young mother from Mexico who through fate, crossed paths in a part of the country where Latin Americans, not African-Americans are the predominant minority. In the role of physician, it didn't matter that we were new acquaintances, born of different races and who spoke different languages. I spoke with my heart and I spoke with my hands a message of hope, trust and recovery. Before leaving the hospital, she gave me an enormous hug. It was a powerful act of gratitude and conveyed a clear message that compassion had indeed become our common language.