Archive for the ‘Spanish fluency’ Category

This year’s first Arctic day seeing patients

October 22, 2017

The one forty-five didn’t show

Perhaps the wind and the snow

Made him think twice

About going out on the ice

Where a fall can be the stop of your go
Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. After 3 months in northern British Columbia, and a month of occasional shifts in northwest Iowa, I have returned to the Arctic. Any identifiable patient information has been included with permission.

I started in to seeing patients this morning after rounds. The first patient of the day would have presented more difficulties if I didn’t speak Spanish with considerable tolerance for dialectic variation.
I got a chance to write when my 1:45PM patient didn’t show.
In less than 72 hours the weather went from overcast and rainy to snowy, then clear. When snow falls, people become the unwilling slaves to Newton’s 3 laws: A body in motion remains in motion absent external force, a body at rest remains at rest absent external force, and for every action there is an equal and opposite reaction. Friction can conceal those laws from our consciousness, but put dry powder snow onto black ice, and people slip, slide and fall. And then they come to see me.
The real heart of a medical visit, though, lies in evaluating what the illness means to the patient. And each patient so far today arrived with unique circumstances with a fascinating back story.

Consider the overall Alaska picture.  Natives have seen tremendous change, and many have been engulfed by linguistic upheavals.  In the memory of people younger than me were the trips onto the winter sea ice, camping in igloos to hunt seal with harpoons, using dogs to find the holes in the ice where the seal come to breathe.  Most non-Natives moved here from somewhere else, and each one finds themselves in the middle of a personal odyssey.  Of the small number of non-Natives, born here, most have moved around, a lot.  Each move has its own tale of motivations, losses, and gains.

Those, like me, who keep coming back to the 49th state, have their own epics.  This time I’ve found two people I’ve worked with before in other places on the Alaska coast, and a third is soon to arrive.

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Bits and pieces from a couple of days in Urgent Care

October 16, 2015

I explained the news in a flash

About laws confusing and brash

With circumstance and pomp

In workman’s comp

We’re not allowed to take cash.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. I spent the winter in Nome, Alaska, followed by assignments in rural Iowa. This summer included a funeral, a bicycle tour in Michigan, cherry picking in Iowa, a medical conference in Denver, and two weeks a month working Urgent Care in suburban Pennsylvania. Any patient information has been included with permission.

I’ll leave out the tortuous background story of why I came to speak Spanish fluently, but I find myself in 21st Century USA with a talent highly valued in the medical profession.

While the United States recognizes an employer’s moral obligation to take care of workers’ on-the-job injuries, each state has a different system and the best of them have Byzantine and incomprehensible nuances.  I have little legal vocabulary in English, and my only Spanish legal vocabulary comes from reading the translation of John Grisham’s Runaway Jury.  English language explanations carry a high level of difficulty that goes to mind-boggling on the other side of a language barrier.  The front office called me up to translate; it got worse when I explained that acceptance of cash for this particular case would have broken the law.

I got a chance to talk to a patient from Uruguay.  The mention of the patient’s hometown brings back wonderful memories and we talked with relish about the high-quality cheese and yogurt that come from the government dairy monopoly.

Occasionally the nurses need me to explain urine drug testing in Spanish to prospective new hires.

But sometimes a day or two goes by without speaking Spanish, and I miss it.

I took care of a patient with a straight-forward ear problem.  After successful resolution I confessed that making people better before they leave keeps me in the game; it’s the doctor’s moment.  Maybe because I listen well, or maybe because my face encourages people to talk, or maybe because the patient was ready, at the end of the visit I listened to a story brimming with more irony than drama but plenty of both, and not reflecting well on my profession.  I explained that as a front-line doc, someone else always knows more than I do about, for example, escalating abdominal symptoms.  At home, I said, I know exactly which doctor I’d send you to.  And then I talked about the inherent problems of being a team player and knowing nothing about the local talent.

Towards the end of the day I attended  a child.  The medical problem soon taken care of, I reached into my pocket and brought out my yoyo, as I usually do at the end of a visit if children are present.  For the first time ever, the parent brought out the telephone video camera to bring back a visual for a sibling.

I attended an English teacher, and I mentioned my writing. We agreed on the difficulty of writing to both genders, and how males in the school system get left behind when it comes to literature. I assured the patient that without me, the inciting medical problem would resolve eventually, but reading West With The Night by Beryl Markham would make for a richer life. We would both like to see English teachers have more input into curriculum.  I talked about the importance of effective written communication when physicians have to send letters or emails to non-physicians..