Posts Tagged ‘Spanish’

Spanish, spinal manipulation, and zoonoses

January 24, 2018

The patients come in, I’m a doc,

And I ask, Are you working with stock?

Do the animals thrive?

Are they even alive?

How big is your herd or your flock?

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. 2017 brought me adventures in Iowa, Alaska, and northern British Columbia, and now I’m living at home and working 48 hours/week in rural Iowa. Any identifiable patient information has been included with permission.

(Post generated week of 1/15 and held till now.)

I faced subzero temps and 40 MPH winds on the drive into work today. Still I came in to find my morning schedule full.

Which conflicted with a complicated ER patient, requiring hospitalization, and, eventually, a very complex transfer. So today I started counting the steps between my clinic work area and the Emergency Department.

The steps added up to 100 each way, but I lost track of the number of times I made the round trip.

Midway through the morning, I noted a holster with a pair of pliers on a patient’s belt. Obviously a quality piece of leather, and just as obviously worn daily for many years, I made the observation that even an American-made pair of pliers has a finite life expectancy if used often, and asked how many pairs of pliers he’d been through.  He chuckled.  He’d been through three pairs so far, and the holster had been custom-made for him.  He gave me permission to recount our conversation.

A lot of farmers and other agricultural workers come to see me. The rules on antibiotic stewardship do not apply to people who work with livestock.  I have concerns not only with zoonoses (diseases acquired from animals) but with the hazard to the animals if the patient transmits microbes.   I generally don’t give out antibiotics for respiratory infections under 5 days duration, but I make exceptions, for example, for those who have just removed thousands of dead or dying pigs from a hog confinement. So along with asking if a person uses tobacco, or if a woman might be pregnant, I ask, “Do you work with livestock?”

Today was a good day for speaking Spanish, relieving suffering among patients from teenagers to septuagenarians just with my fluency. I fielded the usual question:  Where did you learn Spanish (high school, but I’ve been practicing for 50 years), and also, Are you Cuban?  (no).

At one point a non-physician clinician needed an interpreter while I worked my way through clinic, and the nursing staff activated a video service. When I returned 40 minutes later I immediately recognized an accent from Spain, but I did not get a chance to chat up the interpreter.

By the end of the morning, I had cured three patients before they left (ear wax removal for one, and spinal manipulation for two). But the ER patient would stay another 3 hours until transfer could be arranged.

I left in the dark, in subzero temperatures, ferocious winds, and a light snow.


The click of a linguistic show-off

August 29, 2017

That language didn’t come quick

And my accent is still a bit thick

It might sound like a crow cough

But I am a show off

And used my Naa Dene click.

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. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

I spoke a lot of Spanish in my quarter-century working in Sioux City. Eventually, my accent settled into the developing Spanish accent of the area.  On taking care of a Hispanic patient for the first time, I frequently got the question, “Where are you from?”  And I’d reply that I’m American.

The query, “Yes, but what is your nationality?” invariably followed.

(Regretfully, people of Asian descent in both Canada and the US face the same question; the questioner usually implies that a person with a particular appearance must be from somewhere else.)

Sometimes I use the word Gabacho (a derogatory term for white Americans, heard mostly in the Midwest). Sometimes I’ll talk about my grandparents being from Russia and the Austro-Hungarian Empire.   And sometimes I shrug and say I’m a linguistic showoff, because I am.

If they ask me why I speak Spanish, I just say it’s good business.

Many but not all the Natives from the Bands close to here come from the Naa Dene linguistic tradition. So I greeted one of my patients today with, “Daa natch’eyaa,”  meaning, “How are you?”

“Sa’atch’ee,” came the reply, meaning, I’m fine. As I prepared the injection, he asked, “What kind of white man are you that you speak our language?”

“Aalk’iidaan,” I replied, “Shi naalnish Toohaajaalehidi. A long time ago I worked with the Canoncito Band of Navajo.”

Navajo language belongs in the same group as Naa Dene, with some important differences.

Being a linguistic showoff, though, I couldn’t stop there. I asked the Naa Dene word for goat.

It took me three weeks to learn the first consonant in that Navajo word. The linguists use the ! to represent the click, to the best of my knowledge, the only click outside of Africa.

My patient didn’t want to look surprised when I repeated it accurately, but he did.



At a wedding in Mexico

November 4, 2013

In my elevated social position

As a respected family physician

My patients I serve

But there are those who have nerve

To be mean to those of lower condition.

:  I’m a family practitioner from Sioux City, Iowa.  I danced back from the brink of burnout in 2010, and, honoring a one-year non-compete clause, went to have adventures and work in out-of-the-way locations.  After jobs in Alaska, New Zealand, Iowa, and Nebraska, I returned home and took up a part-time, 54 hour a week position with a Community Health Center.  I’m just back from a working vacation in Petersburg, Alaska, an educational trip to San Diego, and a wedding in Cancun.

Bethany and I went to our oldest daughter’s wedding in the tourist district of Mexico, on the Yucatan Peninsula.  The staff treated us royally.  At mealtimes someone would pull out the chair for me to sit and push it in as I did; another someone would unfold the napkin and to place it in my lap.  On the trails that meandered through the jungle from villa to villa, hotel staff would step off the concrete to let us pass.  They learned our names the first day, and on the second morning knew how I take my coffee/tea/chocolate.

Not only do I not expect such service but it made me feel a little creepy.  I tried to ameliorate the sociologic disparity by speaking to the staff in their own language, but it didn’t help, and it took me a couple of days to figure out why.

In any service industry, an inherent power inequality permeates the relationship between the service and the client.  Even a physician, with a high social rank, has to face this inequality with every patient, and I have worked in that position for so long I have grown comfortable with it.  Speaking the language of the client makes me a better service provider, but I still maintain my position as a service provider.
The position of client brought me out of my zone of comfort.

The resort staff, for the most part, spoke English passably or well, and I suspect that gaining employment there depended on a demonstration of language proficiency.  I still spoke Spanish with them because I find it soothing, and because it felt like I ameliorated the disparity between us.

Back home, when I go out to eat, I go out of my way to bring respect to the client-service relationship.  I shudder when I see restaurant wait staff treated like furniture; I make eye contact and I use peoples’ names.  I say please and thank you.  If the server is having a bad day, I do my best not to add to the problem.  And ordering food came easily in Mexico.

I still felt bad for the people who stepped off the path at my approach, even when I figured out that, at the very least, it gave them a small break in their work.

In the end, I came back realizing that the patients who treat me like furniture and who bring no respect to the service-client relationship are the worst patients.  They demand time to get advice they won’t take with no consideration for the patients who come afterwards.

I suspect they’re mean to restaurant wait staff as well.


Slowing down: fifty-four, not seventy-two

April 26, 2011

Here’s a fact that I’ve found

This one I’m sure will astound

     It’s just fifty-four

     Hours, no more

But really, I am slowing down

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  On assignment on the North Island of New Zealand, I’m living in an apartment attached to a clinic in Matakana, north of Auckland.

ANZAC day commemorates the Australia-New Zealand Army Corps losses, first in WWI and then in later wars. It’s not my holiday because I’m not a Kiwi, and I volunteered to work the clinic today. This year the coincidence with the Easter weekend gave the country a four consecutive days off.  I tacked my fourteen hours today onto the fourteen I did on Good Friday and the twenty-four I worked the day after.  I worked at a reasonable pace, and got at least one break a day; today I took a morning and afternoon tea break and went out for both lunch and supper.

Yesterday evening I stopped being able to stay awake at 8:00 PM and went to bed; I slept soundly till 4:30.  Breakfast followed shower.  Without the anticipated traffic I arrived twenty-five minutes early.

Holiday business continued; as of 6:00PM I’ve seen twenty patients and done (or not done) phone prescriptions for 4 more.

‘Two patients have studies pending which I hope prove me wrong.

I looked at one patient whose dermatologic problem has failed to clear for nine years, and instantly disagreed with the previous diagnosis, in part because of inadequate response to medication.  I prescribed a skin creme, handed over my card, and requested a post or email if a cure resulted.

I treated six patients non-pharmacologically. 

I lost track of the number I told to quit smoking and drinking.

I made four patients better before they left; I cured one.

I did no defensive medicine.

When I went out to eat I walked down Wellsford’s main street in the rain, glad of my duck-hunting jacket and my cap.  I heard a couple speaking Spanish outside a cafe; I threw six words into their conversation and made them smile.  I wanted to stop and chat, to find out where they were from, and the forces that had acted on them to be here in this place at this time, but I walked on so I wouldn’t breathe their cigarette smoke.

They had left  by the time I returned; the nurse departed at eight and I spent the next two hours on-line researching my next placement.  When I turned out the lights and set the alarm at ten, I had worked fifty-two hours, twenty less than I usually work on Easter weekend. 

Pouring rain lengthened the drive home by twenty percent.  With light traffic, I fought the urge to break the speed limit along the straightaways.  I arrived in Matakana, the town was dark and quiet, and, like me, tired from the long weekend.

You won’t believe who I ran into in New Zealand

March 17, 2011

OB, I thought, was a blast

But now I’m a thing of the past

     Because I am male

     And I knew when to bail.

I was sure  the thing couldn’t last.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  Just back from a six-week assignment in Barrow, Alaska, the northernmost point in the United States, I’m in Wellington, New Zealand taking care of details before I start work.

Yesterday on the way out of Te Papa, the New Zealand museum in Wellington, two American tourists approached us and asked us if we’d enjoyed the museum. 

We had. 

They asked, How much is it?

Free, we said, and fell to chatting as American tourists do in other countries.

They came from California; they had been two weeks in Australia and would spend another two weeks sight-seeing in New Zealand.  

The subject of languages came up, and the female of the couple, a tall blonde, said a few things in Spanish, mentioning that she learned the language at LA Women’s Hospital where she’d worked as a nurse.

“No me digas,(you don’t say),” I said.  I worked there the month of July 1981, doing an externship during residency.  I delivered a lot of babies that month and I quit counting at fifty.

The nurse, it turned out, had been working in the same place at the same time, and had certainly worked with me.

Memories came flooding back.  My schedule in theory went twenty-four hours on, twenty-four hours off, and an eight-hour clinic.  The reality came out differently; after the twenty-four hours on I had to do postpartum rounds which sometimes stretched into late afternoon.

When I finished my long day, I would dress in shorts and t-shirt and go out into the barrio.  I would look for my favorite video game, Battle Zone, and play a few times.  When I had spent all the quarters I was going to, I would look for the dodgiest restaurant I could find.

At a time when, per hour, I earned less than minimum wage, I could spend two dollars and get enough really great food that I would need another eighteen hours to digest it.

Bethany, pregnant with our first child at the time, hung around the apartment till she figured out how terrible the schedule really was, and went off to visit friends in South California.

I don’t blame her.

I learned a lot about obstetrics that month.  I used that knowledge and enjoyed delivering babies for the next thirty years.  As time went on, my resilience faded to the long hours, vigilance, and sleep deprivation.  I gave it up last May.

Here in New Zealand, the midwife movement has pushed the doctor away from intrapartum OB for the majority of births, and an increasing number of deliveries happen at home.

Some of the docts fought the trend, as they’d built practices and careers on that segment of medicine. 

Decades ago I recognized that only an accident of history would have let men into attending births of babies.  I am grateful to have been part of that experience, and each delivery I did left me euphoric and awestruck.

But I don’t miss it.


Fanfaron: Spanish for “show-off”

January 9, 2011

The Hospice nurse phoned in late,

But I made good use of the wait

      The stranger did vanish

      When I slipped into Spanish

And the form I helped her translate.

I met with the Care Initiatives Hospice nurse at a nearby nursing home; as I walked in she called to tell me she’d be twenty minutes late.

As I’m working with a more flexible schedule, I told her, “No problem.”

Sitting by the door were a woman with a clipboard, another woman in white pants and a nursing smock, and a receptionist.  Closing my phone, I looked at the woman with the clipboard, and I furrowed my eyebrows.

One cannot tell by the face what language the mouth has, but I went out on a limb and said, “Te conozco?” (“Do I know you?”)

“Yes,” she answered in Spanish, “Doctor?  I heard you retired.”

Then we struck up a lively conversation.   I gave her my synopsis, and told her I came to care for dying patients.  She nodded, and asked about my Christmas.  Soon food dominated our conversation.  After five minutes or so I turned to the receptionist, and in English announced my name and my purpose and why I would be starting late.

I turned back to the woman with the clipboard.  “I’m embarrassed to ask,” she said, in Spanish, “but would you help me fill out this form?  I don’t have enough English.”

I sat down with her and soon realized that, however well I can discuss pathophysiology, pharmacology, and disease states, I have never translated an employment application.  The woman, who has above average inherent intelligence but less than a high school education from a third-world country, had been working in the USA for years but had always found help when seeking work.

I did the best I could.  She had documentation of her ability to work legally.

But she had little English.  I told her how my wife and daughter had been teaching English as a Second Language at Western Iowa Tech; she was familiar with the institution and wanted to learn English but she was too busy working to get to classes.  I expounded the virtues of Rosetta Stone.

I had gotten the education and recent work history sections filled out for her when the Deb, the Care Initiatives nurse, walked in out of the cold.  I excused myself and we went to round on two patients.

Some people approach the end of life with awareness and wisdom, some with fear, some without input of their senses or the ability to understand. 

Great stories fill every nursing home.  One doesn’t traverse decades without experiencing fascinating slices of reality.

An hour later, our work finished, we came back past the receptionist.  The woman I had helped had left. 

The Spanish word for show-off is fanfaron.

Market forces, business opportunities, capitalism, Spanish, teachers, and ESL

September 23, 2010

It doesn’t matter the language you speak

If it’s a meat cutting job that you seek

     English won’t vanish

     It displaces Spanish,

Disappearing with nary a squeak

At dinner this evening we spoke with another couple.  The male had attended a one-room school; there were twenty-two students in eight grades, the eighteen-year-old teacher finished high school, and the two German students didn’t speak English.  “No ESL then, I’ll tell ya’.”

A few months ago a major pork processing plant in Sioux City, John Morrell, closed.  The outdated physical building lost efficiency compared to new buildings; we all knew it was only a matter of time and wondered that it took so long.  Sioux City has depended on meatpacking for more than a hundred years; the business model has changed a great deal in that time, but the nature of the work hasn’t changed much.  The labor-intensive activity of turning a hog into pork chops, ham, bacon, and sausage is still cold, dirty, and boring.  You can earn a living wage without English.  It has been an attractive occupation for some in the deaf community.

Our town has depended on waves of emigrants since the 1880’s.  Germans, Swedes, Norwegians, Greeks, Lithuanians, Syrians, southeast Asians, Hispanics and most recently Somalis came to the slaughterhouses to work.  They faced discrimination and prejudice, and the rhetoric has changed very little since the beginning. 

Mostly I hear monolingual Americans complaining about the largest, most recent wave of immigrants, the Hispanics, in linguistic terms.  Stereotypes, even negative ones, dwell on hardworking people with close family connections.  “Let ‘em learn English,” I hear; “I don’t want ‘Press one for English.’”

Before the dinner conversation degenerated I said, “You know, being a capitalist, where other people object to linguistic accommodation, I see a market opportunity.”

Bringing capitalism in a conversation with patriotic people usually puts a new spin on things.  “I speak Spanish,” I said.  “When I left my practice after twenty-three years I was doing half my business in Spanish, and man, have I seen the changes.  Twenty years ago a person with a Hispanic last name generally didn’t speak English at all, but had a big wad of bills in their pocket, and expected to pay cash.  And when they did that, they took my advice.  I’d say ‘Quit smoking and drinking,’ and they’d quit smoking and drinking.”

The other people looked at me in amazement.  I thought they were going to ask me patients taking my advice but the lady said, “You speak Spanish?”

“I hit fluent forty years ago and I’ve just kept getting better since,” I said, “And really, we’re talking about hard-working people who would really like to speak English, but they don’t have the time to learn because they’re working overtime and irregular shifts in jobs that a lot of other people wouldn’t do.  Besides, it gives my wife and daughter work; they’re teaching English as a Second Language through the Community College.” 

In fact, Spanish is an endangered language here.  The first child is bilingual, and teaches the younger siblings English.  Frequently the youngest child can’t speak Spanish and can’t talk with the parents.

Snow days are for making phone calls

February 16, 2010


Over night it blew and it snowed

This morning it closed all the roads 

            I planned  about June

            Till we opened at noon

And I went into healing mode

When the Interstate closes our office closes.  Faced with a workless morning, I got some writing done till it was late enough to make calls.  Mostly I called hospitals and clinics in smaller towns in north central Nebraska.  I tried to call the Indian Health Service sites when it was late enough, forgetting the Presidents’ Day holiday.

I also called some recruiters.  Most seemed clueless, one seemed to know what he was doing.  He had worked at the old St. Vincent’s Hospital in Sioux City many years ago.

My patient stream included a distressing number of the middle aged at major life decision points.  People changing jobs and changing marital status, people considering retirement.  One had started exploring his spirituality.

The thing that I do better than the specialists is examine children, and I got to show off today a couple of times with toddlers/parents who had never met me.  Because I didn’t fight or restrain the kids, I got a good, valid look at the ear drums.  And I had more energy after examining the child than I had had before.

In the dark and the blowing snow at the end of the day I went to the hospital to examine a newborn.  The parents speak Spanish.  They were in the cloud of joy that comes with a first baby.  I didn’t have the heart to tell them I’ll be going elsewhere in a matter of weeks.