Maria Santos is a 65-year-old grandmother who works as a clerk at a convenience store. She awakened before dawn today with a sudden urge to vomit.
This has happened nearly every day for the past two weeks. Each time, she retches intermittently for an hour, but produces nothing other than a small amount of clear sputum. That’s been followed by mild abdominal discomfort that lasts all day.
Today is different. She vomits 300 cc of dark, bloody emesis and collapses in the bathroom. There is no loss of consciousness, but she feels light-headed and too weak to get up. The sheets on her bed are soaked with perspiration. She asks her grandson for the cell phone and dials 9-1-1, while the boy runs next door to fetch help from a neighbor. Mary Clancy and her daughter arrive within a minute. They cover the woman with a bedspread and put a pillow under her head. Before long they hear sirens; then, much closer, air brakes and a big diesel engine.
The medics are calm and kind. They do an initial assessment, use a scoop to extricate Maria, and carry her to a waiting cot in the living room. By the time they get there, a small crowd of what appears to be family members has gathered around the cot.
Maria’s needs soon exceed the crew’s ability to translate to and from her native Mexican Spanish. When they ask for help with translation, almost everyone volunteers. That’s a little too much help, actually, and it causes some confusion. But they manage to get the important stuff—sort of. First the complaint, then the history, the meds and the allergies. They invite the grandson to accompany them to the hospital in the patient compartment.
We’ve had questions about this call and others like it. For one thing, should we be interviewing patients in front of their family members?
You’re right, of course. We ask people a whole lot of personal questions about their age, weight, love life, use of recreational substances, menstrual patterns, pregnancy status and bodily functions. Then we expose them with and without their underwear. Maybe they should have something to say about who gets to witness all that imposed humility.
How do you approach a crowd of people like that, all acting like family, and ask them to leave without sounding rude?
I think it’s best to keep things as simple as possible. Explain Maria’s predicament, that you need to ask her some personal questions, and you need to provide her with a few minutes of privacy. Ask the patient if she would like to choose one person (family or not) to remain in the room while you do what you must.
Make no mistake, the size of your audience is also a safety concern. When you’re on somebody else’s turf, it’s much easier to track the activity of one person than a dozen. In fact, one of the strategies you should always reserve for yourself is to move the patient to the ambulance and ask your questions or do your exam there.
Sometimes even translating the need for privacy can be difficult when there’s a language barrier. In fact, it makes some people hostile. Got any suggestions?
Yes. First, anyone who gets hostile when you try to act nicely on a patient’s behalf should get your attention as a potential threat. If you can’t control them, you should try to evade them.
As for translating, Google distributes a simple, robust, free smart phone app called Google Translate. It’ll text or pronounce messages in either direction, and, as of this writing, it can interpret 58 languages. You talk to it, and it quickly displays a text version of what you’ve said. You can edit your message in English, then tap a speaker icon to trigger its “voice.”
What about using a child as a translator? I know we’ve been relying on kids for years in these kinds of situations, but I don’t exactly feel right about it.
I agree. A six-year-old doesn’t need to see his grandma in her underwear (or without it). And that’s a pretty young age for someone to bear the responsibility for information that will become the basis for your most serious medical decisions.