If you had asked me five years ago what I saw myself doing in 2012, I probably would have given you a variety of answers: playing cello for a symphony orchestra, teaching cello students privately, touring with a chamber group around the U.S. and the world. But I would never have imagined that I would end up working as a medical interpreter.
I was pursuing a career as a professional cellist, and on a typical fall afternoon in 2007, I was on my way to a rehearsal at a church in my neighborhood. I had just stepped inside the sacristy when I heard some commotion outside the door. An elderly Hispanic woman had just collapsed onto the steps, apparently as a result of a massive heart attack, and her husband was frantically pleading for help.
While the church staff called 911, I stood there debating what I should do. Should I just sit and wait for help to come, or should I try to do something myself? I didn’t know CPR, which is clearly what she needed; I was afraid to intervene in any way for fear that it would make things worse. At the same time, I couldn’t just stand there and do nothing. I suddenly realized that they might need help communicating with the paramedics when they came. That’s it, I thought, I’ll use my Spanish to help them understand each other! So I put my cello down and went outside to wait with the husband and his ailing wife, ready to do whatever I could once the ambulance got there.
Sadly, as we waited for help to arrive, the wife took her last breath. I wanted to tell myself that I might be imagining it, that the paramedics would do CPR and everything would be OK. I tried to keep the husband’s hopes up, but we both knew it was over. The ambulance finally came, and I started interpreting as the husband described what had happened to the paramedics. I was shaking as I did it, and yet I felt that what I did brought some comfort to this man. My being there allowed him to express himself at a time when grief and despair might have made it improbable for him to communicate in a language that was not his own.
I believe that this was one step in a series of events that led me into the field of medical interpreting. When I finally decided to become a trained medical interpreter, I realized that I had a lot of misconceptions about what being an interpreter entailed. This may be the case with many of you who see us and work with us on a regular basis, so I thought that sharing some aspects of what an interpreter does might shed some light on our work here at Rush.
Ten things you should know about medical interpreters at Rush:
- We are interpreters, not translators. This distinction is significant in that it describes different endeavors altogether. Translators specialize in working with written language, while interpreters concentrate on spoken language. Each of these two activities requires an entirely different and unique set of skills, training and certification processes. For this reason, interpreters at Rush are not allowed to translate written documents that may have any legal implications. Doing so would put us in a position in which we could be legally liable for performing a task without having the required training and certification. In cases when patients have to fill out paperwork, we will gladly interpret for a provider as he/she goes over the information with the patient.
- We interpret everything that is said as faithfully as possible. As interpreters, we do not add or omit anything that relates to the message that is being transmitted. This also means that everything that is said in a room is interpreted, even the things that someone might deem unimportant. If a mother scolds her child for trying to crawl under the table, we’ll interpret it. If a provider is talking to himself as he updates his notes on the computer, we’ll interpret it. If a patient loses his cool and starts swearing at the provider, we have to interpret it as well. Our job is not to edit what is relevant or not, but to render everything that is being said as accurately as possible.
- As interpreters, we not only focus on the words being said but how they are said, including all the different nuances that are a part of communication. Did you know that up to 90 percent of language transmission is done by non-verbal communication elements such as tone of voice, inflexion, facial gestures, hand movements and body language? All these attributes are included in our interpretation in addition to the actual words being said. We feel like mimes sometimes, emulating what providers and patients do as they speak.
- Interpreters always speak in the first person. The purpose for this is twofold. First, it helps to eliminate any grammatical confusion that might arise when we switch to the target language. Most importantly, it allows us to truly become the voice of those we interpret for, which results in a more direct communication between patient and provider.
- Medical interpreters interpret consecutively, not simultaneously. The difference lies in the timing of the interpretation. While simultaneous interpretation takes place immediately after a few words have been spoken, consecutive interpretation takes place after a few sentences have been spoken. This mode of interpretation is the one that best fits the context of a medical encounter; it fosters clarity in conveying the message while avoiding the confusion of having two languages spoken at once.
- To preserve an ethical distance between ourselves and the patients we serve, we try to avoid spending time with patients outside of the context of the patient-provider encounter. This is why we will step out of a room when a provider does, even if it’s just for a few minutes, and sit away from patients in waiting rooms. In doing so, we remove ourselves from potential situations in which patients might ask for our opinion regarding their medical treatment, share more of their medical history with us than is pertinent, or ask us medical questions that they forgot to bring up during their appointment (and that we are unqualified to answer).
- Interpreters act as cultural brokers between the patient and the provider. Though our role is primarily concerned with the accurate interpretation of the message that is being transmitted, we also act as a bridge between the different cultures represented by the patient and the provider. We are in a unique position in that we are both bilingual and bicultural. Therefore, we are always watching out for instances in which the patient and provider’s cultural differences might adversely affect the transmission of the message. In such cases, we will intervene to offer clarification and provide a quick explanation of the cultural implications of what is being said. In one instance, I had to interpret for a patient who was describing how she used snake pills to treat her cancer instead of following her chemotherapy regimen. Her doctor was thoroughly confused by this so I intervened to explain that, in her culture, snakes were believed to have great medicinal benefits. With that additional information, the doctor was able to present the importance of following her treatment in a way that also acknowledged her cultural beliefs.
- Interpreters occasionally act as advocates for patients. Sometimes, the patients that we help are not familiar with how the health system works in the United States and need assistance navigating through its complexities; other times, they are not aware of the resources that are available to them. In such cases, we direct them to the appropriate staff or resources within the hospital that can meet their needs.
- Our jobs as interpreters at Rush include a wide variety of responsibilities. Aside from interpreting for patients’ appointments in various clinics, we also interpret for inpatients in all the different units throughout the hospital. Rush interpreters are called to assist patients who come to the emergency room and OB triage, as well as patients who are getting ready to go into surgery or are recovering from surgery. Occasionally, we are asked to interpret during certain surgical procedures. We offer our services to patients who get physical, occupational and speech therapy as well as psychotherapy and counseling. Additionally, we interpret for patients and/or providers who need to get in touch with each other over the phone via conference calls. Lastly, we are responsible for creating daily schedules to ensure that patients will have an interpreter for their appointments, which includes contacting outside agencies in order to secure interpreters for languages we do not staff. As you can tell, interpreters have a lot to juggle on a daily basis!
- Rush University Medical Center has 10 Spanish interpreters and one Polish interpreter on staff. We can be contacted at (312) 563-2987. We also use interpreters from outside agencies on an as-needed basis to cover all other languages, including American Sign Language. In addition, we use the services of a language line that provides interpreters over the phone and can be easily accessed from any in-house phone throughout the hospital. That extension (a good one to remember) is (312) 563-7555.