Photo Courtesy of SarahMcD

A very tall man lies a foot or two in front of me, on a stretcher, sitting in his own feces, a small amount of which has managed, at some point during the night, to reach the left sleeve of his short coat. He is a big-boned guy though he isn't fat. You could say he is a little bit chubby. And he is drunk. His gaze oscillates between the physician assistant's eyes and the world of dreams, or nightmares. The physician assistant tries to pull him back into the reality of the emergency room, the stretcher, the feces, and the two yellow blocks on either side of his injured head, with forceful talk, some "tough love," if you will.

I am the new medical interpreter, enthralled with my "second drunk," which is how I'll call this man, not out of any disrespect for him, but as my own term of endearment. He is, after all, intoxicated with alcohol. Not that I have never seen a person in such state before.  But this is different. I am not a neighbor spying from behind a curtain, or a college-student at a bar; I'm an interpreter---the communicator between the white coat and the Spanish-speaking drunk, bridging the deep lacuna that lies between them. And I am fascinated.

Unlike my second drunk, my first drunk had been a short man, but also in his late thirties. My first drunk, unlike my second, who had only downed nine beers, was what seemed to me, in my emergency-room naiveté, a record breaker, a pro ---thirty-five beers. He was shaking, not like your body shakes when you're a bit cold. It was the kind of gelatinous shaking that would leave you wondering how the man was still able to carry on a conversation, ostensibly clear-headed. He was a true athlete of the bottle. Only the piercing odor that his entire body expelled, one that transfixed you at a good five feet of distance from his stretcher, betrayed his intoxicated state.

My second drunk isn't like my first. My first was homeless. He lived wherever he could. "On the square," he said in Spanish, as I interpreted. "And where would you go now when you are done here?" the physician asked him. "To the square," he replied. "Can you help me get a taxi?" he continued. "I can help you call one but I can't help you pay for it," the physician replied. Later on, my first drunk asked when he could leave, assuring the physician he was well and ready, even though he was still trembling. The physician smiled gently and, realizing there was nothing else to be done, agreed, and left to get him the soda he had requested. I found myself alone in the room with this man -- the first patient with whom I had ever worked as an interpreter. He asked me: "Can you help me for the cab?" And I gave him a dollar fifty for the bus.

That was my first violation of the Rules. As a new interpreter, new at the hospital as well as the field, I carried the Rules with me in a folder all the time, in case I needed guidance on any difficult ethical quandaries that could arise. I didn't see this as one, though. All I had seen was a man asking for help during a very cold winter night. How could I deny him any change I could spare? There are others within the organization already designated for the provision of those services, someone assured me later. There had been a few cases where nice patients had been helped with transportation vouchers to get themselves back to their hotel rooms or homes. But who would have helped my first, homeless, malodorous, drunk guy to get "home"?

My second drunk could be homeless too. Perhaps he has decided to visit us on the same day he acquired such status. "I have problems, Miss," he says, crying. He wasn't crying at first, this big man. He had been sleepy. His voice, almost inaudible, answered with difficulty and hesitation the questions of the physician assistant. But the physician assistant left for a few minutes to get the attending physician, and we, my second drunk and I, are left in the company of each other -- he with his injured self on the stretcher, his head bounded by the yellow blocks, and I, standing beside him, to his right, merely watching him be there and wondering how in the world someone could end up like that.

You see, I'm The Interpreter, with a set of behavior guidelines to abide. Despite the fact that there are currently no national standards for the training of medical interpreters, there exist the International Medical Interpreter Standards of Practice. And though these standards are not enforced at every hospital, they are at mine. The standards encourage interpreters to show care and concern for patient needs only by facilitating use of proper resources and promoting patient self-sufficiency. So if patients need transportation, the interpreter does not drive them home, or give them a dollar fifty for the bus. And of course, an interpreter must refrain from becoming personally involved in the patient's life.

So I try, but "You know," my second mistake begins, "it's good if you answer the physician's questions... just so they know what exactly to do to help you," I say. My second drunk patient grimaces in pain, and responding to my advice, produces what looks like a tiny nodding gesture. Suddenly, and out of nowhere, considering I'm not even religious, I find myself trying to bond with him by saying, "Do you believe in God?" What? OK. Just what do you think you're doing? You’re not a chaplain. You’re not a therapist. You’re an interpreter! And a medical interpreter is not even considered part of the healthcare team (yet)! I tell myself. Why, I am only trying to help.  "Maybe everything is going to be fine, you know?" I say, clumsily.

Stop! This is all wrong, I think, because, by seeing a man in pain and reaching out to him as a fellow human, Super Interpreter, you are inadvertently inviting him to share his problems with you. And by inviting him to share his problems with you, he would soon come to see you as a confidant, entrusting you with confidential information. And what will you do with all that? You have no tools with which to help him. Or do you?

"I know it looks like this right now, and you feel very bad, but it's probably going be okay, you know?" I continue. My second drunk doesn't answer. He grimaces a grimace, which slowly turns into a weep that quickly multiplies, and soon the heart monitor displays the random oscillations of a broken heart. "Are you okay?" I dare. "Do you want me to call the doctors?" I say, worried that instead of helping him, I will cause him to flat line, like in the TV shows. "No. Don't call them..." he says, and he unravels a long and intense cry.

I wasn't causing him to flat line -- I had awakened an injured beauty: a man who simply needed to cry, it seemed. Yet whatever this injured beauty might now say, I surely wasn't supposed to hear it all by myself. There were, suddenly, butterflies in my stomach. I had trapped myself into caring---the intimate and dangerous act of caring---and, as a consequence, an ethical dilemma of sorts.

"I have problems," he says. Oh no! Please don't tell them to me! Not now! I'm not really supposed to hear them! I should have cried. Instead I said: "What kind of problems? Do you want to talk about them?" I add, "You don't have to, you know, but if you want to, I don't mind." And he weeps harder. "Let it go," I say, unknowingly stealing, sabotaging what could have been the physician's moment. "Maybe you've had this inside you for so long you have to let it out. Just cry," I repeat myself. Nobody's watching, I want to say, but I don't, afraid that the phrase will somehow stop him by making him realize that I, a perfect stranger, is indeed watching.  "Just let it out," I say instead, as the "Super Interpreter," still putting her foot in her mouth if even out of kindness.

"My wife," he weeps as he says this, "she stabbed me some time ago..."

His wife had stabbed him. He had four kids, and he was desperate, for a reason unknown to me, to get out of the country.

"She stabbed me..." he sobs, and just then, the medical crew makes its entrance. My second drunk swallows his tears, suspends his sobs, and closes his eyes again. The doctor gives me a look. It is a look that says something like "I don't really understand why you're talking to him but since, clearly, you have been, I feel curious to ask you what you know. But I'm not going to.... Well, maybe I will... But I don't want to... Oh, alright, I will." So the doctor turns to me and asks, "...and what is all this weeping about?" I reply, "He has four kids, and a wife. He has problems with his marriage. He wants to leave the country. He says that's why he drank today."

"Of course..." the doctor says, "It's always that way... with lots of people."

And that's how I came to commit the biggest mistake of all. Not only had I sabotaged and compromised the provider-patient therapeutic relationship, unintentionally “misleading” my second drunk “as to who the provider was,” says the Rules book, “disempowering” the provider in the process, but I had also become personally involved to the point that I had kept my second drunk's secret.

Out of respect for my very second drunk, and the trust he had extended to me, I didn't immediately reveal the part about his wife stabbing him. Although it occurred to me that perhaps his wife abused him, he was such a big man! I thought, How could his wife abuse him? How can you abuse a man like that? How could a man be abused? Women are abused -- but surely not men! The unconscious biases I kept came pouring down. No wonder, I thought, when the physician assistant had asked him if he needed them to call anyone to let them know he was there, he had said he didn't have a family, there was no one to call. An abused man, perhaps? I shouldn't have kept a secret like his.

The nurse says, "Maybe he should talk to the psychiatrist." The doctor frowns at the nurse; he doesn't want more work that night. The nurse gets it. "It doesn't have to be now," the male nurse adds, his gaze still fixed on the doctor's. "Tell him he can make an appointment," the nurse tells me. "We have an excellent department here. They can help him there." So I do, I translate and interpret the information to my second drunk. I do it gently. I add, "promise me you'll at least think about it," even though the book of regulations says this really isn't any of my business. My second drunk nods. "I'll do it," he says. And he repeats, "don't tell them about my wife." Just then he's wheeled to radiology for imaging of his head and neck. And I don't tell.

It sounds strange, but I keep thinking about my second drunk. When he finally awoke from his toxic stupor to realize he had spent the entire night resting in his feces, for instance, how did he react? Did someone produce a fresh pair of pants for him to change into? Where had he gone that morning? Where was home, really? Was this tall, big-boned man really going back to a wife who might stab him? And what if nobody had produced a fresh pair of pants? What if by withholding his secret, I endangered him? It was a secret that I, a Latina, an immigrant, would never have thought a Latino man would confess; and one which only surfaced when the tough love had left the room. Who had the pants for situations like these?  In a day or two, I reveal my second drunk's secret to the doctor, in hopes that it isn't too late.

"Can you come with me? I have another Spanish-speaking patient," a nurse says. So I walk away, through the labyrinthine emergency room, reciting in my head the interpreter’s Code of Ethics like a pious churchgoer. Strive to further and better your skills, maintain confidentiality, show respect toward all parts involved, practice impartiality, behave in a professional manner, refrain from personal involvement, from counseling, and from advising. Refrain from personal involvement. Refrain from personal involvement. And then I remember my orientation at the hospital, and what my mentors, two interpreters who have worked in the field for the past thirty years, advised to me. “You should be like a robot,” one of them told me. “You interpret what each person says, and that’s it.”

“I know I don’t do exactly what the code says… “ said the other, during my shadowing of her service, “…but if I know someone needs help, and I can help them, how can I not do it? Don’t get me wrong, I know what the guidelines say, but that’s why I’m human.”

I am a new medical interpreter. I listen to advice; I read my guidelines. And I have lots of questions. If nobody asks the drunk because he’s drunk, if everybody is tired, if nobody has the time, and My drunk needs to be asked, then should I? If My drunk trusts the tone of my voice, or my face, or the softness of my approach, can I fill in where others aren’t able to? Whose decision is it? If I care, in my role as an interpreter, just how human am I allowed to be?

My shift goes on. And for another hour, maybe until I have completely desensitized to pain and no longer care, or perhaps until I've finally learned how to keep a balance, the very mysterious balance between professional distance and humanity, I keep making mistakes.

 Iris Mónica Vargas