I had an interesting morning yesterday at the Free Clinic. Once a week I’m a Spanish interpreter in an organization supported by over 400 volunteers who give a few hours a week of their particular expertise in a smoothly run team. We cater for patients with chronic conditions needing regular medication, having no access to health insurance.
Yesterday we met a new patient who is deaf and mute since birth. We took her through her eligibility interview with a social worker, then a nurse took her health history, followed by a doctor’s consultation and a laboratory test. In the seven years I’ve worked there I’ve never seen all these interviews done for a patient in one day. Her son was concerned because she is diabetic and without insulin for two weeks since her supply ran out; we all ran over time to meet her needs.
Alfredo (not his real name) is her oldest son and spokesman. “Ana” is 56. They arrived from Puerto Rico in December. He had been struggling to buy her medication from Puerto Rico. Ana doesn’t read or write, or even sign except with gestures. She signs her name with a cross. In her eligibility interview we assessed their income to establish that she qualifies to be a patient at the Free Clinic, and listed the health conditions for which she needs help (diabetes, high blood pressure, high cholesterol and depression).
Ana has four grown up children. Alfredo has a daughter of 21 and a grandson aged 8 months. They live together with his wife in an apartment loaned to them. They moved to Virginia from Puerto Rico in December. He works in a poultry processing plant, killing turkeys on the night shift. He told me he is grateful to have a job in these hard times.
In a health history interview we routinely record the patient’s own and her family’s background of cancer, tuberculosis, STDs, heart conditions, diabetes etc. (to establish genetic tendencies), and ask about the state of her heart, stomach, kidneys, liver, lungs, head and so on; we added migraine to her list.
While the nurse who took her (high) blood pressure wrote up her notes, Ana fidgeted, watching keenly the interaction between the nurse, Alfredo and myself. I wanted her to feel included so I smiled at her. Ana waved minimally at me and started to gesture. She indicated little ones with her hand, pointed to herself and her belly and held up four fingers. I responded in silence with a smile, pointing to myself and holding up five. She smiled back. She pointed to herself and held up 5, then 6 fingers. I held up 7 and 6. We had a conversation going. Her alcoholic husband left home when Alfredo was 15, he told me in Spanish
The nurse showed Alfredo how to work the new meter we supplied to take her sugar level readings twice a day and Alfredo demonstrated his ability to work this. He was competent and cooperative, obviously familiar with the technique.
Ana kept searching for eye contact with me. I made signs, pointing to her son, then rocking a baby in my arms, pointing to her, then smiling and giving her the index finger to thumb OK. She knew I was saying how well her son cares for her and she nodded. She signed to me that when he was little he was fat, and ate too much. (She pointed at him, held her hand low to show ‘small’, blew out her cheeks to portray fat, patted her stomach and pointed back to him again, then made a hitting gesture.) I looked to Alfredo and he confirmed this interpretation in Spanish, adding “My father beat her.” I sighed in sympathy. While the nurse was busy I gestured to Ana in silence that now Alfredo is tall and slim and good-looking and she nodded enthusiastically. Alfredo smiled wanly. Ana pointed to a scar on Alfredo’s forehead and made a falling gesture. “That’s from when I fell off the roof,” he said, “as a child.”
The doctor examined her next, called the laboratory staff to take samples for blood work and ordered a mammogram appointment. He was kind as he worked, smiling at Ana in reassurance. He asked Alfredo, what does she do all day? “She only watches television. She never wants to go out. She is afraid to leave the apartment.” “At least she has a window on the world,” said the doctor. I asked her with gestures if she likes to cook? She nodded.
Ana sat up straight, apparently feeling included, enjoying the attention, smiling. At the end of the interview the doctor shook both their hands warmly. The doctor said, “I wish I could speak Spanish.” We asked the pharmacy to fill her prescriptions while they waited.
It was an absorbing encounter and Ana went away a lot happier than when she arrived. Presumably strangers don’t normally “talk” to her, especially being confined to home. I said to Alfredo, “It is evident she is intelligent,” and he agreed. If only she had had access to education, but she never went to school. I hope she will be pleased to come for her next appointment. I tried but failed to imagine what it is like to think without language.
As they left I said “It must have been hard for you when you were a child.” Alfredo answered, “Yes, and for her. My father beat me too.” He added, looking at her, “It’s still hard,” but he was rueful, not complaining. He seems a nice man. I said, “It’s good that you are not like your father,” and he nodded, “Si, gracias a Dios.”