October 17, 2007, 4:52 pm

Lost in the Translation


Thought I’d include a new photo of myself today.

At first I didn’t like this ornament. Thought it was too cutesy and waitress-like.

Today I looked at it and realized I’d become it!

The uniform and stethoscope are because I’m working as a nurse.

The tray with coffee and a flower represents my family’s selfish, unrealistic idea that I’m supposed to serve dinner every night. Who married/raised these people?

The book and clipboard represent my classes, although you’d have to add about another foot-and-a-half of books, a calculator and a Day Runner to be really accurate.

The hot water bottle is for my aching back and the pillow is just in case I get a chance to sleep.

The only thing missing is my MacBookPro which is welded to my hip and I swear I’ve developed an electrical outlet behind my left ear.

Such is my life.

Okay, okay. There’s an iPod in the pocket that you can’t see.

A girl has got to have some fun, you know. Cyndy Lauper said so!



You have got to check out these old ad/comics at James Lileks’ site!

They are for Wonder Bread, there is a nurse in them and they are a hoot!

There are three in total, the first one starts here, but be sure to check out all of them.

And now for the feature presentation:


Almost all of them speak English, but only a handful understand the language.

The majority of them were born in the United States, but only a few of them understand the culture.

Most of them have been educated, but not all of them understand what they are told.

Every one of them is scared, worried, anxious or afraid.


They…….are emergency room patients.

When they walk through our doors, they are entering a foreign country in the world called “medicine”.

Our world. Our country.

We have our own culture: language, traditions, customs, expectations. Taboos.

We fully expect each and every “visitor” to the country to abide by our cultural mores.

Even if they have no idea what they are.


The first tradition the new citizen will encounter is the tradition of triage.

Yes, even if their head is exploding, they are doubled over in abdominal pain or wincing in agony with an ankle the size of a football, they must answer all the questions in order to decide what part of the country they will be admitted into. They might try to defer to a family member, but no, in our country they must answer the questions. That is the expectation of our culture. How dare the family or friend intervene with this delicate interaction!

We do acknowledge faster processing for those who say. “My chest hurts.” and “I can’t breathe.” These allow the visitor immediate access to our vast resources and the rapid assistance of our population.


It is customary to draw blood on most of the visitors, and some will ask what we are testing. Responding with such terminology as “Oh, we’re looking at your CBC, drawing a Chem 14, looking for an elevated amylase and trying to evaluate your cardiac response via troponin levels.” will be incomprehensible to anyone who is not a native citizen of “Medicine”.

We must remember to speak in our “outsider language” and translate to the best of our ability.

But I mean really, do they have to say “I hate needles!”? They want our resources but then gripe when we use them. What a whiny group these visitors are!


It is the custom to limit visitors in the department at any time. What’s that? Oh, in your “outside” culture it’s the norm to have ten family members at the sick bed? I’m sorry, you’re on our turf now. Yes, I know we asked you if there were any cultural needs we could help you with when you first came in, but we’re required to do that by law.

Sorry for any confusion, but this is ER country and our needs take precedence.


And the taboos!

No lookie-loos into other rooms! How rude!

No discussion of other patients! How crass of you to ask!

Demanding to be seen first! How thoughtless can you be?


We expect them to wait without griping.

We expect them to take the treatments we give without whining.

We expect no exhibits of frustration or anger.

We expect them to know what constitutes an “emergency” and what does not.

We expect them to have complete and total understanding/compassion for the other patients in the department, even though they are sick and worried about themselves or a family member.

Conversely, we expect them not to ask about or show any outward curiosity about the other patients.

We expect them to follow all rules, abide by all customs, meet all expectations.

And never, ever break a taboo.


We expect full and complete cooperation.

Only nobody has explained to our guests what is expected of them.

That makes for a scary, stressful experience and the chance that the “natives” are perceived as uncaring, short-fused, and terse individuals.

Maybe if the rationale behind certain customs, traditions and rules were explained in a timely manner so the patient could understand, things would go a lot smoother for them and for the “natives”.

On arrival, our patients are essentially given a green card in the form of a wristband that allows them entry into Emergency country.

We call it home. To them it is foreign soil.

How well they assimilate into the culture is up to us.


  • Site Translations

    October 17, 2007 at 7:27 pm

    As an interpreter who happens to often work in “Medicine” land, bridging the gap between patients and doctors, I must say this was an excelent article – and right on!

  • Jen

    October 17, 2007 at 7:41 pm

    Good post Kim although it took me to half way to realise you didn’t mean new immigrants (despite the “majority born in the US” line… I’m remedial, plus don’t lots of people in CA speak spanish as a first language?) Anyways, when I thought it was about new immigrants I was going to recommend the book “The Spirit Catches You and You Fall Down”. Heck, I’m still going to recommend it! Now back to my immersion course in Medical-land anthropology, which is of course, nursing school…

  • Nurse K

    October 17, 2007 at 9:06 pm

    My goodness, Kim, I find myself disagreeing with you a lot lately. While it is our job to explain what we’re checking for, what it all means, and the basic rules of the game, the consumer has a duty to know at least the basics of medicine. If you have a stubbed toe or you need a drug refill or you woke up with a scratchy throat or think you would like a free pregnancy test, you do not have an emergency. To arrive with something that is not life-threatening by layman’s standards and become rude and demanding in an ER is nothing more that rudeness, plain and simple. I refuse to say “oh, they are in foreign territory.” Total BS. They are not ignorant, they are abusing our system.

    If we ignore and/or enable the abuses and abusers of our system, our system will not be able to serve the people it is meant to serve.

    If you have a legit emergency by layman’s standards, trust me, I’m not particularly bothered if you ask me how long the wait is, but the rules of good manners apply. Cussing (other than cussing related to your pain), accusing, threatening, calling me names and such are not allowed. I’m a frickin’ nurse. A basic level of respect should be awarded to me and everyone in my department, and it’s wrong to expect otherwise.

  • photo » Lost in the Translation

    October 18, 2007 at 8:28 am

    […] Read the rest of this great post here […]

  • Peggikaye

    October 18, 2007 at 8:38 am

    you need to do a post on the other ‘aliens’ … men!

    My husband has been told 4 times this week by his doctor to go to the ER and has refused. “What can they do for me?” (can I pull my hair out now?) He wants the answers first, then he’ll cooperate. How many men get into serious trouble because they want the answer first and wait too long to get help. (his blood pressure is 82/52 … and we don’t know why, this is the same husband that spent 45 days in the hospital earlier this year from post polio and has atrial fibulation … but ..no what can the ER do for me?

    well … some IV fluids and some tests to find out what’s going on for one thing?????

  • Richmond

    October 18, 2007 at 11:39 pm

    There are pedddlers of diffferent rice cakes here in the Philippines who calls in the middle of the afternoon carrying and balancing their goods on top of their heads.

  • Richmond

    October 18, 2007 at 11:41 pm

    I like this post.

    I am going to make you my favorite blog in my links.

  • medrecgal

    October 21, 2007 at 7:04 pm

    Fantastic post…reminded me of too many times when as a patient I wound up having to explain everything to my “layperson” family who have very limited contact with medicine. Also of times when physicians have done a sort of double-take when I offer such explanations, because they don’t expect a patient to know so much about all things medical. That’s what happens when you’re a geeky type who wanted to become a physician from a very young age who’s had exposure to a wide variety of specialties from the patient perspective.

    I’ve found that being a patient can be the total pits much of the time, but that my background helps make it more understandable and somewhat less stressful. None of that crazy, demanding, make it hard on the staff behavior will ever intentionally emanate from this gal. I will say that straddling that fence can be quite peculiar, however.

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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