The Language of Compassion
Anna sat almost motionless at the end of the exam table, her body hunched over and mostly hidden beneath a gown much too large for her frail form, her eyes staring at the floor. Stapled to the chart was a copy of her driver’s license from just a year ago, featuring a photograph of a vibrant, healthy woman in her late sixties smiling jubilantly for the camera. Her exposed extremities were reduced to the thickness of the bones below, and her face was sunken and skeleton-like. Having lost a grandfather to lung cancer, I knew the look all too well. Without asking a single question, I already knew the diagnosis. But, in only the third week of my first clinical rotation and having dealt with no more than the usual sore throat and allergies, it was a diagnosis I felt ill-equipped to handle both clinically and emotionally.
“Good afternoon, Anna.” I approached her with an outstretched hand, which she promptly met in a handshake. At that moment, her gaze shifted upward briefly to meet mine with a fleeting sparkle in her large, blue eyes.
“You speak Polish?” a middle-aged woman sitting in the corner blurted out in broken English.
“No, I don’t,” I responded. “While mylast name is of Polish origin, I am American born and do not speak the language.”
“Well, she no speak English,” the woman firmly stated in a disappointed voice. “I her daughter-law, I bring her here, she visit Poland and get in hospital for one month, they tell me she die from stomach cancer, but I no believe.”
Since there were no translators available, I gathered Anna’s history the best I could through her daughter-in-law. Anna sat frighteningly motionless through the process, rarely lifting her eyes from the floor. I learned that Anna traveled extensively throughout Europe and returned annually to her native Poland to visit family and friends. Shortly after leaving for her most recent trip, she became ill. First, she experienced intermittent abdominal pain that soon became continual. She repeatedly took antacids and reassured her family that she was fine. Slowly, her appetite began to diminish, and within just four months, she lost more than thirty pounds. When she started having difficulty breathing, she was hospitalized, and that’s where she spent the last month of her visit to Poland, diagnosed with terminal stomach cancer.
I gently performed the physical exam, having Anna’s daughter-in-law explain my every move in advance. Anna was in a great deal of pain, most of which she soically attempted to conceal. As I suspected, it became clear on percussion that Anna’s lungs were filled with fluid. She had even more pain over her ribs, but said little more than a soft “boley,” which I found out means “pain” in Polish, as I palpated the affected areas. When I discovered a large, cauliflower-like mass in her epigastric region, it took all my concentration to not gasp in horror. Instead, I remained calm for Anna’s sake. She was so thin that it was easy to determine the size of the mass through her abdominal wall, and, even to my inexperienced hands, it became clear that the situation was quite serious. After consulting with the resident and family practice attending, we decided that she would be best managed by an oncologist after her diagnosis was clarified. First, though, we would send her for imaging studies, a biopsy, and thoracentesis. After having our plans explained to Anna, I said goodbye to her, during which she firmly shook my hand and gave me one of the warmest smiles I have ever experienced.
Although that was my last day working with the resident overseeing Annas case, she still kept me informed on her progress and found me later that week as Anna was undergoing the thoracentesis. She instructed me to run down to the procedure room, for they already had started draining Anna’s pleural effusion. Entering the procedure room, I saw Anna’s frail, exposed back hunched over with a tube draining a copious amount of straw-colored fluid into a clear bag. Anna was by herself this time and appeared very frightened, her eyes, once again, fixed on the floor. Her solitude saddened me, and I found myself fighting back tears. This time, Anna had no one to translate, not even her daughter-in-law.
“Do you speak Polish?” the nurse asked me as I approached teh bed. She had noticed the long, Polish surname on my badge.
“No, not a word,” I replied.
“She doesn’t speak any English,” the nurse stated almost defiantly, as if she was expecting me to recoil in horror.
“I know,” I answered, while I rounded the edge of the bed and came into Anna’s view. As I stretched out my hand and said her name, she immediately looked up and met my hand with hers. She smiled even wider than at our previous encounter, and her eyes sparkled. Her frightened look left. I held her hand throughout the rest of the procedure, and she took on a demeanor I had not previously known. For that moment, the language I spoke mattered little.