“He’s three years old. The mom is
non-compliant. Keeps stuffing him full of chips and pretzels even though he’s on
a sodium restricted diet. They don’t speak English; they’re from somewhere
else.”
I know where they’re from… the chart clearly said. Didn’t
you look at the chart?
“If his kid sister is in there, she
speaks English and might translate for you. It’s hit or miss.”
…YOUAREUSINGACHILDTOTRANSLATEMEDICALINFORMATIONOHMYGOODNESSWHATISWRONGWITHYOU?
“I guess maybe you could try the translation line if you want to bother
with it."
I am struggling to like you in this
moment.
“He doesn’t like us very much. I think because we’re white. He’ll scream
the whole time you’re in the room.”
Been there, done that. Challenge
accepted.
I just got home from clinical. I am somewhere between heartbroken and
livid. Details must be suppressed and changed to satisfy privacy laws and
protect the precious family I was privileged to serve tonight.
They are refugees. Mom is a single parent with half a dozen children. Dad died.
The littlest child is sick with a chronic congenital condition of the kidneys.
They’ve been Stateside for 2 years.
I took report from the nurse, shook it off, and went to the room in the corner.
Sure enough, as soon as I opened the door, the beautiful three-year-old boy on
the bed began to whimper and withdraw. I immediately dropped to my knees to be
on his level and began playing with my penlight. Within about 30 seconds, he
stopped crying and reached out to take the light from me. He shined it on the
sheets. And on his hand. And on my hand. And then he chased me around the room
with the light, trying to keep it pointed on me as I dodged out of the way.
Then he hid it behind his back so I would look for it. I peeked around to find
it, and when I did, he laughed. This wonderful, beautiful, gem of a child
laughed, from deep down in his soul, and his coal black little eyes disappeared
into his scrunched up face.
Then he banged the light on the bed and broke it, but I really didn’t care.
That laugh was worth millions more than some silly penlight.
He listened to my heart with the stethoscope and gaped up at me in wide-eyed
wonder, both hands pressed solidly over his ears, as if the earpieces of the
stethoscope would suddenly leap out and run way if not secured. Miraculously,
the stethoscope was not scary anymore, and now he let me listen to his chest
without screaming bloody murder. He pinched my finger, and then I pinched his
to check his capillary refill. His 10-year-old sister helped me by letting me
take her blood pressure. Then she took my blood pressure. Finally, she pushed
the buttons on the machine to take his blood pressure. And his reaction? A
smile. A toothy, slightly drooly smile.
The little girl would not make eye contact with me. “What’s your name?” She
told me. I couldn’t pronounce it, but my attempt earned me a crooked grin. “Do
you like to draw?” No. I draw ugly. “Do you like any board games?” No. “What do
you like to do?” I don’t know.
Sigh.
With that first set of vitals over, I used the translation hotline to try and
find someone who spoke their dialect. No luck. I am now frustrated beyond
belief, because I know there is a pretty decent population of these people in
the city, and I absolutely cannot believe that a major Nashville hospital has
not laid out a means for translating vital treatment information. This child’s
kidney function is severely compromised. He has massive generalized edema that
could quickly lead to pulmonary edema. The low salt diet helps prevent that.
He’s been here three days. How is it that in three days, no one has
communicated the importance of restricting sodium to this family? Because
within 5 minutes of interacting, I can tell it’s not noncompliance. It’s
knowledge deficit and utter bewilderment. They have no idea. This should not
take three days. And it shouldn’t be a nursing
student who finally steps up and does it.
Nonetheless, it appears that I too must use a child to translate.
I have some charting to do now, so I have to leave the room. I wave to the
little boy. He waves “bye-bye” and blows me a kiss. His mother smiles for the
first time.
The next time I go in, I notice his lunch is still sitting on the counter. He
wouldn’t touch it. I’m frustrated. I speak with the sister again.
Do you like this food? “No.” What do you eat for breakfast usually? “We don’t
have food for breakfast.” What about lunch? “Rice and fish.” And dinner? “Rice
and fish.”
I order more food for him. Rice and fish this time. He eats some, then falls
asleep. I am not surprised. He’s been crying and screaming all day. His sister
is eyeing the tray, but her mother says something in their language, puts the
lids back on, and shuffles away tiredly. She looks exhausted, and worried. The
girl looks at me. “If we eat the food, will you make us pay for it?” No honey.
Please, eat the food.
She excitedly speaks to her mother, and the two of them pounce on the tray and
nearly inhale the leftovers. It hits me that the mother probably has not been
eating much if at all since the child was admitted. It’s been three days.
The hospital has a partnership with a catering company that donates one meal a
day to families that can’t pay for it. We work it out so they can get a tray
for dinner. The little girl lights up. I bring a board game, a stack of paper,
and some markers into the room and ask if she happens to have changed her mind
about games and drawing. What do you know?! She has. She begins plastering the
room with portraits of flowers and butterflies and families playing together.
We start playing a board game on the floor, but the little boy gets upset that
he can’t play, so we move it outside to a bench in the hallway. She talks the
whole time we’re playing—about fifth grade, and how math is her favorite
subject, and how boring the hospital can be. But then she mentions how I let
her hit the buttons on the machines as long as I’m standing right there with
her, and she says she thinks she wants to be a doctor someday. I tell her to
hold onto that dream, and fight for it, because so many people will tell her
she can’t.
One of the things I’m supposed to chart is the family’s religious practice.
Statistically speaking, I know they are probably one of two religions common to
their background. I ask her where they go to church. “Oh, it’s an English
church.” Do you know it’s name? Is it this religion? Or this one? “Nope. It’s
just an English church.” Alright then.
She wins by a landslide. I might have let her. Then we clean it all up and take
it back to the room. I show her how swollen her brother is and explain that
salt makes it worse. We go to the nutrition room, and she helps me pick out
which foods he can eat. Then she “shows” me which ones he cannot eat, and we
review that several times. She’s going to be a good little doctor. Finally, she
translates all of this for her mother, who becomes upset that he cannot have
chips and pretzels—not because she wants to feed it to him, but because she did feed it to him earlier and didn’t
know she wasn’t supposed to. She asks if he will get sicker now. I tell her I’m
going to take really good care of him to keep that from happening. And my heart
breaks, because if he does get worse,
she will blame herself. And this was NOT. HER. FAULT.
He’s still asleep, and has
been since 6pm. Mom says he will sleep through the night and wake up really
early in the morning, before dawn. I bring some breakfast cereal and milk into
the room for them so that she won’t have to wake the girl up to act as
translator if he wakes up hungry. The little girl sits and talks with me while
we draw together, and she teaches me how to say all of the colors in her
language. She says she is surprised how quickly I learn it. Now it’s my turn to
smile.
All the student nurses go downstairs for dinner. I grab my bag. A friend of
mine spent a summer working with the very people group that this family is a
part of, and he brought this bag back for me. I hadn’t even thought of it. The
mother drops what she is holding, exclaims something that I can’t understand,
and smiles as tears run down her face. My heart is full.
I check in on them just as my shift is ending to say goodbye, but they’re all
asleep. Mom is curled protectively around her son in the bed. He is still fast
asleep, one arm flung listlessly out over the bedrail. His sister is asleep on
the couch, buried under blankets that rise and fall slightly with her even,
peaceful breaths. My eyes fall one
last time on the little boy
I don’t wake them up. I hope they know that I care, and more importantly, I
hope and pray with all that I have in me that someone steps up to care a little
extra for this family when I’m gone. I hope that someone fights for him.
I’m still praying as I pull the door closed and walk away. I have never, in
four years of nursing school, been this attached to a patient. Everyone always
tells you not to get attached. But you know what happens then?
You forget to fight.
I will not do that.
Because sometimes, no one else will.
May God forever send me to those precious children that no one else will fight
for.