I spent a large portion of my afternoon yesterday helping two people navigate end of life issues. June, a 93 year old woman presented with her daughter from a local rehabilitation center with an ischemic limb. Although June had been complaining about left foot pain for days, her rehab was for a right hip fracture. Therefore, the focus of care was on the hip fracture. Her referral to our wound center was made by her cardiologist who recognized the signs of critical limb ischemia.

Health Care Interpreters

I spent a large portion of my afternoon yesterday helping two people navigate end of life issues.  June, a 93-year-old woman presented with her daughter from a local rehabilitation center with an ischemic limb.  Although June had been complaining about left foot pain for days, her rehab was for a right hip fracture.  Therefore, the focus of care was on the hip fracture.  Her referral to our wound center was made by her cardiologist who recognized the signs of critical limb ischemia.

June had most of the problems you'd expect to see in someone her age.  The most obvious of her problems was that she couldn't see and she couldn't hear.  These two problems made it difficult for her to communicate in a meaningful way with her caregivers.  Although she had been expressing her leg and foot pain for days, no one at her rehab facility had taken notice of the severity of the problem.

June was brought into our clinic by her daughter who we'll call Nancy.  Nancy was extremely helpful in a number of ways.  Nancy was able to provide an accurate history and brought with her a list of medication that her mom was taking.  Although June was unable to express herself with the clarity needed to describe her problems, Nancy was there for her mom as her advocate.  But Nancy also had another role.  She was acting as an interpreter for her mom.  Nancy was there to interpret the reams of forms, layers of instructions and orders given by June's providers.

We've all experienced the difficulties of working with someone who has a hearing deficit.  It can challenge your patience and it can be a time drain.  And although June was unable to describe her condition in any detail, she was able to understand the severity of her condition.  And she was able to understand what was taking place around her.  Most importantly, she could sense the environment around her.  She was able to recognize those providers who cared for her as a person.

Due to the severity of June's wounds I elected to admit her to the hospital for evaluation by our interventional cardiology team.  Her problems are significant and life-threatening.  As of today, she was not medically stable enough to undergo an angioplasty to determine the extent of peripheral arterial occlusion.  Until an angioplasty can be performed, it's uncertain whether her leg can be saved.

What's the role of an interpreter in health care?  We tend to think of an interpreter as someone who bridges a language barrier.  And in most cases, that language barrier is a foreign language like Somali or Spanish.  But what about June?  The language of medicine was foreign to her.  And without her daughter Nancy, she would have become just another patient; the woman in room 3032.

Health care is complicated.  We need more health care interpreters to unravel the subtleties of how care is provided.  We need more people like Nancy.

Jeff

Jeffrey A. Oster, DPM
Medical Advisor
Myfootshop.com

Updated 12/27/19