Cambridge, Massachusetts, USA
|Still Life – A Student’s Table. William Michael Harnett. 1882.
Philadelphia Museum of Art.
In college, I majored in anthropology. I was interested in understanding the political, social, legal, and economic forces that influence behavior. As language is inherently related to consciousness and culture, its study was central to my learning. In my medical anthropology course, for example, we spent hours discussing the linguistic difference between “disease” and “illness.” I learned that disease refers only to changes in biological functioning, whereas illness is shaped by the individual culture of the afflicted. I envisioned that this framework would help me practice as a compassionate caregiver, one who saw illnesses, not diseases.
In order to become an anthropologist, I had to learn a new language myself. I went to the library with my newly purchased backpack and librarian glasses, ready to be a dedicated student. Surrounded by millions of books, perfectly shelved and waiting for eager hands, I worked my way through a towering pile of the anthropology classics. My anxiety soon started to kick in. I thought I knew how to read pretty well, but I had no idea how to understand the words in front of me. Anticipatory socialization? Conspicuous consumption? Why did this university accept me? There must have been some mistake. Symbolic interactionism? The tears started falling, right on top of the pages, making it even harder to read.
Remembering I was in a public place, surrounded by worthy students, I pulled myself together, turned to my laptop, and frantically searched for summaries of these books and definitions for their foreign phrases. I stayed until the warning bell rang, signaling the library was closing in five minutes. I almost hid in one of the stacks to stay the night. I did not want to be a failure.
I had to learn another new language to become a doctor. I was in a different library, but the chairs were still wooden and uncomfortable, the lights painfully fluorescent. The towering pile of books became a stack of anatomy atlases and a box of plastic bones. My tears came to pay me a visit once again. I could not even pronounce these words! Cauda equina? Hyoid? Gastrocnemius? Not only did I need to learn this new language, I needed to replace my old vocabulary with a new lexicon. The word sweating became diaphoresis; nosebleed became epistaxis.
In the classroom, I referenced these words with confidence because I so badly wanted a membership to the intellectual community of doctors. But when I came home, I practiced saying them over and over again, even waking up in the middle of the night to flip through a few more flashcards.
With time, these medical words also became less scary. I started feeling bigger than my fear. Obviously the gnathion is the lowest point of chin. How did I ever not know that rhinorrhea means runny nose? I started to feel confident. I could read, even write, an entire medical note without having to look up a single term. I could look at a body when walking down the street and recite to myself the visible muscles, nerves, and arteries. I could talk shop with my classmates and teachers. It made me feel legitimate; I was part of the club.
As a fourth-year medical student I cared for Suzanne, an elderly woman who spruced up her hospital outfit with a hot pink hat. Her granddaughter stayed by her side, sleeping every night in the sofa chair. It reminded me of how much I love my grandmother who raised me, and I hoped I would do the same for her.
“Do you have any complaints this morning?” I asked Suzanne, thinking about the medical note I would later write and the oral presentation I would give, beginning with the patient’s “chief compliant”—the self-reported primary reason for seeing a doctor.
“I’ve got nothing to complain about.”
“The echocardiogram for your congestive heart failure came back.”
Suzanne’s eyes squinted. “What’s an echocardiogram?”
“Oh, it’s the picture they took of your heart yesterday. It wasn’t impressive.”
Suzanne’s eyes widened. “What do you mean I’m not impressive?”
“Oh, I mean it was normal. But since you failed your outpatient dose of diuretics, we will increase that today.”
Tears started rolling over the wrinkles of Suzanne’s face. She took off her hat to wipe them away. I saw her beautiful gray hair.
“Is everything ok? Did I do something wrong?” I asked.
The granddaughter explained. “You say words we don’t understand. You call her a complainer? You say she’s not impressive? You call her a failure? Of course she’s going to be upset.”
I sat at the edge of the bed. In the freezing cold room, my confidence melted away. All I could say was, “I’m sorry. I’m so sorry.” I had no excuses. Her tears were like my tears in the library, feeling unimpressive, feeling like a failure. Not only was I using words Suzanne did not understand, the words I did use were harmful. How many other patients had I harmed with my words? Why didn’t they tell me? How could this be me, a scholar of language? I did not know what other words to use. The right words, words I once knew, were long gone from my memory.
Now when I walk into a room to provide care, I remind myself that patients do not have complaints; they have concerns. Patients are not interesting cases; they are not the large tumor or the ruptured spleen. They are individuals with a unique set of life experiences. And they hear the words we learn to say. Language is immensely powerful. It is how we form relationships, develop trust, and communicate information. Yes, there is a vocabulary of body parts, diseases, and procedures I need to know to communicate with health care providers. But I also need to know how to explain these terms to patients. And I have decided that the risk of wounding a patient with my words is not worth the authority I feel when using the vocabulary of doctors. It no longer makes me feel like a failure to use common terminologies. I say red instead of erythema, swelling rather than edema, concern in place of complaint, and normal instead of non-impressive. It makes me feel brave, worthy of caregiving.
CHARLOTTE GRINBERG, MD, is a writer and a resident physician in internal medicine at Harvard’s Mount Auburn Hospital in Cambridge, MA. She has a particular interest in end-of-life care. Her work has appeared in JAMA, Annals of Internal Medicine, Health Affairs, Pulse, and she is the author of a French ethnographic book on pregnancy and citizenship in French Guiana.