Irvine, California, United States
Patients in the lobby think I speak Spanish very well. Although I momentarily feel validated, those compliments would mean more if I did not know I was repeating the same conversation cyclically, drawing from a carefully prepared arsenal of questions and responses and an accent I parrot from the farmworkers I have worked with. My actual Spanish skills are apparent in the exam rooms of our small clinic in downtown San José, Costa Rica, as I struggle to connect with my patients with a few simple words.
Yo voy a tomar su presión. “I’m going to take your blood pressure.”
Ok, this one can be taken at face value. I take a lot of blood pressures.
No quiero café hoy. “I do not want coffee today.”
The clinic staff really likes coffee breaks and were fairly shocked when I refrained one day. They politely told me that I should drink up.
No se preocupe. “Do not worry about it.”
I hear this much more often than I say it. This phrase is meant to relax me, but I know that it really means I have done something incorrectly or misunderstood a direction. My de facto supervisor, a former nun, has much more patience with me and says it more often than my other coworkers.
No se la palabra en español. “I don’t know the word in Spanish.”
I thrive off learning and asking questions, but my vocabulary limits me. Perhaps more importantly, language has profoundly changed my experience of medicine. One of my primary motivations for pursuing a career in medicine was the potential for connection; the importance of my words to this connection truly became apparent after I was left feeling distant and impersonal with a patient, unable to adequately bridge our linguistic gaps.
Yo sé que estoy haciendo. “I know what I am doing.”
I had been warned many times that the indigentes could be difficult to work with, but I always shied away from these warnings fearing any accompanying cynicism. I still fear becoming cynical, but now understand the warnings. I may not know the ins and outs of clinic functions, but I do know how to do my tasks. Thus, it is frustrating when patients tell me I am doing my work incorrectly. Yet I shrug it off as their preservation mechanism born from having to constantly assert their dignity.
¿Qué nosotros tenemos? “What do we have?”
All supplies at the clinic are donations, meaning the clinic is chronically undersupplied—all our supplies easily fit into one small cabinet. Every day is a lesson in frugality, and I see everyone at the clinic make choices in how to practice it. Reusing gloves, gowns, masks, and hairnets for multiple days might send a shiver down a safety officer’s spine, but does the clinic have a choice? Materials may be scarce, but volunteers are omnipresent. Thus, as I take stock of the supplies we have for the day, I add the pleasant small talk, smell of coffee, and tinny radio music wafting back to me from the lobby.
El huele. “He smells.”
The smells of the street hang around the indigentes, particularly after a heavier rain leaves them damp and unable to dry their clothes. It is one of the many indignities they suffer, and thus I am dismayed by the passing comments some of my coworkers drop about our patients.
They remind me of the horrors from medicine’s past; a scalpel used without consent, syphilis medications withheld, and anesthetics gone unused. I see this, and I hang my head. I hear the voices of my forebearers saying this will not do. I hear them list what we must do if we are to be better. I hear what drew me here in the first place—the concern, the compassion, and the drive to be better. All this from two simple words. Sometimes, our words are loaded with meaning.
RILEY SCHERR is a first-year medical student at UC Irvine. As an undergraduate, his research activities were in the anthropology of farmworker health both in California’s Central Coast and northeastern Costa Rica. This piece is adapted from a series of reflections he wrote during his time working at a clinic for the homeless community of downtown San Jose, Costa Rica. He hopes to pursue a career in critical care medicine or interventional radiology.
Submitted for the 2022–23 Medical Student Essay Contest