Parlez-Vous Espanol?

Sometimes I meet the most amazing people.  A few weeks ago I had a medical student who was visiting from the University of Vermont.  His name was Stanislaus and he spoke perfect English, with a delightful Russian accent.  As we got to know one another, he spoke of growing up in a village in Chechnya, and coming to the United States as a refugee when he was nine years old.  He learned English quickly, and in short order discovered that he had a facility for languages.  By the time he was in high school, he spoke Russian, English, Spanish and French fluently.  When he matriculated at Berkeley, he added Italian, Portuguese and Hebrew. He wanted to be a translator for the United Nations, until he discovered the world of science and medicine.  As he examined one of our Hispanic patients, he gently touched her shoulder and expressed his concern in flawless Spanish.  He will make a fine doctor when he graduates this coming June.

Unfortunately I do not share this gift for foreign language.  Growing up in Houston, Texas I made the misguided choice of taking French in high school.  The year was 1969, and Serge Gainsbourg had just recorded a song he wrote for Brigitte Bardot with his then girlfriend Jane Birkin called “Je t’aime.”  I was sixteen and smitten.  Three painful years of language lab left me breathless, but far from sexy or fluent. I tried again in college, until the beautiful blonde French teaching assistant swept my boyfriend, ten years her junior, off his feet.  My crowning achievement was a term paper written entirely in French about the central thesis of Voltaire’s Candide—“Tout est pour le mieux dans le meilleur des mondes possibles”—“All is for the best in this best of all possible worlds.”  I had no clue that Voltaire was being facetious, and  thus embraced this philosophy, if not the language, ever since.

After my busy medical school obstetrics rotation at Jefferson Davis County Hospital, my remembered Spanish consisted of two commands:  “Empuje” and “No empuje”, meaning “Push” and “Don’t Push”.  These phrases were not very useful in the management of cancer patients. In 2004, having practiced in a community for ten years where Spanish was the language of birth for many of my patients, I decided to attempt to correct my foreign language deficiency.  I signed up for a two week intensive Berlitz course in Spanish. I was assigned two full time instructors—for the mornings, a handsome Argentinean man, and for the afternoons, a beautiful Mexican woman.  Their mission was to speak only Spanish to me, eight hours a day, for two consecutive weeks.  My job was to pick up enough Spanish, through inference and repetition, to be able to respond, and then shortly converse with them in their native language. At this point I had spoken no French for twenty years but despite this fact, an amazing thing happened.  At the end of my two week course, these dedicated instructors were still speaking to me in Spanish. And I was answering in fluent French.

In 1984, when I was pregnant with my daughter, my husband and I took a long awaited trip to Paris.  Like me, my husband had taken French in high school and college, and like me, he has no facility for foreign language.  But we were determined to use our rusty French.  One evening, we had dinner at a fine restaurant on the Champs Elysees. After a four course meal including a small glass of red wine, not quite contraband for a pregnant woman thirty years ago, it was time to go and we decided to ask our waiter for our checked coats. But there was a problem—neither of us could remember the French word for “coat”.  We stuttered and stammered and finally resorted to pantomime.  The waiter was stymied at first, but finally caught on.  “Ah, Madame et Monsieur—you  want your COATS!”  And then, with a wicked grin,  he instructed us: “Vous voulez vos manteaux!”

Needless to say, all three of our children took Spanish.  Many years of Spanish. They are better at foreign language than either of their parents, and that has served them very well.

Just Give Me the Gist of it Please

I recently saw an orthopedic specialist who proposed to operate on my arthritic feet, which have been quite done in by my favorite pastime for thirty five years of jogging miles on pavement combined with the wearing of high heeled shoes to work every day to make my short self taller and thus more powerful. The surgeon described to me in detail a procedure designed to take the pressure off the big toe joint, and increase the mobility.  When I got home, my husband had many questions such as “will this be done under general or local anesthesia?” and “will you need to wear special shoes afterwards?” and “how long before you can swim?”  I stared at him slack jawed—I had not written down a list of questions before my visit, and I certainly couldn’t answer his.  How quickly does the doctor become just like her patients who can’t remember what they have been told, despite the consultant’s serious attempt to educate and inform?  Very quickly, it seems.

Some of my patients have taken the opposite approach to the consultation visit, presenting  with dossiers full of notes and questions and treatises printed from questionable internet sites.  This causes me to settle deep into the comfortable chair in my consultation room—I know that I’m in it for the long haul.  I’ve grown to expect this at the first visit, but when the habit extends to the weekly “on treatment” visits, I know I am in trouble. The French have a saying for a particular type of patient—the patient that comes in with a long list of detailed handwritten notes each time he or she is seen.  They call it “La maladie du petite feuille de papier”, or “the sickness of the little piece of paper.”  The great Sir William Osler commented on this type of patient in his aphorism Number 309—”a patient with a written list of symptoms—neurasthenia.” Translate that to mean “anxiety disorder.” I recently had a breast cancer patient whose husband came with her for each on treatment visit.  They had matching notebooks and matching pens, and they each studiously, meticulously and separately transcribed every word I that I uttered into their respective college ruled 100 page blue books.  And when we were all done they asked me the questions that I had just painstaking answered, because neither of them had heard a word I had said—they were too busy writing!

There must be a happy medium in there somewhere.  If you (or I) have specific questions about the risks, benefits and side effects of a proposed treatment, by all means, write them down and get them answered!  But I do not need to see your journal of the quality, quantity, consistency and timing of your daily bowel movements.  Really I don’t.  Just give me the gist of it, please!