What two months on a hospital recliner taught me

Like most students, I hoped to spend the summer before starting medical school enjoying time with friends and family. I was able to do this, but in an unexpected way. For about two months, I slept on a hospital recliner by my grandfather’s side. While we bonded, I witnessed how common it is for patients with limited English proficiency to fall through the cracks in the areas of cultural competency, nutrition and emotional wellness.

Cultural competence

My grandfather speaks a dialect that combines Ukrainian, Hungarian and Russian. When we first arrived in the emergency department (ED) on a busy night, I explained that I was with him to translate. Overwhelmed with the ED chaos, the stringent pandemic visiting restrictions were overlooked and I was permitted to stay by my grandfather’s side.

However, when he was admitted to the hospital later that night, we encountered significant pushback to my role as translator, even though I explained that my grandfather’s specific dialect does not lend itself well to translation services. This information was ignored and a translation service was brought in. As expected, the translation was unsuccessful. The translator did not understand when my grandfather described his symptoms, so I proceeded to translate.

We were frustrated that our initial hesitation regarding the translation service was not acknowledged. My grandfather was a patient at the hospital a few years prior and experienced the same challenges. Just because a translation service is offered does not mean that it will be successful. In my grandfather’s case, the service did not help because the languages offered did not align well with his native language.

Thanks to advocacy from a resident physician, the hospital eventually granted my family permission to stay with my grandfather 24/7. My mother, grandmother and I each took turns staying with him to translate for the medical team.

While our situation was not ideal, I genuinely believe that my grandfather would not be here today if it were not for us translating his requests, concerns and symptoms to the hospital staff. Often, the term “cultural competence” is used in the healthcare setting, but I think that the true meaning is overlooked. To me, a true culturally competent physician goes above and beyond to acknowledge patients’ needs and makes appropriate accommodations.

In our case, this meant recognizing that a translation service would not suffice, and that special visiting permission needed to be granted by the hospital. Patients who do not speak English cannot verbalize their needs and often do not know what their rights are as patients. It is up to physicians to recognize their needs and stand up on their behalf.

Nutrition

Another challenge I witnessed among non-English speaking patients is the barrier to nutritional management. My grandfather’s diet changed several times throughout his hospitalization as his gastrointestinal condition improved and worsened. One day early on in his stay, lunch was delivered while my mother and grandmother were out of the room switching shifts. My grandfather, who had been on a liquid diet and was brought a regular meal, assumed the doctor had changed his diet. By the time my grandmother returned, he had eaten the full meal, which had actually delivered by mistake. This resulted in a complication that ultimately led to a longer recovery time.

The hospital food system was completely inaccessible for patients like my grandfather who do not speak English and struggle with technology. Patients were required to call in each of their meal orders, which is an impossible task for those unfamiliar with the hospital phone system or who have language barriers. Fortunately, we were there to order my grandfather’s meals, but many other patients don’t have that assistance. After our incident with the diet misunderstanding, we asked for more oversight regarding my grandfather’s nutrition plan.

A suggestion that I would make to physicians who have non-English speaking patients is to be more aware of their diets. For patients of different cultures, the food that is served in hospitals is not what they are accustomed to. As seen in my grandfather’s case, patients may also not understand the reasoning behind certain diets. For someone who eats potatoes and meat most days of the week, Jell-O for dinner is nonsensical – it is important to take time to explain the decision process.

Lastly, even when patients know what their diets should be, it may be difficult for them to communicate to staff when something is incorrect. By ensuring patients’ diets are correct and properly followed, the risk of complications is lowered, and this overall helps with a quicker recovery.

Emotional wellness

For anyone who is hospitalized, the experience can be stressful, scary and isolating. These feelings are amplified for non-English speakers. When I was with my grandfather, especially in the evenings, I noticed that the healthcare providers often did not attempt to interact with him. They stepped in, spoke to me, completed the task at hand and left.

My grandfather and I had a running joke during his stay that the providers forgot that he was the patient. It is understandable that healthcare professionals have limited time; however, it is critical to interact with patients regardless of the language barrier. A smile and friendly gesture go a long way in strengthening morale of patients.

Physicians can also seek out other healthcare providers who speak the same language as the patient and encourage them to visit the patient. There was one physician on my grandfather’s medical team who spoke Russian. While Russian is not my grandfather’s native language, he knows enough to have a simple conversation.

Each day, my grandfather looked forward to seeing this doctor because they shared a common interest in gardening. They conversed over the types of vegetables they grow and shared tips and tricks. These interactions kept my grandfather engaged and gave him optimism that he would soon be able to return home and get back to what he loves doing.

For physicians who do not speak their patients’ native language, I recommend finding a team member who does or somebody who speaks a language closer to that of the patient. Encourage them to visit the patient and ask them about their hobbies and interests. Moreover, for physicians who speak a language besides English, it is valuable to be cognizant of non-English speaking patients. For many hospitalized patients, short interactions with those who speak a similar language may be the only times they are reminded of what they have to look forward to once they get well again. 

While my summer before medical school was not what I expected, I gained an invaluable perspective and understanding of the experiences of hospitalized non-English speaking patients. Having a background in public health, I am trained to think about equity from a systemic perspective. However, over the two months in the hospital with my grandfather, I realized that as an individual and as a physician, one person can make a significant positive impact on the well-being of a patient.

Related reading:

How I navigated my grandfather’s death as a medical student

Becoming the medical expert in my family