By Rod Moser, PA, PhD
My recent blog about language barriers stirred some considerable controversy, especially regarding accommodations for deaf patients. Throughout my career, I have done what I could to provide medical services for non-English speaking and deaf patients. With patience and mutual respect, we all manage to complete a successful visit. I returned to work yesterday after being off for months following not one, but two shoulder surgeries. My first two patients did not speak English. Fortunately, we do have a certified Spanish interpreter as one of our medical assistants. This is not what I want to discuss, however. Proving that nobody is immune to such things, I have recently experienced a language barrier as a patient myself.
Our European trip was planned for over a year, cancelled from a previously scheduled vacation when one of our traveling companions was diagnosed with a lymphoma. She is fine now, incidentally. For two days, we hiked in the Swiss Alps like the teenagers we once were. At over 9,000 feet, we traversed cloud-shrouded and snow-covered mountains, enchanted by the magnificent views and lulled into a peaceful state by the distant sounds of bells hanging from the necks of cows. They were perfect walks, about 10 miles per day. Surprisingly, I did fine. I had thought my sea-level existence (and lack of exercise) would have caused some issues, but it did not. The next day, we had a long drive to Salzburg, Austria.
That night, I developed a sudden and unusually productive cough. I wasn’t sick. When I turned on the light, I was startled to find that I had coughed up a large amount of fresh blood. Taking a deep breath, I immediately noticed the rattling sounds of fluid in my lungs. This hemorrhage continued for several hours, so I woke my wife around 4 a.m. and informed her that we needed to go to the hospital. She woke up our startled friends. Our little hotel did not have the front desk staffed at night; the owners go home. We managed to circumvent some language barriers while using a cell phone and arranged for an ambulance. Unfortunately, the road was completely closed in front of the hotel so we did not know how to tell them were to find us. We picked the closest cross street. The ambulance picked the opposite one. After a few blocks of walking, we finally met and I was off to the emergency room in a foreign country. The ambulance attendants did not speak English. I do not speak German.
Arriving at the ER only a minute before my wife and friends arrived by taxi, I somehow managed to get through the receptionist. I figured out that they needed some money, my insurance, my passport, and some other data. Asking for a co-payment is a universal language in all emergency rooms.
I was put in an exam room. My wife and friends had to stay in the waiting room. My doctor was really a “resident” (doctor-in-training). She spoke a little English, but not Medical English. I spoke “Medical”, but not in German. She put in an IV, took some blood, and gave me an injection of a blood pressure drug. My BP was very high; not that unusual when you are drowning in your own blood. I was sent to x-ray and then on to an ENT to scope my throat. I was treated like royalty. In Austria and parts of Germany, the name Moser is very common. My ENT was a Moser, as was another doctor that cared for me. Apparently, Moser is really a German version of Smith. I also found out that my ER doctor’s mother was a Moser. Eventually, it was determined that I had ruptured a blood vessel in my lungs, most likely due to the high-altitude hiking. After a few hours (still coughing blood, but considerably less), I was discharged on a potent blood pressure drug and told it was safe for me to fly home as scheduled, a few days later.
My ER experience in Austria was a different experience from what I’m used to, but I thought my care was excellent. It could have been because I was treated like a long-lost cousin, but I don’t think so. Yes, there was a language barrier, but no one brought in an English interpreter. We just muddled through as best as we could.
One week later, I am home. I am still coughing up some residual blood, but I’m well enough to return to the clinic. I saw my own doctor, and my blood pressure is better and I am adapting to my shoulder limitations.
Now, the hard part…I have to deal with my insurances. I called for some claim forms. I could barely understand the person on the phone. Sometimes, no matter where you are, you’re going to have a communication problem.