Wednesday, July 6, 2011


by Paul Steve C. Sumortin

Scene1 : Lost in Translation
Triage Area Emergency department - Children's Hospital, Washington DC
Sometime in May 2011, I saw the reflection of my next patient from the privacy screen of my computer. A Hispanic Mom with her daughter patiently waiting until I finished entering data in the computer of my last patient.

Me:          Hi, how are you?   
Mom:       Hola, habla espanol Senor? (Hello, do you speak Spanish Sir?) 
Me:          Poquito , necesita un interprete? (A little bit, do you need an  interpreter? ) 
Mom:      Si, por favor (Yes please) 
Me:         Un momento por favor, tome asiento. (One moment please, have a seat).
Scene2 :  The Interpreter

I was able to get more information with the help of our in-house interpreter. She brought her 6 year- old daughter that day due to swelling on the right side of her neck. Her daughter was diagnosed with ear infection 3 weeks ago, already changed her antibiotics twice but still with on and off fever. Her daughter has Down's syndrome. The Dad is the only working and was at home with their 3 other kids. They have no health insurance.


When I was rotated back to the main ED she happened to be my patient. It was a high census night and they were in the Asthma room sitting on a chair. The outgoing nurse told me that they sent CBC twice already but it got clotted. I approached them with a smile and introduced myself. The Mom smiled back and said she remembered me as the person who triaged them. The patient as happy as she can be waved at me. 

Through an interpreter I explained to the Mom the plan of care- placed an IV and send another blood. She was hesitant at first but after explaining what happened she agreed. It was less than an hour when I received a call from the lab. They usually call if you messed up a specimen, wrong label or it's a critical result. I was betting with a Resident that night- she's for another clotted specimen, I was for high WBC. Both of us end up wrong, her blood count was positive for BLASTS !


I moved the family to a more private room after conferring with the Charge Nurse. I knew anytime soon, people will just get in and out of that room from Attending MD, Oncology Fellow, Admitting Residents, ER residents and other members of healthcare. I provided both of them with blankets and something to eat. I did more lab draws and started her on antibiotics per protocol. I explained to the Mom about the procedures but not mentioning about the newly diagnosed ALL (Acute Lymphoblastic Leukemia). The Mom was teary eyed when I entered the room to check them. The Oncology Fellow just came out of the room. In my limited spanish I asked her if she's okay. Tears started to swell in her eyes. She's asking for an interpreter. 

Through an interpreter I learned she had lots of questions, so confused ,worried on how and what  to tell her husband. Her greatest fear was the patient will not survive. I asked our ED Social work to facilitate calling her husband and talk about community resources and support group. I informed the ED Attending to talk again with the mother's concern and questions. My shift was over and they were still in the ED. I went to their room, the Mom was holding a rosary. She gave me a weak smile and said: " Mi amor va a estar bien" (My love will be fine). 


Children's Hospital Lobby
July 5, 2011

Yesterday morning I was running late for our in-service seminar. I yelled on to whoever inside the elevator to hold the door. A tiny hand held it for me- she's wearing a cute bandana to cover her thinning hair and had a purple backpack with a familiar cartoon character. I remember her and the Mom and vice versa. The Mom introduced me to her husband and say something else I can't comprehend. Her husband gave me a firm and warm handshake : Muchas Gracias Senor !


1) Formation of Humanistic-Altruistic System of Values 
In this scenario , I practiced kindness irrespective of one's age, RACE, sex, religion , MENTAL and PHYSICAL abilities. We should not pass judgment and provide ALL patients with same respect and level of care.

2) Instillation of Faith-Hope
I instilled trust and hope by being available to meet their needs such as :

a) using an interpreter for the Mom to relay information and answers the questions she can best understand well.

b) healthcare team availability for any questions

c) providing her with informations on how she can avail of resources : social work, community resources and support group.

3) Sensitivity to Self and Others
Having got the news that your kid has a cancer can be very devastating especially for someone with a language barrier. My presence and checking them every now and then is an indirect way of saying " I'm here to support".

4) Helping-trusting , human care relationship
I earned their trust by being cultural sensitive, listening and being present, facilitating what they need, giving them a heads up of any procedure, updating them with plan of care and advocate for them.

5) Expressing positive / negative feelings
Asking her question such as Are you okay?  helped in exploring patient's feelings.

6) Systematic use of Creative Problem Solving Caring Process
It's a group effort in helping the Mom explore alternative ways  or find new meaning in their situation in dealing with the problem ( e.g. Social work recommendations about community resources and facilitating reaching the father, Attending MD consulting Oncology department , RN as liason, Interpreter in facilitating a smooth flow of communications).

7) Promoting Transpersonal teaching-learning
Since the Mom was still confused about the diagnosis, I asked the Attending to address her concerns with the help of an interpreter. We helped her understand about the child's illness but we don't give her too much information so as not to overwhelm her.

8) Supportive, protective and or corrective mental, physical, sociocultural and spiritual environment.
By moving them in a single room, I provided them the privacy that they need and enable the patient to rest.

9) Assistance of Gratification of Needs.
I met their needs by helping them less worried, respecting their privacy, facilitating involvement of other family members and assisting with basic needs (food, comfort, giving antibiotics).

10) Allowance for Existential-Phenomenological-Spiritual forces.
Allowing for the unknown to unfold.

Cara, C. (2003). A Pragmatic View of Jean Watson's Caring Theory,

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