There are various types of pain, each with a different degree of intensity, which we suffer involuntarily or knowingly inflict upon ourselves. We experience physical pain, caused by an unexpected or unpredictable trauma that occurs too swiftly for our brain to warn us about. Then we have chronic pain — caused by a disease affecting one or more parts of our bodies, a pain that almost never abandons you and ruins life day and night. Among the worst is that lacerating pain stemming straight from the heart, caused by actions or words that wound us to the depths of our soul; this pain we seldom manage rationally, and sometimes only overcome by throwing ourselves headlong into the open wound.
Finally, we have reflex pain: a shared pain for those who bear witness, and which increases proportionate to the degree of empathy with which we are endowed (or condemned). Reflex pain brings tears that fall in a harrowing scene of a movie or erases a smile in front of a suffering person. Many who work in hospitals experience this type of pain – for what other place contains more pain than a hospital?
I am Italian, I have lived and worked in New York since 2014 – and I bear this final type of pain daily by choice. For four years I have been a medical interpreter in the most prestigious hospitals in Manhattan: New York University Langone, Memorial Sloan Kettering, Mount Sinai, Presbyterian Cornell, among others. After years of working freelance in an Italy battling its struggling economy, I decided to pursue the American dream. I had no idea the field of medical interpreting even existed, let alone associations offering training courses on terminology, professional ethics, and HIPAA standards — the protocol on the confidentiality of health information, fundamental to behavior that is acceptable in a hospital environment. Given my passion for medicine, as well as for languages, I did not hesitate to enroll in the course.
The six or seven Italian interpreters present in the rotating agency serve in the hospital structures of Manhattan, but also in Brooklyn, Queens and the Bronx. In some of these structures the presence of the interpreter is mandatory, and in the absence of a human person, it is relied upon by a robot-looking machine named Marti, which connects an interpreter through a phone call (audio, but also video) for any language required.
Being witness to the drama of these situations and a person’s survival instinct truly bolsters one’s sense of humanity and perspective.
I grew up in a family of doctors. I spent Sunday mornings watching recordings of oral surgeries my father was studying, or hearing the stories of my sister’s anorexic or bulimic patients. This certainly helped to build an initial curiosity and interest in everything related to anatomy and pathology, psychiatric disorders, and esteem for medical figures. Furthermore, the blood, the sutures, the wounds had stopped disturbing me. I confess that during my linguistic studies, I sneaked into the classrooms of the University of Medicine of Varese to follow the lessons in biology and pathological anatomy and build my glossary in English.
I am often asked what the main linguistic difficulty is in a medical context. And I always answer: the acronyms. In America you seldom spell out a scientific name, so an MRI is simply an MRI (Magnetic Resonance Imaging), intravenous injection an IV (Intravenous), blood pressure BP (Blood Pressure), chronic obstructive pulmonary disease COPD (Chronic obstructive pulmonary disease), et cetera. Even the names of drugs are not exactly intuitive for a virgin mind and, even more so, a foreign one, and it takes time to hear them as much as possible and to memorize them.
What struck me immediately was the attitudes of the doctors toward an interpreter. I immediately felt I was a key figure, one who is given a front-row seat and a great deal of gratitude for being a facilitator. This role gives life to a delicate, complicated and often emotionally demanding conversation. We were taught not to give too much space to personal conversations, not to express friendliness more than necessary — in short, to be rigorous. At the beginning, I did so. Yet, in some cases, having to translate to a big Sicilian man of 50, in the presence of his family, that his pancreatic cancer gave him at most a year of life, or to the parents of a 16-year-old girl intubated in pediatric intensive care that her life was at risk, it tested my composure. But hearing answers such as: “Well, 1 year is better than 6 months” or seeing patients so young struggle with extraordinary strength of mind strengthened by the love of their parents is disarming. Being witness to the drama of these situations and a person’s survival instinct truly bolsters one’s sense of humanity and perspective. You train yourself to be better, not to constantly complain about everyday problems, to better understand the moods of others and yourself, and to highlight important things. I have never tried to quit. Actually, I’m afraid of the idea, because by not training to be better, we end up prey to the superficiality of this society, and we flatten ourselves out. I don’t want that to happen. This epiphany about myself took place in those wards, among those beds, in the hospitals of New York City.
The patients who go to New York for treatment come from all over Italy, from North to South. Campania, Lombardy, Lazio mostly. Those interested in a consultancy or a specialist visit, as they are almost always without medical insurance, generally have a greater financial availability, and therefore can be classified in a medium-high class. In the case of patients, generally young minors, affected by rare diseases that would not be able to receive assistance of equal level (both for different treatment protocol, equipped facilities or available machinery) there is no distinction of class. Following a request to the ASL (local healthcare authority) of residence and obtaining the SSN, reimbursements of care, procedures, but also travel, accommodation for the patient and family can be obtained. Not everything is subsidized entirely, however. In the most serious cases, parents create real fundraising associations to help support the enormous medical expenses they face.
Patients who emigrated in the 60s, 70s, and who still do not feel able to face a conversation with technical English, are almost exclusively from southern Italy (in order: Sicily, Campania, Puglia, Calabria, Lazio and in rare cases, from the northern regions) and have decidedly humble roots. In these families – almost always – the father worked as a construction worker, sometimes a barber or pizza maker, while his wife took care of the children or worked as a seamstress or worker. Often they reached a cousin or an uncle already resident in America and with great sacrifices began a new life. A patient once told me: “Linda, remember, for the Italians who came to America, the dollar is stained with blood.” Their lives were wholly dedicated to work and family. And now, upon retirement, they see their savings and pensions poured into the pockets of US medical insurance. However, almost none of them would willingly return to Italy – and their greatest curiosity is whether I would.
The role of medical interpreter is often not that of “handing down a sentence,” but of receiving it together with the patient.
When I reflect on how this work has changed me, I find that while on one hand it has made me feel more aware of everything related to the health of our body, on the other it has made me more fatalistic, as if everything in the end was marked and I wear a sort of armor that prevents me from feeling the need for protection.
New York is an extremely intense city, full of stimuli at every corner, luxury on the one hand and desperation on the other, even when one is still, one moves. I always have the feeling of having to run even if I’m not in a hurry, to hear all the voices even with loud music in my ears. You have to protect yourself. There is no room for fragility, even less when working with those who suffer.
However, seeking too much empathy and pushing oneself to the edge of drama is a risk. There is no single way to protect yourself. It depends on the personality of each one. I have had fellow interpreters who have explicitly asked not to be sent to palliative care wards, or to refuse to enter pediatric intensive care because they are too emotionally heavy. For me the exposure to pain, which in any case we all experience sooner or later, is a sort of gym for my personal and fundamental growth to appreciate the carefree moments that are given to us outside of work. All the drama we see in the movies, in the medical TV series, is not realistic. The strength and integrity that sick people have is incredible, and one can only learn from them.
The role of medical interpreter is often not that of “handing down a sentence,” but of receiving it together with the patient. There are also guidelines on where and how the interpreter should position himself during the conversation, which is a step back, next to the patient, just like a shadow. Patients often vent their feelings in the waiting room and recount all the misadventures that brought them there, and at that moment I feel I become part of the team, not the assistant coach who imparts notions from above and gives news. I receive the verdict with them and simply express it in their language.
The Italians who go abroad for various types of medical treatment are 350,000 a year, thousands of them in the United States alone. The major centers of specialization in New York, in particular, are the destination of Italians suffering mainly from oncological or neurodegenerative diseases, such as Parkinson’s disease, Alzheimer’s disease and multiple sclerosis, which are pathologies with the greatest need for scientific research, of which the US soil is a great homeland, and Italy sadly poor.
The main desire of the Italians who choose to cross the ocean and face expenses, contingencies and language barriers, is to receive, if not a less tragic diagnosis, then the possibility of counting on drug treatments not yet approved by agencies such as the EMA (European Drug Agency). What a desperate patient appreciates about many American doctors’ approach is the courage and willingness to take certain risks to improve health and lifestyle. The Italian approach is often more conservative, for example in the approach to risky surgery. The defect, however, that I believe there is in America, is the doctors’ extreme specialization, which tarnishes ability to see the whole that Italian doctors still retain. The specter of the malpractice complaint is always lurking and their tendency is to avoid diagnosing in fields that are not their own. Also, the privacy bureaucracy is very intense, and patients find themselves signing dozens of documents and answering the same questions, sometimes getting annoyed. But this is probably a price that patients willingly pay to see the light of salvation.
Fabrizio Caramagna wrote: “A pain teaches you to travel backwards. From large to small. From rich to poor. From the superfluous to the essential.” I like to think that during that journey I can act as a ferryman, messenger of words, professional of my beloved language and bearer of empathy.
I assisted and translated conversations between doctors and parents of quadriplegic children who, with intensive physiotherapy sessions, recovered degrees of limb mobility never recorded before by their Italian doctors; real cries for help from brain cancer patients who discovered to be operable after a special magnetic resonance performed in New York. I found myself being embraced by patients filled with new hope, albeit “relieved” of a few hundreds of dollars for a brief check-up with the luminary of Alzheimer’s disease and prescriptions for the purchase of drugs sold only in America. But I also heard incredible stories of fellow military men of Elvis Presley, musicians who performed in the jazz club for the biggest Mafia families of the 70s, couples who met on the ship and after 12 days of sailing decided to secretly get married in Brooklyn. And the list goes on.
Is it worth taking on so much pain? Oh yes – every moment – for it is above all through pain that one grows. Difficult though it is, experiencing the pain of others helped me grow tremendously.
“The greater the ability to love, the greater the ability to feel pain,” said an anonymous person. On reflection, this quotation would also make sense in reverse. There is no cause and effect. Pain and love travel on the same level and exchange places at regular intervals. Fabrizio Caramagna wrote: “A pain teaches you to travel backwards. From large to small. From rich to poor. From the superfluous to the essential.” I like to think that during that journey I can act as a ferryman, messenger of words, professional of my beloved language and bearer of empathy. Empathy is something our country is so desperately lacking at present and, in a hospital, as in any other daily reality, we need it ever so much.