One of the highlights of my career in family medicine was the patients we had from Japan. Honda opened a manufacturing plant in Lincoln, Alabama almost twenty years ago, and brought with them many Japanese families. Our practice wasn’t that close to Lincoln, but several families chose to live in the area and commute to work. The Honda employees worked a five year commitment at the Lincoln plant, and then they would usually transfer to a different Honda plant in Japan or elsewhere.
The employees had access to a physician on campus, but their spouses and children had to seek outside medical care. I’m really not sure how Harvey and I began to see these patients, but somehow they started to come to our practice, and word of mouth brought more.
They were always accompanied by one of two interpreters that Honda employed for this express purpose because not many were fluent in English. Not only did the interpreters come to doctors’ appointments, they went with these families to dentists, optometrists, and schools. They helped the families fill out forms and translated in person at all of these interactions. These two women were deeply devoted to the families, developing close ties with them, and taking call for them 24/7.
I was honored to be entrusted with the medical care of these wives and their children. The two interpreters became friends of ours because we saw them so often, at least two to three times a week.
At first, I found the encounters in the practice to be stressful, and they took a long time. Some of the frustration was the difference in expectations surrounding medical care. We saw each patient yearly for a preventive medicine visit. Honda had ironed out what measures were to be covered, and it often seemed excessive to me. There were a few other little quirks and differences in out medical cultures, but we adjusted to each other.
The language barrier made the office visits feel stiff and awkward in the beginning, but as I became more familiar with the two interpreters, it became much easier. I came to enjoy the encounters, developing personal relationships myself with some of the families. Over time, I learned to speak in a way that worked really well for the interpreters and the families.
I spoke slowly, with simple sentences and simple words. Does that sound familiar? I wrote about this last week, as applied to conversing with people living with dementia.
This style of speech was a challenge for me. I had to constantly monitor my words and try to substitute meaningful, yet easy-to-understand, ones. I was already used to doing this with all of my patients—translating medical speak into common language. Now, I used even simpler words, short sentences, and paused often. I had to make my words comprehensible, and also succinct and translatable. We would often go back and forth to make sure the interpreters understood what I was saying before relaying the information to the patient.
(There’s a new game out called “Poetry for Neanderthals” that can give a hint at what this type of communication feels like. It’s a word game that requires players to use only one syllable words to get their teammates to guess a particular word. For example, for the team to guess “tyrannosaurus rex,” one cannot say, “dinosaur” or “lizard,” but might say, “Big teeth. Short arms. Roar.” Try it. It’s hard!)
The two interpreters told me that I was really good at this type of communication, and that no other medical professionals that they interacted with were as skilled. That feedback was really nice to hear, and it meant that the patients understood what was happening when they were in my office.
I also learned not to use sarcasm. Evidently there is no sarcasm in Japanese culture. I had no idea how pervasive my sarcasm was until I had to eliminate it. I don’t mean the heavy, mean-spirited kind, just a light joking kind, such as, “Is it hot enough today for you?” People living with dementia would likewise have a hard time understanding sarcasm.
One of the chapters in my memoir is entitled “Imagine Waking Up in a Foreign Country and You Don’t Understand the Language.” This is a great way to understand what it must be like to live in the late stage of Alzheimer’s, unable to make sense of your world. It’s akin to my Japanese patients having a medical emergency, or even a routine pregnancy, in this country, without a working knowledge of English.
Not only did I learn from my Japanese patients how to speak in a simple manner that I later employed with Harvey, but I like to think that I developed a better understanding and empathy of what it must have been like for him to wake up everyday in a world that was incomprehensible.