Caroline Zhao, a fourth-year medical student at Feinberg, knew she had to do something to help the elderly patient in the neurology department communicate.
The patient arrived at the hospital after being found on the sidewalk lying in a puddle of his own blood. He was Chinese, but attempts at using a video translator had failed. None of the doctors were able to communicate with the patient or contact his family.
That’s when Zhao, along with fellow Feinberg medical students Terry Lou and Wesley Peng, stepped in to help.
Zhao went on to write about the experience in an article published in the journal Academic Medicine.
Read a Q&A about Zhao’s experience below.
Why did you choose to attend Feinberg?
I chose Feinberg for a couple of different reasons. I thought that Feinberg’s ECMH clinics were incredibly unique because they allowed students to have clinical exposure to real patients starting from day one, so that they could learn to build those skills early on. I was also drawn to the AOSC project which allows students to jump into research with guidance, even if they’d had no research experience before. But above all, I think what I really loved was the community that I saw on my interview day. I loved how everybody was so welcoming to me as a prospective student and how when they interacted with each other everybody seemed like they were friends and everybody was so kind, and I felt like there were a lot of people who would be willing to help the people next to them on their journey through medical school.
Tell me what your experience with this patient was like.
So this experience was on my neurology rotation. I had just come onto the general neurology team with two other medical students who are also fourth years. We met this patient on our very first day. He was coming from the neuro ICU and we heard his backstory from the attending. He had been found down in a puddle of blood and brought in. He was found to have a brain bleed. He was taken by neurosurgery to the OR and had been in the neuro ICU for probably about 10 days before he came to us on the general neurology floor, and all that he’d had on him were his clothes and an ID which had an address that was out of state.
The last name on the ID was of Chinese origin, so previous teams had tried video translators in Chinese and Cantonese, but they didn’t seem to work. Since the three of us who were coming onto the general neurology team all spoke varying levels of Chinese, we thought, well, would it work if we translated in-person because we can be as loud as we need to. Maybe he can read lips or something like that. Maybe it would help if we could get right up next to him. We tried that on rounds that first day, and he kind of seemed to respond, but he couldn’t really follow any commands. So we weren’t really sure if he understood us.
The three of us got together and thought, well, maybe he speaks a dialect. Maybe we can try different dialects and we’ll see where that goes. My parents both speak dialects of Chinese, so that night when I went home I asked my mom to record something so I could practice and try to say it to him.
When we got there the next morning, Wes Peng proposed we try writing something because Chinese characters are the same no matter what the dialect is. So even if the pronunciation is different, it’ll look the same on paper. He thought this might be easier than us trying every dialect that there is in China.
I wrote down on a piece of paper in Chinese: ‘Do you speak Mandarin?’ really big and we brought it with us on rounds and held it in front of his face. He started nodding and trying to take off his oxygen mask. And so, we thought, okay, so he does speak Mandarin. Something must have gone wrong with the video translation attempts.
We went back after rounds to try again. He had his hands in these gloves because he had been trying to pull some of his IVs out.
He was a little bit hard to understand since he was a little bit dysarthric, likely because of his head injury, but we managed to piece together some of what he was trying to tell us when he kept motioning to his ears. He was trying to tell us he couldn’t hear us when we were trying to talk. That led to us asking the nurses if we could take the gloves off and we gave him a whiteboard and he was able to shakily write a little bit. Through all this, we learned that he actually didn’t know why he was in the hospital, so we were able to tell him.
And then we asked, ‘Is anybody looking for you?’ And he said along the lines of, ‘Yes, my family, my kids, they’re looking for me.’
We went back to the attending who put in an order for an official in-person translator who could probably do a better job than the three of us trying to use our varying levels of Chinese.
So the translator and the social worker were able to work with him with a whiteboard and get the names and phone numbers of his children and his new address in Chicago.
From what I heard, he went to a nursing facility after that and then went home.
What inspired you to write about this for Academic Medicine?
I think part of being a medical student is feeling like there’s a lot that you can’t do. You can’t sign your own orders; you can’t make decisions by yourself for any of your patients. Sometimes when you’re watching all the residents doing their own thing and their work, it’s hard to feel useful.
What myself and the other students thought was that helping him was something unique we could do with our time. Nobody else is going to have the kind of time to sit next to a patient for hours and figure out what language he speaks, if there’s anybody looking for him, or what happened. Everybody else is managing all the patients on the floor.
What I learned is that the amount of time that medical students have is unique and I think it’s precious because a lot of residents and attendings don’t have that kind of time anymore due to the nature of how busy the job can get.
Sometimes it’s up to the medical students to check on their patients in the afternoon and spend that time at the bedside learning about their patient outside of the disease they came into the hospital for. Like what I said in the piece that I wrote for Academic Medicine, it’s easy to be able to take out a laptop and do practice questions because you have to pass an exam at the end of each clerkship or ask if the residents need anything else and hope to be sent home a little early.
We could have easily said that we were taking the best care of him because his brain bleed was being managed, he was being monitored, he wasn’t having any complications, and he was physically healing. But I think if he had just sat there and not been able to communicate with anybody for his entire hospital stay and while his family was out there looking for him, then I don’t know if it would’ve really been true.
It was really important to have that social aspect in order to truly take the best care of him because patient care is more than just treating a disease or fixing a medical problem, it’s also looking at the bigger picture of who the patient is, how they got to that situation and how you can get them back to where they were before they came in.