"Lost in Translation" 1st place 2019 essay contest

It was one of the most difficult experiences of my life, which to date included homelessness, foster care, and attending eleven different public schools. It was harder than giving up a 13-year career as a Fire Fighter/Paramedic and going back to school because my community needed more doctors. When I was forced to start my elementary education in a language that I didn’t know, I was beyond frustrated. I didn’t speak Spanish. I only spoke English, but people didn’t understand me when I started kindergarten in California. I only spoke “pidgin”, but I was young and brown, so I can see how I was mistaken for Hispanic. That was how I ended up in English as a second language despite only speaking English. As a result, I couldn’t understand the instructions or interact with the other students. It was a feeling of helplessness that I never wanted to revisit in my life. However, during my pathway to medicine, I’ve been reminded of those feelings.

In the summer of 2012 a childhood friend and classmate died from a heart attack. He was a late 30s Native Hawaiian National Parks worker, who ignored the signs of a heart attack for over a day, until it was too late. Unfortunately, this is not uncommon. Native Hawaiians have severe health disparities and are prone to chronic diseases like diabetes and heart disease at younger ages than the general population. A fact I would learn more about and see often during my time in medical school.

During my 3rd year clerkship, I had a patient that reminded me a lot of my friend. A late 30s Native Hawaiian male who was in clinic for a follow up appointment. He had been discharged from the hospital for acute decompensated heart failure. Diagnosed with heart failure a year prior, he was lost to follow up until his recent admission. We spoke about the reasons he missed previous appointments, and the bottom line was that he didn’t understand the need. He knew he had a “heart condition”. He knew that he should be taking his medications and seeing his doctor regularly; but despite being able to say those words, it didn’t seem that he understood what they meant. Something was lost in translation. He didn’t understand the consequence of his nonadherence. It was then that I was reminded of my experience in kindergarten and the whole blocks of instruction that I never understood.

However, because I was from the same culture and had similar childhood experiences as this patient, I was able to explain the need for continued care in terms that he understood. I felt like I was able to help him put his care in the proper perspective for him and his family. I saw that the light of understanding was shining in his eyes, and before the appointment was done, we had scheduled his echocardiogram and an appointment with a cardiologist. I was beyond elated. I was helping this patient avoid the fate of my friend and that meant a lot to me.

You see, where my friend and I grew up no longer physically exists. That area of Hawaii is now covered by lava and our childhood homes are only a memory. The people of that underserved community, however, are still there. Resilient. Strong. They need a lot, but the one thing that they have always needed and need now more than ever before, is basic medical care and education provided in a way that they understand.

I saw my future during encounters like this, because the people I saw were so much like those from back home; diverse in ethnicity with rich cultures and experiences that are unique and take time to understand. Strong and resilient people. My people. That is why I believe that patient care starts with caring for patients and everything that makes them who they are.