Lost in hospital translation?

One issue that adds to the healthcare reform debate is that of hospitals and translators. According to Adam Gurvitch, director of health advocacy at the New York Immigration Coalition," most hospitals will likely rely on volunteers, bilingual staff and telephone translation agencies..." when it comes to meeting state rules regarding the use of translators. New York is an example of a state that has laws set in place for all hospitals to require "skilled" translators for its non-English speaking patients. www.msnbc.msn.com/id/14838695/.

I recently reviewed a medical record of a patient that was non-English speaking. The patient was about to undergo a procedure in the past, but started complaining to staff and appeared to be in a lot of pain. Finally, after the hospital staff spent a considerable amount of time treating the patient's perceived pain, a family member arrived, translated, and relayed to the staff that the patient "wanted a Pepsi" to drink. Fortunately, in that situation, the family member was a reliable source.

But take the case of an 18-year-old man in Florida, told by Mara Youdelman of the National Health Law Program. www.npr.org/templates/story/story.php?storyId=111066555. Unfortunately, his girlfriend or mother didn't speak English. It's too bad that the Spanish word for nauseated is "intoxicado". The man went on to receive 36 hours of unnecessary treatment for a suspected drug overdose. Staff thought the man was intoxicated or "high on drugs."

I received my bachelor's degree in Spanish in 1998. 11 years have gone by. Speaking as a Registered Nurse, a hospital employee, legal nurse consultant, husband and father, I have issues with going to translate when called upon to do so at my hospital/employer. I have close friends that I speak Spanish with on a regular basis. I have traveled to Chile, Argentina and Uruguay, and spoke some Spanish there. I have translated for a number of patients in an emergency room, a labor and deliver unit, and multiple acute/critical care units. I recently used some Spanish when consulting with an attorney on a health-related case. Despite the degree, the practice with friends, the experience in the hospital and with the attorney, am I "skilled"? Sometimes I feel like I am. Then I think of the time I translated for an anesthesiologist who was placing an epidural for a lady in labor. I think I got most of the dialogue correct, but I sure felt a little uneasy after leaving the birthing suite. The woman was in intense pain, moaning and grunting just like my wife did when she was going through labor. The moaning and the grunting made it difficult to understand all her words. Thank God that the anesthesiologist placed the epidural line successfully.

It's great that New York put forth a plan for "skilled" translators a couple years ago. I think a lot of hospitals and states would have many different definitions for "skilled", however.

Most facilities will agree that patient safety comes first. The challenge lies in relying on family members, volunteer staff, telephone interpreters vs. "skilled" full-time interpreters. Then there's the whole issue of who pays for these "skilled" interpreters.

Until we figure this out, I'll keep practicing my Spanish.

By Brian Brandser, RN, BSN, CCRN, CLNC

A 10-year heart check-up

August 20th, 1999 (10 years ago today). This was the 6th day of our amazing honeymoon.
We were enjoying the hot weather and the view from our balcony in Tucson, Arizona. In a couple hours, we would be on our way for reception #2 in New Mexico.
10 year ago today, my father, James Russell Brandser, died of a Myocardial Infarction (heart attack) at the age of 49. He had just began his work day in Fargo, North Dakota. Apparently, he collapsed on the job in the early morning hours. 911 was called. Paramedics tried to revive him. He died at a downtown hospital a couple miles away.

According to the American Heart Association, www.americanheart.org/presenter.jhtml?identifier=4591, coronary heart disease (CHD) accounted for 445, 687 deaths in the United States in 2005 (about 1 of every 5 deaths).

We arrived at the ranch near Church Rock, New Mexico, in the early evening hours 10 years ago. The first thing my mother-in-law, Pamela, told me was to call my mom. Strange, I thought. I had never given my mom my in-laws' phone number. Somehow, she got ahold of it.

My mother told me the news. I was shocked. Many tears flowed that night and during the days that followed.

Within the next week, I examined the details of my dad's short trip in the ambulance. Apparently, he was in Ventricular Fibrillation www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=745 when the medics found him. Called V fib for short, this is a life-threatening condition in which the heart's electrical activity becomes disordered. When this occurs, the heart's lower (pumping) chambers contract in a rapid, unsynchronized manner. (The ventricles "flutter" rather than beat.) The heart pumps little to no blood.

My dad's death was unfortunate. Everyone talked about how "young he was" and how it "happened unexpectedly." In some ways, I agreed. However, my dad had told me years before that my grandfather (his dad) died at age 50. Another relative had told me that "most of the men" on my dads' side of the family died around that age.

When dad died, I was working in a cardiac unit at Avera Mckennan Hospital www.mckennan.org/amck/index.aspx in Sioux Falls, South Dakota. I was getting ready to start my 2nd semester of nursing school. I had a desire to work with heart patients due to my family history. My dad's death fueled that passion all the more when he died.

For the last 8 years, my greatest passion at Northwest Hospital & Medical Center www.nwhospital.org/ has been working with heart surgery patients and heart attack survivors. I often wonder what it would be like to see my dad walk out of the hospital alive and well. He never had that chance. But it brings joy to my heart to see heart surgery patients and heart attack survivors go home with their spouses and to their families.

Dad, thanks for the memories.

(Picture above: James Brandser [right] with wife Linda)

By Brian Brandser, RN, BSN, CCRN, CLNC

In Loving Memory of Barbara Ann Morgan

I never like taking my wife, Michelle, to the airport.
However, today I not only dropped off Michelle, but also my 1-year old son and my mother Linda as well. I don't have any regrets about this trip, however. Michelle is currently on a flight from Seattle to Phoenix, then on to her home state of New Mexico. Michelle's cousin, Barbara Ann Morgan, died Friday, August 14, 2009, and the family is having a funeral for her this Wednesday. Yep, another victim of Endometrial (uterine)cancer. cdc.gov/cancer/uterine/index.htm
According to the Center for Disease Control and Prevention, uterine cancer typically strikes women over 50. Unfortunately, Barb didn't live to see her 50th birthday.
Barb, a resident of Olympia, Washington, for the past several years, was diagnosed last year with the disease.
Other than remembering that celebrity Fran Drescher copingmag.com/cwc/index.php/celebrities/celebrity_article/fran_drescher battled the disease, my only experience with uterine cancer was a patient I took care of at a hospital in the midwest during my final weeks of nursing school. I remember her quite well, especially the Morphine I was giving her every hour...and that was barely relieving her pain.
Every trip we made from Everett to Olympia to visit her was worth it. From the time she had a melon-shaped tumor removed from her abdominal area, to the moments we spent listening to her late-night gasps for air and grunts while walking to her bathroom at her home in Olympia, it's encouraging to know that her battle is over. The cancer had not only spread to her stomach, but to her kidneys and spine. Eventually, it slowly collapsed both of her lungs as well.
Though we weren't in Phoenix on the 14th to witness her death, it is comforting to know that Barb was surrounded by many loving family members in her last moments on earth.
Barb has a supportive family that lives miles away in Arizona. Despite the distance, either her father, mother or sisters were with her every step of her battle since January of this year. The family fought hard to pull her away from the beautiful state of Washington, and won.
Barb: thanks for the laughs. Thanks for your fighter's spirit. Though I don't know all the battles that you were fighting inside, I never heard you complain once.
With love, Brian.
(Picture: Barb, at left, with cousin Michelle Brandser)

By Brian Brandser, RN, BSN, CCRN, CLNC

The Mom I Know

I received the call in the spring of 1998 from my mother Linda and I remember everything so vividly. I shut the door, sat down at the desk in my dorm room and listened carefully because something sounded different with mom this time.
The tone of mom’s voice kept me patiently waiting. Maybe a family member back in North Dakota was sick or had suddenly died, I thought.
“Brian,” she said, “My doctor has diagnosed me with Parkinson’s disease.”
Being a pre-nursing student at the time, I had heard of Parkinson’s, but I didn’t know much about it. I knew it involved the brain and I knew that Michael J. Fox had the disease, but that’s about it.
Mom was only 45 years old at the time. Medical literature told me that people aren’t typically diagnosed with Parkinson’s until their 60s.
Mom quickly joined a support group and was doing fine, she would tell me. She was good at taking her medications as ordered. The only thing I noticed when I went back home to visit was my mom’s gait disturbance, which is common in Parkinson’s. Typically, mom would shuffle her feet and take short steps, having to grab on to things if needed. I was relieved to see that mom didn’t develop any major tremors or battle with severe pain.
Time passed. I got into nursing school. I would keep up with mom over the phone and made sure I asked how she was getting along. Mom was strong, just like I thought she would be. She managed to keep working. Grandmother Nona always had good things to say about mom’s willpower and perseverance. I gave ample amount of credit to the medications mom was taking, because they seemed to be helping her. Mom had Parkinson’s, but it didn’t have her, I would tell myself.
In 2000, things changed with mom, and I wasn’t quite sure what was happening. Mom told me she was on the same medications. Her walking seemed to be more of a challenge. She was now dealing with tremors. The thing that worried me most, however, was my mom’s state of mind. She seemed to be depressed when I would talk with her. She just didn’t seem the same. I received letters throughout the year from her sisters claiming that mom was now asking the family for money to support a possible gambling addiction. “Mom is gambling? No way,” I thought. This is not the mom I know. Mom eventually asked me for money, too.
Mom, however, did admit that she had been gambling, but was getting help for it through Gamblers Anonymous (GA). Then the phone call from Aunt Kathy came in the fall of 2002. Kathy thought it would be a good idea for me to fly back home so I could see mom. She had reached an all-time low. Her debts were increasing. She had just been bailed out of jail.
It wasn’t until 2004 that David Tullar, PA, realized that mom had been experiencing one of the rare side effects of Mirapex, the drug she had been on for 6 years. Tullar discontinued the drug due to mom’s compulsive gambling. Mom stayed committed to her GA weekly meetings.
I have taken care of many patients with Parkinson’s disease in the hospital, many of whom take Mirapex. I may never know how the drug has affected or will affect them. But one thing is certain: since being taken off of Mirapex, mom has remained strong and no longer gambles.
The mom I know is back and that comforts me.

By Brian Brandser, RN, BSN, CCRN, CLNC

A career in journalism?

That's the question I asked myself when I was sitting next to the sports editor at The Forum http://www.inforum.com/ in Fargo, North Dakota, back in 1993.
I was a senior in high school and my journalism instructor, Robert Hendricks, had landed me an internship/job as a sports reporter with the "big guys" in the sports department at The Forum.
At the time, I was the co-editor of our high school newspaper, The Sudhian. I was grateful to have "my foot in the door" before I headed off to journalism school at the University of Nebraska-Lincoln in Lincoln.
However, this night changed my life and career path for years to come. I was sitting next to the editor, taking commands as I usually did. "Yes, sir." "You bet...no problem," were usually my replies. Phone calls were coming in left and right and I was trying to keep up with all the latest scores and comments from local coaches. I hadn't had a bathroom break the entire evening.
I tried to keep to myself at The Forum, do my job, not step on any toes and hopefully get out by 12:00 or 1:00 a.m. so that I could manage to get a couple hours of sleep before going back to school the next day.
The shift was coming to a close. The paper had just finished its first run on the press. I was dreaming of my bed. I wasn't a fan of the second hand smoke coming from one of our news editors (who I will call "Jim" for privacy purposes). I think "Jim" had been there going on 30 years. I don't think he had moved all night either. No wonder he was about 300 pounds, I thought. He seemed pretty unhappy, too. He had been cursing most of the night. If I didn't have a clear view of him, I would have thought he was talking to a fellow reporter...but I was the closest one to him with no one else in sight.
I always had my eye on the clock. But for the last part of the shift, I lost all sense of time. I thought about Jim. "Do I want to be like him 20 years from now?"
To this day, I am thankful for Jim, Robert Hendricks, and those late nights at The Forum for sending me in a different direction and on a different career path.
I have been a critical care Registered Nurse for 8 years now and I love nursing. On top of the excitement of critical care nursing is legal nurse consulting, which I have been doing for a little over a year.
I like responding to instructions from a doctor or lawyer much better. I also get to take bathroom breaks as needed. Thanks to today's age, I now enjoy breathing fresh air as well. And yes, nurses do walk a lot, so the exercise is better than being planted in a chair for 8 hours.
Thanks again, Jim.

By Brian Brandser, RN, BSN, CCRN, CLNC