Fluent Virginian

Our patient was in the clinical ED exam room, awaiting transport with his father and uncle.  They were from the West Coast, in town for a march or protest or something like that, when appendicitis struck.  Time to go to Nearby Hospital for surgery.

DTs entered the room as he usually does, to speak with them for a brief moment and let them know transport was here, what was happening next (me getting report from the nurse), how long it should take, and so forth.

“So y’all relax for just a few minutes and I’ll be right back”, says Our Hero.  And for the umpteenth time noticed the good-natured smirk and barely-concealed eye-rolling.  No offense taken, these folks weren’t even Yankees, and Yankees don’t know better.  But…

There’s something I’ve wanted to get off my chest for some time now, and that is the grammatical correctness of speaking good, plain Virginian.

Now, before my learned colleagues in the more Southerly- and Westerly- states protest, let me explain – Virginia is, traveling southbound, simply the first state encountered where grammatical English is spoken.  One can certainly be understood in Delaware, or Maryland, to be sure.  And good English can be found in the Carolinas, Tennessee, Alabama, and yes, Texas.  But I think a traveler, let him be from Maine, who let us say stops for fuel, will in Virginia first be greeted with the ubiquitous and highly grammatical conjugate, “Y’all”.

“Y’all” is of course a contraction of “You-all”.  As contractions go, it is no less legitimate than “Isn’t”, “Wasn’t”, or “I’ll”, notwithstanding that the exemplars provided are subject-verb combinations.

“Y’all” is homey and warm.  It is embracing.  Y’all.  “Y’all come back now, hear?”  You will hear it at your better coffee stops.  “Y’all want a refill on that?”  But notice that any waitress asking that is already pouring as she smiles at you.  We’re a friendly folk – Y’all is what you will hear.

The uncontracted form is uncertain, uninviting – “You all from around here?”.  It can be menacing.  Virginians do not use this form.  Even worse is just plain “You”.  “You ready to order?”  Abrupt.  Cold.

“DTs”, you say, “You jest.  Y’all is wrong no matter how you slice it.  It bespeaks low educational values and a penchant for inbreeding.”

I disagree.  My arguments are many and completely invalidate this narrow-minded perception.  For the Virginian-impaired, I will illustrate.

If you have studied any other language, you will recall perhaps seeing a little table displaying the conjugates of verbs:

Spanish listar, “To Listen”
“I” form (yo) listo “We” form (nosotros) listamos
“You” singular () listas “You” plural (vosotros) listáis
“He” form (él) lista “They” form (ellos) listan

Verbs have different forms depending on the subject of the sentence – remember the phrase “subject-verb agreement”?  One does not say, “I am, she am, he am, we am, they am…”.  The verb form changes to agree with the subject of the sentence, therefore: “I am, you are, he is, we are, you are, they are…”

In most languages, there is a separate verb form for second-person plurals.  “You” speaking to a person, and another “You” form when addressing a group.

A Spanish-speaking cop, for instance, addressing a large group with the above-tabled verb, will say “You listen” (tu listas) when addressing the group leader, but “You (ALL) listen” – (vosotros listais) – when addressing the group as a whole.   An English-speaking cop lets the entire group know he’s addressing them by raising his voice.  That’s all English has, for the plural “You” is lacking, in English – but not in Virginian.  We cut out a lot of confusion that way.  “Y’all go home now” has broken up many a riot, I’m sure.

Also, in most languages, there are also two forms of address – the informal, used for persons one knows and, in some cultures, children; and the formal, used to address persons one does not know, and as a sign of respect when addressing elders.   Y’all is terribly versatile, and can be both, depending on inflection and tone.

In short, Y’all expands English to include second-person plural.  It is a refinement.

So y’all keep smirking if you want.  We know perfectly well who’s speaking well.

Y’all hear, now?

Backfire

I don’t travel much, so I don’t know a lot about other parts of the country. I would guess though, that Northern Virginia probably has a population with a diversity of languages greater almost than anyplace but New York. I try therefore to be able to speak at least a few words in a language my patient understands. Doing so really seems to set them at ease. In some cases, though, I get chewed out.

For instance, we entered the ED and saw a rather flustered and grumpy 98 year old female patient, glaring at everyone around her. The nurse said, “Here’s Mrs. X, but she only speaks Ukranian. Her daughter was translating but she had to leave.”

Privet! May nya za voot DTs“, Hello! My name is DTs says I (yeah, it’s grammatically piss-poor Russian, but they’re close enough). Our patient’s face lights up and she’s the nicest, least-grumpy patient one could wish for. When we leave her at the receiving facility she calls down God and all the saints to watch over us and our children to the thirtieth generation or some such thing.

So we got that going for us, which is nice.

We leave our Korean patient at the rest home. “Hang-uun-ule peem-nee dah!” says DTs,bowing out. I hope and sincerely pray it means, “Goodbye and good luck!”, at least I think it does. The patient stares intently for a few moments and releases a spate of rapid-fire Korean back at me. I don’t know if I just told her off, or she’s saying, “If you speak Korean, why didn’t you before?”, but it’s time to go…

Spanish is one we deal with so routinely that, well, I have a routine. In very poor Spanish I can tell my patient, or his family, “Before we go I need to get your signature on this form. When you sign this form, you’re giving us permission to take you in the ambulance; to care for you during the ride, and to send the bill for the ride to the insurance company so you don’t have to worry about it.”

I have to be careful to say this slower than I’m able. When I speak too quickly the patient gets the impression I speak fluent Spanish. A pediatric patient’s mom signed the form and, probably thought, “Finally! Someone who speaks Spanish! I can at last tell the story!” Faster than an auctioneer, she starts: “My daughter first began having this difficulty about three days ago, no, it was four days ago and…” I had to do the “whoa whoa” hand motions and apologize for the misunderstanding.

Now, DTs speaks none of these, but rather carries a somewhat extensive electronic phrase book so I may ask “Chest pain?”, “Allergies?”, “Nausea?” and such. Since I put it together myself I try and verify it when I can.

I just don’t get Chinese, though. I’m considering just leaving that one alone.

Our patient spoke only Chinese, but his wife spoke very good English. “If I wanted to say, “Hello, my name is DTs”, would it be: Wo shee DTs yee sheng? I’m just checking…”

“Oh, yes!” said the wife. “That’s exactly right. You would say: ” and here she said something completely different. Not even a good pronunciation of what I tried, but completely and utterly different syllables.

I stared at her for a second, then asked, “So… I’d say…?”

And she said something else, different from the first thing she said.

Richard Feynman, in his autobiography Surely You’re Joking, Mr. Feynman, relates the following:

“When I was in Brazil I had struggled to learn the local language, and decided to give my physics lectures in Portuguese. Soon after I came to Caltech, I was invited to a party hosted by Professor Bacher. Before I arrived at the party, Bacher told the guests, “This guy Feynman thinks he’s smart because he learned a little Portuguese, so let’s fix him good: Mrs Smith, here (she’s completely Caucasian), grew up in China. Let’s have her greet Feynman in Chinese.”

“I walk into the party innocently, and Bacher introduces me to all these people: “Mr. Feynman, this is Mr. So-and-so.”

“Pleased to meet you, Mr. Feynman.”

“And this is Mr. Such-and-such.”

“My pleasure, Mr. Feynman.”

“And this is Mrs. Smith.”

Ai, choong, ngong jia!” she says, bowing.

This is such a surprise to me that I figure the only thing to do is to reply in the same spirit. I bow politely to her, and with complete confidence I say, “Ah ching, jong jien!

“Oh, my God!” she exclaims, losing her own composure. “I knew this would happen – I speak Mandarin and he speaks Cantonese!”

Yah gee-ay chah-joo ohmneeka?

Think I’ll say something here about languages, since that is what I’m primarily working on at the moment. Well, languages and numbers.

The reason upwardly-mobile parents push their kids into becoming dentists and doctors is that everyone has teeth, at some point, and everyone has medical problems of some sort, and if everyone is coming to you for treatment you make lots of money. Then of course there are lawyers, who realize that not everyone will be happy with their root canals and surgery, but let’s not talk about them.

So everybody gets sick, everybody FDGB. This means of course that everyone, or a representative sampling thereof, may at some point be our patient. And representative sampling is just what census data is all about.

Flipping through that, we find that most of the sort of people who fill out census forms in Northern Virginia are of European descent, second generation or more, and English-speaking. All well and good, and because that’s just what I happen to be I should have no problem communicating with about 80% of the population.

It’s that other 20% who present a little problem then.

While pointing and gesturing are all well and good – “I am having chest pain” comes across quite clearly no matter what language you speak – our treatments may vary based on little specifics that gesturing can’t quite convey. Take that chest pain: When did it start? Was it sudden or gradual? Does it go away when you rest? On a 1/10 scale what number would you give the pain? Have you ever had this before? Do you take heart medicines? Any medicines? Are you allergic to anything? And so on.

Try getting that information in pantomime.

Now, there’s a little trick they teach you which allows you to treat anybody, anywhere, male or female, young or old, no matter what language they speak, even English. The little trick is called Pretend They’re Unconscious, and it works like this: Pretend the patient is unconscious.

Unconscious is the penultimate barrier to communication. Here’s the patient, what you see with your eyes, ears, and tools is what you get, treat accordingly. The ultimate barrier to communication, death, we don’t much treat – toss that in with the lawyers we discarded at the beginning.

One problem with PTU is that it greatly narrows your treatment options. For instance, here’s our heart monitor, showing atrial fibrillation. Our treatment of a brand-new a-fib is very very different from a pre-existing a-fib that the patient’s had for a few weeks. Which is it? If you can’t ask, you have to default to the most restrictive treatment option. And if I am about to inject someone with medicine, it would be extremely nice to first make sure they’re not allergic to it.

Okay, so to recap: 80% of everybody (in NoVA) we can treat just fine, the other 20% we can treat but in a slap-dash fashion, and even if all 20% do really, really badly 80% is a “B-” which if it were a report card ain’t too shabby.

Problem is of course that it’s not a report card, it’s people. So what do we do? Well, I said at the beginning we’d look at language, and numbers. For NoVA, that 20% non-English speaking population breaks down further. 17% speak Spanish, which makes Spanish the next-best thing to learn. Korean seems next in line, a few percentage points. Finally one may pick a less-encountered language as a backstop. We’re not talking about becoming fluent, necessarily, just a few words (“Relax” is a good one!) can make a difference. As bambulance folk we only have patient contact for half an hour or so anyway.

“They’re in America!” some shout. “They should learn English!” Yeah, they should, I agree. But do you come to an accident scene, see that the driver wasn’t wearing a seatbelt, and leave? “He should have been wearing his seatbelt!” “She shouldn’t have drank booze after taking those pills!” “He shouldn’t have been up on that ladder!”…

Lump all those observations into the “If I Ran The World” pile, realize you don’t, and do your best around it. Sometimes “doing your best” means “learning something new”.

The title? Korean, gets a little laugh in the ER sometimes if you say “Nohng-dahm eem-needah” after that. It means, “Do you come here often? Just joking.”

Hat Trick

Monday, July 11 2005

The fun thing about working in patient transport is that you are in this big ol’ damn ambulance when you’re driving around. When Tragedy Strikes, vehicle-wise, you are in a fine position to do something about it, should you so choose. Actually, being a bambulance, you kinda-sorta-gotta.

Case in point. At this time of year the DC area is humid, hot, dank, sweaty… and prone to sudden thunderstorms. One struck Wednesday, causing torrential but brief downpours in the area. The plot thickens.

On the Capital Beltway we happened upon a scene of Chaos and Trauma, to whit: Skid Marks leading to the side of the road; An Unhappy Vehicle, resting on it’s driver’s side door and facing against traffic; Four Fellows standing next to same.

DTs and his partner determined there were no EMS on scene, just yet. Flip on lights and pull onto shoulder.

Now, it turns out three of the fellows were facing a fourth. Naturally, (he says) one would anticipate that the fourth person was the Leader. As such, we address our questions to him.

“Hey, anybody hurt here?”
“No, no.”
“Anybody still in the vehicle?”
“No, no.”
“Any other vehicles involved?”
“No, no.”

“Everybody okay?”
“Si, si.”

Oh dear. Okay, first things first.

“Everybody please, it’s still raining. Let’s get into the ambulance and wait for the police.”

And into the bambulance we go. And why not? Work ‘em up. Were they wearing seat belts? Why yes, it turns out, all four of them were – in that pickup truck. Ooookay.

Suddenly two of our guests develop neck pain; another develops wrist pain; yet another finds he has back pain which shoots down his leg… ack! (Typical reaction: Fine during emergency, once relaxed find out something’s wrong – adrenaline is wonderful for what it does.) LET’S dial 911 again, shall we?

EMS Proper arrives; we turn into Fast Food Medics.

Take patient information. Do you have allergies with that? Have a collar. Put down backboard onto cot; place patient; a smear of spider straps; a soupcon of head block; a twist of tape and slide them out the end of the unit onto a County cot.

Next!

Fun! No one was seriously hurt, but due to mechanism of injury they all needed to be checked out, and well done on them to avoid the “patient refusal” syndrome.

Clever Ploy or Biting Criticism?

Saturday, June 18 2005

“Que pasa?” asks DTs as he identifies the patient in the group. “What’s going on?”

The patient glances around for support. “No hablo Ingles,” says the patient to DTs.

“Que molestias tiene?” asked DTs. “What’s bothering you?”

“No hablo Ingles,” came the reply. Various nods in the silent group. It is true.

“Ooookay. Um, donde el dolor?” “Where is the pain?”

“No hablo Ingles,” again.

“Habla Ingles algien aqui?” “Does anyone here speak English?” asks DTs plaintively.

Quoth the patient, “No hablo Ingles”.

Sigh. Is my pronunciation that bad? Must look up “I don’t care about immigration status” and keep that handy.

On the Language Thing

Sunday, February 27 2005

The EMS field was to me completely unexplored territory when first I entered in mid-2002. I didn’t even have a CPR certification. Since then there have been classrooms, labs, books, books books. From where I sit at the computer I see no fewer than 39 EMS textbooks and 8 scribble-filled notebooks. I have in the course of time read all of them, some several times over. Some I am still studying from. In this, DTs is no different from his EMS Brethren – everybody who graduated from my Paramedic class had to do the same.

In order to do the Job more effectively, though, we all had to augment these books with “outside references” – EKG interpretation, for instance, is one field where you can never study enough. So to those 39 add in well over three dozen “outside” reference books, and Pocket References Galore. Although the classes are over, the books continue to accumulate.

So it’s no wonder, when all is said and done, that those folk who have to their own satisfaction “made it” to their level of choice (Basic, Intermediate, or Paramedic) are usually quite finished with book larnin’ and very glad to throw down stuff by Brady and, if they are of what passes for firehouse literary persuasion, pick up something by Koontz or Steele.

Those in the House who are not of literary persuasion – by far the majority – Look At You Sideways when spotting you with a book in hand. But everyone in the House is always doing some sort of training, some sort of recertification. In the Station, then, not so much reaction. DTs with a Book: Acknowledged.

In the Private Sector, however, from the Sideways Look there are three typical follow-up actions:

If said book is merely an EMS “fun” book, such as Manhattan Medics or Into the Breach, no words, or a grunt. Also expect this reaction if you are reading, say, Garfield’s Word Search or Highlights. As long as it’s not a Textbook. (DO read the two italicized books if ever you get the chance – they’re both excellent!)

If said book is a textbook, one is usually asked if a test or recertification or “upgrade” is in the works – typical banter.

If, as has lately been the case with DTs, the book is Medical Spanish or Spanish for Law Enforcement or an English-Spanish Dictionary – prepare for incredulity. Your EMS brothers are much too polite to roll their eyes, circle their ears with a forefinger, laugh outright, or… what else is it they always do, lemme think…

Books, books and more books. Away with our books, then! Especially language books, because:

“They’re in America – let ‘em learn English.”

“Their kids probably speak English – let them translate.”

“Let the hospital deal with it – normal saline never hurt nobody and a splint’s a splint”

“The detailed history can wait until the ER.”

“They Point and You Patch.”

“If they were unconscious you wouldn’t get verbal info, so just pretend…”

All, to my way of thinking, baloney. We don’t tell obese patients, “Lose the weight, then we’ll talk about getting you onto the stretcher”. Rather, we in EMS work out. I see no difference between accommodating a patient with my muscle and accommodating them with some added study. Either way, I’m investing time in myself.

It all distills into What Makes Us Better At Our Job? And one never knows when the extra bits will come into play.

For example, I had to leave my driver at the scene of a wreck last duty. Her Spanish was better than mine, and the medic needed her help with a patient who was a fly out. My patient was a “load and go” as well, due solely to mechanism – both patients were ejected from the car, mine straight into the arms of angels – not a scratch or broken bone anywhere. Better safe than sorry and my X-Ray Glasses have yet to arrive from DC Comics.

Here too, Spanish was it. No Spanish = No communication.

Nobody needed to speak to the third occupant.

Folie à Deux For One, Please.

Thursday, February 24 2005

I apologize to all for the lack of recent posts – I know that while BC and BE continue to expose you to 30 seconds of this site, the least I could do is change the view from time to time. However, if this were the Bible, the past week would be a big “begat” list – very boring.

With the exception of a non-911 call ran earlier this week. The patient was an 80 yoF nursing home resident 2xBKA, extensive other medical hx, requiring routine dialysis. We were told prior to transport that she had extreme dementia (A&Ox0) and was “noisy but harmless”.

I looked in on my patient on the way to the nurses station to do paperwork. She was supine in bed and had removed all her clothes, and was busily trying to remove the diaper she wore. She was quite loud and chattering away to herself; the words were difficult to make out because they were of the “veryquicklywithouttakingabreath” variety.

Paperwork was taken care of while the nurses dressed the patient for her trip. We loaded her (strangely subdued) onto our cot and into the ambulance for her 15-or-so minute ride. My turn to tech, so I’m in the back when she starts writhing around on the cot and the fast talking starts up again.

In French, I’m sure of it. Very very fast French.

Now folks, DTs hasn’t spoken French since 1978. Even when I worked near Embassy Row in DC one could have expected at least one encounter with a French-speaking person. No such luck. I am told by reliable visitors to that country that the French would rather speak English than hear your poor efforts mangle their language. My source tells me you can construct a perfect sentence but say “le” instead of “la”, both of which mean “the”, and they’ll cock their heads and discard the entire sentence as unintelligible. My source usually finished this observation with, “So f* the French.”

But I try anyway, stuttering out “n’est ce pas tres vit, s’il vous plait” which think I remember meaning, “Not so fast, please”. It must be close enough. My patient repeated slowly and clearly, “Mon dieu! Ma derriere blesse!” – “My god! My ass hurts!”.

I can’t help it, I’m a bad person. I laughed, big time. “Je me regret! Je me regret, mais nous sommes ici, la maison dialysis, dans cinque minutes, je, um, dit le doctor” and while the French is poor, my meaning of “I’m sorry, I’m sorry, but we’re here, at the dialysis place, in five minutes, I’ll tell the doctor” seems to get through and she calms down. I get the word “dormez” or “dorm-” something as she closes her eyes – she wants to sleep.

Suddenly she doesn’t seem as demented.

Both the folks at dialysis, and the nursing home, knew that she was indeed speaking French; she still had dementia, it turns out. She just had a fleeting moment of lucidity with me when I seemed to “get it” and she calmed down.

Which was a nice thing to happen, to me at any rate, and led me to consider the whole language thing. A subject for a later post, methinks.

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