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.”


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