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Conversations About Death in Healthcare Encounters for Interpreters

Death should be easy to discuss, since every single person on this planet dies, yet it is still a difficult topic to talk about. Death is especially relevant to healthcare workers. People often die in front of you, shortly before you get there, or shortly after you leave their side. We as interpreters are there in the encounter when the patient first hears about the shadow on his lung or when she realizes her arrhythmia is a ticking time bomb. Death is always present, but rarely called out by name.

Why is it important to discuss death?

Healthcare interpreters are an integral part of the care team, but face three challenges when interpreting discussions about death in patient encounters. These three challenges are the patient, the care team, and yourself!

Start with why you are in the encounter. The interpreter provides a language bridge between the care team and patient so that each party can fully understand and contribute to the discussion. The interpreter’s main technical responsibility is to interpret accurately and completely. How can you accomplish that when death comes up in the encounter?

Consider how the patient takes in information about death. Some patients express the idea of death clearly, for example, “Doctor, if I don’t have the amputation, will I die? How long will it take me to die? Will it be painful?”

Most patients either use vague terms to refer to death, or act as though they don’t know death is near at all. No matter what the provider says to them, they do not talk about death straightforwardly. So, from this point on, either the interpreter expresses things related to death in vague terms, or the patient simply does not respond directly to any discussion of death from those around them.

How Healthcare Professionals Often Confront Death

Now let’s look at the doctor, nurse, nursing assistant, techs, pharmacists, therapists, and others who provide care to the patient. These professionals are all very experienced with death, but they are also human, often skirting the issue of death themselves. The unspoken expectation is that the American healthcare system should do all it can to defeat death, so we avoid admitting that a patient is going to die. Plus, you likely have this idea that showing emotion is not professional, so you avoid being direct to not provoke feelings of sadness or defeat.

The doctor may be vague and say, “I am sorry about the pain. We are going to give you medicine so that you can rest”, or “Hospice makes you feel comfortable, not like here in the busy hospital”.

The interpreter now has a provider who avoids discussing death altogether or uses euphemisms about death when speaking with a patient who is avoiding the topic themself.

And as an interpreter, you have your own views about how to talk about death. Some of us are straightforward about the topic, while some of us like to substitute expressions like, “pass away”, “no longer with us”, or “did not make it”. The result is often a discussion where death is never addressed directly and overtly.

What It Means for the Interpreter 

We know from research that patients are often confused by a doctor’s lack of clarity. Many hospice patients and patients discharged to nursing homes do not understand that they will never go home or get better.

We also know that patients and family members will not discuss death, which frustrates many doctors who wish to educate patients about their options.

Ambiguous discussions about a patient’s death also add to the distress interpreters experience. While straightforward discussions about death may shock some interpreters, it is disturbing to others when the patient does not seem to grasp that death is imminent. Ask yourself these questions:

What words do you use, what words do you not use, even if they might be closer to what the patient or care team is meaning?
Do you partner successfully with the care team to discuss death in a clear way?
Do you encourage the provider to ask the patient what they mean when they use a vague term related to her terminal status?

After all, to be accurate and complete, you, as the interpreter, may be the best agent to enable concise communication for all parties.

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3 Tips for When Your Interpreting Encounter Turns Into a Mental Health Discussion

Interpreting Encounter Turns Into a Mental Health

We have all been there...

The doctor or Nurse Practitioner is talking with the patient about the need to take his meds faithfully for his chronic disease, and the patient goes quiet for a minute. He says in a low voice that there is really no point in his taking the medicine because his life is not worth living anyway.  

The provider does a reset, and so do you. You both realize that this encounter has changed from a businesslike discussion of how to manage hypertension to a discussion about mental health.

The provider needs your support, as the interpreter, to follow her lead. The moment that a patient discloses his frame of mind and his difficulty in coping is a moment that requires calm, focused attention to silences as well as to words.

THIS IS A PIVOT

Watch to see how the provider adjusts her tone and her body language, and most probably, how she slows down and lets the moment develop. This is a time to build trust, to let the patient think, to not hurry him.  

There are several things that you can do during the interpreting encounter to support good communication when mental health or mental hurt is discussed.

FIRST

Be aware immediately of your own response to the patient’s disclosure. If you have a negative response, such as wanting the patient to not be so needy, or feeling uncomfortable with the patient’s statement in any way, sequester that reaction behind a barrier. Your role as part of the care team is not to jolly the patient out of his downcast state, nor is your role to want him to feel different. It is his life, and his hurt, and he is here for help.

SECOND

Pay close attention to the words the patient uses, and the way in which he uses them. If he does not finish his sentences, or if he uses language in an unusual way, be sure to convey the exact same use of language in English. You can use the Interpreter Voice to state to both the patient and provider that you are conveying the patient’s message the same way that he is saying it.

THIRD

Pay close attention to how the provider phrases comments to the patient. Is she asking questions? Is she making statements? Is she being persuasive, or supportive, or testing to see how deep the pain goes? If the patient were English-speaking, the provider could get across this nuance to the patient. As the interpreter, you have the difficult and important job of conveying the exact same nuance. 

You did it! You managed the pivot gracefully, following the lead of the provider and patient.