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.