The Power of Language

The Power of Language

I work as an Internal Medicine physician and often see patients for their primary care. I enjoy this quite a bit and often try to say things to establish a relationship with the patient and make them comfortable. This does not always go as intended.

During my school days I had been very poor at foreign languages. I had taken French in school, but had to drop out in eighth grade as I just could not pick it up. My French teacher’s admonishment of “Silaunse, Ekoutez Bien” (silence, listen properly) still rings in my ears. I have always been in awe of people who could speak different languages.

There was a time I had a new patient coming in for his first visit. He was in his sixties and was a recent immigrant from the Philippines. I had been good friends with a person from the Philippines during my residency days and knew that they spoke a language called Tagalog.

I had also developed a fascination with the Google translate program. When I saw that this new patient was from the Philippines, I quickly looked up how to say hello in Tagalog on Google translate. The word was ‘Kamusta’. I went into his room. He was accompanied by his daughter. I came in and said Kamusta to them.

They both appeared taken aback and looked surprised. They then asked me - can you speak Tagalog? No, I told them I looked it up. They both laughed and thanked me. Then my patient told me that he was from the island of Cebu, and his mother tongue was called Bisaya and not Tagalog.

Now, I felt really foolish. I had not known that there was more than one language in the Philippines. However, we all laughed about it. I have since then developed an excellent relationship with him. Interestingly, a few months later I had an Intern originally from Maine, doing a rotation with me. When we went to see this patient, he started speaking to him in fluent Bisaya. Both me and the patient were totally amazed. The Intern then told us that he had spent two years doing missionary work on my patient's home island of Cebu.

I had another patient who had been born in Germany. She was in her sixties. From Google translate, I greeted her with ‘Guten Tag Fraulein” (Good day Miss). I was curtly informed by her that she was a Frau (Mrs) and not Fraulein (Miss)! I guess Google translate is not perfect.

I had better luck with a Moroccan patient. I started with “Ahlan Washalan” Arabic for welcome. A Yoruba patient from Nigeria was greeted with “Ek Aasan” (Good Afternoon). Since I grew up in Nigeria, I did not need Google for this. Similarly, a French Belgian was welcomed with a “Bonjour” (Good day).  I can still remember some French from my school days.

There are some languages that I have not attempted. One was a patient from Eritrea. He spoke several languages. I have also had patients from diverse places such as Burma and Russia. All these patients spoke good English, so I got by easily.

Why do I insist in trying to speak these different languages? The first reason is that part of me has this fascination with languages. I look at multi lingual people with envy. I myself primarily speak English and can carry a conversation in my mother tongue Urdu. I can also speak some Hausa which is the local language in Northern Nigeria where I grew up.

The other reason is that it can be a great start to a physician patient relationship. Even when I get it wrong, most patients appreciate it tremendously.

I still remember one particular patient. She was an elderly Indian lady. She was brought in by her son. She had developed dementia and had no one to look after her in India. Her son who lived in the United States had brought her back to live with him. Her dementia was advanced and she did not speak much, and looked at me with a blank stare.

She was from the same North Eastern part of India that my parents had been born. Her mother tongue Hindi is very similar to the spoken form of my mother tongue Urdu, and I started to speak to her. She recognized what I was saying and suddenly brightened up. An amazing thing then happened. She started answering back and talking.

That was a very rewarding experience. On that day I learnt the amazing power of language.

Tukur Tukur

Tukur Tukur

The following story is from my earlier days as a school boy before I became a doctor. It is a tribute to a person that I have had a great deal of admiration and respect for, the late Mr. Khalil Mahmud, (3/7/1929 to 1/29/2006). He was a great man, and this is just one of my many fond memories. May he rest in peace.

I had grown up in the small town of Zaria in Northern Nigeria in West Africa. My dad taught at the local university there.

Our primary school was within the University, but when we moved to secondary school in seventh grade (which we called Form one), we had to go to a local school in town.

Our local school was called Barewa College. It was a school originally built as a boarding school for the male children of ‘Elites’ in Northern Nigeria. It was designed in the best traditions of a British public school. By the time we started going there, it had lost a lot of its luster, but we still took pride in the fact that several of Nigeria’s leaders had graduated from there.

I became a day student there, and a car pool was made to ferry myself and other classmates to the school and back. It was a good 30-minute ride away. I would be crammed in a car with four other boys. Two of those boys were American brothers.

Their Father grew up in Boston, Massachusetts. He was an extremely smart African American man, and got a full scholarship to Harvard in the 1950’s. He however chose to go to the smaller Brandeis University. They had a better program on Islamic studies and he was a convert to Islam.

In the 1960’s, he moved to Nigeria in West Africa with his wife. In Nigeria, he eventually had four sons, the older two would be in the car pool with me. He had become the University Librarian, which was a very senior position in the University.

He was very distinguished in appearance, with a full beard and an extremely soft voice. I can still hear him speaking in that authorative but very soft New England accent. He was a very kind person.

He drove a white Peugeot 504 station wagon which had an extra back seat and was more comfortable than the smaller Volkswagen Beetle my dad had. His driving style was different too. He was a very good driver, but in complete contrast to his very sedate appearance, he could drive quite fast.

I recall one particular day about 35 years ago. We were running late. He was driving fast. As was his habit, he had his window rolled down. Normally in warm West Africa, this would be a good thing, but this was the Harmattan season, which was our winter. Cold air would come down from the Sahara creating a dusty haze in the air. We felt really cold.

Mr. Mahmud did not seem bothered with the cold air. He had grown up in Boston, and when I visited Boston in winter many years later, I realized that our Harmattan was probably just like a balmy day for him.

As I mentioned earlier, we were running late. This could have consequences for us. If we did not get to the morning assembly in time, we could be called to the Principal’s office and be punished.

It was at this point someone suggested taking a shortcut. Instead of going down the highway, we could cut through the village of Tukur Tukur. This was a typical village in Northern Nigeria. A haphazard collection of mud houses just north of our school. It had a large rocky hill (also called an Inselberg) overlooking it. I thought this was a bad idea as I was not even sure there was a road going through the village.

Mr. Mahmud did not give it a second thought. He swung off the highway on to the dirt track leading to the village. While he was absolutely calm, my heart was in my mouth as we sped towards the cluster of mud houses. It was early morning and the village was deserted.

Tukur Tukur village from the Inselberg in the 1970's

We were rapidly driven through the narrow spaces between those village houses. The only way I can describe that experience is that I was reminded of it when I later saw stock car racing in the United States. We darted in between the narrow spaces expertly with plumes of dust in our wake, and finally got to the school.

We got to school on time. We ran to the assembly and stood up to say the national anthem. The village of Tukur Tukur still exists as does my old school Barewa College, but I doubt if anyone can drive as quickly or as expertly through that village as we did on that morning many years ago.

E Pluribus Unum

E Pluribus Unum

One of the patients being seen in my Internal Medicine clinic was a young woman in her twenties. She was coming to see me for the first time for routine care. She was generally healthy and had no problems. Her name was however unusual. It appeared to be Middle Eastern in origin.

When I saw her, she looked no different from most other young woman in our area.  I was however curious about her unusual name. During the course of our exam, I asked her how she got her name. Oh it is Afghan, she said.

This was an unexpected answer for me. How did you get an Afghan name, I asked? She replied that her father was from Afghanistan. When the Soviets invaded Afghanistan in 1979, he had fled with his family. He was sixteen years old at that time. The family first went to Germany and was able to eventually migrate to the United States and settle here.

Her father met her American mother and married her. He had four children with her, but unfortunately the marriage failed. My patient was brought up by her American mother, but kept her Afghan name.

On that day, I was also being shadowed by a medical student. After the patient left, he came up to me and said that his father had fled the Afghan war too. He was sixteen at that time as well. Oh, I asked, was your father from Afghanistan too? No he was Russian he replied.

Now I was confused. I said, "but the Russians are the ones that invaded Afghanistan"! He then explained to me that his paternal grandfather was forcibly conscripted into the Soviet army in the 1950’s during the Soviet invasion of Hungary. He did not want his children to have the same fate. When his son turned sixteen, the Afghan war had started and young Russians were being drafted into the army again. Many were being killed in action. The grandfather wanted to prevent his son from being forced to join the army.

He decided to get him out of the country, but getting out of the Soviet Union was not easy. His grandfather was able to devise a plan to get his young son out and away from the Soviet Union and thus avoid being drafted into the army. The young man eventually came to the United States. He went to college, got married to an American woman and had three children, the oldest of whom was my medical student. He was also in his twenties.

In that afternoon, I saw a meeting between the children of people from the opposite sides of the Afghan war. However both of these children were now American. The phrase that came to my mind was the original motto of the United States of America "E Pluribus Unum", which means "Out of Many, One". Originally meant to denote the first 13 states coming together to form a nation, it is now often considered a reflection of the melting pot nature of the United States of America.

As I saw for myself, this also includes people from opposing sides of the war in Afghanistan. Now barely, a generation later they were one. E Pluribus Unum indeed!

The Quilt

The Quilt

In my career as a physician, there have been many patients that left a lasting impression on me. There is one that I will never forget. Here is her story.

It was many years ago, and I had just started my first job as an Attending Physician in a small town. One of my earliest patients in those days was a very pleasant lady in her sixties. She was a breast cancer survivor. As part of the treatment for this, she had undergone a mastectomy, followed by chemotherapy and radiation therapy. Just as her cancer went into remission, her husband died. She had never had any children, and continued to live alone in the small town that had been her home all her life.

The first time she saw me, I was a young doctor fresh out of residency. She had been widowed for about a year at that time. I remember her being excited that her hair had grown back after she had lost it due to the cancer treatment. She had been married for about forty years before her husband died. She missed him dearly, but the thing I remember most about her was her positive outlook. She always had a smile on her face.

I developed a great relationship with her. Her visits would often be extended beyond our allotted time as we talked about local traditions in the Southern United States. I have always been fascinated with the ‘South’ ever since I read ‘Gone with The Wind’ as a young student in Africa. Her family had lived in that small Southern town for many generations. She knew everything about Southern culture and traditions.

One day, she came to see me and told me that she felt a lump at her mastectomy site. Concerned, I quickly examined her. It was a small round nodule at the site of her surgery. I had a sinking feeling that the cancer could be coming back. I did my best to sound reassuring, and ordered a CAT scan on her.

The scan confirmed my worst fears. The cancer had come back. I braced myself and called her with the news. She responded very calmly and asked me what we needed to do. I quickly referred her back to her cancer doctors. They resumed her chemotherapy and radiation therapy. Unfortunately, this time, the cancer did not respond to the treatment. Eventually a decision was made that further treatment was futile.

She then came to see me. She had lost her hair again with all her recent treatment and was wearing a hat. She looked me in the eyes and said that she had a request. It was to please make sure she does not suffer. I will admit that this was a very difficult conversation for me. People often think that doctors see these things all the time, and it should be routine. It is not. I was visibly shaken.

She saw that I was upset, and then she is the one who tried to comfort me. She said that she was looking forward to re-uniting with her husband. She had led a good life, and had no regrets. I promised her then that I will do everything to always keep her comfortable. She smiled and patted my hand. She said that she is going to get me a present. I protested, that getting presents should be the last thing on her mind at this time. She just smiled.

A few weeks later, she came to see me with a large bag. What is this, I asked? It is a quilt for you she said. I made it myself. You made a quilt for me I asked in amazement? It is a tradition in the South she said. Quilts are works of art and are often passed down from one generation to the next. They are created by sewing two layers of fabric together with an interior padding.

Her quilt was an impressive collection of small squares of multi colored fabric neatly stitched together in a pattern. She had made this by hand herself. It was beautiful.

I cannot take this, you do not need to do this, I protested. She smiled at me and said, I know. I just want you to have something to remember me by. And so, I kept the quilt.

A few weeks later, my patient fell ill and I admitted her to the hospital. I took care of her in her last days and did my best to make sure her transition was as comfortable as possible. She died peacefully. I hope she remains at peace and is back with her husband.

The quilt has remained with me everywhere I have moved. It remains one of my most prized possessions.

PTSD

PTSD

Recently, I was seeing one of my regular patients in the clinic. He was a well-built extremely athletic looking man in his early fifties. A couple of years ago, he had retired from the United States Army. He had been a special forces soldier.

He now lived with his wife with whom he had been married for a few years. This was his second marriage. His first marriage had ended in a divorce many years ago. His opinion was that this was in part due to his frequent and prolonged deployments overseas. He had no children or step children.

On his visit, he was having palpitations and difficulty sleeping along with frequent headaches. I did a detailed work up. This included multiple lab tests as well as an electrocardiogram. Everything came back as normal.

I then said to him that these could possibly be symptoms from stress and anxiety. He could have Post Traumatic Stress Disorder (PTSD) from his time in active military duty overseas. Were you ever in a war zone, I asked?

He laughed. For over twenty-five years, his life had been about deployments from one war zone to another. Some of these were obscure places as he was a special forces soldier. He explained to me that sometimes he would be sent on missions to places that never made news headlines.

Now, I was curious. What kind of missions, I asked? He then described one mission in which he was part of a mine clearing unit in a country in Southern Africa. He said that while they took precautions, it was still a dangerous task. He loved his work though, and told me that those two years he spent in the African Bush were very memorable.

He remembered another assignment in a Central African country. He was in the middle of the jungle along with a platoon of other United States special forces. They were on some kind of peace keeping mission and were on patrol one day, when they saw a small plane circling and appeared to come down to land nearby. The platoon decided to investigate. They came upon a landing strip in the middle of the jungle.

There was a small plane that had landed there. Surrounding the plane were some heavily armed men, carrying Uzi submachine guns. They were Israeli mercenaries that had come to pick up a shipment of illegally mined diamonds.

The Israelis and the Americans looked at each other. Both sides were heavily armed. His platoon decided that it was none of their business as to what the Israelis were doing and backed off.

There you go, I said. All those stressful situations are probably causing you symptoms of PTSD. He disagreed with me.

He said that at his military discharge, he had a very thorough medical checkup. He even had a Psychiatrist evaluate him specifically for PTSD, and he was given a clean bill of health. Unlike some veterans, he had very fond memories of his military days.

So, what happened after you got back, I asked? He moved back in with his wife and started adjusting to civilian life. He had to learn to do groceries and cut the grass in his yard for example. It is a good life he told me, but he would sometimes have arguments with his wife. She can get angry very quickly, he said.

He then admitted to me that it was sometimes stressful being around his wife. He could not often understand the reasons why she got upset. Being in a war zone is a piece of cake compared to being around an angry wife, he told me.

Aha, I said to him, I think I have your diagnosis. You have PTSD from your wife. He looked at me quizzically. You mean that what twenty-five years of being in a war zone did not do, a couple of years living with a woman has done?

That was a joke, I clarified, and we both laughed.