What the Heck is a Stress Test? (Medical Interpreting)

Medical interpreting is exciting because it is often unpredictable. No one appointment is the same, and interpreters often walk into their assignments without much knowledge about the matter in discussion. Even so, as part of our professionalism, we must be as prepared as we can be to ensure we are providing the best service and fulfilling our job of enabling communication between the provider and patient.  As many of you may know, we’re not always given a lot of detailed information about the appointment at hand, so what I do is take any relevant information as clues for what is to come. These can include the hospital, the doctor’s name, the age of the patient, or basic information about the type of appointment, such as a consultation or a physical. As interpreters, we should be resourceful and use what we have as the basis for our research and preparation for the appointment.

Recently, the one clue I received was “cardiac imaging,” so I read about the different types of cardiac imaging and made sure I was up to speed on the procedure and technical terms. When I arrived to the assignment, I learned that the patient was taking a  Dobutamine Stress Echocardiogram. Thankfully, I knew all about it by the time of the appointment so it went smoothly.

Below is a quick summary of what the exam is about and how it works, as well, a list of terms that came up during the appointment, which I hope will be helpful to you.

Basic overview of the Dobutamine Stress Echocardiogram: 

Dobutamine Stress Echocardiogram is a type of stress test, which is used to evaluate the heart’s ability to respond to stress. During the test, the patient is connected to an electrocardiogram to monitor his heart rate and a blood pressure machine to monitor his blood pressure before, during, and after the heart rate reaches capacity. The goal is to see how the heart responds when it is working hard. Four sets of ultrasound images are taken throughout the process. One before the injection of the Dobutamine, two as the medication takes effect, and one after the heart rate goes back to normal when the medication loses effect. There are two ways to stimulate the heart rate: one by exercise, and one by medication. Dobutamine Stress Echocardiogram the type of cardiac imaging used when the patient is unable to walk or run on the treadmill and when the medication, Dobutamine, is injected through an IV instead to simulate how the heart responds to exercise.

The difference between a Dobutamine Stress Echocardiogram and a regular Stress Echocardiogram:

The process for the two is pretty much the same, except that with a regular stress echocardiogram, patients are asked to walk/run on the treadmill to help increase the heart rate. Pictures are taken before the patient walks on the treadmill, right after the heart rate reaches capacity, and after the heart rate slows down.

Keywords during a stress test: 

1. CARDIAC IMAGING / 心臟影像檢查 (xīnzàng yǐngxiàng jiǎnchá). Stress tests are one type of cardiac imaging.
2. DOBUTAMINE STRESS ECHOCARDIOGRAM / 多巴酚丁胺負荷超聲心動圖 (fùhè chāoshēng xīndòngtú).
3. DOBUTAMINE / 多巴酚丁胺  (duō bā fēn dīng àn). The medication used to stimulate the heart during the exam.
4. INTRAVENOUS INJECTION (IV) / 靜脈注射 (jìngmài zhùshè). Medication is injected using an IV.
5. INJECTION / 注射 (zhùshè). The medication, Dobutamine, will be injected into the bloodstream using an IV.
6. STRESS TEST / 壓力測試 (yālì cèshì).
7. SUPERVISE / 監都 (jiāndū). Sometimes the cardiologist will supervise the test along side the technicians
8. BRA / 內衣(nèiyī) or 胸罩 (xiōngzhào). Patients are asked to remove everything from the waist up, including their bra.
9. WAIST-UP / 腰部以上 (yāobù yǐshàng). Patients are asked to remove clothing from the waist up and put on a waist-length patient gown.
10. CARDIOLOGIST / 心臟科醫師 (xīnzàngkē yīshī).
11. ECHOCARDIOGRAM TECHNICIAN OR ECHO TECH/ 超聲心動圖技術員 (chāoshēng xīndòngtú jìshùyuán).
12. SMALL BREATH / 吸小口氣 (xī xiǎokǒu qì). The echo tech may ask the patient to take in small breaths to help her get better pictures.
13. HOLD BREATH / 屏住呼吸 (bǐng zhù hūxī). After asking the patient to take in a small breath, the echo tech will ask the patient to hold his breath for a bit.
14. BREATHE, EXHALE / 吐氣 (tǔqì). The echo tech will instruct the patient to breathe out once they are done taking the pictures.
15. LIE ON THE SIDE / 側躺 (cètǎng). Patients are asked to turn to their left side when images are taken with the ultrasound machine.
16. LIE ON THE BACK / 平躺 (píngtǎng).
17. WAITING ROOM / 候診室 (hòuzhěnshì).
18. ULTRASOUND / 超聲波 (chāoshēngbō).
19. GEL / 凝膠 (níngjiāo). A gel is applied to the transducer for easy navigation.
20. COLD / 冰冰的 (bīng bīng de). The ultrasound gel is a little cold when it touches the skin.
21. ECHOCARDIOGRAM (EKG) / 超聲心動圖 (chāoshēng xīndòngtú). Uses sound waves to create pictures of the heart.
22. ELECTROCARDIOGRAM (ECG or EKG) / 心電圖. Traces the electrical activity of the heart.
23. MONITOR / 螢幕 (yíngmù). The heart rate and pictures are shown on two different monitors.
24. DOSE / 劑量 (jìliàng). During a Dobutamine Stress Echocardiogram, a patient will receive a certain number of dosages of the medication to help the heart rate reach its capacity.
25. SERIES / 系列 (xìliè). During the stress test, four sets of pictures are taken. One taken before medication is injected, two during when the medication is taking effect, and one after the medication has lost effect.
26. EFFECT OF THE MEDICATION / 藥效 (yào xiào). The last series of pictures are taken when the effects of the medication are gone.
27. TREADMILL / 跑步機 (pǎobù jī).
28. RUN / 跑步 (pǎobù).
29. JOG / 慢跑 (mànpǎo).
30. WALK/ 走路 (zǒulù).
31. BLANKET / 被子 (bèizi) or 毯子 (tǎnzi). Patients are often offered warm blankets during the test in case they feel chilly,
32. WARMER / 暖箱 (nuǎn xiāng). Some places have warmers to heat up the blankets.
33. RESULTS / 結果 (jiéguǒ). If the cardiologist is on site, he would give the patients the results right after completion of the echocardiogram. If not, the patient will receive a call with the results.

Good luck with your assignment and happy interpreting!

On the Job: Relay Interpreting in a Medical Appointment

Relay interpretation is a type of consecutive interpretation used when multiple languages are at play at the same time, where the source language is  interpreted into different languages, and at least two interpreters are present. We see this most commonly used in conference interpreting where the source language is rendered into a common target language and then further rendered into specific language groups. This type of interpretation is similar to the game “telephone,” where one message is whispered down a line of people, and the last person in line announces to the group what the message was. If you’ve played this game before, you’d know how easily it is for the original message to become distorted at the end of the line.

With this in mind, we can see the challenges of relay interpretation. Because multiple players are involved, the risk of distorting the message is high, where omission from or addition to the original message can occur; thus, it is important that all interpreters involved are professionals and are  familiar with the code of ethics and the  necessary means they need to take to ensure accurate interpretation of the message.

At a recent  medical appointment, a Mandarin interpreter was requested. I learned early on that while the patient spoke Mandarin, he also spoke a Chinese dialect that I am unfamiliar with. This was not a problem because he understood Mandarin, but his son was present as well, and my work complicated when the two of them communicated in their dialect, leaving both the provider and myself out of the conversation.

During the appointment, the patient and his relative would have side conversations in their dialect. I had to inform the provider that the side conversations were in a different dialect that I didn’t understand, so she knew I wasn’t keeping information from her. After the side conversations ended, I tried to find out what they were talking about, and the son would kindly summarize it for me, allowing me to interpret the summary to the provider.

Much of the appointment went like this: the provider spoke, I interpreted the English into Mandarin Chinese, after hearing my interpretation, the patient and the son would converse in their dialect, and then the son would respond in English or in Chinese–if in Chinese, I would interpret it into English for the provider. What worried me was that while the side conversations lasted for at least 30 seconds at a time, the summaries were only a few words long, such as, “he said okay.”

In this case, relay interpretation took place, from English to Mandarin to the separate dialect back to Chinese then to English again. As I mentioned earlier, to ensure that messages get transmitted without distortion, we need to make sure that the interpreters are professionals; however, since the son was a family member, he felt that as long as he understood the message, it was okay. This is partly why family members are highly discouraged to act as interpreters. As well, when messages are summarized, the interpreter, not the speaker, decides what was most important and less important in the message. Because of this, important information can be lost during the transmission of information.

As an interpreter, I always want to make sure that messages are being understood, so I worried about what the patient was saying to his son and whether they full understood the provider’s instructions. However, it seems like the  in situations like this, it’s hard to repeatedly instruct the family members to interpret everything, or ask that the patient speak for himself rather than through the family member.

Fellow interpreters, what would you have done in this situation?

On the Job: What if My Client Insists on Speaking English? (Interpretation)

As interpreters, we are called on when there is a perceived need for our language skills. Our job is to ensure effective communication by transferring the most accurate and clearest intent from one language speaker to another. With our help, we can help deliver services and satisfy needs. In my world (America), the target language more often than not is English. While many of our clients are people with limited English proficiency (LEP), they may still have some understanding of it, and in some cases, they may even opt to communicate directly to the provider–physicians in medical cases or attorneys in legal cases. What is an interpreter to do when this happens?

The “first line of defense” is your introduction. When you introduce yourself as an interpreter, you’re letting the client know that you are his voice and that he should trust that you are there to help him get what he needs. You will speak for him by interpreting everything that he says; you will also interpret everything the provider says, so your client will have full understanding of what is going on. Once this is put aside, the client may feel more at ease that his concerns will be met with your help, and may feel more comfortable using his native tongue. If not, the client may just feel he doesn’t need an interpreter.

If this happens in a medical case, I’d recommend being there to listen and to make sure the information is clearly delivered on both ends. If a client insists on using English, gently interrupt when needed–such as if you see that the messages aren’t getting through to either party.

In legal cases, however, this may be different. In depositions, for example, the attorneys may have communicated and agreed that the witness should speak only in his native tongue. And to make sure the accounts are accurately documented, the court reporter would record what the interpreter says, so it is crucial that the witness stays in his native tongue. This keeps things clear and less confusing for record keeping, it is also to the benefit of the witness as less will be lost in translation.

In a deposition I interpreted at last week, the witness had a tendency to jump between Mandarin Chinese and English, even though his attorney asked him to speak in Mandarin only. When the witness started to speak in English, I began to interpret from English to English by repeating what he said, or rephrased it in the way it was intended, such as by correcting the grammar. This prompted the attorneys to remind the witness to stick to his native tongue. Although I wanted to remind the witness on multiple occasions to speak in Mandarin only, I wasn’t sure it was my place to since I was there to interpret only. Under the code of ethics, I was there to say what was said and not what wasn’t.

However, even with that in mind, I asked the attorney a few times if the interpreter could remind the witness to speak in Mandarin, using third-person, of course. Once he approved, I turned around to remind the witness to speak in Mandarin, which is what everyone in the room wanted.

To answer the question in the subject line: when a client insists on speaking in his native tongue, an interpreter should remain alert and use her best judgement so that the client can get the service he needs and that all parties’ expectations are satisfactorily met.

Fellow interpreters, I’d love to hear from you! What would you have done in my situation? What do you do when a client doesn’t use his native tongue during an appointment?

Crossing the Line: Is It Okay to Become Friends with My Clients? (Interpreting)

As interpreters, we run in a small circle of limited-English speakers. It’s possible that you would work with the same client over and over again; it’s also possible that you’ll work with a client once and never see him again. Regardless, it’s important to keep a professional relationship, not only through keeping up your skill set, arriving to appointments on time, and interpreting as faithfully as you can, but also through treating your clients as equals and not taking advantage of their vulnerability as limited-English speakers.

One question that interpreters run into revolves around whether it is okay to become friends with a client. Different interpreters have different opinions about this, but most would agree that it’s better to keep business separate from friendship. This is really hard though, especially when clients are always excited to find people who speak their language and want to know more about the person who’s helping them get the services they need.

From my point of view, the main risk of breaking the professional relationship is that the client may have different expectations of the interpreter during appointments. Also, once you become friends, the client may want to show his appreciation in different ways besides just saying “thank you,” such as with gifts. Accepting gifts, is a tricky one.

What can we do to make sure we maintain professionalism with our patients?

1. Keep Your distance. One way to avoid developing a close relationship with your client is through keeping your distance with the client. I know an interpreter who never allows herself to be alone with a client. After she introduces herself as the interpreter and explains how the process will work, she always finds an excuse to sit on the other side of the waiting room (“I need to prepare for a test” or “I need to work on some personal things while we wait”), and in medical interpreting cases, she stands outside the doctor’s office until the doctor walks in, simply to avoid conversation with the client. Without conversation outside of appointments, the interpreter and client won’t ever have a chance to build a personal relationship. And by explaining why she needs to be alone from the client, the client won’t feel like he is being ignored.

2. Clarify Your Role. It’s not always easy to create distance between you and your client. Some clients may feel offended if you’re not willing to socialize with them. If removing yourself from the client’s presence is not possible for you, it’s important to clarify your role as an interpreter early on when you introduce yourself and make reminders during your conversations as well. Make it clear to them that you are there to interpret everything that is said, and nothing that is not said, so if the client discloses information that he wishes to convey to the provider (doctor or lawyer, or whomever), you should remind him to bring it up at the appointment: “make sure to bring this up when you see the doctor (or lawyer), so I can interpret for you.” Personal dialogue between an interpreter and client can lead to expectations that the interpreter will convey everything that’s been said outside of an appointment. By clarifying and reminding the client of your role, you’ll help him remember that you are there to help him communicate, not there to communicate for him.“

3. Use a Higher Power. Clients are often very grateful to have someone who speaks their language to help them get the services they need. Sometimes, they’ll thank you repeatedly, other times, they might want to give you a gift or offer you services, such as a ride, to show their appreciation. Outright refusal of a gift you find inappropriate may hurt a client’s feelings, so it’s important to explain your position in such situations and let the client know that you appreciate the thought, but your agency or company does now allow you to accept gifts from clients. You can use this as an excuse for other uncomfortable situations that come up as well. Explaining your position while using a “higher authority” will make your refusal less personal.

Where should we draw the line?
It’s always difficult to figure out where to draw the line when it comes to building a friendship with a client, but the important thing to keep in mind is that all your actions have implications. In deciding whether to further a relationship or accept a gift from a client, interpreters should make sure that we are not in any way exploiting the patient. By doing so, an interpreter is doing her job to protect herself and also a client, and that’s a part of an interpreter’s professionalism as well.

For a summary of the code of ethics for a medical interpreter, click here.

Good luck!

On the Job: How to Introduce Yourself as an Interpreter

At any interpreting job, it’s safe to assume the possibility that your clients have not worked with interpreters. Even if they have, the interpreters they’ve worked with may not have explained to them how it works. This is why it’s helpful when you introduce yourself, to also ask if they’ve worked with an interpreter, and if they haven’t, slip in your 20-second spiel to explain your role and how the session will go.

The introduction should be short, brief, and to the point. Your goal is to convey your role and to let the clients know how to communicate through an interpreter. Sometimes you’ll find it hard to explain your role because the service provider (doctor, lawyer, etc.) may be impatient, but try your best to get through it.

Your self-introduction should include four elements.
1. Confidentiality- Everything said will be kept confidential. This applies especially to legal and medical interpreting cases.

2. First person- Everything will be interpreted in first person. If the patient says, “my head hurts,” the interpreter will relay, “my head hurts,” for the provider.

3. Flow of Communication- To ensure the flow of communication, interpreters should ask all parties to speak directly to each other and keep sentences short to ensure accuracy of the message. Interpreters should also assign a hand motion to signal pauses (in case the speaker goes on too long) to allow time to complete the interpretation.

4. Everything- Everything that is said will be interpreted, even if it was not directed to the other party. For example: If the doctor has side conversations with the nurse and you and the patient can both hear it, interpret it. The patient has the right to hear everything spoken in the room.

Here’s an example of what you can say.
My name is [Name], hired by [Agency], and I will be interpreting for you and the patient/client today. I will repeat everything that is said today, and everything will be interpreted in first person. To ensure accuracy, please keep your sentences short. If i raise my hand like this [stop signal], please pause so I can catch up. Finally, I will keep everything said here confidential.

Note: When speaking to the provider, you’ll use your source language, and when speaking to the client, you’ll repeat the same information in the target language.

What if the Provider Says He’s Worked with Interpreters?
If the provider has worked with interpreters, they may not want to or need to spend the extra 20 seconds with you to learn about something they already know how to do. Don’t force it. But during the session, if you notice that the provider is speaking to you and not to the client, you can make gentle nudges to help them speak directly to the client. This is not just about following the “rules” of interpreting, it’s also about showing respect to the client. Even though our clients have limited fluency in English, some of them still understand a little bit of English, and hearing the provider say, “tell him this, tell him that,” would not feel good to them at all.

Our role as interpreters is to act as conduits and help make  communication possible between people who speak different languages. We care about our clients and want to make sure that everyone involved is kept in the loop, that’s why we should insist on interpreting everything and monitoring the flow of communication.

{photo courtesy of xdxs}

How do you introduce yourself at interpreting jobs? What are the challenges you find? I’d love to hear from you!

Good luck and happy interpreting.

Don’t Be A Choosy Language Learner

Translation is always in the back of my mind, so I’m always thinking: How would I say this in Chinese? or How would I say this in English? And sometimes the strangest things strike my interest. This time, they’re the phrases in an article on balding and hair loss.

Language is ever-changing, and a good linguist–translator or interpreter–always finds ways to expand her vocabulary. There are topics or occurrences in our daily lives that we don’t always think are important enough to further explore, when actually, anything can be a learning experience. Don’t discriminate against odd subjects!

Okay, so let’s get into the hair loss/ baldness vocabulary from the article I read on udn.com, a Taiwanese online news source.

1. 頭髮 (tóufa)- hair (on the head). 頭: head; 髮: hair (on the head).
2. 髮線 (fàxiàn)- hairline. 髮: hair (on the head). 線: line.
3. 禿頭 tūtóu- baldness.
4. 雄性禿 xióngxìng tū- male pattern baldness. 雄性: male. 禿: bald(ness).
5. 額髮線後退 (é fàxiàn hòutuì)- receding hairline. 額: forehead. 額髮線: forelock. 後退: to go back.
6. 促進生髮的藥物 (cùjìn shēngfà de yàowù)- medication that promotes hair growth. 促進: promote. 生: grow. 髮: hair. 藥物: drug, medicine.
7. 電燈泡 (diàndēngpào) 電火球仔 dian hui chu ah>- lightbulb. Used to describe a completely bald head. Note: Another usage for 電燈泡 (diàndēngpào) is what American English terms “third wheel.”
8. 植髮中心 (zhífà zhōngxīn)- center for hair transplants. 植: to plant. 髮: hair. 中心: center.
9. 急性休止期落髮 (jíxìng xiūzhǐqī luòfà)- acute telogen effluvium. Hair loss caused by illnesses. 急性: acute.
10. 圓禿 (yuántū) or 鬼剃頭 (guǐtìtóu)- alopecia areata, also known as spot baldness. 圓: round, circle. 禿: baldness. 鬼: ghost. 剃頭: to shave one’s head. 鬼剃頭 is the colloquial usage.
11. 假髮 (jiǎfà)- wig. 假: fake; 髮: hair.
12. 生髮水 (shēngfàshuǐ)- hair regrowth tonic. 生: grow. 髮: hair. 水: water, solution.

Side note, have you heard that washing your hair every day isn’t good for you and may lead to hair loss? That actually isn’t always the case. We should actually wash our hair and scalp regularly to avoid clogged hair follicles, which can lead to more hair loss.

Hope you learned something today!

Dirty Mouth: Let’s Talk Cursing (and Interpreting)

The default role of an interpreter is a conduit. Merriam Webster defines conduit as a natural or artificial channel through which something is conveyed. If we think of the channel as a telephone wire, the conduit transmits anything and everything that is received from one end to another. In other words, an interpreter relays all information that is spoken, without any omission, additions, or distortions of the message.

In medical and legal interpreting, there are times when we have to give bad news. And in times like this, the client may become upset and use curse words to express his feelings. In my medical interpreting training, someone raised a question of whether interpreters still need to relay everything in such cases, particularly if an interpreter has qualms about cursing. Despite what an interpreter’s personal feelings are toward swearing, interpreters must stay true to the original message, even if it means cursing or using words they wouldn’t necessarily use in their daily lives. Such is what’s implied in the code of ethics for interpreters.

Regardless of the cultural or social implications of cursing, if it happens that you must curse on the job, then you need to do it as part of your professionalism. I don’t curse, and haven’t really thought about how English curse words correspond with Chinese curse words, but as a responsible interpreter, I’ve put together a short list (you know, for my work, of course). Cursing is an interesting thing. You’ll notice below that the common curse words we use in English relate  to sex and excretion and mothers. Even though sex and excretion are unavoidable parts of natural human conditions, and we all love our mothers, these words are considered indecent and taboo in both the American and Chinese cultures.

1. Bastard-王八蛋 (wáng bā dàn)、 龜孫子(guī sūn zi)
2. Fuck [angry fuck]- 幹 (gàn)、肏 (cào)
3. Fuck, Fuck me, Fuckin’ awesome, Holy shit [excitement]-我靠 (wǒ kào)
4. Fuck you, Go to hell- 去你的 (qù nǐ de)、 我鳥你 (wǒ niǎo nǐ)
5. Fuck him, Screw him-鳥他的 (niǎo tā de)、去他的 (qù tā de)
6. Bullshit–屁 (pì)、屁話 (pì huà)、鳥話 (niǎo huà)、你個狗屁 (nǐ ge gǒu pì)
   Example: What the fuck are you talking about-你在講什麼鳥話 (nǐ zài jiǎng shén me niǎo huà)
7. What the fuck is this?-這是什麼鬼? (zhè shì shén me guǐ)
8. What the fuck are you doing?-你搞什麼鬼? (nǐ  gǎo shén me guǐ))
9. Damnit- 他媽的 (tāmāde)
10. Son of a bitch- 狗崽子 (gǒu zǎi zǐ)

These are just some common English curse words and their cursory Chinese equivalents. If you’re interested in learning about Chinese curse words, their detailed explanations, and how they relate to English, the Transparent Language blog has a good post about it that you should check out.

Happy cursing! (Just kidding. Cursing is bad.)

Literature in Translation: Prostate-Specific Antigen

The Key Number: PSA ≦ 6.5

Prostate-Specific Antigen (PSA) is a type of protein produced by the prostate gland. Its levels increase with age, and the normal rates are ≦3.5 for those under age 59.; ≦4.5 for those between ages 60 to 69; and ≦6.5 for those between ages 70 to 79.

High PSA levels could be a sign of prostatitis (infection of the prostate) or benign prostatic hyperplasia (enlarged prostate). In some, it may even be a marker for prostate cancer. However, diagnosis of prostate cancer is usually determined by digital rectal exams and ultrasounds of the rectum and prostate.

If the possibilities of prostate cancer cannot be ruled out, a biopsy would be done for pathological diagnosis. Patients who have been diagnosed with prostate cancer can use PSA to assess and track their response to therapy.

Vocabulary

1. 攝護腺 (shè hù xiàn) or 前列腺 (qián liè xiàn)- Prostate gland.
2. 攝護腺炎 (shè hù xiàn yán)-Prostatitis, or infection of the prostate. 炎: infection.
3. 攝護腺特異抗原 (shèhùxiàn tèyì kàngyuán)- Prostate-Specific Antigen (PSA). 攝護腺: prostate gland. 特異: distinct, peculiar, specific. 抗原: Antigen.
4. 數值 (shù zhí)-Number, level, score.
5. 良性攝護腺肥大 (liángxìng shèhùxiàn féidà)- Benign prostatic hyperplasia. 良性: positive, good, benign (tumor). 攝護腺: prostate gland. 肥大: swelling, hypertrophy.
6. 標記 (biāo jì)- Marker.
7. 排除(pái chú)- To rule out.
8. 直腸指診 (zhí cháng zhǐ zhěn)or 肛診 (gāng zhěn- Digital rectal exam. 直腸: rectum. 指: finger. 診: exam. 肛: anus.
9. 切片檢查(qiē piàn jiǎn chá)- biopsy. 切片: slice. 檢查: examination.
10. 效果(xiào guǒ)-Results, effect.
11. 超音波 (chāo yīn bō)-Ultrasound. 超: ultra, super. 音: sound. 波: waves.
12. 確診 (què zhěn)- To make a definite diagnosis.

*Original article “PSA ≦ 6.5” from 聯合報D2。Date: 中華民國一〇〇年十一月十六日。