The Courage to Speak a Foreign Language Poorly

MDB Reflection- Blake Gordon Zwerling

Zwerling, in front of the entrance to the military hospital in Riobamba, Ecuador.

Photos Courtesy of Blake Gordon Zwerling

Whenever I call a patient in the US in Spanish, I spend the moments immediately preceding picking up the phone worrying about language. Will I be able to understand them without the added aid of reading their lips? Will I forget a necessary vocabulary word? Sometimes life has a way of taking such fears and ironically multiplying them in the real world, as happened during my first week of the Mary Duke Biddle Scholarship in Riobamba, Ecuador.

At Cachamsi Medical Spanish Institute, I was lucky enough to accompany the OB/GYN I was shadowing – Dr. Perez* – to the operating room. Though my Spanish was relatively proficient before arriving in Ecuador, adjusting to a brand new city on a brand new continent in a foreign language at 9000 feet still felt like a significant challenge. Generally, in the consultorio (outpatient clinic) I benefited from Ecuadorian’s typical classical, precisely annunciated Spanish spoken especially slowly and clearly for my benefit. However, in the operating room, Dr. Perez chatted with his residents, scrub technicians, and circulating staff informally and rapidly with language peppered with idiomatic expressions. To make matters even worse, of course everyone was wearing surgical masks. Throughout most of the operation I managed to stay out of the staffs’ way in a corner and nod politely on the rare occasion someone spoke directly to me. But then, my worst nightmare happened: the phone rang.

As luck would have it, the circulator who generally handles tasks outside of the sterile field was out of the room searching for an additional piece of equipment when the rings started to fill the operating room. I let the bell chime three or four times, hoping against hope that she might return in the nick of time, but I was out of luck. Dr. Perez turned to me as the only person not scrubbed in the room to ask (in Spanish): ‘Would you mind answering the phone?’. I tried to comply with the same casual air his tone implied, but my palms were already beginning to sweat. Picking up the phone, a woman’s voice quickly started explaining a patient case and asking if Dr. Perez was available. I could only catch every third word or so and kept repeating: ‘Mande? (Excuse me?)’. Eventually I understood enough to describe the gist of the message to Dr. Perez, and thankfully he instructed me to relay that he was busy in the operating room rather than asking for more details I did not have. The three words ‘He is operating’ seemed to satisfy the woman on the other side of the line and she quickly hung up. Everyone seamlessly continued their tasks while I took a moment to recover from all the unseen excitement.

The author (center) with her Ecuadorian host family and fellow Cachamsi students.

Sometimes at political rallies in the US or in videos on the news I will see signs that read: ‘You’re in America! Speak English!’. Constantly surrounded by people that speak our native language, it is easy to forget the incredible courage required to speak a foreign language, especially when you speak it poorly. I have previously lived abroad in non-English-speaking countries, and even I forgot the discomfort of wondering whether I would be able to understand simple instructions at the post office or whether strangers would hear my accent and immediately decide I was not worth the effort of a conversation. Moreover, the cognitive load of constantly planning sentences and deciphering words from context is exhausting. I would analyze my own sentences ex post facto, too – did I use the subjunctive correctly in that sentence? Was I meant to use the preterite of the subjunctive in that formulation rather than the conditional? This immersion in an unfamiliar healthcare system in Spanish initially made me feel inadequate and hopeless until another physician greeted me in English.

During a case, the anesthesiologist Dr. Moreno came to stand next to me at the head of the bed. “How have you been?” he asked. At first, I could not understand the sentence. I did not expect to hear English, and so for a split second with his thick accent I assumed I had misunderstood another Spanish command. Additionally, I had never met this doctor before – why was he using a question formulation that implied a pre-existing relationship? Once I understood the sentence, I was overcome with an immense sense of gratitude. Dr. Moreno was going out of his way to make me feel comfortable. He also gave me the gift of renewed confidence: his English was imperfect, but I could still understand him just fine. I did not naturally question his intelligence based on grammar mistakes; in fact, I was impressed he could speak so well despite the occasional minor error. He gave me the courage to try. I knew I would make mistakes when speaking Spanish, but at the same time, I had renewed confidence that I could make myself understood anyway.

My time in Ecuador was humbling; it gave me renewed respect for my Hispanic patients here in the US.

My time in Ecuador was humbling; it gave me renewed respect for my Hispanic patients here in the US. I had expected to improve my Spanish and cultural sensitivity when treating Latinx patients while living in Riobamba, but I could not have predicted the unexpected gift of a new perspective on the immigrant experience through firsthand experience. I struggled during my transition to Ecuador despite the fact that I have been taking Spanish lessons since age thirteen and had virtually all of the logistics of my stay arranged by the wonderfully caring and competent staff of the Cachamsi Medical Spanish Institute. I can only imagine how vulnerable my Spanish-speaking patients must feel presenting alone to the hospital in a foreign country unfamiliar with our complex healthcare system and unsure if the providers will be able to understand them. I hope this program will help me provide the level of service such a courageous population deserves.

About the Author

Blake Zwerling is a fourth year medical student at Stanford School of Medicine who spent six weeks in Riobamba, Ecuador at the Cachamsi Medical Spanish Institute with the generous support of the Mary Duke Biddle Scholars Program. She has been interested in pursuing women’s health since middle school and prior to medical school studied at the London School of Hygiene and Tropical Medicine pursuing a Masters in Reproductive and Sexual Health Research as a Fulbright Scholar. This summer she will begin her OB/GYN residency at the University of California, Irvine. 

*All names changed to protect the individuals’ privacy.