bout de papier, Vol. 30, No. 1 (2017), pp. 30–32
Let me digress for a moment to describe Dave. At the time, he was 32 years old, slender, athletic (he played in the Taipei Ice Hockey League), and had passed a few months earlier a thorough health exam with a very clean bill of health. We spent our weekends in Taipei hiking, biking, playing ultimate Frisbee, and other outdoor pursuits, and were in pretty strong physical shape.
Now back to the hospital. Not a single person working in the emergency department that night spoke English. Not the triage nurses, and not the attending physician. Nor did my husband speak much Chinese — a few words (the essentials learned through pre-posting spousal language training support — like “my name is…”, “how much is…?”, “where’s the bathroom?” etc). Very useful skills, but not even close to being applicable in an emergency situation.
Fortunately, I had attended almost a full year of Mandarin language training before leaving for Taiwan at Bisson Campus, where the Center for Foreign Languages (CFSL) of the Canadian Foreign Service Institute (CFSI) delivers language training. I did not get the full two years that is the standard for a level 3 (advanced) Mandarin-designated language position, but managed to eke out at 2+ before my departure. Again, luckily for me, during my first year in Taiwan, the Department announced the “flexible fluency” program, allowing those like me that did not get the full amount of training and had not yet attained the required level, to apply for additional funds to study in-country. My manager approved an additional six weeks of full-time training a year into my posting, enabling me to obtain the level 3. Throughout my three-year posting, I was also able to benefit from CFSL-funded, twice-per-week maintenance, classes. While by no means perfect (not even close), I was confident in my language ability and often delivered remarks at universities and other public events in Mandarin. It made me a more effective officer, as I was able to engage with Taiwanese interlocutors, attend local-language events like conferences, watch the local news, and build relationships with people with whom it would have otherwise been very challenging to interact. The fact that language ability is essential to the work that many of us do abroad is something that, in my View, no one can reasonably dispute. Beyond this, I think we can all agree that local language ability also facilitates life abroad; allowing people like me to navigate new cities, order in restaurants, and easily locate the nearest washroom when nature calls. But what I had never realized, nor truly appreciated, was the extent to which my language training went beyond making me a more effective diplomat or helping me to order a delicious bowl of beef noodle soup, and was literally a survival skill, until I reflected back on that April 2012 night and the ensuing days at the hospital in Taiwan.
Allow me to elaborate. And remember that all of the exchanges described below took place entirely in Mandarin. The triage nurses asked what was wrong, and I explained the extreme pain that my husband was experiencing. They asked whether he had fallen, or had been injured in some way. I responded that he had not. They took his temperature, and his blood pressure, and then brought us in to see a doctor. The doctor reviewed his file (we had gone to that hospital before for medical check-ups), asked several questions, and gave my husband a shot of morphine. I was responding to questions such as his age, medical history, whether he had any allergies, any history of health issues in the family, and would then translate back to English for Dave so that he’d know what was happening. I repeatedly reiterated to the nurses and doctor the serious pain that Dave was experiencing — even after having received one, and then another, and then a third shot of morphine. Nothing helped. I overheard the doctor and nurses use the word heart attack amongst each other, and understood that they were performing an electrocardiogram (EKG) to check for abnormal heart activity. Dave asked me what was going on, and whether they thought he was having a heart attack. He had a look of fear in his eyes when he asked me that question that I will never forget as long as I live. I lied. I told him no, in part, because I didn’t want to terrify him and make a bad situation worse, but also because I was in denial. The whole thing didn’t make any sense, and was certainly not part of the life plan that involved wild adventure travel followed by raising a family upon our eventual return to Canada.
The EKG was not conclusive, but they brought in the on-call cardiologist to review his case. He was the only person we saw that night that spoke English. He looked at the EKG results, reviewed Dave’s file, and told Dave that if he was on drugs he’d better admit it right away (Dave was not). The cardiologist concluded that it was not a heart attack. He explained that Dave’s recent health exam revealed low cholesterol, he was young, fit, and simply did not have any of the risk factors. He said they’d run a blood test to confirm (apparently the body releases enzymes into the bloodstream during a heart attack), but that the results wouldn’t be available until the lab opened around 9am that morning. And then the cardiologist went home. It was about 2am.
Switching back to Mandarin again, and with Dave still in extreme pain, the emergency doctor decided to perform an MRI to see whether Dave was injured. After what seemed like an hour, and after they reviewed the results, the conclusion was that there was no injury. They had run out of ideas for what to do. It was about 4am. They gave him another shot of morphine (we were at five shots at that point), again to no effect, and transferred him to the ICU. When we got there I translated again, asking the nurses there for more morphine — Dave was still in extreme pain. They told me that he’d had the limit, and that there would be no more morphine. That was not an easy message to translate back to Dave. The ICU doctor explained that at this point they were suspecting myocardial infarction (read: heart attack), given that Dave’s pain was so extreme and could not be alleviated with morphine. He added that results would be available when the lab opened in a few hours, and told me to go home and get a few hours of sleep. It was the longest few hours of my life. Needless to say, sleep never came.
The results indeed indicated a significant heart attack, which we later discovered was a 96% blockage of Dave’s left anterior descending artery — the most important artery in the heart (often referred to as the widow maker, as a blockage of this artery can often be fatal). That artery, by the way, is only about 4mm wide. The width of a pencil lead. The cardiologist performed an angioplasty and angiogram around noon that day — about 12 hours after the pain had started the night before. He removed the blockage and inserted a stent to hold open the artery. Dave said his pain relief was immediate. The cardiologist explained that the heart attack was likely caused by a rupture in the plaque lining his artery (we all have some plaque in there, cholesterol levels aside) and the body — assuming there was some kind of lesion or cut — sent platelets to that location to block the rupture. The platelets effectively clogged the artery, causing the heart attack. This was an extremely rare occurrence for someone so young and so healthy. They showed me the tissue that they pulled out of his artery. It was minuscule enough to have hidden under a person’s fingernail.
They kept Dave in the ICU for four days — and only allowed visitors for one hour, twice per day. None of the ICU nurses spoke English, nor did the attending doctor. So when I came during visiting hours I was responsible for telling the nurses whether Dave needed anything, how he was feeling, etc., and for getting updates from the doctor on his condition. I would also smuggle in a cell phone so he could speak with his parents, and then (if time permitted) would get a few moments of one-on-one time with him to digest what was going on. Other than those few moments a day, he was completely at the mercy of the doctors and nurses, his only source of information being the pulse, blood pressure and other blinking numbers Toby, Dave and his Doctor.
on the screens surrounding his hospital bed in the ICU unit. He was in the ICU in a foreign country, having suffered a shocking heart attack, with almost no ability to communicate. Whatever shape I was in emotionally, it must have been infinitely more intense and terrifying for him. Thankfully, after four days he was transferred to a normal hospital room, and I was permitted to be there for several hours a day to support him and to communicate with hospital staff.
Language challenges aside, in the end our week-long hospital experience in Taiwan was extremely positive, and Dave’s treatment was first-rate. Yes, it took the doctors a long time to make the heart attack diagnosis, but I don’t resent this. Dave was not your typical heart attack victim, and every doctor he has seen since that incident has expressed disbelief when they hear this story. Dave is now healthier than he has ever been, although the heart invariably suffered some long-term damage (there goes my retirement plan of living off his NHL salary). Nevertheless, the story has a happy ending: In true Taiwan style in which a tall, blue-eyed, Western man is somewhat of a novelty, upon discharging Dave, the cardiologist sheepishly asked whether he could take some photos with him. He confessed that Dave was the “most handsome patient” he’d ever had. The hospital then asked him if he would do a taped interview for the hospital’s website to describe his experience —as they were apparently trying to attract more expat business. So I brought in Dave’s suit, they did his make-up, and
bout de papier Vol.
taped an interview. We laughed that while Taiwan’s tourism motto was “Taiwan — touch my heart”, for us it was now “Taiwan — fix my heart”!
So why am I sharing what is an extremely personal story with bout de papier? Because I do not know if there is a deep enough appreciation of how critical language training is to our lives abroad. Had I not been able to communicate with the nurses and doctors in the hospital that night, at best the most emotional, difficult experience of my life and that of my husband would have been unimaginably frustrating and painful; the challenge of that situation would have been intensely amplified. An inability to communicate could have meant that things might have been much worse — physically and emotionally. What I can say for certain is that my ability to communicate and translate in those circumstances was invariably the most important practical application of my language training that I could possibly conceive. For that reason above all else, I am profoundly grateful for the training I received, for the dedication of my Mandarin teachers, for my long hours of
Originally published in bout de papier, Vol. 30, No. 1 (2017), pp. 30–32. Read the rest of this issue →
