3 October 2018

How a disembodied voice can be a lifeline between medics and terrified patients

Sylvia could have been anywhere in the world, but she gave hope to Hanna, lost in Britain and ashamed to go back home.

The minor injuries unit nurse came and found me. “Can you see this one, please?” she said. “Abdo pain and vomiting, and she’s known to have gallstones.” She handed across a page of notes and gave me a rueful smile. “Oh, and she’s Polish – hardly speaks English at all.”

Hanna was 22 and had the characteristic features of Turner’s syndrome, a chromosomal abnormality associated with, among other things, mild learning difficulties. I took her round to my consulting room. She walked comfortably enough, which was a reassuring sign, but she looked anxious, frightened even.

It quickly became apparent how little English she knew. In order to make a proper assessment I would need to ask detailed, personal questions that were going to be beyond her. Fortunately, we have a contract with LanguageLine, which can connect you to an interpreter for just about any language at any time of the day or night. Within a minute I was put through to Sylvia, whom I briefed then put on speakerphone. As a stream of Polish broadcast into the room, Hanna’s shoulders, which had been hunched, fell, and she sat back more easily in the chair.

With Sylvia relaying questions and answers, I gradually gleaned all I needed to know. She came across as redoubtable: probably in her fifties, brisk and businesslike, and impervious to drama. You never know where the LanguageLine interpreter you’re speaking with is from – not even whether they’re in the UK or abroad. I imagined an archetypal Polish matriarch, working from some grand Warsaw apartment. In any case, she seemed immensely reassuring to Hanna.

It was interesting, the ways we related to our interpreter’s disembodied presence. I found myself directly addressing the phone as if Sylvia were somehow housed inside it. Hanna talked out into the room, her gaze directed at the far wall. It struck me she might be allowing herself to imagine it was her own mother who was there with her.

The speakerphone has excellent pick-up so Sylvia was able to talk Hanna through the examination I needed to perform, even though the couch was on the other side of the room. Fortunately there was nothing to indicate immediate surgery was required – which had been Hanna’s big fear – so we made a plan to treat with pain relief and anti-sickness medication, and only follow up if things didn’t settle.

In discussing her aftercare, I developed a picture of her circumstances. She wasn’t registered with a GP: she’d been in the country only a couple of months, and had recently been dismissed from her chambermaid position because her English hadn’t proven good enough. In losing the job she’d also lost her accommodation, so she was sleeping on casual acquaintances’ sofas while looking for other work. The idea of returning home filled her with shame; she would be letting her family down.

It is an odd experience, these days, conducting a consultation such as this. All the while I’m aware of the anti-immigration narratives being spun in our public sphere. No doubt some would depict Hanna’s situation in negative terms, just one more example of the “drain” on our public services that freedom of movement within the EU has brought. The costs of nurse and doctor time, to say nothing of LanguageLine’s fees, are not insignificant.

But these things are more complicated, and always have a human face. Hanna was a young woman left isolated when the low-paid job she’d travelled over a thousand miles to take up fell through, dashing her hopes for herself and her family back home. And in the midst of trying to salvage something from her predicament, illness threatened major surgery with no loved one anywhere near.

Sylvia’s services came at a price, of course, as did our hospital care. But they seem to me precisely what a civilised society should extend to those we’ve come to depend on to service the jobs few people here want to do.