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Amanda Patterson

TMC Spanish Interpreter Internship Report


12.16.2014
Tucson Medical Center (TMC) Internship with International Services
I.

Introduction
During my internship with International Services at the Tucson Medical Center from
September 2014 through November 2014, I observed the interpreting services of Liz,
Karla and Iram. The interpreters at TMC demonstrate high competency and
professionalism, and from them I learned the dynamic ways in which medical
interpreters interact with the medical personnel and patients, as well as much new
medical terminology. The following summarizes my experience with the interpreters
including the types of medical encounters, commentary on register the interpreters
used and their positioning, and the type of terminology I learned. The types of
medical encounters for which I observed interpreting are ordered by frequency.

II.

Mother-Baby Madre-beb
a. Medical Scenarios: In the Mother-baby unit, I observed Karla and Liz provide
interpreting services for 17 mothers with newborns. The language services in the
Mother-baby unit usually consisted of the interpreter providing language
assistance for a nurse and her patient while the nurse checked on the patients
recovery and the babys health after birth.
The interpreters usually matched the register of the nurses or lactation specialists
because the register used was accessible for the patient. If the patient seemed to
not understand, the interpreters sometimes added useful information and then
always informed the nurse of the information they had added for the patients
benefit. I noticed that the interpreters sometimes stood by the side of the
healthcare provider and at other times used the interpreting triangle (by placing
themselves in between the patient and the healthcare professional). The
interpreters at TMC provide assistance that goes beyond providing language
access (i.e., helping a patient out of bed and into a walker), so their positioning
changes depending on the situation.

One especially interesting encounter I observed four times in Mother-Baby unit


involved a lactation specialist educating her patient on breastfeeding. This
entailed an examination of the breasts and assistance to the mother while she fed a
baby experiencing difficulty latching onto the nipple. It required the interpreters
to be very dynamic in their positioning, as the lactation specialist quickly changed
from one side to the other of the hospital bed and worked very intimately with the
patient as she tried to maneuver the baby into the best position. The interpreters
were very efficient in their interpretation of terminology that the lactation
specialist was using at a fast pace and in changing their physical position as to not
obstruct the specialist.
i. Terminology Terminologa
1. Audiology test=Prueba de la audicin
2. Belly binder=Faja
3. Breast=Seno; Pecho
4. Breast feed=Dar pecho; Amamantar
5. Breastfeeding/Nursing=Lactancia materna
6. Breast milk=Leche materna
7. So that your milk flows=Para que baje la leche
8. Colostrum=Calostro
9. Does it feel pinchy?=Siente que se le est pellizcando?
10. Encourage him to wake up=Echarle la manita para que se despierte
11. Fist=puos
12. Football hold=Agarra de ftbol americano
13. Fussiness=Inquietud
14. Got the runs=Le dio diarrea
15. Heading of the discharge instructions=Encabezado de las
instrucciones de alta
16. Lactation specialist=Especialista en lactancia
17. Plugged ducts=Ductos tapados
18. Postpartum despression=La depresin posparto
19. Skin-to-skin=Piel con piel
20. Sleepy=Adormilado
21. Spirometer=Espirmetro
22. Stiff=Tieso; Rgido
23. The baby is latching on well= Se est prendiendo bien
24. Whatever you need for the pain=Conforme a lo que necesite para
el dolor
25. You dont need to wrap your baby with many layers=No necesita
sobre arroparlo.
26. You will lose milk=Van a empezar a secar (sus senos)

III.

Main OR (Operating Room) Sala de operaciones; El quirfano


a. Medical Scenarios: In the OR, I observed interpreting services for patients about
to enter surgery and for their family. These usually involved a nurse taking a brief
medical history that included what medications the patient had recently taken, any
past issues he had experienced with anesthesia, any allergies to medication and
any metal the patient had implanted in his body. The medical encounters also
almost always involved the signing of consent papers. Sometimes, they involved a
doctor explaining to the patient what procedure he would be performing.
The interpreters had to often lower the register in these settings so that the patients
could better understand and ask questions. The interpreters always asked the
patients if they understood or if they had any questions. One piece of advice that
Liz offered and that reflects something Professor Fats taught us in class is to not
enter the patients room without a medical professional present. Liz explained she
does this to avoid medical questions that the patient may try to ask without the
doctor present. I found this advice very useful, as it can help interpreters to
control to what extent they leave their role a language facilitator. The positioning
during these encounters usually consisted of a triangle or of the interpreter next to
the provider.
One especially interesting encounter I observed involved a nurse taking a
patients recent medical history before his surgery. The operation had to be
canceled because the patient was not aware that he could not take his Metformin
before being put under anesthesia, as this could cause kidney failure. He said that
these instructions (it was not evident whether they were given by phone or email)
were not clear. Although I cannot speculate as to who gave him the instructions
and if they were bilingual, this is indicative of the disadvantage non-English
speaking patients have in the U.S. healthcare system in terms of communication
and shows how important medical interpreters are to the quality of their care.
Thanks to the TMC interpreting services, the hospital avoided putting someones
life in grave danger.

i. Terminology
1. Albuderol=Albuterol
2. Aneurism: Aneurisma
3. Blood clot=Cogulo de sangre
4. Blood transfusion=Transfusin de sangre
5. Bruise=Moretn
6. Cataracts=Cataratas
7. Consent=Consentimiento
8. Defilibrator=Defilibrador
9. Discharge=Dar de alta
10. Do you have any metal in your body?=Tiene algn tipo de metal
implantado?
11. Do you have?=Padece de?
12. DVT (Deep vein thrombosis)=Trombosis venosa profunda
13. Everything is going well=Todo marcha bien
14. Fatty liver=Hgado grasoso
15. Hearing aids=Aparatos de audicin
16. Implanted metal=Metal implantado
17. It comes and goes=Va y viene; Me pega aqu y se me quita
18. Its going to sting=Le va a picar
19. In case of an emergency=En dado caso haya una emergencia
20. IV=Lnea intravenosa; el suero
21. Layer of cholesterol in the carotid artery= Laminita de colesterol
en la cartida
22. Lidocaine=Lidocana
23. Life threatening=Poner en riesgo a su vida
24. Lining=forro
25. Metformin=La Metformina
26. Out-patient= Paciente externo
27. Packed cells=Concentrado celular
28. PCP (Primary Care Physician)=Mdico de cabecera
29. Power of attorney=Alguien quien puede tomar decisiones mdicas
para usted
30. Rash=Salpullido
31. Recreational drugs=Drogas callejeras
32. Red BCs=Glbulos rojos
33. Soft foods=Comida blandas
34. Sorbas=Sips
35. Tachycardy=Taquicardia
36. That you know of=Que usted sepa
37. Thyroid=Tiroides; La mariposa
38. Ulcers=lceras
39. Walker=Andador
40. Wire=Alambre

IV.

Pediatrics Pediatra
a. Medical Scenarios: In the Pediatrics unit, I observed interpreting services mainly
for non-English speaking parents of children needing care. These included:
consultations with nurses, anesthesiologists and the childs parents before an MRI
was to be conducted (such cases included children suffering from epilepsy);
discharge instructions for children post surgery (tonsil removal, appendicitis,
circumcision); pre-operation consultations with the parents and the doctors
(surgery to correct clubbed feet); and a catheter placement for a bladder exam.
The interpreters lowered the register when necessary during these encounters
when it was apparent the parents did not understand a term. During these medical
encounters, the interpreters often went beyond their role of providing language
access by calming distressed parents. This is indicative of how much the TMC
interpreters learn about the roles of the nurses and doctors they serve and their
typical routines with patients. When adding information (such as reassuring the
patient that their doctors are very experienced and that their child is in good
hands), the interpreters always informed the healthcare professional of what they
had told the patient. This shows how the interpreters at TMC advocate for their
patients and encourage communication between the healthcare professionals and
their patients by making sure that an LEP (limited English proficiency) worried
parent is reassured just as much as would be a worried parent with no language
barrier. They also promote the relationship between the doctors and their patients
by assisting doctors who want to use their intermediate Spanish with the children.
The interpreters adapted their roles in situations like these by telling the doctor
how to name certain body parts or complete specific questions they wanted to ask
of their patients directly, in Spanish.
One especially interesting encounter I observed involved a child having a bladder
exam performed with a nurse practitioner, and RN, a child life specialist, and the
patients mom surrounding the patient during the procedure. This required the
interpreter to be creative in her positioning so that she could not only hear what
each person was saying, but also adequately interpret for the rest of the
individuals. In this case, the mother spoke a little bit of English and this slightly

eased the stress of the situation. Through this observation, I learned that medical
interpreters must be prepared to change their positioning as the medical
professionals move about the room and be prepared for hearing difficulties due to
chaos of the situation.
i. Terminology
1. Breathe=Agarra aire
2. Cast=Yeso
3. Catheter=Sonda; Catter
4. Clubbed feet=Pi de zamba
5. Follow-up appointment=Cita de seguimiento
6. Have they given him anesthesia recently?=Le han puesto
anastesia anteriormente?
7. Heading of the discharge instructions=Encabezado de las
instrucciones de alta
8. Heart murmur: Soplos
9. In order to rule it out=Para descartarlo
10. Lengthening of Aquiles tendon=Hacer ms grande el Aquiles
tendn
11. Local anesthesia=Anestesia local
12. On just one side=De un solo lado
13. Prepuce=Prepucio
14. Quick assessment=Evaluacin rpida
15. Rashes=Ronchas
16. Rhinovirus=Rinovirus
17. Seizure=Ataque epilptico
18. Steri strips=Cintas adhesivas estriles
19. Threw himself back=Se tir para atrs
20. Tonsils=Amgdalas
21. Up-to-date with vaccines=Est al da con sus vacunas
V.

Radiology Radiologa
a. Medical scenarios: In the radiology unit, I observed a two kidney biopsies. These
involved the doctor extracting kidney tissue from the patient while the patient laid
face down. The communication consisted of instructions from the radiology tech,
the nurse and the doctor, as well as questions or complaints from the patient.
The interpreters lowered the register when it seemed that the patient didnt
understand and offered extra explanation (i.e., when the patient did not understand
how to position herself for the procedure, the interpreter gave additional
instruction and even demonstrated physically what the doctor needed her to do).

One interesting linguistic observation I made was that the interpreters must have a
wide knowledge of expressions such as piece of cake, or cool beans. While
Iram was able to interpret piece of cake, as pan comido, he found more
difficulty interpreting other expressions used by the radiology tech, such as cool
beans. The positioning during these operations consisted of the interpreter near
the patients head.
Something that I found particularly interesting about these two procedures (both
with the same doctor) is that doctor said some things during one of the procedures
that the patient might have found offensive and then told the interpreter: Dont
interpret that. I think Liz handled the situation well by informing him that she
MUST interpret everything he says. This reflects the importance of hospital-wide
education of the role of the interpreter.
i. Terminology
1. Back of the bed=El respaldo
2. Benign=Benigno
3. Bleeding problem=Problemas de sangrado
4. Bleeding=Sangrado
5. Blood clotting numbers=Nmero de coagulacin de sangre
6. Blow the bubble=Splale la burbuja
7. Break the skin=Perforar la piel
8. Cushion=colchoncito
9. Germicidal soap=Jabn germicida; Jabn que mata grmenes
10. Glomerulonephritis=Glomerulonefritis
11. Has she been diagnosed with asthma?=Ha sido diagnosticada con
el asma?
12. Head injury=Lesin en la cabeza
13. Head of the bed=La cabecera de la cama
14. How are you?=Cmo se encuentra?
15. IV=Lnea intravenosa; Suero
16. Less than one year=Menor de un ao
17. Loose teeth=Dientes flojos; Dientes sueltos
18. Needle=Aguja
19. Pass the catheter=Meter el catter
20. Piece of cake=pan comido
21. Pole (holding the IV line)=El tubo
22. Relaxers=Relajantes
23. Scheduled the room=Agend el cuarto
24. Sedative=Sedante
25. Sterile techniques=Tcnicas esterilizadas
26. Sting=Piquete

27. Thickness=El grosor


28. The nurse taking care of you today=El enfermero que va a estar
pendiente de usted hoy
29. They are going to schedule it=Lo van a programar
30. Thickness=Grosor
31. To make this area numb=Para adormecer esta rea; Para entumecer
esta rea
32. To scan=Escanear
33. Well let you know, step-by-step=Le vamos a dejar saber, paso por
paso.
34. With your head back=Acostada
VI.

Neurology Neurologa
a. Medical Scenarios: In the neurology unit, I observed two encounters that
involved physical therapists and their patients and one that involved a medical
student performing a neurological exam on a stroke victim. All of these involved
Karla as the interpreter.
Karla lowered the register during these encounters so that the patients (all elderly
patients with some kind of cognitive complication) could clearly understand the
physical therapists instructions and the doctors questions. Karla impressively
and very quickly adapted her register to a level appropriate for the stroke victim.
Specifically, she used the terms el dedo gordo, instead of el pulgar, and el
segundo dedo, instead of el dedo ndice, as she knew the patient may not
understand the higher register terms. It proved very effective for the patient and
helped the neurological exam run more smoothly. Karlas positioning was very
dynamic in the neurological unit. When she was with the physical therapist, she
went above her role as a language facilitator by helping the physical therapist
support the patients as they walked, and when they got into and out of their
walkers. Additionally, she knew the therapists routine so well, that she was able
to give many instructions to the patient without the therapist giving them and also
knew what types of questions to ask the patient (i.e., Se siente mareado?,
Necesita descansar?, Despacito, despacito). This shows how at TMC, the
interpreters and healthcare professionals work together to provide the best care to
Spanish-speaking patients. In this way, the interpreters are advocates for the
patients and can make up for some of the lost communication between healthcare

providers and their patients when the healthcare provider feels awkward using
English with an LEP patient and may hesitate to speak as much as he would with
a non-LEP patient.
Karlas performance during the neurological exam was especially interesting and
impressive. Given the nature of the exam (a series of questions that test the
patients motor and cognitive skills) she had to resist from using her hands when
speaking and state exactly what the patient said, even when it did not make sense.
For example, when the doctor asked the patient to bring his right hand to his left
ear, Karla had to resist from showing any motion with her hands as to not
inadvertently assist the patient in the task. In addition, Karla took great care when
asking the patient to repeat a series of words the doctor had stated minutes earlier.
As the doctor needed to test his memory, it was extremely important that Karla
repeat exactly what the patient had said, even when it was convoluted and could
have created cognitive dissonance for the interpreter. The exam was clearly more
difficult to give with through an interpreter, but Karla interpreted flawlessly and
compensated for the language barrier. This case shows how extremely important
it is to have live interpreters and for physicians to know how to work with
interpreters.
i. Terminology
1. Follow-up appointment=Cita de seguimiento
2. Go onto your back=Recostar
3. Got the runs=Le dio diarrea
4. Head of the bed=Cabecera de la cama
5. His stomach can get upset=Puede ser que se le revuelva el
estmago
6. Physcial therapist/physiotherapist=Fisioterapeuta
7. Power of attorney=Alguien quien puede tomar decisiones mdicas
para usted
8. Side of the bed=Orilla de la cama
9. Sleepy=Adormilado
10. Stiff=Rgido;Tieso
11. Whatever you need for the pain=Conforme a lo que necesite para
el dolor

VII. Emergency Room La Sala de Urgencias


a. Medical Scenarios: I observed interpretation services for one patient physical in
the Emergency room and two other patients receiving intake and discharge
instructions.
The doctors and nurses in the Emergency room were good at keeping the register
low so that patients easily understood their questions. Therefore, the interpreter
matched their low register. In the Emergency room, there is less room for the
interpreter to be by the bedside, so the interpreter stood at the foot of the bed
while the doctor was at the bedside performing the exam.
The most interesting encounter in the Emergency room was the physical exam of
a patient experiencing back pain and stomach pain. This encounter revealed an
important public health issue. The patient was surprised when the doctor told her
that the Emergency department could not fix all of her health problems and that
she needed to follow up with her regular doctor. The patient said she did not have
a primary physician in Mexico and the doctor educated her on the importance of
regular visits with the same physician. This shows the importance of live
interpreters because the patient benefited greatly from the smooth flow of
information as the doctor gave her important advice.
i. Terminology
1. Back pain=Dolor de espalda
2. Does it burn when you pee?=Le arde cuando orina?
3. Loose stool=Excremento aguado
4. On a scale of 1 to 10, how bad is the pain?=En una escala de 1 a
10, cun intenso es el dolor?
5. Primary care physician=Mdico de cabecera
6. Relaxers=Relajantes
7. Stabbing pain=Dolor punzante
VIII. Cardiology Cardiologa
a. Medical scenarios: I observed the interpreting services for two patients receiving
different types of exams related to their hearts. One patient received a stress test
and one received a tilt table test (this is used to evaluate the cause of unexplained
fainting).

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During the stress test, the interpreter used high register terms such as fibrilacin
auricular, but also made sure the patient understood by asking if she had any
questions. Her positioning during this test was interesting because the patient was
on a treadmill facing the wall. Therefore, the interpreter placed herself to the side
of the treadmill, next to the nurse and the doctor. The interpreter went beyond her
role as a language access provider by helping the patient change into the attire
necessary for the test while the nurse was busy preparing to give the exam. This
shows how TMC interpreters are very compassionate and ready to help in anyway
to put the patient at ease and make the meeting more efficient.
During the tilt table test, the interpreter lowered the register for the elderly patient.
The tilt table test was an interesting interpretation to observe. As this test involves
the patient strapped to a bed that is then tilted until the patient stands vertical
while the nurse monitors his blood pressure, Liz had to position herself right in
front of the patient and next to the nurse so that the patient would clearly hear
important questions.
i. Terminology Terminologa
1. Atrial fibrillation=Fibrilacin auricular
2. Blood pressure=La presin arterial
3. Dizzy=Mareado
4. EKG (electrocardiogram)=Electrocardiograma
5. Short of breath=Le falta la respiracin
6. Stress exam=Prueba de estrs
7. Syncope=Sncope; Desmayos
8. Tilt-table test=Prueba de mesa reclinable
IX.

Labor and Delivery Trabajo del parto y nacimiento


a. Medical scenario: In Labor and Delivery, I observed the interpreting services
during a natural vaginal delivery. This medical encounter involved two nurses, a
midwife, and two surgical techs.
During the delivery, Liz used the same low register that the nurses used and
helped explain concepts and make sure that the patient understood everything
being explained to her. Liz positioned herself at the head of the bed while the
nurses were usually on the other side or at one end of the bed.

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Lizs role during the birth further showed how TMC interpreters go beyond their
role as language access providers to be a cultural broker when necessary and to
also put their patients at ease. The patient was very surprised that in the U.S.,
nurses perform all births and a doctor only comes in case of an emergency. Liz
was able to relate to the patients surprise, as she is familiar with the birthing
protocols in Mexico. Furthermore, Liz offered emotional support to the patient
and her husband, as well as assisted the nurses (such as feeding the patient ice). I
think this situation showed how the interpreters at TMC always do their best to
make the patients feel very comfortable and by doing this, they encourage more
communication between the patient and the healthcare providers.
i. Terminology Terminologa
1. Birth canal=Canal del parto
2. Birth=Nacimiento; Parto; Alumbramiento
3. Breathe deeply=Respire profundo; Agarre aire
4. Breech birth=Presentacin de nalgas; La presentacin trasera
5. Contraction=Contracciones
6. Epidural=Anestesia epidural
7. Golden hour (the hour of privacy after birth that the baby spends
with mom in which skin-to-skin contact is used)=La hora de oro
(la hora despus del parto durante la cual se le da privacidad a la
madre para pasar tiempo con su beb mientras usa contacto pielcon-piel)
8. Heartburn=Acidez estomacal
9. Midwife=Partera
10. Nursery=Sala de nios recin nacidos
11. Placenta=Placenta
12. Push (Bear down)=Empujar
13. Umbilical cord=Cordn umbilical
14. Vaginal delivery=Parto vaginal
X.

NICU (Neonatal Intensive Care Unit) Unidad de Cuidados Intensivos


Neonatales
a. Medical scenario: I visited the NICU unit once during my internship to observe
interpretation of a nurses instructions for the new mom. The nurse was informing
the patient that the baby was now ready to breastfeed and that they could help her
with this.

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The interpreters positioning during this encounter was in a triangle formation


with the interpreter in between the patient and the nurse. The interpreter
maintained the register used by the nurse because the nurse was already using
easy-to-understand terminology.

XI.

i. Terminology Terminologa
1. Breastfeed=Amamantar
2. Delicate=Delicado
3. Infant=Recin nacido
4. Premature=Prematuro
5. Weak=Dbil
Suggestions
Medical interpreters are life-long students by profession. It is obvious that the TMC
interpreters work hard to continue expanding their vocabulary and keep records of
new words they find useful for their everyday tasks. Due to their dynamic work days
that call for interpreting tasks in various units of the hospital, I suggest medical
interpreters make glossaries that pertain to each area of the hospital they visit. Having
glossaries on hand can allow the interpreter to review technical terminology daily so
that they can be ready for the diverse interpreting demands they face. There are some
units of the hospital that more frequently request interpreting services than others; a
daily 30-minute review of the type of vocabulary used in the less-visited units of the
hospital can help interpreters to keep those terms readily available in memory.

XII. Conclusion
I am very grateful to have had this experience shadowing interpreters at TMC. About
to finish the Translation and Interpretation program at the University of Arizona and
entering the Nursing program in the Spring, this experience provided me with very
useful knowledge of not only how interpreters carry out their jobs and all of the
medical terminology they must know, but also of how the hospital staff work together
to give the best care to both LEP and non-LEP patients. Medical interpreters are
unique in that their jobs in the hospital change daily because they provide services in
all units of the hospital. This allowed me to gain better insight of what all areas of the
hospital are like and which units have the highest concentrations of Spanish-speaking
patients.

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The TMC interpreters taught me that in a hospital setting, they must be prepared to
assume the role of patient advocate and assistant to the medical professionals due to
the delicate and sometimes high-stress environment in which they find themselves.
While this does not follow the common interpreting theory that the interpreter must
remain within his or her role of providing communication between the LEP patient
and the healthcare provider, the medical interpreter is in an environment where the
patients health and safety are of top priority. At TMC the interpreters do not hesitate
to guarantee this and therefore fulfill part of the mission at TMC to respect diversity,
practice kindness, reach out, and work hard for their patients and each other.

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