Communication is a fascinating thing. It enables descriptions of the world in different sounds, different gestures, different expressions. A shrug of indifference in one culture is a greeting in another. A nod can convey a myriad of intentions -context is everything. Only the smile seems a common currency. As a gynaecologist, I am ruled by boundaries, beyond which I dare not venture without, at the very least, the permission of a smile. It is a sign hung upon the face that needs no words -the Rosetta Stone that unlocks the mysteries of culture and walks the unfamiliar language like a bridge.
My office is a tiny United Nations, with a rainbow range of clothes on display, and skins to match. The waiting room is impossible to ignore, but equally difficult to understand. Words are encrypted by language, and intent masked by the panoply of expressions encoded in millennia of habitual use. It is a place of pleasant noise. Expectant. Pregnant, if I may say, with expectations both imminent and anticipated. Now is just a passing fancy; it is the future they await: a baby, a diagnosis, or just the reassurance that they are in not imminent need of help. It is a place of smiles, both nervous and shy -signals that they understand their different reasons for sitting side by side.
But it is sometimes a more confusing world once they have entered my consulting room. Words matter there. Meanings are crucial, explanations need context, symptoms require a modicum of description. Except for the more flagrant and visible aberrations of bodily integrity, diagnoses require detail. Language. And patients who are adept at simple conversations in English often struggle with words they would not encounter in the home. What is hidden from sight, is usually hidden from discussion: there is seldom a need to talk about an ovary nor, for that matter, a vagina -even in their own language. It is more often passed over with a blush, or an anxious smile.
I tell the referring doctors to ask their patients to bring a translator with them if they think it may be a problem, but too often it is a family member with similar language skills who accompanies them -a daughter who is too embarrassed to say the words, or a husband in front of whom she is ashamed to admit the problem. Everyone smiles, but often with incomprehension or discomfort. I love the challenge.
Sometimes the challenge is of a different sort, however; sometimes it is me who is embarrassed.
There were just two of them in the waiting room -sisters, likely, and not too far apart in age. As I walked into the room to greet them, they were huddled together whispering loudly about something and didn’t notice me until I was standing right beside them.
“Wei?” I said in a rather tentative voice, reading the name off the referral letter that was written on a piece of paper, but not certain I had pronounced it correctly.
I was immediately greeted by a smile -two smiles- and they both stood up. Neither made eye contact, but they followed me down the corridor to my office -normally a good sign. I felt confident that one of them was Wei.
“Wei, you sit in this chair by the desk,” I said, addressing the space between them, and hoping for clarification in the assigned seat. But instead, they seemed confused and I could almost feel the mental flipping of coins as to who sat where. I addressed the Wei seat first. “Wei?” I said, to cement the relationship.
They both smiled -nervously, I thought. The Wei seat answered for them both. “Wai,” she said -by way of correction I assumed. Even though I’d taken conversational Cantonese many years before, I never mastered even the rudiments of the many variations of pronunciation, let alone meanings of words that seemed otherwise identical. But I was happy at the confirmation of identity and smiled my acknowledgement.
“So why are you here today, Wai?” I said, careful of my pronunciation. And careful to differentiate her from her sister. Apart from the name, the referral letter was illegible.
They exchanged glances, apparently trying to decide who should answer. Obviously one of them was better at English, and they wanted to make sure I understood. It was Wai in the assigned patient chair who answered. She seemed pleased that she was able to speak, but she, too, seemed to need to clarify the situation before proceeding any further. “She my sister,” she said pointing at the other chair.
I smiled and nodded at the information. “How do you do?” I said to each of them. Clearly there was a series of preliminary introductions and small talk that were deemed necessary. Polite. I decided not to rush things, but after conferring briefly with her sister, she got right to the point.
“Me?” she said, pointing to herself. I nodded in assent. She smiled broadly and looked at her sister. Proudly, I thought. I could see her struggling to find the correct words. “Baby,” she said, and her smile almost split her face in two. “First baby!”
I could tell this was going to be a difficult. Her sister stayed quiet, merely nodding whenever Wai said anything. “Do you speak English?” I said, politely turning to the sister. Hope springs eternal. But she shook her head smiled. “Only little,” she added after a moment and an inquisitive glance at Wai.
It was Wai’s turn. “I the good English,” she said confidently and not without an ill-disguised condescending glance at her sister.
I wasn’t really sure how to proceed. Taking an adequate history was impossible -even finding out if there were problems with the pregnancy so far seemed remote. But Wai appeared so enthusiastic and happy, I thought I’d try for a few basics. “So, when is the baby due?” I immediately regretted the word ‘due’ because her face fell. I decided to try a more basic form: “When baby come?” I felt embarrassed to say it like that -it too, seemed condescending- but Wai understood and smiled again.
“Seven,” she said, holding up seven fingers.
Encouraged, I considered pressing on with more detail. I thought I’d try for the date of her last period -that would help me plan what to do next in terms of ultrasounds, blood tests, and so forth. “When did your last period start?” I said as slowly as I could without sounding silly. But I quickly realized I’d framed it poorly. “When last bleeding?” I tried, blushing at the clumsy attempt.
Again the smile. “June one,” she said, this time holding up one finger confidently.
Great, I was getting somewhere at last. But when I then tried to ask her if she’d had an ultrasound yet, it became immediately apparent that I had reached the bottom of the well. I shrugged and put on my best smile. “I’m going to need more information…” I sighed to show I knew how difficult it must be for her. “You’re going to need to bring an interpreter next time, Wai…” She looked disappointed, so I think she understood. She turned unexpectedly to her sister and quickly said something to her that sounded like she was confused. They both looked at me for a moment, and then huddled together in quiet conversation, occasionally risking a puzzled stare and then submerged themselves in words again.
“So, you not talk to Wei?” she said, pronouncing the name as I had in the waiting room and pointing to her sister.
“Are you not Wai?” I said, confused at the pronunciations, then glancing at my watch.
She nodded vigorously and smiled. “I Wai; my sister Wei,” she said, touching her sister gently on the arm. Then they both began to laugh. “You make mistake..?” said Wai -I think it was Wai; I was becoming quite confused. But I have to admit I blushed all the same.
I managed to chuckle along with them; they seemed quite amused by the whole encounter.
“Not problem,” said Wai, glancing at her watch. “We come back.”
And so began another day at the regional section of my own United Nations Gynaecology division… Do you see why I love what I do?