Speaking of death, in my own short-lived cancer-prone clan, I’ve buried enough of those I love to consider myself something of a hands-on expert on exit conversations. Thank God and knock on wood I’ve never been the one to have to break the bad news – end-of-life conversations of any kind are hard enough.

I recall with pride my grandfather’s farewell, and my shame that I wasn’t able to acknowledge it, and with sorrow my sister’s white-hot rage as she was denied the balance of her too-short life. These conversations haunt me. We all will meet our maker in different ways and, sadly, to participate in that process takes practice to do it well and courage to keep your heart in it.

This comes to mind from reading “A Dangerous Conversation,” a recent STAT article, on the need to train linguists on how to interpret end-of-life conversations.

Interpreters in Palliative Care

Dying patients provide a special challenge for interpreters since interactions among health care providers, dying patients and their families are nuanced, culturally specific and always emotionally charged. In these cases, real, two-way communication becomes even more important. Patients and their family members need to fully understand the extent of the patient’s diagnosis and then make informed palliative care decisions.

(A personal note here, or rather a curse: A pox on every lazy physician who has ever roped a bilingual relative into bearing this bad news!)

What do you need to know to tell a dying man who speaks no English that he is indeed dying, and explain how? It doesn’t matter if we’re talking about law, fashion or medicine. When expressing a set of ideas in a different language, subject expertise is paramount. You have to understand what someone is saying before you can begin to interpret it with accuracy – the way it was meant to be expressed. Doubly so with bad news – compassion demands it.

Training for Medical Interpreters

It is the job of medical interpreters to help patients communicate with their health care providers when patients and health care providers don’t share a common language. This often includes symptom descriptions, diagnoses and treatment options. But are medical interpreters prepared for the dying?

In the United States, according to the 2011 Census, more than 60 million people speak a language other than English at home. Of these, 13.5 million believe that they speak English “not well” or “not at all.” As a result, medical interpreting has become a very important part of helping limited English speaking patients receive adequate health care and make more informed health care decisions.

Some palliative care training courses for interpreters are available. They explain key concepts and terminology related to palliative care, as well as provide strategies for interpreters to deal with their own emotions as they help the dying navigate these conversations.

Ready or Not

An end-of-life discussion is one of the most important conversations one can have. While a patient may not yet be ready to have it, his or her medical interpreter should be.

The undiscovered Country, from whose bourn
No Traveller returns, Puzzles the will,
And makes us rather bear those ills we have,
Than fly to others that we know not of.
Thus Conscience does make Cowards of us all.
–William Shakespeare