All This to Say
I am supposed to be writing a book. But the final weeks of summer catch me tripping in my clogs on my way to the hospital, barely awake, watching the first pink streak of daylight cut across the inky sky. I keep track of time by the Chinese folk playing cards at the picnic table in the playground across from my apartment. Only a few nights did I come home after they were gone, and only then did I feel that there were no more hours left in the day.
On my day off, I read an essay by Judith Thurman called “Maltese for Beginners.” It’s about hyperpolyglots—those who speak a multitude of languages. “The accepted threshold is eleven,” Thurman writes. She speaks three. I do, too. We are, as Thurman explains, “nothing to boast of in most parts of the world, where multilingualism is the norm. People who live at a crossroads of cultures… acquire languages without considering it a noteworthy achievement.”
I didn’t grow up at a crossroads of cultures. A crossroads, by definition, is an intersection, an exchange. When I moved from China to the Midwest at the age of four, the experience was more like merging onto a highway—abrupt, hurtling, and at times unyielding. There were many accidents. But most of all, there was no turning around. In those first few years, I didn’t meet anyone who spoke another language, who had left her home in another country. Yet the fact that I did and had was hardly fascinating. The traffic I navigated was not the intersection of communities but the intersection of my own household and the world as I had come to know it. No one learned my language or ate my food, and eventually I learned to stop sharing.
The following week, I read In Altre Parole (In Other Words) by Jhumpa Lahiri. A celebrated American author, Lahiri fell in love with Italian as an adult and moved to Rome with her family. This was her first book written entirely in Italian (translated by Ann Goldstein). I had studied Lahiri’s fiction in college, but this collection of reflections spoke to an emptiness—a certain bewilderment I had always sensed in my own life as a writer—that we try, time and again, to fill with words, in languages not fully our own.
“In a sense I’m used to a kind of linguistic exile. My mother tongue, Bengali, is foreign in America. When you live in a country where your own language is considered foreign you can feel a continuous sense of estrangement… In my case there is another distance, another schism. I don’t know Bengali perfectly. I don’t know how to read it, or even write it… As a result I consider my mother tongue, paradoxically, a foreign language, too.”
I attempt to translate Lahiri, translated. A consecuencia considero mi idioma materno, paradójicamente, un idioma extranjero. Imperfect, but I was pleased by the way it sounded. My third language, Spanish, became for me the final stroke of a triangle Lahiri drew between English, her mother tongue, and her love affair. I discovered Spanish in high school, abandoned it in college, and became reacquainted with it in medical school in the hopes that it would make me a more useful doctor—hardly a bestselling romance. Lahiri, by contrast, was motivated not by pragmatism but by the sublime. The process itself was joy. The undertaking, she admits, was pure fancy—an established writer abruptly altering course to write, haltingly, in a new language, in search of a new voice. It struck me as the sort of thing I would never do. Upon finishing the book, I realized that my admiration for Lahiri was blighted by a deeper, more personal sadness. In Spanish, I knew twenty words for pain, when all I craved was poetry.
For my next project, I decide to translate an operative report. I worry the idea is kitsch or that someone, somewhere, has done it before and better. Then I remember that I am not a fiction writer. I lack imagination. I hate treading the line between real and unreal, a discomfort that speaks perhaps to an uncertainty within me, a tenuous hold on my own reality, a fear that dabbling in fiction will somehow taint my nonfiction. I feel, at times, that I am more of an interpreter than a creator, unable to imagine a world outside my own or a voice that isn’t mine. But I try anyway.
The lower uterine segment was incised in a transverse fashion with the scalpel.
The first time she cut into a uterus, she thought of menstrual cramps. It seemed like the ultimate revenge, trading pain for pain. They were both just doing their job. She squeezed her fingers around the scalpel but that only made the trembling worse.
The infant’s head was brought to the incision. The infant was delivered atraumatically in the usual fashion onto the sterile field. The cord was clamped and cut.
It must be bizarre to be born this way. One second, you’re warm and snug, and the next—bright lights and paparazzi. It’s no wonder you wait to take your first breath, to live in denial a little while longer, to defer acknowledgement of this brave, new world.
The skin was closed with running 4-0 Monocryl in a subcuticular fashion.
The needle entered and exited just beneath the surface as if in a rhythm of its own. She imagined, out of an almost pathological concern, that it was her own skin she was sewing. She wondered if every wound ever made could, with the right effort, be re-approximated. There was the smallest dimple in one corner of the incision, but it would heal just fine. As if the body could somehow forget.
I think the real crossroads lies within—the chives and basil growing side by side on the windowsill, chocolate milk and tofu sharing a shelf in the fridge. Not two, but three languages were spoken in our household: Mandarin, English, and medicine. My parents could discuss a paper on checkpoint inhibitors at a regional oncology conference yet find themselves bewildered at a car rental. Only after starting medical school could I join in their conversations. Each one made me wonder how many others, growing up, I had missed. In the last few years, medicine has become, if not our mother tongue, at least our common one. Sometimes it feels like the only language we share.
We learn medicine the way we learn a language, from the encyclopedia of terms describing parts of the body we never knew to the culture I still struggle to parse. Those who work in medicine “talk shop” to each other. Talking to patients, on the other hand, is an act of translation. Everything else is science but this, to me, is art. We shed the complex, unpronounceable diagnoses like “thrombophlebitis” and say, simply, what we mean. Some things are irreducible, but we try anyway.
I believe that medicine, like a foreign language, can never be mastered. I am lucky to acquire, at best, a working knowledge. We find our niche, get a grasp of a few tenses, a couple thousand words, and slowly, over a lifetime, nibble at the rest. This was no more apparent to me than during the month I spent as an intern on the general medicine teaching unit. I was barely a few months into my training as an obstetrician-gynecologist, yet I was startled by how much my knowledge of other specialties had fallen by the wayside. Things I once knew suddenly became dubious. I was out of practice. The labor and delivery unit was only a short walk away, but it felt like I had crossed into another realm.
My patients were sick in dizzying, endless ways. Simply summarizing all that occurred over a few days in the hospital, let alone a lifetime of illness, defied syntax. I picked up an idiom from a resident physician on my team. “All this to say,” he would begin, before illuminating the heart of the matter where I had previously missed the forest for the trees. I wondered how one so elegantly encapsulated matters of life and death. All this to say—what? For a profession obsessed with taxonomy and diagnosis, naming the unnameable seemed to me the most fragile part.
One evening finds me talking with a patient in Spanish. He was in his seventies and admitted to the hospital for management of hyperkalemia, secondary to an acute on chronic kidney injury, which itself was likely secondary to hypovolemia, although we didn’t know for sure. The language was simple. You have too much potassium in your body because your kidneys aren’t working. “Why aren’t they working?” We’re not sure yet. In talking with him, I sensed, for the first time, a clarity beneath the uncertainty. I couldn’t shield myself with language—neither English nor medicine would suffice. Vamos a ver.
Translation served me more than it served my patient—it brought me closer, not only to him but to myself. In the mix of adjectives, comparatives, conjugations, and conditionals, I catch, in between breaths, something familiar. It sounds a bit like poetry.