Language Barrier: A flaw or a weapon for a young surgeon?
“I hated it here once”
said Dr. Anirudh Murali as he packed up the boxes in his quaint home in Calcutta, India to move to Nashik. He was happy that he could finally live with his once girlfriend and now wife after years of long distance. It was now the end of a monumental growth phase in his life he would feel forever grateful for.
One busy morning in May 2018, Dr. Anirudh started his journey as a resident of General Surgery at the Institute of Post Graduate Medical Education and Research & SSKM hospital in Calcutta, West Bengal. He walked past those busy corridors lined by below poverty line patients sprawled across the floors with their families waiting for available beds. You would think he feared walking into his first pre-rounds of fifty patients. Considering he had just traveled 2,000 kilometers away from Coimbatore, the place he had lived all his life up til then, not knowing an ounce of Bengali, having cortical access to only primary school’s worth of third language Hindi, and not to forget the fifty patients he had to interact within a couple of hours to learn from and help significantly on his first day. He did not feel an ounce of fear. He kept his head held high despite these gargantuan setbacks because he innocently thought he had seen it all in Surgery during medical school. He was an intern in the busiest surgical unit of his medical school, working under one of the most reputable Surgeons in Coimbatore, India. Having attended the same medical school as Dr. Anirudh, I can safely say that I have literally seen catfights and tears happening in the wards over trade-offs for positions in this surgical unit, as it was headed by one of the most inclusive and nurturing academic surgeons known to medical students. Dr. Anirudh went off on a passionate tangent describing the diverse platter of cases he had closely worked as a part of during those forty five days in medical school. “Ventral hernia repair, colectomy, small intestine resection, inguinal hernia, varicose veins, esophagectomy, gastrectomy, cholecystectomy, hemiglossectomy, neck dissections, thyroidectomies” among a few other ostomies and ectomies he recalled with fervor. With naivety, he believed this was as big as the buffet could sprawl for general surgery. However, he was in for a colossal slap from reality as soon as his memory of his family’s goodbye and good luck hugs faded away from behind his ‘first-day-of-school’ confident smile. He met with his clinical care team and within moments came across more enterocutaneous fistulas than he had ever read about. One woman with a burst abdomen with abdominal contents protruding out of the midline of her abdomen lay vulnerable right there in the middle of the ward. A few multiples of 24 hours later, Dr. Anirudh stood a wide sore-eyed man, his decrepit buckling knees about to give way as his six-foot skeletal structure weakly cackled through his post-operative rounds. Holding on to the railings of his patient’s cot for his dear life, he couldn’t help but use his last few functioning brain cells to fathom how physically demanding the next couple of years were going to be.
Dr. Anirudh had thrown several attempts to elicit clear patient communication through his then rudimentary Hindi. However, with all his trials, there was always a pitfall. Patients would respond only in Bengali even if spoken to in Hindi, and even the numbers would be said only in Bengali. In contrast, in Tamil Nadu, undereducated individuals would still commonly use English numbers when speaking. He was often stuck working up cases in the emergency room independently. Initially feeling helpless with a thick veil blinding the way between the voice of the patient and his ears. Just strings of words on end, he could not piece together. This pushed him to rely solely on his clinical observation skills and lab report analysis to assess the improvement or deterioration of a patient. Much like how an individual with impaired vision would use acoustic impressions a great deal more, resulting in a better trained sense of hearing. Dr. Anirudh had now discovered the glistening side to the double-edged sword of a shortcoming he brought with himself on this journey. Of course, this isn’t a movie, and not everything can be rosy. Albeit he had advantageous clinical acumen that was birthed out of his restrained exchange of words, this ended up building layers of unnecessary paranoia. As much as a mild deviation in pulse would signal Dr. Anirudh to look for something wrong. He once encountered a frail disoriented gentleman in the emergency room who had undiagnosed pain abdomen and had reached the murky waters of sepsis and toxemia. At the time, Dr. Anirudh was utterly confused, but in retrospect, he figured the language this patient whimpered out was a different dialect of Bengali that was more reflective of Bangladeshi influences. A more sing-song variation of Bengali indicating that the patient hailed from the border of West Bengal. He again resorted to closely observing clinical signs and laboratory parameters. He made a diagnosis of intestinal obstruction due to a strangulated hernia, gathering all of that with barely any words exchanged with the patient. This situation and a few more made him acutely aware of his shortfalls. Two weeks into training, he realized that he could only stagger a few steps further down the road of learning the art of Surgery in this esteemed center if he didn’t soon learn Bengali. He was grievously homesick. He wasn’t a big fan of the food. Despite having tasted only quarter-eaten plates of food, being constantly interrupted by calls from the ward. Little did he know this would be the biggest challenge he would have to face throughout all his years of education. He would reach the wards an hour before and after his colleagues to work heavily on his Bengali communication skills. This would often mean he had barely three hours to sleep every night. He acquired help from virtually everyone around him, medical students, nurses, janitors, and colleagues. He compiled cheat sheets of Bengali-English translations from various individuals. Before he knew it, he was riding hands-free on a bicycle for which he once needed training wheels. A cloud of endorphins hit his brain like a ton of bricks the moment he realized he had developed a mind voice that spoke Bengali. No longer did he have to make such a conscious effort to go through the ‘listening Bengali to English mind voice to spoken Bengali and then respond’ chain of events in his mind that once prolonged his response time significantly. Acquiring fluency in a foreign language is among one of the highest cortical skills, making it one of the most challenging skills to acquire. In their state of the art study on gifted foreign language learners, Scheniderman and Desmarasis suggested that linguistic talent denotes greater neurocognitive flexibility which was later confirmed by Reiterer et al through neuroimaging[1]. Medical training usually involves a lot of travelling through the years. Training can be very daunting in a diverse country like India, with many indigenous languages and dialects. It’s interesting how clinical training during the last years of medical school and residency are conducive times for not only gaining formidable ability to assimilate medical knowledge with a drastic increase in volume to rate ratio but also for learning languages. Mastering a foreign language is overwhelmingly empowering. It opens a new dimension to an individual, providing access to communication with a larger volume of people and thereby access to novel cultural insights. It can be very advantageous to the blooming Doctor as it also broadens their patient population. During the first year of his residency, the IPGMER & SKKM hospital did not have a post-operative intensive care unit or recovery room. Whether a patient had undergone a thirty minute umbilical hernia repair or a six hour multiorgan resection procedure, as soon as the patient was sewn up, the tube threaded down to the larynx to ensure intraoperative breathing would immediately be taken out, and the patient would be sent directly to the ward. Most post-operative patients are given ICU care for four or more hours to ensure infection control, as well as meticulous and focused supervision before they are taken back to the ward. In addition to this, there were no available scrub techs or scrub nurses. Hence the first year residents, above all of their already existing tasks, were expected to master the surgical trolly, perform the sponge and instrument counts, ensure the quality of laparoscopic and cautery instruments, and make sure to disinfect some of the instruments in a short window of time before the next case. During his first year of residency, Dr. Anirudh co-led an initiative to set up a post operative ICU and recovery room at this center. He was warmly welcomed by the ‘Didi’s’ and ‘Dada’s’ (how nurses are addressed in Calcutta), and various employees of the hospital because they all had a deep-seated sense of pride in helping him overcome his language barrier. They in fact felt respected in the highest manner when they noticed his consistent efforts to gown upon himself, the West Bengal culture. After all, true bravery is often sensed deeply by the world around us, even if we may feel invisible through many exhaustingly abortive efforts. Dr. Anirudh now walks through the same hospital halls with such weightless comfort as if it were his living room. The same halls he once gasped at the sight of. He grew tremendously, from training through thousands of complicated cases that were referred to this centre from hospitals all over West Bengal. He has been a practicing General Surgeon for about one and a half years, from counting sponges to only suctioning during procedures to now having independently stood a knife over multiple Whipple procedures (one of the most complex surgeries) and coaching trainees in the process. In addition, he gained satisfaction from serving his compassion and surgical skills through the years to patients of significant financial deprivation. Patients who tended to stay in the hospital for as long as possible to ensure a roof over their heads, a bathroom to use, a free meal allowance, and dry floors to walk on.
He sits in his living room in Calcutta, taping up the boxes of his treasured life experience as a young surgeon of five years. He is now excited to move and share the same home, for the first time, with his once medical school girlfriend and now Surgeon wife. As he wraps up his last couple weeks at IPGMER & SKKM Hospital, he reflects saying “Always leave a place better than you found it.”
[1] Biedroń, Adriana. (2015). Neurology of foreign language aptitude. Studies in Second Language Learning and Teaching. 5. 13. 10.14746/ssllt.2015.5.1.2.
Loops and Loupes of Journeys 