No Translator Necessary
by Mike Litrel, M.D.

A month later I was surprised when a still pregnant Rosa came back to my office. She had decided to let the pregnancy run its course. Rosa spoke an Mayan Indian dialect called Mong. Helena, Rosa's shy and petite eleven year old niece, was the only translator available, and came with her to every appointment. The conversations that followed as a result of this terrible diagnosis would have been difficult enough for an adult, much less a child. But Helena was mature beyond her years, a serious and thoughtful soul. We relied on her completely.

So Rosa's pregnancy continued. At each appointment, I expected her baby to have died. A baby with serious malformations will almost always miscarry: miscarriage is God's way of sparing the mother the pain of a full term pregnancy for an unhealthy fetus. However, upon each visit, we found the heartbeat of Rosa's baby still loud and clear. And the unsightly birth defects — nature so clearly and terribly going astray — became more and more pronounced.

My concern deepened when Rosa's pregnancy began to drive her blood pressure to dangerous levels. But Rosa steadfastly refused intervention, even blood pressure medication. I couldn't help but wonder if she understood what was going on. If her blood pressure rose to a certain level she could have seizures and actually experience brain damage herself. I would listen as Helena spoke to her aunt, and wonder what was being conveyed. But Helena seemed to understand and share my concerns. She had more trouble explaining her aunt's response.

Rosa went into labor right around her due date. Many Guatemalans are stoic when it comes to pain, both physical and otherwise. Rosa was typical. She didn't want pain medicine, and labored largely in silence. The baby's head was abnormally enlarged. It was difficult to deliver. Special maneuvers and a very large incision were required.

At last I held Rosa's baby. It was terribly malformed — an enormous head, no eyes, one nostril... As I cut the cord, the baby took one gasp — and died in my hands.

I remember Helena's usually steady voice cracked when she told her Aunt that her baby had died. Rosa bore the news in silence, just as she had labored. We stopped her bleeding and sutured her incision. The nurse washed the baby and gave it to Rosa to hold. The room was silent as I operated. No one said anything, no one felt anything. The baby was growing cold thirty minutes later by the time I had finished.

Afterwards, I wondered why had Rosa chosen to go through all this. Why take the path of more pain? Did she not trust our diagnosis? Or was it something else?

An answer came three years later. I was again in the delivery room with Rosa and Helena. This time, Rosa's pregnancy had been entirely uncomplicated. Again she labored quietly without pain medication. The baby came more easily this time. I placed it on Rosa's abdomen.

There was silence in the room just as with the first delivery. No noise. No emotions. Like a breath being held. Except this time a baby began to cry softly. It was the high quavering voice of a newborn saying "I am here, I am here."

Helena smiled. Like sunlight on a cloud, her serious young face was transformed. A few seconds later, she broke into laughter: a real child's laugh, the pure and happy laugh owned only by the very young. She quickly stopped as though she was breaking a rule. But she couldn't hide her joy.

Then Rosa, usually stone-faced like so many women from Guatemala, also smiled, despite herself. I watched as she cradled her beautiful baby. She stared at her newborn as though not trusting her eyes. By a force of will her smile disappeared. I wondered what she was thinking and feeling. It was as though she would not let herself believe in God's gift.

The baby yawned. For the first time in all her labors of physical pain and thwarted motherhood, Rosa began to weep. And no translator was necessary.

Dr. Litrel is in practice at Cherokee Women's OB/GYN in Woodstock and Canton and is a Clinical Assistant Professor at Emory University School of Medicine. He lives in Towne Lake with his wife Ann and their two sons Tyler and Joseph. (Atlantalitrels@CS.com)

Spanish was my worst subject in high school. It wasn't that it was especially difficult — I just never studied. Typical adolescent thinking: When will I ever need this stuff, anyway? It's not like I'm moving to Mexico. I didn't know that Mexico would be moving to me.

More than ten percent of the babies I've delivered in Georgia have been born to mothers who don't speak English. I wasn't two days into my residency at Emory when I came face-to-face with a pregnant Mexican patient who needed an exam and couldn't speak a word of English. Suddenly I realized how stupid I had been for blowing off high school Spanish.

Over the next four years of my residency, I picked up some key Spanish verbs so I could usually get my meaning across — "relax, breathe, push, don't push..." The trouble started when I came to practice in Cherokee County. My Guatemalan patients had no idea what I was saying. It took me over a year to figure out why.

Many Guatemalans don't speak Spanish either. (They use native Indian dialects.)

Just recently, I looked up Guatemala in the atlas. I saw, to my surprise, that it's located just below Mexico. Suddenly, everything made sense. All this time I had been wondering how so many of my pregnant patients had managed the long voyage across the South Pacific. I guess Geography wasn't my strong point, either.

When it comes to having babies, however, it really doesn't matter if a person is from Guam or Guatemala. Black or white, rich or poor, all babies arrive pretty much the same way. It almost makes you believe that all the things we use to separate ourselves — money, race, religion, country — aren't that important.

Language and cultural differences do make some difference, however, when it comes to the practice of obstetrics. A woman who delivered her last two babies in a hut with a dirt floor usually doesn't see why she needs to make all those prenatal visits to her new American doctor.

Several years ago, a young Guatemalan woman named Rosa arrived in my office pregnant. We quickly discovered that her growing fetus had a terrible malformation of the brain, clearly visible on her four month ultrasound. We sent Rosa on to Emory for a second opinion to make certain. A specialist in high risk pregnancies confirmed the diagnosis and recommended the pregnancy be terminated as soon as possible. There was no cure. The baby couldn't survive.

We tend to think of pregnancy as a joyful time. The obstetrician shares in that joy, but is also responsible for keeping in mind another truth: it is more dangerous to a woman's health to be pregnant than not. Conditions like diabetes and high blood pressure are just a few of the potential complications in a pregnancy. It doesn't make sense to put a woman through the risks of pregnancy if there is no chance the baby will survive.

Such was the case with Rosa and her four month old fetus.

Sadly, we agreed with the specialist's recommendation to end the pregnancy, and turned Rosa's care over to him. He arranged for her admission to Grady Hospital.