No Translator Necessary
by Mike Litrel, M.D.

accompanied Rosa to every appointment. The conversations that revolved around the baby's 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. Having no choice, we relied on her completely.

Rosa's pregnancy continued. At each appointment I half expected her baby to have miscarried; miscarriage is God's way of sparing the mother the pain of full term delivery for a baby not likely to live. However, upon each visit, we could hear the heartbeat of Rosa's baby, loud and clear. And the unsightly birth defect - nature so clearly and terribly going astray - became more and more pronounced.

Rosa's condition became more serious as her pregnancy drove her blood pressure to dangerous levels. High blood pressure can lead to seizures or worse. Rosa, however, steadfastly refused intervention, even blood pressure medication. As I listened to Helena addressing her aunt, I couldn't help but wonder how much of the situation was being conveyed. Helena, however, 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 stoical when it comes to pain, and Rosa was typical. She didn't want pain medicine, and labored largely in silence. The baby's head was enlarged. Despite our best efforts to maneuver Rosa's body to ease the delivery, it was a difficult one.

At last I held Rosa's baby. Terribly malformed, he took one gasp - and died in my hands.

I remember Helena's usually steady voice faltered when she told her Aunt that her baby had died. Rosa bore the news in silence, just as she had labored. She didn't respond to Helena's and our attempts to comfort her. 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 we operated. Rosa neither spoke nor showed emotion, her baby growing cold on her stomach.

Afterward, I found myself wondering why Rosa had chosen to go through a full term pregnancy. Were her reasons religious? Was the translation process at fault? Did she not trust our diagnosis? Or was it something else?

Three years later came an answer. This time, Rosa's pregnancy had been uncomplicated. Again I found myself in the delivery room with Rosa and Helena. And again Rosa labored quietly without pain medication. The beautifully formed little girl came more easily than had her brother. I placed her on Rosa's abdomen.

There was silence in the room just as with the first delivery. No noise, no emotion on Rosa's face. The charged atmosphere in the room was like a breath being held, as the 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, and she laughed the pure and happy laugh owned only by the very young. Then finally, miraculously, Rosa smiled too. She bowed her head over her beautiful baby as she cradled it in her arms. She stared at the newborn as though not trusting her eyes. After a few moments, seemingly by force of will, the 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. And for the first time in all her labors of physical pain and thwarted motherhood, Rosa began to weep.

This time, no translator was necessary.

This article is a reprint from a previous issue of The TowneLaker.

Dr. Litrel is a surgeon in private practice with Cherokee Women's Health Specialists in Canton and Towne Lake, and is a Clinical Professor at Emory Medical School. His new book on faith and health is called "The Eyes Don't See What the Mind Don't Know." It is available at www.doctor-mike.net. Dr. Litrel lives in Towne Lake with his wife Ann and their two sons, Tyler and Joseph. You can e-mail him at mikelitrel@comcast.net.

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 a little while to figure out why. It turns out that most Guatemalans don't speak Spanish. They use native Mayan dialects.

Fortunately, when it comes to having babies, it 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 makes you think that maybe all those things we use to set ourselves apart - money, race, religion - aren't too essential.

The real difficulty comes in convincing a patient from a third world country of the importance of regular prenatal visits - especially when her last three babies were born on the dirt floor of a hut.

Several years ago, a young Guatemalan named Rosa came to my office pregnant. At her four month ultrasound, we could clearly see the terrible brain malformation that was part of her growing fetus. A specialist in high risk pregnancies at Emory confirmed the diagnosis. There was no cure; the baby wouldn't survive. He recommended the pregnancy be terminated as soon as possible.

Pregnancy is usually happy news. The obstetrician can share in the joy, but must also mind a medical truth: it is more dangerous to a woman's health to be pregnant than not. Diabetes and high blood pressure are among the more common complications. It doesn't make "scientific" sense to put a woman through the risks of pregnancy if there is no chance the baby will survive.

It was a sad follow-up visit with Rosa at our office. We concurred 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.

I was surprised when a month later, a still pregnant Rosa came back to my office. Apparently, she had decided to let the pregnancy run its course.

Rosa spoke a Mayan dialect called Mong. The only translator available was Helena, Rosa's shy and petite niece. Just eleven years old, Helena