Lost in Translation

A few months ago I met a Japanese couple and their cocker spaniel. They had just moved to Austin temporarily for some big job, and they speak very little English. What was clear was how much they loved their dog. I gave her a check-up, boosted her Rabies, and made sure she was on heartworm prevention.

Last week they came in and saw another doctor. Their dog was vomiting and was quite ill. The presumptive diagnosis was pancreatitis. This requires several days of hospitalization and can have a good or poor prognosis. My colleague explained everything to them, and they nodded and said yes. Then they said, "Why she vomit?" Unfortunately, in a clash of cultures she mistook their nodding for understanding, and they were just being polite in a Japanese way. Eventually, we found they could understand written English better than spoken, and there are some incredible websites now that will translate for you (apparently this is how the husband gets along at his job).

Late last week the case was transferred to me. The dog seemed better, and was even able to eat and keep food down. Her bilirubin went down to normal, and her white blood cell count approached normal. We had tried to get an ultrasonagrapher in to check the dog earlier in the week, but she was unavailable. Then on Friday, there was a cancellation, and we got the dog an ultrasound appointment.

On Friday morning, her liver enzymes and bilirubin were worse. The ultrasonagrapher approached me with wide eyes. "I want to show you the gall bladder," she said. It was large and sludgey and in danger of rupturing. The pancreatitis was resolving, but now this secondary problem was worse. I called a friend of mine who was a surgeon. She said she could cut the dog later that same day, if the owners could bring them in.

I called the owners, and they came in to discuss the dog's case. I found that if I spoke slowly and used the simplest English, the husband could understand me well. (I think trying to communicate with my limited Italian in Italy has helped me learn how to speak English better to non-native people!) They were concerned for their dog and agreed to the surgery. The husband said, "I have just one question. There are two gall bladders?" No, I said, only one. "But, you remove it?" Ah, very good question! I explained that the gall bladder would be removed, but the tube (duct) would remain. They were satisfied and took their dog to the surgeon, since I told them I would even let her work on my dog.

Fortunately, another surgeon at the referral practice had a sister-in-law who was also Japanese and even knew this couple. So their communications with them were much easier. I found out on Tuesday that the dog did well through the weekend and went home.

I hope that these people had a good experience during a scary time with their dog. I think that the staff from our clinic were very nice to them, and did everything they could to make them comfortable. They racked up a huge bill with 5 days of hospitalization and diagnostics at our place, before the huge surgery. They never questioned a bill, and always trusted our recommendations. How scary that would be, to be in a country that I only had basic language skills in, with such a different culture, with a sick "family member," and not knowing if the doctors were really doing their best, or just saying that the dog needs to stay in the hospital for arbitrary reasons. One of our staff said, "I hope we have given them a good impression, and thank goodness they didn't go to a crappy vet hospital!" (Sadly, there is a lot of disparity among vet hospitals.) I totally agree -- I can't imagine being in Tokyo and being bewildered and hoping that people were taking the best care possible for my dog.