Communication

If I could have one super power, it would be the ability to speak every single language in the world. I hate not being able to communicate to a patient, and it can make you feel very disconnected. This can impact on patient care, which was a huge issue for us recently.

A patient entered A&E at 22:00, I'll call her Fatima, was brought in by her sister. Fatima spoke only Somalian, but her sister was able to translate for us. She brought her in because of her strange behaviour, according to Fatima's sister, she'd felt suicidal and was being quite aggressive, which was quite worrying because she had 5 children to look after. She also hadn't eaten anything for a week, and it definitely showed. Fatima's sister had also claimed that she'd lashed out at her. The biggest problem for us was that Fatima did not trust her sister, and didn't want to talk to her, so it was incredibly difficult to obtain any history from her. Obviously she was quite distressed, so she was referred to see a psychiatrist. She was sent down to the A&E ward, where I was working, to wait to be seen. She refused any medical treatment, she refused to give us a urine sample, and she refused bloods to be taken. She kept trying to leave, so we had the doors shut and security guards to make sure she would stay. She was deemed not competant, so they were well within their rights to do this.

The psychiatrist turned up at around 01:00, and refused to see her. For one thing, there was no interpreter, and at 1am on a Saturday morning there would be no chance of getting one here before Monday. I'd tried the whole department, and there wasn't one member of staff that could speak Somalian. Using language line would mean doing the psychiatric assessment in front of other patients, which was not an option due to patient confidentiality. Also, because she'd had no medical tests carried out, it couldn't be ruled out that her confusion wasn't caused by a simple urine infection. All the while, Fatima was getting more and more frustrated, and while her sister was trying to tell her what was happening, she didn't trust her. We talked about the situation, and how bad our patient's care was, all because of the language barrier. I thought about how isolated she must have felt.

We waited for the doctor, trying to think of a way we could work this out. Fatima started wandering around, and she didn't take her eyes off of us. Her behaviour certainly seemed strange. Then, at 03:00, another security guard turned up, and he was Somalian! Fantastic, we thought! Finally we could start to communicate with this patient! Or so we'd thought. She was still reluctant to give out any details, and it seemed she didn't want to talk to anyone. A decision was made. We needed to know if there was anything medically wrong with her that could be causing this behaviour, and understandably, the psychiatrist would not see her until this was done. Our doctor was going to take bloods, with or without her permission. We got four security guards, and told the Somalian speaking guard to try his best to explain to her what was happening. I moved her sister out of the room, and explained what we were doing. I told her that it wasn't going to be nice. I stood with her sister while we waited, and listened. To my surprise, she didn't fight, but then she hadn't eaten anything for days and she hadn't been sleeping, so she must have felt very weak anyway.

So the plan was to find out the blood results, and complete an A form. (For those that don't know, an A form is a child protection document that notifies the safeguarding team of anything they need to know regarding child safety, an A form had to be filled in for Fatima because she has 5 children and was behaving aggressively at home).

So the nurse went over to Fatima to ask her some questions through our translating security guard, she asked her for the names of her children so that she could start filling out the A form, when Fatima replied in very fluent English;

'You have all of my details on the computer, you know their names, you ask too many questions'

We all looked around at each other in disbelief. It was 4am, Fatima had been here for 6 hours, claiming that she only knew Somalian. It turned out that we just needed to annoy her a bit to get some communication. She wrote down the names of her children. Not only did she speak English, but she could read and write English as well. All of the time, she knew what was going on around her, she just didn't want to speak to anyone. She still had psychiatric issues of course, that much was clear, and she'd still need treatment, but it was so frustrating that our jobs could have been made so much easier if only she would have been honest with us.

The doctor commented that she may have been pretending that she can't speak English so that she didn't have to work. I didn't want to believe that. I just want to believe that it was her mental issues that stopped her from wanting to talk to anyone. I could go on to moan about people taking advantage of government services and benefits, but for now I think I just need something to reaffirm my faith in people's good nature, and I do meet lots of good people every day.