“Mucho Gusto”

China Rae Newman

Fam Med. 2020;52(9):669-670.

DOI: 10.22454/FamMed.2020.823187

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I find you in the emergency room with your daughter
And ask what brought you in.
Estoy aquí porque tengo mucho dolor de estómago” (stomach pain,)
You tell me.
Tres semanas” (three weeks.)
Fui a mi doctor” (I went to my doctor,)
Fui a la emergencia hace una semana” (I went to the emergency room last week,)
Estoy aquí esta noche porque…” (I’m here tonight because…)
No se cómo se dice “I couldn’t take it any more.”

“My mom had cancer and she is worried that it is back”
Your daughter says.
She is bilingual.
I know that we are both grateful for this.

I ask you to tell me about your cancer.
Hace diez años, en el seno” (breast cancer, 10 years ago.)
You had a mastectomy, chemo, radiation. Done in Mexico.
You didn’t have insurance here.
Hace un año, en un nodo.”
They found it in a lymph node. You thought it was gone.
Hace dos meses, en los pulmones.”
Now it is in your lungs.
I immediately know the top of my differential.
I am not happy about it.

I talk with the team.
The attending asks what I think about what is happening.
Metastatic cancer causing some sort of gastric emptying problem.

But I hope my resident is right and it is just gastritis.
They put a camera en su estómago y toma fotos (in your stomach to take photos.)
Y toma un poco de su estómago (and take a tiny bit,)
Para examinar con un microscopio (to examine with a microscope.)
You understand.
You’ve done this before.

Retained liquid in the stomach. Nodular tissue around the pylorus. Diffuse thickening.
Not a gastric outlet syndrome.
More suspicious for linitus plastica.
Tumor cells, marching along the mucosa,
Destroying the nerves,
Making it so your stomach cannot squeeze.
We don’t explain all of this now.
The attending lets you know that the biopsy will be back in a few weeks,
But that the exam was suspicious for cancer.
You understand the implications.

I linger a moment,
Because I can see the tears in your daughter’s eyes
As she asks the attending questions.
I see the tears in your eyes
After they leave.
Ustedes estan fuerte.
You are strong,
But I know that this must be hard.
The third time you hear
Your cancer has returned.
I stay a moment.
We share hugs and deep looks and hand-squeezes.
I tell you that I can call someone
Whose job it is to talk about emotions.
Your daughter says that would be nice.
I place a call. I ask for the in-person interpreter to come. I don’t want a video in the way.

When I return,
You are at the window.
I ask, que quiere? (What do you want?)
You want to go home.
I bother my team.
I want you to be
Wherever you feel best.

I come back to say goodbye.
It is hard to say the right thing
When something bad happens.
It is harder to say it in a language that is not your own.
I look into your eyes. They are watery. So are mine.
All I can remember how to say at this moment is mucho gusto, (pleasure to meet you,)
But I can see that you know what I mean.
Maybe it is easier to say things
When you don’t let words get in the way.
You pull me into an embrace,
Speaking a language we both understand.

Lead Author

China Rae Newman

Affiliations: University of Arizona College of Medicine – Tucson, AZ

Corresponding Author

China Rae Newman


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