Open domain, closed domain: what makes medical interpreting hard

At 4 AM today I threw a suitcase full of clothes that will work for both hot, sweaty tropical evenings and freezing-cold operating rooms into the trunk of an Uber car and climbed into the passenger seat.  As we pulled away from the house toward the airport and a plane to Guatemala, the driver made a sudden discovery: Oh, shoot!  I’m out of gas!  (Explanations of oh, shoot! and other obscure English expressions at the end of the post.)  She was, too–a big ol’ red light was shining on the dash, and there was a big, glowing E (for Empty) showing on the gas gauge.

This was a problem: because of the balancing act that these ridiculously early morning flights require between not showing up before the airport opens but also not showing up late and missing your flight, I needed this ride to go as smoothly as Uber rides usually do–and I needed my driver to take me straight to the airport.  What to do?  Pull over and fill up the tank, and we risk missing my flight.  But, if we run out of gas between the freeway and the airport, I am definitely missing my flight.

I stopped worrying about this and started worrying about other things pretty quickly, because she more or less immediately blew through a stop sign while checking her text messages.  OK, down side: I may die on the way to the airport tonight.  But, upside: I am super-heavily insured at the moment, and my loved ones will be nicely taken care of.  Just a little bit more reflection, and I concluded that risking missing my flight was a better option than definitely missing my flight, so I encouraged my Uber driver to pull over and get some gas.

She was happy to do so, and drove straight to a station that she knew about.  Only problem: at 4 in the morning, it was locked up tight.  Hmmmm….  Back on the freeway, the big red light on the dash looking even brighter, deeper red, more ominous.

An aside: if I think I might be late for something important, I ask myself a question: can I move any faster than I’m moving?  If the answer is yes: I speed up.  If the answer is no: I figure that worrying about what will happen if I’m late is pointless, and instead I focus on whatever needs to be focussed on to get me to my destination in one piece.  In this case, it was the nice Uber lady driving, not me, so there wasn’t really anything that I could do to affect the situation.  Can’t affect the situation?  Then it’s not efficient to worry about it.  I like music, and hers was blasting, so why not pay attention?  Turns out the lyrics went something like this:  I’m gonna get drunk, I’m gonna get high, I’m gonna get drunk and high.   (You probably think that I’m making this shit up, don’t you?  Well: I’m not.)  I thought my happy thoughts about how heavily insured I am again, and threw in some reflection of the fact that I’ve had a great life and I could totally die in a violent car crash with no regrets about untasted cheeses, undrunk pinot noirs, and so on.  I kept thinking those thoughts as we pulled off the freeway and got some gas while the nice Uber lady told me stories about her childhood that made me doubt the existence of a future of any kind for America.  I kept thinking those thoughts as we pulled back onto the freeway to the sounds of I’m gonna get drunk, I’m gonna get high, I’m gonna get drunk and high.  I kept thinking them some more as we immediately pulled off of the freeway again and headed down some frontage road that I was pretty sure was going to take us to the UPS/FedEx terminal, not the airport for humans.  (Back in the days when grant proposals got mailed to the National Institutes of Health in a big box, usually at the last minute, the prudent researcher learnt every possible way to drive to the UPS/FedEx terminal.)  There was an erratic jag to the north.  (Definitely happened–Uber showed me the route that we had followed when it was all over.  This isn’t going to get us to the airport, I said.  The normally loquacious nice Uber lady fell silent, for the first and only time of the night.  Or morning.  Whatever–it was really dark out.)

And then it was over–I saw the United doors appearing in the distance, and then I was thanking the nice Uber lady, dragging my suitcase up to the ticket counter, and pulling out my passport.  The lady at the ticket counter was being nice to me in that way that the ticket counter agents are nice to you when you fly 100,000 miles a year, or at least they were treating me somewhat like a human being in that way that they do when you fly 100,000 miles a year.  I drifted off, and soon we were landing in Houston, and then we were in the air towards Guatemala, and then in the van that takes us all from the airport to Antigua (and that was the reason that I really needed to not miss my flight–we all travel together from Guatemala City to the highlands).  Traffic was beyond belief, and exhaust fumes were pouring in through the open windows, and the camioneta (colorful bus, usually packed with people and assorted livestock, roof covered with luggage) next to us was clearly going to sideswipe us–and I didn’t even care, because when the radio is not blasting I’m gonna get drunk, I’m gonna get high, I’m gonna get drunk and high, I figure: no problem!

…and now I’m sitting in my hotel room, getting ready for what will be the hardest day of the next week.  I’m here in Guatemala with a group called Surgicorps.  Our raison d’être (yes, we say that in English, too) is providing free surgical care to people who couldn’t afford it otherwise.  Burn scars that leave men unable to use their hands–the only things that let them earn a living.  Disfiguring acid burns on a woman’s face and chest, courtesy of…I don’t have a good word to describe the guy that did it to her.  Kids with congenital malformations of pretty much anything that can be congenitally malformed.  Women who can’t go to the market to sell their corn because they’re incontinent and they can’t ride the bus.  The Surgicorps surgeons, nurses, anesthesiologists, techs, and therapists take care of pretty much anyone, and I interpret for them.

We just got into Antigua tonight–Saturday.  Sunday is the most intense day of the week: screening day.  The surgeons will spend the entire day seeing everyone who walks in the door wanting surgery for their kid, or themself, or their mother, or whoever.  They’ll be able to help a lot of them, and those folks will go off to be seen by one of our anesthesiologists.  If the anesthesia folks clear them for surgery, then other people will start the process of getting their lab work, find a place for their family to stay while they wait, and so on.  Eventually we’ll end up with a bit over 90 or so people who will get operated on in the week to come.

A couple of our surgeons speak Spanish, but most of those people will run into an interpreter multiple times.  For us interpreters, it’s a long day of constant, constant bouncing back and forth between the two languages, in both directions—English to Spanish to repeat the doctors’ questions and instructions, and Spanish to English to repeat the patients’ answers.   The long day is tiring, but it’s the difficulty of the interpreting itself that wears me out.

I get pretty similar remarks from people when I tell them about my annual Surgicorps trip: it must be hard, learning all of that medical vocabulary.  Actually, that’s not the hard part at all.  Here’s the thing about medical vocabulary: it’s finite.  It is related to what we call in computational linguistics a closed domain: there are only so many things that can be talked about in it.  If you had a big enough book, you could learn all of the medical terminology in Spanish (or whatever language you deal with), and then you’d be done.

I usually spend screening day with a hand surgeon.  I learn more hand vocabulary every year–this year I’ve been focussing on parts of the finger.  I don’t worry about that stuff–the chances of me being called upon to use words that differentiate between the body of the fingernail and the end of the fingernail are pretty slim.

Here’s the thing, though.  Take a seat in front of our hand surgeon, show him the scars that are keeping you from opening your fist, or the finger sticking out at an angle, or whatever, and the first thing that he’s going to ask is: how did that happen?  The answer to that question doesn’t come out of the closed domain of medicine–it comes out of the open domain of life.  Here are some possible answers:

• I cut it while I was cutting up a chunk of frozen spinach to cook for my son.
• I jammed a thorn into my hand.
• I was sitting in my friend’s car and the fuel pump blew up.
• I fell into the cooking fire.
• A snake bit me.

(Can you guess which one of those was me when I paid my visit to the hand surgeon to get a joint capsule repaired?)  So: the closed domain of hand anatomy has a finite vocabulary, and it’s not actually that big–no problem memorizing it all.  The open domain of the world at large has an enormous vocabulary, and you know what Zipf’s Law tells us about the nature of that vocabulary: most of the words in it are going to occur at the statistical equivalent of never–but, they do occur.  And as a non-native speaker, they’re going to bite you.

And that’s it: what makes doing medical interpretation hard.  It’s not the medical vocabulary–it’s the entire rest of the world.  It’s all of the stuff that led to what happened to your hand, which led to you sitting in front of our hand surgeon, which led to me talking to you after an exciting trip through the wilds of the Denver night and the Guatemala City traffic.  And that’s why I’m going to bed a little nervous tonight–it’s screening day tomorrow.

Want to support Surgicorps’s work?  You really should–if you don’t feel better about life after you make a donation, I’ll give you your money back!  I’m not asking you to support my participation–like all Surgicorps volunteers, I pay for my own plane ticket, lodging, etc.  Your donation goes to the costs of surgery for someone’s kid, or mother, or wife, or…  They’re human.  That’s all.  Click here to donate.

English notes:

• Oh, shoot!  This is a very mild way of expressing surprise, disappointment, and similar emotions occurring together.  It’s a bowdlerized form of oh, shit!  …but, truly, it’s so mild that your grandmother could use it.  Not my grandmother–she preferred oh, sugar!  …but, one’s grandmother could.  How it showed up in the post: As we pulled away from the house toward the airport and a plane to Guatemala, the driver made a sudden discovery: Oh, shoot!  I’m out of gas!
• Big ol’: On some level, this is a contracted form of big old.  Syntactically, it functions as an adjectival expression, although a somewhat strange one.  Semantically, it describes size–but, not age.  Big ol’ means big.  It does not mean old.  Sociolinguistically, it’s stigmatized–the associations are with being rural, uneducated, probably Southern.  (I’m not asserting that Southerners are all rural and uneducated–they certainly are not.  I’m asserting that these are the associations that native speakers are likely to have with the expression.)  Used by someone like me–that is to say, an extremely urban Northerner with a graduate degree–the effect is to add an air of humor and casualness to the story.  How it showed up in the post: She was, too–a big ol’ red light was shining on the dash, and there was a big, glowing E (for Empty) showing on the gas gauge.
• Pretty + adjective/adverb: “Pretty” is an intensifier here, meaning something like “very, or at least more than a normal amount, but not necessarily as much as possible.”  I’d be pretty careful about doing that, if I were you.  It’s pretty late–I’m going to bed.  That’s a pretty big mess you’ve made there.  How it showed up in the post: I quickly stopped worrying about this and started worrying about other things pretty quickly, because she more or less immediately blew through a stop sign while checking her text messages.

French and Spanish vocabulary:

English	French	Spanish
open domain	le domaine ouvert	el ámbito abierto
closed domain	le domaine fermé	el ámbito cerrado

Want to know more about hand surgery?  Here are some posts from the past.  Sorry, no French–the vocabulary under discussion is all Spanish.

• What is hand surgery?
• Risks of hand surgery
• The hand surgery screening interview