Your hands and how you feed your children

On an atypical day, the biggest hardship that one has to overcome is explosive diarrhea and projectile vomiting due to forgetfulness about not rinsing your toothbrush in the tap water.

That curly thing (it’s called a “pigtail”) is a catheter sitting in the left ventricle of the heart. Frame D is what it looks like when a healthy heart contracts–if you’ve had damage from a heart attack, you’ll see it here as a section of the chamber that doesn’t contract. Picture source:

One week a year I get on a plane with a bunch of surgeons, nurses, anesthesiologists, and therapists and head to Guatemala, where everyone else spends the week providing free surgery for people for whom the almost-free health care provided by the government medical system is still too expensive, and I spend the week interpreting.  Don’t get totally lost in Doctors Without Borders fantasies–we stay in a lovely hotel, the surgeries happen in a four-OR operating suite, and on a typical day the biggest hardship that one has to overcome is finding someone to relieve you so that you can get to the cafeteria before the hand-made Guatemalan tortillas (yes, they’re different from the ones that you’re used to) are gone.  (On an atypical day, the biggest hardship that one has to overcome is explosive diarrhea and projectile vomiting due to forgetfulness about not rinsing your toothbrush in the tap water–but, as I said, that’s atypical.)

The left ventricle needs to get filled with dye far more quickly than your hand could inject it, so you need a special pump to slam it in quickly. Picture source:

When new interpreters join us for the first time, the thing that they’re most worried about is the medical vocabulary.  However, that’s actually the least of your problems–medical vocabulary is more or less finite, and you can buy a book about it, memorize it, and modulo local dialect differences (every cardiac catheterization lab that I ever worked in had a different name for the special pump that you use to shoot a bolus of radiopaque dye into the left ventricle), you’ll be just fine.  (Modulo is explained in the English notes at the end of the post.)

The real problem is everything but the medical vocabulary.  Think about this: a patient presents themself to the surgeon.  They’re missing two fingers, and one is just hanging there, useless.  The surgeon’s first question: what happened?  The answer could be anything.  

  • I was getting out of my car and three guys attacked me with a machete.
  • I fell into the cooking fire.
  • I was sitting in a truck and the carburetor exploded.

I didn’t make any of these up, and the cooking fire thing happens tragically often–mostly with children.

I mostly work with a hand surgeon.  The basic principle of hand surgery is this: make the person be able to function again at whatever they do.  You often have to make choices about trade-offs–a surgery that would let you open your hand again after it’s been scarred into a fist by burns might leave you with a weak grip, and that’s going to be a problem for a farmhand; a surgery that would give you back your full grip strength might make it tough for you to do things that require fine motor control, which is not OK if you’re a seamstress.  Consequently, one of the questions that the hand surgeon always asks is: what do you do for a living?  …and that could be pretty much anything.  

So, yeah: it’s not the technical vocabulary that keeps you on your toes in medical interpreting–it’s the entire remainder of the language, and if you’re a regular reader of this blog, you know that the statistical properties of human languages are such that if you’re not a native speaker, you will come across vocabulary items that you don’t know Every. Single. Day. Of. Your. Life.

The shirts are called huipiles. In the Guatemalan highlands, you will see women wearing them every single day. Weaving one takes about a year. Picture source:

For today’s vocabulary, here are some words for professions that require quite a bit of use of your hands.  Note that almost any profession requires some use of your hands–I’m picking just a few here, focussing on ones that you wouldn’t be surprised to come across in low-income people in Central America.  If you have almost no education, and you’re doing any of these for a living, and you lose the use of a hand, your options for feeding your children become quite limited.  Hand surgery is about removing those limitations.  Want to support this kind of work?  Twenty bucks from you would literally pay for more than all of the pain medication that we’ll hand out in one week’s time.  You can donate here.

English Spanish French
farmhand granjero  ouvrier agricole
farmer  agricultor  fermier, agriculteur
gardener jardinero jardinier
seamstress modista  couturière
tailor  sastre  tailleur
waiter/waitress  mesero, camarero  serveur
weaver tejedor/a tisseur, tisserand
 carpenter carpintero  charpentier
 construction worker el albañil  ouvrier du bâtiment

English notes

modulo This is originally a term from mathematics.  In casual use, it means something like with the exception of, or besides.  I should point out that this word is characteristic of the speech of geeks, and only geeks–but, amongst my people (geeks), it’s quite common.

This example should be incomprehensible to any normal human, but I find it adorable due to exactly that incomprehensibility–“init” refers to a common part of a program, and the writer is saying that she’s left the “init” part out of what she’s showing you:

How it was used in the post: Medical vocabulary is more or less finite, and you can buy a book about it, memorize it, and modulo local dialect differences, you’ll be just fine. 

themselfHere we get into the controversial topic of pronouns in the Pacific Northwest, the part of the United States where I grew up.  Many native speakers of American English would balk at this pronoun, as well as theirself, which we also use in the Pacific Northwest.  Another vagary of our local use of pronouns is that when you have a subject that consists of two conjoined pronouns, they have to be in the dative: Me and him are going to the store, do you want some Redman?  Here’s a nice article on the themself form from the Merriam-Webster web site, which points out that themselves (which every other native speaker thinks us Pacific Northwest natives should be using) didn’t show up in English until the 1400s, with themself being the only possibility up to that point.

How it got used in the post: Think about this: a patient presents themself to the surgeon.  They’re missing two fingers, and one is just hanging there, useless.  

French notes

There are two French words that could translate the English word “carpenter:” charpentier, and menuisier.  Looking them both up on Google Images, it seems to be the case that a charpentier is a carpenter in the sense of someone who builds buildings, while a menuisier is a carpenter in the sense of a woodworker.  Native speakers, do you have thoughts about this?

Hits for charpentier from Google Images:

Hits for menuisier from Google Images:

…and, yes, this is how linguists try to figure things out.  We’re actually less excited about dictionaries than you might think…

Juventud, divino tesoro

…con el cabello gris, me acerco a los rosales del jardín…

Darío lived in Paris for 4 months–who knew? 4, rue Herschel, 75006. Picture source: DanielaBPSept.

For National Poetry Month, here’s some Rubén Darío.  I first came across this poem sitting in a night class at Old Dominion University, purveyor of fine educational experiences to a wide range of traditional and non-traditional students, including a hell of a lot of sailors.  The first stanza was carved into the top of the desk at which I was sitting (the desk I was sitting at, more commonly):

Juventud, divino tesoro,
¡ya te vas para no volver!
Cuando quiero llorar, no lloro…
y a veces lloro sin querer…

Youth, divine treasure, // you’re gone, never to return! // When I want to cry, I can’t… // and sometimes I cry without wanting to….

I thought it was the saddest thing I’d ever read, and in isolation, it most certainly, certainly is.

In isolation.  And, oddly: even more so at 25 or so than at 55.

Eventually, I tracked down the rest of the poem–much harder back in those pre-Google days–and made it to the end.

Mas a pesar del tiempo
terco, mi sed de amor no tiene fin;
con el cabello gris, me acerco a los
rosales del jardín…

But despite pig-headed // time, my thirst for love is endless; // gray-haired, I approach the rose-bushes in the garden…

(Don’t feel bad–I had to look up terco, too.)

As the grandson of a man who started a new family in the United States in his 60s (¡muy fuerte!, say my Mexican buddies when I tell them the story–I’ll spare you the accompanying gesture of admiration), I think I get the metaphor.  You go, pépère.  You go, Rubén.  Do I ever cry without wanting to?  Rarely–I am certainly an American male of my generation–but, yeah: it happens.  Nonetheless: I’m headed out to the back porch for a cigarette next to the lilacs, and the plum tree, and the flowering chestnut…


Juventud, divino tesoro,
¡ya te vas para no volver!
Cuando quiero llorar, no lloro…
y a veces lloro sin querer…

Plural ha sido la celeste
historia de mi corazón.
Era una dulce niña,
en este mundo de duelo y de aflicción.

Miraba como el alba pura;
sonreía como una flor.
Era su cabellera obscura

hecha de noche y de dolor.
Yo era tímido como un niño.

Ella, naturalmente, fue,
para mi amor hecho de armiño,

Herodías y Salomé…
Juventud, divino tesoro,
¡ya te vas para no volver!
Cuando quiero llorar, no lloro…
y a veces lloro sin querer…

Y más consoladora y más
halagadora y expresiva,
la otra fue más sensitiva
cual no pensé encontrar jamás.
Pues a su continua ternura
una pasión violenta unía.
En un peplo de gasa pura
una bacante se envolvía…

En sus brazos tomó mi ensueño
y lo arrulló como a un bebé…
Y te mató, triste y pequeño,
falto de luz, falto de fe…

Juventud, divino tesoro,
¡te fuiste para no volver!
Cuando quiero llorar, no lloro…
y a veces lloro sin querer…

Otra juzgó que era mi boca
el estuche de su pasión;
y que me roería, loca,

con sus dientes el corazón.

Poniendo en un amor de exceso

la mira de su voluntad,
mientras eran abrazo y beso
síntesis de la eternidad;

y de nuestra carne ligera
imaginar siempre un Edén,
sin pensar que la Primavera
y la carne acaban también…

Juventud, divino tesoro,
¡ya te vas para no volver!
Cuando quiero llorar, no lloro…
y a veces lloro sin querer.

¡Y las demás! En tantos
climas, en tantas tierras siempre son,
si no pretextos de mis rimas
fantasmas de mi corazón.

En vano busqué a la princesa

que estaba triste de esperar.
La vida es dura. Amarga y pesa.
¡Ya no hay princesa que cantar!

Mas a pesar del tiempo
terco, mi sed de amor no tiene fin;
con el cabello gris, me acerco a los
rosales del jardín…

Juventud, divino tesoro,
¡ya te vas para no volver!
Cuando quiero llorar, no lloro…
y a veces lloro sin querer…
¡Mas es mía el Alba de oro!

I can’t tortilla: denominal verbs and hand surgery

When we talk about hand surgery being all about function: it’s about the function of the hand, sure. But: it’s also about the function of the person. 

I’m in Guatemala at the moment. I come here once a year with a group called Surgicorps. We’re volunteer surgeons, anesthesiologists, nurses, technicians, therapists, and interpreters (that’s me) who provide surgical services to people who are so poor that for them, even the almost-free Guatemalan health care system is too expensive. There are a lot of groups like us, actually–you can find them all over the world. What makes Surgicorps special is the set of surgical specialties that we bring with us. One of those is hand surgery. Hand surgery is a very specialized occupation—in the course of learning his trade, our hand surgeon did fellowships in both plastic surgery and orthopedics. A fellowship is about five years, and that’s on top of four years of college, four years of medical school, and a three-year residency—so, these guys are hard to come by.

Every medical and surgical specialty has its central concept, its central concern. In hand surgery, that’s function. When our hand surgeon told me about this, he was talking about the function of the hand–the goal is to take something that isn’t working, and make it able to do things again. Hand surgery is about function in a larger sense, too, though. The thing is: in a country like Guatemala, most people work either in agriculture or in manufacturing, and opportunities for education are few. (In 2010, 31% of the female population was illiterate.)  In that kind of economy, for most people it’s the case that either you work with your hands, or you don’t feed your children.  Functioning here means doing manual labor, which for men is likely to be farming and for women is likely to include weaving and doing housework.  You’ve got a hand that doesn’t function?  Then you don’t function.

2016-08-07 12.05.28
Guatemalan handmade tortillas from the hospital cafeteria. Picture source: me.

For women here, part of functioning is making tortillas.  Guatemalans might not get much in the way of nutrition, but getting enough calories per se is usually not a problem: when there’s no drought, corn is plentiful and cheap.  If a Guatemalan is poor enough, he might be living on tortillas and salt–but, he’s living, not dying.  Not from hunger, at any rate.  (The top five causes of death in Guatemala: respiratory/pulmonary diseases (influenza and pneumonia), violence, coronary artery disease, diabetes, and stroke.)



dupuytren's contracture ArticleImageHandler.ashx
A contracture.  I’m showing you one called a Dupuytren’s contracture because after a week of looking at poorly healed burns, skin grafts gone bad, and the like, I just can’t take any more. Call me a wimp, but it’s difficult. Picture source:

You make tortillas with your hands.  They’re actually made somewhat differently here in Guatemala, as compared to elsewhere: not so much with the palms, as patted out with the fingers.  So, when women show up on screening day with a contracture in one of their hands from a burn, or a cut, or whatever horrid thing has happened to them and won’t let them open their hand all the way, and our hand surgeon asks them what the matter is, they say: No puedo tortillar–I can’t make tortillas–while making a characteristic slapping-your-fingers-together-while-turning-your-hands-over motion.

Here’s a short video that shows you how a Guatemalan woman makes tortillas.  Like 70% of the country, she’s Mayan.  There are a bunch of things to notice in the clip:

  • When the video starts, the language that you’re hearing is one of the 20-22 different Mayan languages spoken in Guatemala.  (There are some more spoken in Mexico.)
  • The women are wearing the traditional clothing of their village.  Mayan women most definitely do still wear the traditional clothing, every single day.  Choosing not to wear it makes a huge statement about your personal identity and affiliation, and the waiting rooms of the hospital where we do our thing are jammed with people in this kind of clothing.  I’ll point out that every village has its pattern of dress, apron, and huipil (the shirt that the ladies are wearing), and leave it at that.
  • The lady is cooking over an open fire.  Super-common here, and I haven’t yet been here without a few people showing up on screening day to show us their burn-scar-contracted hands.
  • The American speaking crappy Spanish.  One of the main industries of the town that we’re in is intensive Spanish lessons.
  • The lady’s hands are wide open, and fingers are flat–with a contraction like the one that you see above, she couldn’t do it.
  • At about 1:05, the verb tortillar. 

Tortillar is an interesting little verb (at least if you’re the kind of person who gets excited about verbs).  As far as I can tell, it doesn’t exist anywhere else.  Here’s where I looked:

  •, which has an amazingly complete on-line dictionary.  No luck.
  • The Bantam New College Spanish and English Dictionary, which is by no means huge, but has excellent coverage of Central American Spanish.  (If you’re an American, and therefore don’t know where Guatemala is: it’s in Central America.)  Also no luck.
  • Google, through which I found a number of blog posts written by people who ran across the word while travelling this part of the world, but no evidence that the word exists anywhere else.
  • (I did find a French dictionary of the natural sciences from 1845 that lists the word as the common name of some species of Orme with a tall trunk and small leaves.  I have no clue what an Orme is.)

What the verb tortillar means: to make tortillas.  It’s a nice example of a verb that comes from a noun–what’s called in linguistics a denominal verb.  We have lots of these in English–“bare” or “zero-derived” ones like to tango, to cash, to water; ones made with prefixes, like to defrost and to encage; and ones made with suffixes, like to victimize, to vaccinate, and to classify.  (Language geeks: yes, I am leaving out back-formation.  No hate mail, please.)

One of the interesting things about the process of making nouns of out verbs is that there is some systematicity to it–there are particular types of relationships that tend to exist between the original noun and the derived verb.  You might remember a post in which we talked about the particular kinds of relationships that exist between the nouns in compound nouns, like kitchen knife (knife that is used in a kitchen), bread knife (knife that is used to cut butter), and pocket knife (knife that is carried in a pocket).  In that post we talked about how the set of relationships between those nouns is limited, and about how trying to explain that set of relationships is a good example of the issue of falsifiability in scientific theories–if you can posit any old relationship on the basis of any particular compound noun that you happen to run across, then you have a theory that cannot, even in theory, ever be shown to be wrong (“falsified”).  That’s a theory that can’t actually be tested, and a theory that can’t be tested is a crappy theory.

How about verbs?  Carolyn Gottfurcht wrote a fascinating doctoral dissertation on the subject of denominal verbs and the kinds of relationships that can exist between the original noun and the derived verb.  (All of the English verb examples in this post are from her dissertation.) She looked at 8,900 English verbs and found that in that language, one of the most common relationships is what is called the resultative

The resultative relationship is especially relevant to us today, because that’s what the Guatemalan verb tortillar is based on.  The resultative relationship holds between a noun and a verb that is derived from that noun when doing the verb brings the noun into being.  For example:

  • to granulate: to cause something to exist as granules
  • to enslave: to cause someone to be a slave
  • to mummify: to cause someone to be a mummy
  • to summarize: to cause a summary to exist
  • to cripple: to cause someone to be a cripple

This is the kind of verb that tortillar is: to tortillar is to cause tortillas to exist.

Here’s the thing about causing tortillas to exist: if you’re a functioning Mayan woman, that’s one of the things that you do.  That’s not the only thing that you do–but, if you can’t do it, you can’t take care of your family.  So, when we talk about hand surgery being all about function: it’s about the function of the hand, sure.  But: it’s also about the function of the person

Like the rest of us Surgicorps volunteers, our hand surgeon donates his services, buys his own plane ticket, pays for his food and lodging, and contributes a week of hard-earned vacation.  The costs of the surgeries themselves–instruments, medications, dressing materials, anesthetic agents, pain medications, etc.–are covered by Surgicorps.  Surgicorps lives or dies on the basis of donations from nice folks like you.  Want to make a donation?  Click here.  $250 will pay for all of the costs of surgery for one patient.  $100 will pay for four surgical packs.  $25 will pay for a nice lunch for you–or one surgical pack for us.  $10 will pay for all of the Tylenol that we’ll send our patients home with all week–and, yes, we send our patients home with nothing stronger than Tylenol, in the vast majority of cases–or, it’ll buy you a latte and a scone.  I have nothing against lattes and scones–I’m a big fan of both–but, when you think about it from that perspective, how can you not click on this link and make a donation?

No French stuff today–back to the language of Molière on Monday.  Now, donate some money!  I’ll stop hitting you up for donations next week.


The next splint is here: metonymy and hand surgery in the Guatemalan highlands

The most important part of a surgical mission: it’s not actually the surgeons. Plus, here’s how you can be a hamburger in the corner.

Yesterday I was interpreting for our hand therapist. She was putting bilateral (this and other obscure English words discussed below) splints on a young man. (Some patient details changed to protect privacy.) “The next splint is here,” she said. Great, I thought, looking around—where? I’ll grab it for her. I didn’t see a splint, though. “Where is it?”, I asked her, somewhat puzzled. She watched me look around. “No—there’s someone else coming in to get a splint, and he’s here.” Ahah—metonymy. More on this later, but first, let’s talk about those splints—and that hand therapist.

I’m in Guatemala at the moment, with a group called Surgicorps. We’re a team of all-volunteer surgeons, anesthesiologists, nurses, technicians, therapists, and assorted non-medical personnel, such as myself—I’m an interpreter. There are lots of groups like ours that come here to Guatemala—there’s an enormous need for surgical care, and not a lot of options for getting it for the very poor population that we serve.

What makes us special: among other things, it’s the fact that we have a hand surgeon. Hand surgery is a very specialized occupation—in the course of learning his trade, our hand surgeon did fellowships in both plastic surgery and orthopedics. A fellowship is about five years, and that’s on top of four years of college, four years of medical school, and a three-year residency—so, these guys are hard to come by.

As specialized and as in short supply as the hand surgeons of the world are, there’s another profession that’s even harder to find an expert in: hand therapists. Hand therapy is a subfield of occupational therapy, which is the art and science of teaching people how to function normally after things like strokes, heart attacks, and amputations. The other day, one of the physicians said to me: The first time I went on one of these missions, I heard that we had a hand therapist with us, and I thought: why the hell do we need one of those? What could she possibly do on a surgical trip? Then I saw her working, and I realized: she’s more important than the physicians.

Almost every kind of hand surgery requires some kind of splinting afterwards, and it’s to the extent that the splinting is or isn’t successful that the surgery is or isn’t successful. For example: an operation that our hand surgeon does here quite frequently is repairing something called syndactyly. Syndactyly is a condition in which fingers don’t separate from each other during development in the womb. It’s ruinous here in Guatemala, where most people’s educational opportunities are nil, and the only option for earning a living for most people is manual labor.

syndactyly 7232340_orig
Syndactyly. Picture source;

Our hand surgeon can undo the syndactyly. Typically what happens in syndactyly is that the genes that should cause the tissue between the fingers in the fetal hand to reabsorb don’t work right, and what the surgeon does is to cut that tissue away, and then graft some skin between the fingers. (I’m simplifying the description of the surgery!) Once that surgery is done, though, those fingers have to be kept apart for several months. Otherwise, the fingers will re-fuse. How you keep that from happening: a hand therapist builds you a special kind of splint. These have to be made to order after the surgery, as they have to fit the individual child very well, and they have to fit that child when he has bandages on his fingers after the surgery. (That’s why you can’t do it before the surgery.)

A custom-made splint. Imagine trying to mold that on a toddler who is scared, nauseous, doesn’t speak the same language as you, and thrashing around while screaming for mama at the top of his lungs. Picture source:

The surgery to repair syndactyly is usually done when a child is small. So, here’s what it’s like to fit one of those custom-made splints after surgery: you’ve got a little kid. The kid is coming out from under anesthesia and is disoriented, nauseous, surrounded by funny-looking people speaking a language that he can’t understand—and he’s scared shitless. So, you’re trying to build a very precisely-sized splint for a kid whose hand you need to fit it to—while he cries, and screams, and tries to pull his arm away from you, and tries to make a little fist while you’re trying to get things between his fingers. Add to the mix the fact that the splint is made from a kind of epoxy that is rigid when cool, and flexible when heated. You heat it up, then take it over to the kid and try to mold it to the right size while he cries, and screams, and tries to pull his arm away from you, and tries to make a little fist while you’re trying to fit it between his fingers. The resin cools down while you’re trying to do your thing, and then it won’t bend any more? Tough shit—go back to your heat source, heat it up again, and then try again.

So: the surgery doesn’t work without a good hand therapist. Being a hand therapist is a difficult job to do, and it’s hard to find places to learn to do it, and in addition to having considerable technical skills in order to make the splints correctly, you need to be able to do it under very adverse conditions, and to keep your cool while you’re doing it. Indeed, it’s the hand therapist that is the key to our mission.  We can replace a surgeon, or an anesthesiologist, or a nurse—or an interpreter—but a good hand therapist is hard to come by.

cerebral palsy index
Kids with cerebral palsy. Picture source:

So, back to the young man and “the next splint:” he has cerebral palsy. This means that he has essentially no control over his muscles whatsoever. They twitch, and cramp, and they make his hands clench into useless fists that can’t be opened. He can’t speak.  He can’t nod his head “yes,” or shake it “no.”  Our hand therapist was making splints for the young man that would keep his hands open for half of the day. If they can stay open, he will be able to grasp things. This is a smart teenager who can’t hold so much as a pencil—having hands that function even a little bit would be life-changing for him. Can the hand surgeon make this happen? No—it’s only the hand therapist who can give him that new capacity, one that you and I probably never even think about.

So, “the next splint is here:” this is an example of a phenomenon called metonymy. Metonymy is the process of referring to something by one of its attributes. For example:

  • The hamburger in the corner is a slob and needs more napkins. Meaning: the person who is eating a hamburger and is in the corner is a slob, etc.
  • Would you ask if the right front flat in bay two is also supposed to get an oil change? Meaning: there’s a car that has a right front flat in bay two, and I need to know if it’s also supposed to get an oil change.

This is a different phenomenon from metaphor, in which we refer to something as something else entirely—love is a river, life is a journey, for example—as opposed to referring to it by some attribute that it has—the hamburger that the sloppy customer has, or the flat tire that the car has, or whatever. Metonymy is a super-common phenomenon in language that lets us take advantage of context in the course of communication—and not just linguistic context, but what you could think of as “world” context, and from a theoretical point of view, that’s pretty interesting, for the following reason.  Most linguistic theories are entirely about language and its structure (I’m simplifying here—if you’re a sociolinguist, please don’t send me hate mail), and if you need to incorporate the world into your theory about how language works, that’s quite a challenge. Being context-dependent, it also requires that both the speaker and the hearer know what that context is—I didn’t know that the therapist had another patient scheduled, so I totally misunderstood her statement, thinking that she was referring to an actual splint, not to a person who was going to receive a splint.

Hand contracture in cerebral palsy. Picture source:

Back to the kid again: he went home happy, him and his mother hopeful that next year his hands will be more functional. We’re talking about a kid who is super-happy to be spending his days in a wheelchair, because it means that he’s not spending his days in bed. (How’s your day going, dear reader?)  If he gets some improvement over the course of this year, then when we come back with a hand therapist again next year, he can improve even more with another splint. Someday he might be able to hold a pencil and use writing to get all of the stuff that’s in his head out of it, like I do—he sure as hell isn’t ever going to be able to speak.

Courtney IMG_1910
Courtney Retzer Vargo, PhD, checking a splint.

Here’s the thing: if there’s no Surgicorps, then there’s no hand therapist, and there’s no hope for functional hands for that kid—a teenager with a fully functional mind and not a lot of physical abilities.  (OK: no physical abilities.)  One of our hand therapists is Courtney Retzer Vargo.  Courtney has a PhD in occupational therapy, two kids, a hot husband, and a busy job in the United States.  But, every so often she burns up a week of her hard-earned vacation time and flies to Guatemala or Zambia to volunteer a week of her time doing exactly this.  Like all of us in Surgicorps, she buys her own plane ticket, pays for her own food and lodging–contributes a week of hard-earned vacation time. Surgicorps pays for all of the costs of the patients’ treatments, and Surgicorps lives or dies on the basis of donations from nice people like you. Click on this link, and making a donation will take you less than 5 minutes. $250 will pay all surgical costs for one patient, or the expenses for transportation and lodging for a patient and their parent during the period of the surgery. (See this post for what that trip is like, and why they need us to put them up.) $100 will pay for four surgical packs. $10 will pay for all of the Tylenol that we’ll send our patients home with this week—and, yes, our patients go home with nothing stronger than that. Do it—if you don’t feel better about life immediately, I’ll give you your money back—and you know where I live!

English notes:

  • Bilateral: on both sides. Bilateral symmetry is one of the most common features of multi-celled animals. How it was used in the post: She was putting bilateral splints on a young man.
  • To be hard to come by: to be difficult to obtain. During a famine, there actually is usually food, but it’s very expensive and hard to come by. How it was used in the post: Indeed, it’s the hand therapist that is the key to our mission—we can replace a surgeon, or an anesthesiologist, or a nurse—or an interpreter—but a good hand therapist is hard to come by.
  • Physician: a somewhat technical or formal term for doctor, and specifically, a medical doctor. Non-health-care people don’t use it very often, but health care professionals use it frequently—especially doctors. 🙂  How it was used in the post: The other day, one of the physicians said to me: The first time I went on one of these missions, I heard that we had a hand therapist with us, and I thought: why the hell do we need one of those?  What could she possibly do on a surgical trip?  Then I saw her working, and I realized: she’s more important than the doctors.

Spanish notes:

  • Férula or tablilla: a splint. I’ve noticed over the course of the past four years that some people know one word, some people know the other, and many, many of them don’t know either. In that case, I ask the therapist if I can tell the patient that a férula is a piece of hard plastic that will keep their fingers apart/fist from closing/wrist from moving/whatever.

French notes:

  • une attelle: a splint. I think there’s also a word une éclisse, but I haven’t been able to verify that one.



Life isn’t cheap here, but sometimes things go to sh…: consecutive and simultaneous interpretation

Writing from Guatemala in the 1980s, Jonathan Maslow said that it is not true, as is often said, that life is cheap in Central America, but it is true that life is briefer there, and so takes place faster. I thought about this yesterday when a conversation went completely to shit. (I was talking about this with one of the anesthesiologists today. “It went completely to pieces,” I said. “Kevin, you can say it went to shit,” she said. This and other obscure English expressions discussed at the end of the post.)

There are two basic kinds of interpretation, known as consecutive interpretation and simultaneous interpretation. In consecutive interpretation, the person for whom you are interpreting says something, and when they stop, you repeat it.   In simultaneous interpretation, the person for whom you are interpreting speaks without any pause other than their normal ones, and you repeat what they said immediately, essentially phrase by phrase.

Each form of interpretation has its advantages and disadvantages. I’ll summarize them:

  Consecutive interpretation Simultaneous interpretation
Plusses ·      Much easier with some language pairs

·      Easier for bilinguals to listen to

·      Obligatory in “double interpretation” situations (see below)

·      Greater accuracy

·      Required in legal situations, where both languages are recorded

·      Faster—as little as half the time of consecutive

·      Better provider/patient contact

·      Obligatory in certain situations: multilingual (more than two languages), speeches, conferences, and live media

Minusses ·      Slower (see below for how you can make it less slow) ·      Sometimes harder for bilinguals

·      More difficult—special training required

·      Interpreter can’t clarify without interrupting

·      In many situations, requires two interpreters

A number of these are relevant to interpreting for Surgicorps, the group with which I’ve come to Guatemala. Here are some specifics:

  • “Double interpretation” refers to a situation where the interpreter and the person who speaks the “target language” don’t share a language. This happens on occasion here, and the solution is “double interpretation:” the health care provider speaks in English, the interpreter speaks in Spanish to a second person who speaks Spanish and one of the many indigenous languages, and then that person speaks to the patient in the language that they share—then it goes back in the other direction. This kind of situation has to be handled with consecutive interpretation. (I had a double interpretation situation on screening day. The gentleman who was doing the Spanish <-> indigenous language interpretation had no teeth, and it was a challenge to understand him, even for me.)
  • How you can help with the relative slowness of consecutive interpretation if you’re a health care provider: use shorter sentences. If you use long sentences, professional interpreters will often write down notes while you speak. The shorter your sentences, the less need there is for note-taking on the part of the interpreter.

How this all became relevant yesterday: I was interpreting between one of the Surgicorps people and one of the Guatemalan staff. The Surgicorps person was anticipating the end of the local nurse’s sentences while I was still repeating them, and responding in English. So, now I’m speaking a sentence that I’m having to remember in Spanish so that I can interpret it in the Spanish -> English direction, while someone is speaking to me in English. This is the kind of context in which you need two interpreters because you’re basically doing simultaneous interpretation instead of consecutive interpretation: this is the kind of situation where everything immediately goes to shit.

…and that’s when I thought about Maslow on Central America: life is briefer there, and so takes place faster. No problem: the other thing about Central America is that people here know how to make things work in suboptimal conditions. Ask everyone to stop, tell them that you’re having trouble and why, and people will do their best to accommodate—the Americans, as well as the Guatemalans. As is almost always the case: communicate what you need, because the only way to guarantee that you won’t get it is to not tell people what it is.

How about helping our work in Guatemala?  Surgicorps provides free surgical care to people who cannot afford it.  We pay for all of our patients’ costs through the generous donations of the kind of person who would read a blog like this.  Click here to donate–I’m the funny-looking bald guy. 

English notes here—French and Spanish vocabulary below:

  • Life is cheap: a delightfully ambiguous expression. The most common interpretation: it’s a way of saying that life is not valued. That’s not to say that people don’t value their own lives, but more that the society doesn’t, in general, value people’s lives. That’s the sense in which it is used in the Maslow quote: it is not true, as is often said, that life is cheap in Central America, but it is true that life is briefer there, and so takes place faster. The other possible interpretation is the more obvious, but the much less common one: it is inexpensive to live. For example: life is cheap in Benin—I think a nice apartment is maybe $50 a month. From the context, it will probably be clear which is which; in case of doubt, the default interpretation is the “life is not valued” one.
  • to go to pieces or to go to shit: for a situation to suddenly start going very badly, for things to stop working. To go to pieces is acceptable in pretty much any social context, but to go to shit is very casual and mildly obscene, and you should only use it with peers with whom you are very comfortable. Now: if you’re talking about a person, then to go to pieces (but not to go to shit) has a different meaning. It means something like to stop functioning, perhaps to start crying if you’re talking about an incident; or, if you’re talking about a chronic situation, not to cry, but to stop functioning normally in life. An example of the isolated incident version: I dropped her cell phone and the screen broke, and she completely went to pieces—locked herself in the bathroom and cried for maybe 15 minutes. The chronic one: After his wife died, he completely went to pieces—stopped showering, then stopped showing up for work, got fired, and ended up living with his daughter.

French notes:

  • merder: to go to shit, to get complicated.

Spanish notes:

  • embolismo: this word does not mean what it looks like—a false cognate. In Spanish it is basically a situation that has gone to shit. The word for “embolism” is embolia, e.g. una embolia cerebral, a cerebral embolism (a kind of stroke).  (The other kind of stroke is a derrame.)

Open domain, closed domain: what makes medical interpreting hard

What makes medical interpreting hard: it’s not what you think. Plus, the Uber driver from Hell.

guatemala camioneta tumblr_lywjcqtcme1r1ymoao1_5001
A camioneta in Guatemala. People routinely ride these things for 15 hours to bring us their kids for surgery. Picture credit: Fotografía obtenida de Así es mi Guatemala: Picture source:

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 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.  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.

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The sign marking the hand surgery screening area last year.  Picture source: me.

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.



Hold Infinity in the palm of your hand: Amniotic band syndrome

Amniotic band syndrome. Picture source: By Moscowmom – Own work, Public Domain,

To see a world in a Grain of Sand,
And a Heaven in a Wild Flower,
Hold Infinity in the palm of your hand,
And eternity in an hour.

William Blake

This is what your hand looks like if you’re born with amniotic band syndrome.  The thought is that it happens when there’s a partial rupture of the amniotic sack and the hand gets caught up in it.  It’s supposed to be purely mechanical.  But: amniotic band syndrome often co-occurs with other congenital anomalies that aren’t even possibly remotely mechanically related, such as cleft lip and cleft palate.  This leads to another theory about where amniotic band syndrome comes from, which is that it’s related to some kind of circulatory disorder that can affect both the digits and the developing palate.

In a region where people don’t typically get very much education and the most common way of supporting yourself is manual labor, a person who isn’t treated for this congenital defect can pretty easily find themselves in a life of poverty without an obvious way out.  That means a childhood of poverty for their kids, too.  That’s a lot of suffering.

You might be thinking: having amniotic band syndrome would suck, but there’s nothing that I can do about all of those little kids who are born with it.  I’m happy to tell you: that’s not true!

There’s a group called Surgicorps that goes to various and sundry places around the world to do free surgeries for the most destitute of the destitute.  There are lots of groups like that, but there’s something special about Surgicorps: they have a hand surgeon.  The goal of surgery for something like amniotic band syndrome is to restore function to the hand.  Doing this is difficult, and requires a lot of very specialized training–the Surgicorps hand surgeon did fellowships in both plastic surgery and orthopedics.  (For doctors, a fellowship is advanced training that you do after your residency if you want to develop very specialized skills.  A fellowship can easily be five years long, and that’s on top of four years of college, four years of medical, and a three-year residency.)

Where you fit into this: Surgicorps does its work entirely on the basis of donations.  The surgeons, anesthesiologists, nurses, technicians, interpreters (I’m one of them), and others all donate their time, pay for their own travel expenses, and pay for their lodging.  Surgicorps pays for all aspects of the patients’ treatment–the surgical equipment and supplies, housing for the parents while the kid is hospitalized afterwards, the anesthesia, medications–everything.  That money comes from charitable donations.

That’s where you come in!  In the days to come, I’m going to hit you up for a donation.  I’ll tell you more about what Surgicorps does, tell you about some of the people we treat (within the bounds of privacy), and try to give you a bit of the feel of what it’s like to be in Guatemala.

Language stuff: I work closely with our hand surgeon, which means that I need to know a lot of terms related to the kinds of feelings that you might have in your hands and fingers.  Here are some of those words, in English, Spanish, and of course French.  Scroll down past them for notes on the English in this post.  Spoiler alert: in the English section, I’ll be talking about the verb to cleave, the noun digit, and the idiom to come in.

English Spanish French
numb entumido, entumecido engourdi, insensible
sleepy/numb adormecido
itchy hormigoso qui démange, qui gratte
tingly corrientazo qui picote
  • cleft: this is the past participle of the super-interesting verb to cleave.  What’s cool about to cleave: it is its own opposite.  That is to say: it has two meanings, and they are each other’s opposites.  (Quotes from,,, Jewish Publication Society, and
    • One meaning of to cleave is to forcefully split something, or (intransitively) to split, especially along a natural line.  This is the origin of the name of the kind of heavy knife called a cleaver
      • One swallow does not make a summer, but one skein of geese, cleaving the murk of March thaw, is the Spring.  Aldo Leopold.
      • Hamlet thou has’t cleft my heart in twain.  Shakespeare, Hamlet.
      • I tend to foster drama via bleakness. If I want the reader to feel sympathy for a character, I cleave the character in half, on his birthday. And then it starts raining. And he’s made of sugar.  George Saunders. 
      • When I was at Babbo, I was covered in scars and scabs and burned bits – melted hair, ribbed burns I got reaching across the top of a hot skillet… I sliced off the tip of my finger. I cleaved my forehead – a deep, ugly wound. Luckily, it regenerated.  Bill Buford
      • Like Honeycrisp, SweeTango has much larger cells than other apples, and when you bite into it, the cells shatter rather than cleaving along the cell walls, as is the case with most popular apples. The bursting of the cells fills your mouth with juice. Chunks of SweeTango snap off in your mouth with a loud cracking sound.  John Seabrook.  (This is the intransitive use.)
        Cupid’s arrow, Hafiz’s heart tore and cleaved
        I see his verses, with their wet ink, bleed. 
        Khajeh Shamseddin Mohammad Hafiz Shirazi
    • The other meaning of to cleave is to stick to something.
      • Cleave to no faith when faith brings blood.  Arthur Miller, The crucible. 
      • She counted to ten as she had been taught when about to deliver a big speech, but when she tried to force some words of outrage from between her teeth her tongue clove to the roof of her mouth and the most she could do was make a small cry of protest deep in her throat. (British National Corpus.  Like that past tense?  J’adore!)
      • We all are originally sinners as Adam and in Adam, his leprosy cleaving faster to us than Naaman’s did to Gahazai, so that even the infant, before it has seen the light of the world, has this blemish inherent in its unborn members.  John Wycliffe.  (A little language/interpretation connection: Wycliffe Bible Translators, the biggest Bible-translating group in the world, is named after John Wycliffe.)
      • Therefore shall a man leave his father and his mother, and shall cleave unto his wife, and they shall be one flesh.  God, Genesis 2:24.
         תִּדְבַּק-לְשׁוֹנִי, לְחִכִּי–    אִם-לֹא אֶזְכְּרֵכִי: Let my tongue cleave to the roof of my mouth, if I remember thee not.  Psalms 137:6.
    • I ran into this example in the British National Corpus, and I have no idea whatsoever what it means: The horse shied a little and the butt cleaved into the side of my head, almost taking my ear off.
  • digit: you know that this can mean a number, but it can also mean a finger or toe.  From the post: This leads to another theory about where amniotic band syndrome comes from, which is that it’s related to some kind of circulatory disorder that can affect both the digits and the developing palate.
    • Painful, rapidly growing tumor in the subungual area of the first digit of the right hand.  Perelló-Alzamora et al.
    • Surgical amputation of the digit: an investigation into the technical variations among hand surgeons.  Li et al.
  • to come in: this idiom has a few meanings.  Here’s the definition for the way that I used it, from Merriam-Webster: to assume a role or function <that’s where you come in> From the post: That’s where you come in!  In the days to come, I’m going to hit you up for a donation.