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We Are Failing At Accessibility in The OR
Last week I mentioned the “spinal tap” that I had on Thursday, and how many I’ve had this past year. What I didn’t fully divulge- though I will be writing a tempered Instagram post about it in the future- is what happened in terms of accessibility.
The short version of the story is that interpreter who showed up (though enormously kind and warm as a person) was not capable of providing fast language access in the OR. I won’t go too into details, but basically, it’s as if someone who knew Language 101 came to interpret for a fast, important, sterile procedure, in which the patient obviously wants and needs and deserves full understanding of what’s going on, quickly and properly. It is horrifying to think that the Deaf population continues to have interpreters who aren’t versed enough in the language to make things equal. Scary, dangerous, tiring.
Physicians obviously assume I am getting everything that they’re saying, and there is very little “check in” with the patient along the way. It’s up to the patient, of course, to advocate for themselves, but this is tough for some who might not have a support system around, might be feeling extremely poorly, or might not even realize that what’s being signed is not the depth of what’s being said (I had the advantage of a hearing husband with me, and a constant master study in body language on my side). Not everyone has these advantages or time.
But that is not why I’m writing this post. What I’m really writing about is: How can we design healthcare so that it factors in as many populations as possible?
Once in the OR, I had to lay with my face down against the mattress for large portions (so I could not see the new VRI interpreter I requested, on a small screen to the side), unable to of course hear, either visually or physically. I had to hold perfectly still and could not move my hands. Now, as a speaking Deaf woman, I can use my voice if I need help… but what if I wasn’t? What about the Deaf populace who literally would feel strapped to a gurney, unable to communicate or see communication in the room, just waiting without warning for a needle to enter their back.
Can you imagine that? Put yourself in that situation and think about that for a second… Wouldn’t you wish we could slow the system down for two seconds, and accommodate someone’s communication and safety needs to befit more than just a hearing (or sighted, etc) environment?
I don’t have any fixes or lessons or closing arguments, honestly. I just wanted to ask you all to put yourselves in those shoes for the day, and then remark on how that would feel, or if you feel we should think about these things more often. Thoughts? Feelings? I so appreciate this empathy exercise!
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4 Replies
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It would feel claustrophobic and I guess in that situation I would completely surrender to find peace of mind and some relaxation.
I think afterwards I would draft a proposal with sort of a protocol for a better procedure and try to discuss this with the hospital care manager to improve things for the future. Things can and have to be learned from your experience. -
I’m a physician and have done “spinal taps” in a fluoroscopy suite, similar to an OR, on a large number of occasions. they are usually done in a procedure room, or if there is a real need, in the OR.
I was also injured while serving in the U.S. Army Medical Corps, suffering a spinal cord injury. I’ve had lumbar punctures done on myself on a number of occasions. My wife had an “epidural” when she had my son, which involves a lumbar puncture.
I’m sorry that you feel unheard and I understand anxiety regarding procedures, ESPECIALLY when someone is doing something involving your spinal canal.
Regarding the lack of warning during the procedure, notice that the the doctor’s fingers localize the proper location between vertebrae and the patient prior to placing the needle. A suggestion: you could ask the doctor to have an assistant give you a tactile reminder (tap your hand several times or something) right before s/he enters with the needle, without violating sterile conditions.
There really isn’t a danger to a lumbar puncture/LP, previously referred to as a spinal tap. They’re entering well below the level of the spinal cord, and the risk of damage to a nerve is very low, again because of the location of the procedure. Some physicians overemphasize the minimal risk because of fears about medical malpractice. if the physician or nurse who obtains informed consent doesn’t tell you all this, I apologize for them.
Actual communication while doing the procedure is rarely needed. the procedure is routinely done on newborns with a fever, to rule out meningitis. Spanish-speaking only (SSO) patients did not require interpreters for this procedure where I did them in El Paso. Maybe that was a mistake, but as long as we explained what was going to happen before hand, they were comfortable with it. And I understood some basic Spanish words like stop, pain, no, wait, etc.
I would insist that an interpreter be nearby after the procedure is done to communicate any postprocedural symptoms. like the postprocedural headache.
Just talk to any physician who performs this procedure and they will verify everything that I’m saying.
And in terms of an interpreter for deaf people in a medical setting, not many deaf individuals have proper training in medical terminology. That’s something you need to address directly with the hospital. As you’re well aware, it’s an ADA issue. The hospital may need to use a different deaf person interpreterservice… Or this individual needs additional training from the service that employs her.
If I recall correctly from an earlier post, you mentioned that you have serious anxiety related to work situations also. There’s treatment for severe anxiety that most people would consider to be somewhat excessive. And while I’m not attempting to diagnose you, OCD is an anxiety disorder.
And OCD is actually much more common in persons with chronic medical disorders like CF. My son has CF and seems to be developing some anxiety issues too.
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Bailey, wow. My initial reaction to this is one of frustration because this shouldn’t be an issue. We should be doing so much better. *Sigh*
As I imagined myself in your position, I could feel my anxiety creeping in. I am someone who wants to know all the details — what’s happening, what I might feel, what happens next. For instance, my ENT is always so good to vocalize his actions, although it’s not necessary that he do so and maybe it’s something he doesn’t even like to do. He’ll say things like, “Are you ready? You should feel pressure, not pain. Now this spot is a bit tight, so more pressure. Now I’m going to look at this area.” I appreciate this so much! When I know what to expect, my mind is so much more at ease. I am grateful for the doctors who do this kind of thing for me (my ENT isn’t the only one, just the first who came to mind).
I can’t imagine being cut off from all communication during a procedure, especially a procedure like the one you had! I am so sorry you experienced this, and I’m horrified to think of how often things like this must happen. Thank you for bringing this up and for calling our attention to an aspect of care that we might not otherwise even think of.
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My apologies. I rely primarily upon voice recognition to “type” and made a blunder.
Did not mean to say “not many deaf INDIVIDUALS have proper training in medical terminology”.
Should’ve read… not many deaf INTERPRETERS have proper training in medical terminology, not deaf individuals”. (I know that you do by this point in your life.)
I really should proofread better.
Total respect for the soldiers I served while in the Army! It was my honor every day to take care of them.
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