Lost in Translation

Amira had worked as a medical interpreter for six years, and she had learned that the most dangerous misunderstandings were not the obvious ones. When a patient and a doctor clearly didn’t understand each other, everyone slowed down and checked. It was when they thought they understood each other that things went wrong.

That Thursday, she was called to the cardiology department to interpret for Mr Haddad, a seventy-eight-year-old man who had moved from Lebanon to live with his daughter. His daughter usually came to his appointments, but today she was at work.

The doctor, Dr Fischer, was efficient and friendly but clearly under pressure. She had a waiting room full of patients and was already forty minutes behind. She asked her questions quickly, and Amira translated them into Arabic just as quickly.

“Are you taking your new medication?”

“Yes,” said Mr Haddad. “Every day.”

“Any chest pain?”

“No, no pain.”

“Shortness of breath?”

“A little, when I climb the stairs. But I am old.”

Dr Fischer nodded and typed. “Good. And are you taking the tablets with food, like I said?”

Mr Haddad smiled. “Of course. Every morning, I take one with my breakfast.”

“Excellent.” Dr Fischer was already reaching for her next patient’s notes. “Then we’ll increase the dose slightly and see you in three months.”

It all seemed perfectly normal. And yet something was bothering Amira. It was the word “one”. The prescription on Dr Fischer’s screen, which Amira could see from where she sat, said “twice daily”. The tablets were supposed to be taken morning and evening.

Amira hesitated. Her job was to interpret, not to give medical opinions. Interpreters were trained to be invisible, to say exactly what was said and nothing more. If she intervened, she might seem unprofessional. Dr Fischer might even be annoyed. Perhaps she was wrong. Perhaps the old man had simply chosen the wrong word.

But she had a nagging doubt, and over the years she had learned to trust it.

“Excuse me, doctor,” she said carefully. “As the interpreter, I’d like to check something to avoid a possible misunderstanding. May I ask Mr Haddad to clarify how many tablets he takes each day?”

Dr Fischer looked up, surprised, then nodded.

Amira asked the question in Arabic. Mr Haddad looked puzzled. “One,” he said. “In the morning. The pharmacist gave me a box. I take one tablet a day.” He went into his bag and brought out the box. The label on it was in English, and it said “Take ONE tablet TWICE a day”.

For the past two months, Mr Haddad had been taking exactly half of his medication. He had understood “one tablet” perfectly well. He simply hadn’t understood “twice”, because his daughter, who normally read the instructions to him, had been abroad when the prescription arrived. He had assumed that one tablet meant one a day.

His breathlessness on the stairs, which everyone had attributed to his age, was probably because his heart wasn’t getting enough treatment.

Dr Fischer was silent for a moment. Then she took off her glasses and rubbed her eyes. “I was about to double the dose,” she said quietly. “Based on what I thought he was already taking.” She turned to Amira. “Thank you. Really.”

They spent the next twenty minutes, despite the waiting room, going through every one of Mr Haddad’s medications. Amira translated the labels, and the doctor wrote clear instructions in both languages. They arranged for a pharmacist to call his daughter.

On her way out, Mr Haddad held Amira’s hand for a moment. “You listen,” he said in Arabic. “Not only to the words.”

That evening, Amira wrote a short report for the hospital’s interpreting service. She suggested that interpreters should always be allowed to check numbers, doses and dates, even if it slowed things down. Two months later, the suggestion became part of the official guidelines. It had a long title, but among the interpreters, it quickly became known as “the Haddad rule”.