Lost in translation

Issue: BCMJ, vol. 52 , No. 1 , January February 2010 , Pages 11 MDs To Be

Switzerland offers fertile ground for medical students to practise medicine … and languages

It was June 2008. I had finished my last clinical exam and was on the way to Zurich, Switzerland, the country where I had lived for the 4 years prior to matriculating into medical school. I had the special privilege of learning how a hospital was managed in a European country. It was a surgical rotation with 1 week being spent on a different subspecialty. 

First up was urology. Although I had a very basic command of Swiss German, I had not yet learned how to say, “Mr Meyer, this part of the physical exam requires me to palpate your prostate.” The power of full body demonstrations on one’s self, however, can be instrumental in conveying an idea. 

The second station was general surgery. I was advised by one of my colleagues to study well before entering the operating room. One of the chiefs of the department, whose name translates to “Cutter,” was known to intensely question medical students while simultaneously correcting their retracting technique. The terms inadequacy and helplessness still come to mind. Pimping, I recently learned, refers to the action of quizzing a student, resident, or fellow on relevant medical trivia.

“What are the top three risk factors for acute pancreatitis?” she shouted in Swiss German. I thought she was kindly asking the float nurse outside of the operating room to bring more sponges. Apparently, she was talking to the Canadian medical student situated right beside her. 

“Sorry, my German is not so good,” I responded in broken Swiss German. Switzerland has four official languages, and English is not one of them. I was certain that I dodged a bullet. She switched to fluent English. Successfully pimped. Although I will never, ever forget that alcohol, gallstones, and medications are the top three risk factors for acute pancreatitis, the Pavlovian phenomenon has always caused my heart to go into sinus tachycardia whenever asked this question. 

After touring through the other slices of surgical services such as orthopaedics and emergency trauma, I arrived to cardiac surgery for the grand humbling finale. It was Thursday afternoon and I had just finished lunch, a double espresso with a stick of Swiss chocolate. 

The telephone in my pocket had rung, which meant that the sternotomy was likely finished and that my mastered skill of spraying a fine mist at the ultrafine suture material was needed. This allows the surgeon to effectively graft the new blood vessel to the patient’s heart so that it can better perfuse previously starved regions and ultimately contract more efficiently.

One of the things that I appreciate most about surgery is the opportunity to work in team-oriented environments: anesthesiologists, surgeons, nurses, and technicians all functioning together to bring comparatively immediate improvements to patients’ lives. 

I had just arrived to operationssalle nummer acht (operating room 8). The technician had successfully harvested the saphenous vein, one of the frequently used vessels for coronary artery by­pass grafts, and passed it to the cardiac surgeon. “Bitte Inizieren” (please in­ject). The saphenous vein needs to be injected with a saline solution so that the surgeon can see where micro holes exist and close them with a small stapling device. This prevents the graft from leaking. Unfortunately, I had understood Bitte Ziehen (please pull). Like a good surgical clerk I followed instructions and started tugging on the vein that the technician had so carefully removed. 

“What are you doing?” the surgeon screamed. “This is cardiac surgery!” I was not sure what was happening as I had done everything that was asked of me. I stopped pulling the blood vessel. Thankfully it was not harmed in the ordeal and the patient successfully received a new graft. Surprisingly, though, the telephone in my pocket did not ring on Friday.

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Mr Malebranch is an MD candidate in the class of 2011 at the University of British Columbia.

A. Daniel Malebranche, MSc, MD,. Lost in translation. BCMJ, Vol. 52, No. 1, January, February, 2010, Page(s) 11 - MDs To Be.



Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

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