It happens to me often. A nurse, a patient, or a member of the transport team catches my eye and smiles widely in recognition.
“I know you! Where do I know you from?”
After giving them the benefit of the doubt and scanning their eager, friendly faces through my mental database of friends and family, I shrug. “I’m not sure. Maybe I remind you of someone?”
Their expression begins to cloud with uncertainty as the exclamation points in both eyes slowly curve into question marks. “Maybe… yes, that must be it. You just look so familiar.”
And then I deliver my standard line, grinning conspiratorially to take the edge off the situation. “It is the generic face!”
“No really, I have a generic face. Apparently, when you mix enough races together, you look familiar to everyone. It is pretty awesome. I blend in anywhere and I get to meet new people like you…”
They fill in their name, and we begin to talk. Invariably, we find something or someone in common to make the awkwardness turn into satisfaction. We part ways and I continue on until my face catches another stranger’s attention.
My face. Exotic, with its Asian eyes, German chin, and other features far less traceable, it is also paradoxically…universal. Even my name, Sara, is one of the most ubiquitous, unplaceable names worldwide. I hated this contradictory belonging and not belonging as a child. Tall with strong, expansive hips and shoulders, I never fit in with my Asian friends. I did not go to Chinese school every Sunday, and I certainly did not get any red pocket money on New Year’s. My Caucasian friends, on the other hand, pegged me as “the ethnic one.” I constantly fielded questions such as “Is this culturally offensive?” and “Why do Chinese people not like Japan?”—queries I felt completely unequipped to answer.
As I became a little older, though, I began to see the perks of the situation. In addition to being continually “recognized,” my appearance also let me blend in. I could travel and usually avoid being identified as a tourist. I could walk into parties or clubs and look familiar enough to escape questioning. And people of all ethnicities loved to pull me aside and guess where I was from, with speculations ranging from Alaska to Argentina.
Growing up in Texas, I was most commonly mistaken for Latina. After years of being approached by flustered tourists and chatty customers and understanding nothing of their rapid fire Spanish except for hola and por favor, I realized that I had to learn this language. My face demanded it of me.
On arriving at medical school, I could not have been more thankful for my face and mi otra lengua. As I entered a patient’s room, I could see the hope spread in their eyes when they saw my thick brown hair, caramel skin, and black eyes. Then, as I began speaking my passable Spanish, their hope morphed into relief. My appearance was my ticket in and my Spanish saved me a seat. In my position as a medical student, insecurity and fear of incompetence were constant daily battles. However, I had two secret weapons guaranteed to shorten the time I spent taking my histories and win points with my English-only residents and attendings. I could communicate with these patients. I was useful.
Until I began my psychiatry rotation. As I sat down with my first Spanish-speaking patient in the tiny “interrogation room,” I felt exposed and helpless. My introduction had gone well, but I soon realized that my nicely accented greeting promised more than my limited vocabulary could deliver. I could ask about sore throats and bowel movements. I could even screen for depression. But how was I supposed to ask about expansive mood? The interview progressed, and I floundered more and more. I understood the literal meaning of most of the words my patient was urgently, desperately firing in my direction, but not their meaning. Now they were being used in a different context and had nuances that I was never taught in AP Spanish.
Flustered, I finally called for a translator. Within 20 minutes, the interview was over. I had the answers to my questions. But as I looked into my patient’s eyes, brimming with real or projected disappointment, I felt like I had failed. Instead of expressing recognition or relief, he looked resigned.
The next day, and several English-speaking patients later, I felt much better. Scanning the board for a new patient, I stopped short. Alvarez, Maria. To be seen. My tachycardia must have sent pressure waves across the room.
“Bring a translator. No one else speaks Spanish,” my resident pointed out. “She’s already been waiting 4 hours to be seen. It is a postpartum psychosis. She thinks she’s a wolf and she’s supposed to eat her baby.”
I took a deep breath and considered my choices. I could call the translator and get a brief, perfunctory history. Or I could confront my uncertainties and make it work. I already knew that I wanted to be a psychiatrist. Learning how to conduct an interview in Spanish would be an invaluable tool to add to my chest. So I took a deep breath and called her name.
Within 15 minutes, though, I was at a familiar standstill with the beautiful Colombian woman sitting cross-legged in front of me. So far, I had gathered that she was 25 years old and 1 month postpartum from her first child. Her husband had dropped her off at the emergency room after she disclosed thoughts of killing her baby. No past psychiatric history. No past medical history. No medications. I exhausted my rote list of standard questions and then fell quiet.
She gazed down at her thin blue hospital gown and picked at its fraying edges. Her hair fell in front of her face down to her waist. It was the same length as mine, although I had tucked mine into a tight bun. In another world, we could have been cousins. So far, though, she had not even raised her eyes. Grasping for a connection, I asked the simplest question I could think of:
“What is your baby’s name?”
Suddenly, I was confronted with the most intense eye contact I had ever experienced. Tears spilled over her heavily fringed lower lid, and her rapid blinking was the only thing that interrupted her stare. In a strangulated voice barely over a whisper she responded, “Angel.”
“What a pretty name!” I said, pausing a moment before carefully continuing, “What do you feel when you say his name?”
“Guilt. I feel guilt. I cannot allow myself to say his name. I am too bad, too horrible.”
“Why horrible? You take good care of your baby.”
She looked at me as if I should have been the one in the gown. “I am a wolf.”
“You think you are a wolf?” Hope permeated my body. Now we were headed in the right direction
“Yes, I am a wolf. I am a wolf and I am a little girl at the same time. The wolf says, ‘Attack Angel!’ and the little girl screams, ‘No, no!’” She gestured wildly with this admission, alternately baring her teeth like a wolf and clutching her hands to her chest like a frightened child.
I tried to elicit more details. Did she think she was an actual wolf? Did she see a wolf in front of us now? Did the wolf speak from outside her body and tell her to do things?
She grew impatient. “No, no, the wolf is like… he is like… my terror!”
I felt stunned. “When I asked you if you were anxious before, you said no.”
“No… listen to me. I am not anxious. Anxiety is something I control. I am not anxious now. I am terrified.”
“Are you terrified the wolf will win?”
Her face closed up again. “I do not know. But if the wolf gets any stronger, I’ll kill him.”
“I’ll kill myself.” She saw my face and shook her head. “You asked me before if I wanted to kill myself. Of course not. I do not want to kill myself, but I will if I can protect Angel.”
“So you do not want to kill Angel?”
She shook her head violently. “No. I never wanted to kill Angel. It is that sometimes I get so scared that I think I might hurt him.”
My differential diagnosis began to swing widely. Gradually, her responses to my questions turned from frustrated head shakes to emphatic nods and confirmatory outbursts. She told me that the wolf came on in episodes, making her heartbeat wildly and her arms feel wooden and mechanical. At the peak of her fear, she began imagining the most terrible things that could happen to her, and the worst thing that she had thought of so far was taking her own child’s life. The image of herself striking her baby haunted her constantly now, even when her wolf was not present. She would not let herself leave the house with the baby and refused to care for him without a chaperone present. Her fear was ruining her marriage, her life.
After presenting her case to my astonished resident, I returned to her bedside. She watched me approach, smiling—albeit weakly—for the first time. As I explained our impression and plan for outpatient medication and cognitive behavior therapy, she looked me in the eye, following every word.
When I had finished and answered her questions, she took my hands in hers
“Gracias por todo, mi Sarita. I am happy to call you my little sister.”
I laughed a little. “That is so nice of you, but I’m not actually Latina.”
The head shake came back. “I’m not talking about your race. Of course you are not Latina. With that accent?” She laughed at me, but then pulled herself together and continued in a serious tone. “I have talked to my real family, friends from Colombia, even my regular doctor, who is from Mexico. But you are the one who has spoken to me in my language and tried to understand what I have said back to you. For that, you are my family.”
Although I like to think of my face as my entry pass and my camouflage, I knew that this time it was not my Aztec cheekbones or skill at Spanish conjugation that had gained me Maria’s trust. With patients, a ticket and seat on the bus may get me to a destination. But it is the scenery, the pit stops, and the detours along the way that give the journey accuracy, art, and joy. I realized that speaking her language alone was not communicating. It took something deeper—a curiosity and a desire to understand her unique story and her individual truth. Only by accepting this could I finally truly hear Maria.