Part of being an outsider living in a foreign land is becoming accustomed to the feeling of groundlessness. Most days, I experience moments when I literally have no idea what is going on. It is beyond the expression “lost in translation” because I have no translation. I am just lost. Lost in a sea of foreign language, expressions, and cultural behaviors. The translation is entirely missing from the experience. I am lost without translation.
A realm of life in Belgium where I experience this treading of water with no buoy or raft in site is (to maintain the “sea” metaphor) has been through my navigation of the medical system.
Let me say start me saying that I have a deeply rooted disinclination to make phone calls. It is so pervasive that I tend to try to avoid spending time on the phone even with good friends. My own anxieties already make it challenging to consider making telephone calls. I will avoid making a call for as long as possible and will always, always look to see if I can send an email instead (even though a phone call tends to resolve any questions far more efficiently and quickly than the back and forth and easy-to-misinterpret written communication).
In a multilingual country, there is the additional challenge of being a student of a foreign language. When I first moved to Belgium, I would write out the vocabulary I needed to know in order to make a phone call. I would even explain to the person I was speaking with that French was not my mother tongue so I might need to ask them to repeat something or slow down. This seemed to work well and elicited an empathetic response from the voice of Oz on the other end of the line.
Even with repetition, I would often end a call with the vet or customer service representative at a medical institution and realize I had no idea what they had communicated. Sometimes, I had to call back (see previous note about extreme anxiety making phone calls to fill in the emotional blanks of this exercise). With time, I have learned to respond to the vet’s question at the end of the call, Ça va? (ok?) with, No. I am not sure I understand what you just said.
I have essentially explained to my inner critic to ease up so that I do not feel embarrassed if I have to call back or shame in saying when I do not follow something someone has said. There is no reason to be embarrassed. I am learning a foreign language. It’s a process.
I have also learned to allow the space and pause in a conversation in order to give my brain time to decide whether or not the meaning has been transmitted. Often, if I pause for a few seconds (before the panic sets in) I realize that I did actually understand what the person said. It has taken a lot (a lot) of practice and positive reinforcement to quiet my inner critic/voice of constant rebuke, and this just covers telephone calls not the actual visits.
I recently had an experience that pretty much broke the mold on being lost without translation. I found a lump in my left breast and of course freaked out. I first looked at my GP’s online schedule and saw it was booked for the next two days. With the weekend, that would mean waiting four days for an appointment, during which time my already quick to elevate anxiety levels would surely skyrocket. Cortisol levels off the charts. Bad things.
Without hesitating, I initiated a call to the clinic. They always answer in the Dutch because it is the clinic associated with the Flemish university where my husband is currently studying for his doctorate. I have found that I respond in English they instantly switch languages. The policy at this university for classes seems to be that if one person in the room does not speak Dutch everyone speaks English. Clearly, I am in Europe and not the United States.
I was rewarded for my courage in placing a phone call and given an appointment for the next morning at 11h15. That meant less than 24 hours of freaking out.
My experience at the university clinic is generally very positive. I like my doctor, and she speaks three languages, one of which is English. She didn’t think it was cancer but also thought I should schedule an ultrasound (echo in French) just to be sure. She offered to call and see if there was an appoint available en urgence (right away) to check for breast cancer, and I was relieved until it turned out there were no appointments available for another week.
She gave me the numbers for two other hospitals to call and also told me that if she suspected cancer she would have suggested that I go straight to the emergency room.
My husband met me after the appointment with a sandwich he picked up for a picnic. I was in a bit of a state. Even though there was likely nothing to worry about, I knew that I was not going to feel entirely at ease until I had definitive confirmation.
I called the first hospital and the call kept dropping most likely because I was walking away from a WiFi zone.
My husband suggested I wait until we were sitting somewhere and it was more calm.
No, I snapped back. I need to call now!
Ok, definitely operating from a heightened level of stress.
My very sweet husband did not get ruffled or upset and just walked beside me while I tried the call again after turning off WiFi.
No appointments until the end of September.
I could be dead by then, I said to my husband after ending the call. Then added, though of course that is not my intention.
I called the third and final hospital radiologie department and reached a representative who put me on hold. When the call reconnected another person answered, so I began my explanation a second time. I explained that I needed to make an appointment for an echo.
When the person asked me for what part of the body, I realized I did not know the French word for breast. I couldn’t even think of the word for chest or any way to even describe the general location of the area on my body.
She asked what was written on my prescription, and I explained that the prescription was written in Dutch. I tried to read the Dutch, and she said she didn’t speak Dutch.
This, in and of itself, was shocking because it seems like most people in Brussels speak at least some combination of two, if not three, languages. Dutch and English or French and English or all three. Then there are those insanely lucky individuals who were born to a Belgian parent and an Italian parent and spent part of their children in the United States. So they grew up speaking three languages and from there had no trouble learning four more.
Ok, I might be slightly exaggerating, but you get the idea.
I finally asked the representative if there was someone else who could help me book an appointment. She transferred me to an English speaker. In the meantime, my husband had looked up the word for breast, and I realized—too late—that the word the French speaker had suggested I might be referring to was indeed correct.
Eureka. The third hospital had an appointment for Tuesday morning. Still several days away but better than Thursday and much better than the end of September.
We sat and ate lunch, and my energy eventually settled. A group of women with exercise mats and small weights walked by and began an exercise class set to an interesting array of music spanning the 1980s to present. It was a juxtaposition, to be sure.
My stress level reached higher than normal and decided to live there until the following Tuesday. This meant that anything I did in the time between that would normally cause my anxiety to rise had an even more extreme impact. I had planned last minute to join a weekend Anusara yoga training, which I thought might be relaxing and help me to concentrate on something other than the possibility of cancer coursing through my body. The weekend did prove distracting in the best way, but the travel to and from was anxiety-inducing.
It’s all a practice, and for me a great part of the practice is to learn how to create grounding, calm, and freedom in moments when I feel tethered by the uncertainties of life, over which I often have little control.
My husband reminds me on a regular basis with beautifully wise, grounding phrases:
You are not in control.
Ride the wave.
You are already free.
They cannot hurt you.
Bless you, dear husband. Someday, I hope I can truly embody your wisdom and sage advice. For now, it is baby steps toward moksha, the Sanskrit word for freedom.
Tuesday finally dawned sunny and very hot and humid.
I did not bother to shower before leaving. In fact, I don’t think I even washed my face because I ran out of time before rushing to the bus. It had been super hot and humid for the past week, so I knew that the instant I left the house I would be dripping with sweat anyway and that the stress of waiting for my appointment would not reduce this tendency. And certainly, spending time on public transit during a heat wave does not improve anyone’s body odor. I can tell you this from experience. The metro does not smell better with an increase in temperature.
What this meant was that by the time I arrived at the hospital, I was experiencing a moment akin to what Janine Garofalo described in the movie “Reality Bites” when she said, “sometimes I get that not-so-fresh feeling.”
Since I am making pop culture references, I will add that my hair had taken on a frizzy state that was a kin to Monica‘s hair in the episode where all the “Friends” go to see Ross give his keynote speaker speech at a paleontology conference in Bermuda. Monica’s hair grew increasingly frizzy and expanded in volume over the course of the trip to the point where Chandler described it as “inexplicable.” Of course, unlike Monica I will definitely not be getting my hair plaited with beads because, no.
My journey to the hospital was relatively easy. There was one moment where Bus 17 pulled up to the Keym stop as Bus 41 was pulling away. Often the drivers will let people off in time to make the transfer, but this was not the case at this particular moment. When I first looked at the little screen with arrival times for each bus, it said 28 minutes until the next Bus 41 would arrive. My already elevated system went into full on alarm mode, and I definitely texted some expletives to my husband (my poor husband). It was only a moment later (after the initial freak out) that I remembered that the screen has to shift to show when the next two buses for each line will arrive. There is an earlier and a later bus. So once the screen shifted and I saw the next Bus 41 was actually in 12 minutes, I was able to resume breathing again.
I got off the bus, walked past all of the patients sitting or standing outside, smoking cigarettes. One old man was walking, cigarette in one hand and cane in the other, outfitted in the standard hospital gown.
Once inside, I was completely lost. I knew I needed to go to the -1 floor. In Europe, the ground floor (or what we could call the first floor in the United States) is generally called the zero floor.
I walked past the gift shop and saw one place where there were the little computers for signing in and people waiting in line. I walked up and saw a sign that told me to go down to the -1 floor and follow the 410 route for radiologie.
I walked past the gift shop and then went in (I was already nearly a half an hour early for my appointment). I looked at the fancy pajamas and stuffed animals. Did I really want a keepsake for this moment in my life?
I resumed the search for route 410.
The elevators were set against a very vivid and textured red wall. I pressed the button (there was just one button and no up or down arrows). Then I noticed a man opening a door that would lead to stairs and opted to walk, thereby avoiding the inevitable confusion over whether or not the elevator (if and when it arrived) would be traveling up or down.
Once downstairs, I opened the door to a narrow corridor and saw two signs: 400-450 and 450-500. There were no arrows pointing left or right, but I assumed that the placement was indicative of direction and decided to turn left.
A few feet (meters) to the left, and I entered a T where my corridor ended and another ran perpendicular. In this crossroads (Carrefour) I finally found the ever elusive route 410 signage, which pointed me to the right, through a set of double doors, and to a small waiting area.
From previous experiences at hospitals in both Belgium and France, I knew that it was often necessary to find the machine with little printed tickets before registering for my appointment. It’s similar to the system in the United States at a DMV for renewing driver’s license, registering cars, etc.
I went up to the machine, which had text only in Dutch, pressed the only button on it, and hoped for the best.
A small piece of paper with text and the number 321 appeared, and I took it and sat down. The number on the screen above was 319. Not bad.
As soon as I sat down, I looked around. There were several older women and a couple of older men, one of whom exhaled quite exuberantly every 10-20 seconds. I fumbled in my bag for my ear buds to continue the current episode of This American Life I had been listening to.
When my number was called, I brought my ticket to give to one of the two women behind the glass who were registering patients prior to their appointments.
She asked for my prescription, and I dug it out of my purse. Once I was signed in, she told me to sit in the space just before the double portes (double doors). I assumed that was the space where I ad already been waiting because it was indeed space beside the double doors I had originally passed through on my way in.
Time continued its never-ending passage. Ten minutes went by. Then 15. When 20 minute had passed I began to get nervous that I had not understood the registration person’s directions for where I was supposed to wait to be called in for my appointment.
I vacillated between staying where I was and going up to the windows to ask. I got up and went for a short walk around the general vicinity of where I had been sitting to see if there were other obvious double doors I might have missed. I returned to my seat and wavered a bit more. Finally, my concern that I might have somehow missed the appointment entirely won out over my desire to avoid talking to a stranger in a foreign language and potentially looking like an idiot.
It turned out (I was mostly sure) that I was indeed in the right waiting area. I still wasn’t 100% certain I was in the right place, but at this point I wasn’t willing to say once more that I hadn’t completely understand what the staff person said when she explained in French and pointed in the air to nowhere in particular. I also learned that while the original person I spoke with on the phone had scheduled my appointment for 2:10pm, this was not actually the time of my appointment. The way this hospital “worked,” you arrive at the time they tell you on the phone. Then you register. Then you wait 30 minutes for your appointment. So, all in all I waited just under an hour for my “real” appointment because I had already arrived 25 minutes before my “not real” appointment.
Why is this the system? Is it so people are certain to be on time for their appointment? I really don’t know.
Lost without translation.
I sat for a few more minutes, all the while pondering the differences in culture from one country to the next. By this point, the man with the particular and loud exhale had long since gone with a staff person to his destination and many other people, several of whom had arrived after me, had also left the waiting area.
Finally, a woman called my name, and I followed her to a tiny room between two doors. I was instructed to take off my shirt and bra and sit, half naked, on a chair in this tiny closet-sized room between two doors. There was one mirror on the wall and a shelf with a magazine on it.
I must have looked perplexed because the woman asked if I understand and if I spoke French, Dutch, or English. I replied, in French, that either French or English was fine. She explained a second time in English, adding that a doctor would open the door that did not open to the public hallway from which we had just entered.
I sat down and took my bra and tank top off. There was no hospital gown to put on, so I decided to put my shirt back on.
I texted my husband, Feels so exposed to sit topless.
He responded, you could drape your shirt over your shoulder to somewhat alleviate the exposure.
What if someone opens the door to the “outside” and I’m just sitting here half naked? It’s like having a bathroom door opened on you but worse.
I had one moment where I thought of the Holocaust, when people took off their clothing and went into what they thought were group showers, but I stopped that train of thought because I really didn’t want to go there.
Finally, the interior door opened and a man, (a very good looking man, I might add) invited me to follow him down another hallway. I was glad I had my shirt on because it just felt beyond strange to follow someone down a hallway in just pants and shoes.
I was again asked to take off my top and lie on a bed inside a small room. The ultrasound went quickly. My right breast was pronounced cancer free. He took a little longer with the left breast and asked me to turn on my side. Then he asked me to lift my arms above my head. Remember, I had just been sweating on the bus, so the thought of exposing my armpits to this very good-looking, male doctor was decidedly uninviting. But I acquiesced and tried not to think about body odor or the state of my frizzy hair.
My left breast passed the test as well, to my enormous relief, and I was allowed to return to the tiny room to put my clothing back on and resume my day.
Finally back home and making dinner that evening, I talked about the experience with my husband, in particular the complete inability to navigate the process of making the appointment with the French speaker without knowing the French word for breast.
He responded, you’d think booby would be universal…
Uh huh, I responded, rolling my eyes. But there is something strange about calling to make a medical appointment and asking for an ultrasound for my boobies.
In the end, I was relieved beyond word can express to be cancer free. Even though there had only been a small chance, I still felt my world turned upside down and the effect of the added stress on my already cortisol-taxed system was difficult and uncomfortable. I was also reminded that all of the little things I had been fixating upon had very little meaning. This revelation was not new or surprising, of course, but it was a helpful reminder to try to spend less time “sweating the small stuff.”
It is a humbling experience, living in a foreign land where I regularly have to navigate different language, traditions, systems, etc. It’s like everyone else has the answer key for a secret, coded language while I am left to guess.
Part of the challenge with the medical world is that doctors speak in a kind of medical code. Even when conversing with a doctor in English, I am often at a loss to understand what is going on. I nearly always send my test results to my dad, who is a retired doctor. I was inordinately grateful to be given the “everything looks fine” results in real-time rather than waiting to receive them in the mail and have to try to use Google translate for the either Dutch or French explanation in medical terms.
Of course, since I am in Belgium I likely would not ever receive the results in the mail. I learned this past spring that results for x–rays and MRI are not sent to the patient but to their primary care doctor. When I went for an MRI for my back at the start of January (there was a six month wait for MRI appointments in Brussels), I asked when I could expect the results. I had thought the nurse said that a doctor would call me to schedule an appointment to discuss the results. However, when several months passed with no word from any doctor or results in the mail, I finally called the hospital and was told they had been sent to my GP, who also had not contacted me so I didn’t know if they had as yet arrived there either. I deduced that it must be the same case for the x-rays that were taken of my right foot, even though I had also asked the technician who did the x-rays, who told me they would be sending the results to me.
Apparently, at least so far in my experience in Belgium, only blood work results are sent to the patient. Mine have been in Dutch and French, so I inevitably send them to my dad and hope he can figure out what they mean. Everything else goes to the primary care doctor, and it is up to the patient to guess when the results might have arrived and then schedule an appointment.
After nearly three years in Belgium, I still feel lost without translation more often than not, but I am learning to “ride the wave” of life in a foreign land.