Conduit
River Adams
I spotted them as soon as I approached the oncology clinic: an obviously Georgian family clad in shawls of blossoming colors, creating about them a low ruckus of bubbly conversation that jumped and splashed like a mountain river above the murmur of the waiting room. The hospital didn’t have a Georgian interpreter on staff, but most immigrants from the former Soviet Republics spoke Russian, so I’d been called.
They were mother, grandmother, and a teenage girl—slight and lovely, as transparent almost as rice paper, a dried-up tiny arm curled into her side. Her mother unwrapped a piece of baklava in an oil-stained tissue and tried to feed her, and the girl shook her head and smiled absently, time after time, as the food was turned before her at various tempting angles.
“You must be mine,” I said in Russian, lifting up my badge. “I’m your interpreter.”
“Ah! I told you she won’t be late! I told you!” The triumphant boom came from the grandmother, followed by an unexpectedly fervent hug. “I’m Keto,” she said, “and this is Lali.” She pointed to her daughter, who was hastily rewrapping the untouched baklava. “And this”—her voice grew soft— “is Tatia.”
I knew that Keto was short for Ketevan. I wasn’t sure about Lali, but after such a warm welcome and informal introduction, I felt that this family should know me by my Russian diminutive. “Masha,” I said, waving dismissively at the name on my badge.
Tatia had neurofibromatosis type 1. This genetic disorder causes benign tumors to grow along the nerves, but they can infiltrate bones and muscles and often accelerate during puberty. Tatia was sixteen now and struggling with a neurofibroma that was choking her arm. All of this information was poured over me quickly and eagerly in Keto’s heavy Georgian accent, which to a Russian ear makes everything sound flamboyant. She devoured my face with her eyes as she spoke, as though I might be able to deliver the healing right there in the waiting room, and lowered herself back onto the couch, mindfully, as she would onto a church pew. This is a temple for them, I thought. This is where the gods will be merciful or not. And I speak for the gods.
I’d had patients like this before—desperate, hopeful, emotionally charged—but we all meet a patient, sooner or later, who becomes “the one.” Doctors do. Nurses do. So do paramedics, social workers, hospital chaplains, and hospital clowns. On the day I met Tatia and her family, I couldn’t imagine that I’d think about them ten years later and hundreds of miles away. Tatia was my “one.”
Lali, meanwhile, had once again taken out the poor, hassled piece of baklava and offered it to me.
“Oh, no, thank you very much.” I was listening to Keto but watching Tatia, who had tucked her knees under her chin, an angular lump under an enormous flowery wrap. Where it had slipped off her leg, I could see the clash of civilizations between her millennial-style metal-studded capri pants with cargo pockets and the ancient breath of the hand-woven shawl. Her gaze drifted unfocused, a half-smile floating on her face. Lali patted her knee, and she nodded—whether to her mother’s touch or to her grandmother’s voice, I couldn’t tell.
Tatia had been treated in Georgia, but her case was unusually severe, and her doctors had reached their limits. Here, in the US, they’d come to one of the best children’s hospitals in the world. They’d come in supplication. They’d come for a miracle.
Lali held the baklava closer to my face. “Please, take a bite! You need sweet in your life!” I tore off a symbolic piece and licked the offering from my fingers. It tasted like memory.
“Tateea Googa…shalai?” The curse and the entertainment of immigrants is hearing the locals pronounce our names.
“That’s us!” I shepherded my technicolor flock through the door, sneaking a spritz of hand sanitizer on the way. Keto hadn’t had time to tell me that this was their third visit at the clinic. They’d had their initial consultation and an MRI. This was results day.
In the tight squeeze of the exam room, Keto took the lone chair while Tatia perched on the corner of the exam table. Lali stood beside the table next to her daughter, and I, behind Lali’s shoulder. But as soon as white coats filled our already-crowded space, I knew something was wrong. The oncologist came in trailed by a resident, two medical students, a radiation therapist, and a social worker, no clipboard with consent forms for surgery in his hands. As he squeezed past us to the desk, we exchanged a quick, quiet glance. He knew that I knew.
There are times when medical interpreters must advocate for patients, guide them through the healthcare system, or step in to prevent cultural misunderstandings. But most of the time we are present only as voice: the voice of the patient, the answer of medicine. We are meant to serve as unobtrusive conduits of information, and “conduit” is the default mode of medical interpreting. We are instructed to look down when we talk, to avoid eye contact, to encourage the patient and doctor to talk to each other and not to us.
But in that room, all three generations of women focused on me. Surrounded by his snow-clad posse, backlit by the abstraction of computer images discernible only to the initiated, the oncologist was an unreachable, all-powerful god. He did not speak their language. I did.
And so he spoke, somber and assured, but they turned their heads away from him and craned their necks to peer into my face, Lali white-knuckling my hand, and I broke the rules and looked back at them directly to deliver the verdict: Tatia had cancer. A rare and aggressive cancer that embodied a deathly, clinical word: inoperable.
Keto abandoned her chair and enveloped her granddaughter in her arms, rocking her in minute motions, but Tatia only stared vaguely at her see-through bones displayed on the screen. Lali was now stifling sobs into my shoulder. This was another rule I was breaking, holding a patient while interpreting, but it seemed unthinkable to push her away.
Doctors don’t let patients grieve in an exam room. As soon as the word “cancer” is spoken, the options are unloaded in rapid-fire sequence so that grief can be tempered by hope, and this time was no different: the options kept coming. There was radiation to be done, aided by chemo. Should these fail, there would be other therapies to try: new, advanced, experimental. There were social services, financial support, and community outreach. Hands kept reaching over with brochures and instructions. I dutifully interpreted everything, stacked the papers into a neat pile on the exam table, and stroked Lali’s back, feeling her wet snorts in the crease of my neck.
Half an hour later, with appointments secured for chemo, for radiation, and for bloodwork, I walked the silent family out to the exit. In the lobby, Lali grabbed my wrist. “Masha, will you come again next time?”
“Me or another Russian interpreter, sure.”
“But can it be you?” Her voice came out sniffly and hoarse. “Can we make it always you?”
“Well… The hospital doesn’t guarantee a particular interpreter, but you can request me. I’ll try my best to get assigned to you, how’s that?”
Over the next year Tatia came to the hospital one to three times a week. We went through chemo, radiation, labs, MRIs together. Tatia did better, then worse, then better again, her fragile frame a brittle reed, a swaying stalk of grass, and I interpreted at all their appointments, which I helped them make. Keto and Lali handed me articles about neurofibromatosis and city maps they couldn’t make sense of. I spent evenings doing futile research, just to make Keto feel better. My life revolved around Tatia.
Tatia herself never spoke much. In the downtime between scans and treatments, her mother and grandmother were the ones who boasted about Tatia’s unequaled work ethic, her academic achievements, and her once-in-a-generation mind. It wouldn’t occur to me to disagree. Tatia’s English quickly became good enough to excel in high school and begin to plan for college in America. She liked natural sciences, and, in a logical cliché, I kept expecting her to start a path towards medicine, but she kept drifting, wanting to study neuroscience first, then neurobiology, microbiology, and then biochemistry. Yet the scanners that buzzed around her every month fascinated her more than the images they produced, and so I wondered if she wouldn’t end up in physics or even engineering. Most of our limited conversations were about the MRI machine.
Soon we developed a habit of arriving early for their appointments. Lali now brought food for four to every visit, despite knowing that Tatia rarely ate anything, and my favorite dishes began appearing from her bottomless handbag: flaky pies, sweaty stuffed grape leaves, freshly baked flat lavash with the aroma of warm hearth, springy suluguni cheese.
Keto cozied up every procedure room and waiting-room couch with a blanket and pillow for Tatia, napkins, and a thermos of hot tea. Every medic who entered the room was treated as a family friend. I inhaled the odors of Georgian cuisine and savored the family’s inimitable accent—so familiar, so unmistakable. They were the breath of my hope-filled past. My youth. My home. Before the world had started referring to my homeland as former. I began to catch myself saying “we” when discussing Tatia’s treatment: “We didn’t do well with this drug,” or “We’ll have to see after the next scan.”
On an afternoon in early June, I hurried in as usual for Tatia’s treatment session. Her cancer had proved unyielding, and some weeks before we had begun an experimental therapy designed to starve the tumor of blood supply.
At the sight of me, Lali rose from the sofa and opened her arms, Keto clapped her hands, Tatia smiled, squinting like a cat in the sun. I went through the hugs, wondering about the effusive greeting. “Is there good news?”
Tatia held on to me with her good hand. Mischief was stirring uncharacteristic sparks of life in her eyes. “Happy birthday!”
“Uh… Thanks,” I said. “If only it were my birthday. Which it’s not.”
Tatia threw her head back and banged her feet against the couch. She was actually laughing—quietly, in little bursts—but laughing. I stood dumb and grinning like someone trying to look marginally less foolish on Candid Camera. Keto draped her arm around my shoulders. “Of course. We didn’t know what your birthday was, so we got you something for today.” She gave me an enthusiastic shake. “For Pushkin’s birthday. You celebrate, don’t you?”
Naturally, I celebrated June 6. Alexander Pushkin is the soul of Russian prose, the heart of Russian poetry, everything that makes us what we are. The yeast and the frosting of my mother tongue. Still, I was surprised and touched: of the great Russian poets, Georgians are more loyal to Mikhail Lermontov, who fell in love with the Caucasus when he was exiled there for the impudence of his poetry and spent the rest of his short life writing about the beauty of its mountains, the unconquerable pride of its people, and the wisdom of its myths. Every city in Georgia has a street that bears his name.
Pushkin and Lermontov both died young, as befits their tragic genius, and it’s my great sadness in life that their poetry is not translatable to English, but Pushkin is the Mozart of Russian literature: words poured off his pen with such playful ease that perfection has been defined by them for two centuries. In Russia, June 6 is Literature Day.
“Happy Pushkin’s Birthday!” Lali plunged her hands into her bag and then emerged with a white cardboard box gripped by a turquoise ribbon, tied into a bow on top.
I hesitated. Accepting gifts from patients is ethically dicey. Somewhere the rules are written down and categorized, and I know we’re not really supposed to do it, yet everybody does — doctors, nurses, speech pathologists, physician assistants, receptionists. Hospital clowns. Everybody accepts an occasional small gift, most often at parting, from a recovered patient. It’s always a judgment call.
I looked at the box and three beaming faces—Tatia, laughing—and then took it in my hands. In between “wows” and “you-shouldn’t-haves,” I untied the bow and opened the box. It was a single tea cup. White, delicate Lomonosov china, classic latticed pattern. It was breathtaking.
“Russians drink tea when we drink wine, don’t you?” Keto said. “For every good and ail?” She still had her hand around my shoulder, and she squeezed again. I felt a hoarseness in my throat, but I was on a job. Can’t forget that.
“That, we do,” I said. “We drink a lot of tea.”
Later that fall, I got a call from the office that the next appointment was canceled. This had happened before, when Tatia had gotten sick, weak, out of transportation. “Rescheduled?” I asked. No, just canceled.
I called the family at home. No answer. Once, twice, three times. Ringing, endless ringing.
The next time I was at the hospital, I went to the office and checked: there were no more interpreting services requested for Tatia. This was odd. I walked over to the oncology clinic and asked what had happened.
We’re not supposed to tell you, they said. HIPAA. Privacy.
Yes, of course, I understand. But you know me, I’m their interpreter. There may have been a mix-up that I could help straighten out. Could you just tell me if she is coming back?
We’re sorry. HIPAA. Privacy.
Legally, to Tatia, I was no one. Outside of a medical encounter, we were strangers.
I went to medical records and begged. Could you just tell me if this person still exists as a patient? If there is a record of a living patient?
We’re sorry. HIPAA. Privacy.
They were right, of course, to say nothing. To Tatia, I was no one.
I’ve never found out what happened to Tatia. I called their number periodically over the next few months, but no one ever answered. Had they found a new, promising treatment in another city? Had she gone into a sudden remission? A more likely answer hovered, but my wondering always stopped before I got to it. My mind refused to think it. And so, ten years later, I still do not know what happened to Tatia.
When my mother was diagnosed with breast cancer four years ago, I stood behind her shoulder, where interpreters stand. Where I’ve always stood. She had told no one about the growing tumor until it was the size of an orange and the cancer had spread to her bones. I had no time to think during the early weeks of the diagnostic whirlwind—biopsies, labs, and scans—but later, through almost three years of doctors’ visits, procedures, infusions, and CT scans, and then, amidst my mother’s daily, steady decline at home with the hospice nurses, thinking became inescapable. Every day I stood behind her shoulder as the conduit, being her voice and the voice of medicine. She pulled her favorite flowery shawl around her shoulders and clutched on to my hand.
Once again I broke the rules: I held her, I spoke for her, I looked her in the eye. I dried her tears and stroked her hair and tried to feed her bits of black Russian bread in hospital waiting rooms. We’re not really supposed to interpret for our own families. I broke the rules and, often, I thought of Tatia.
My mother is gone now. I still break down when I come across her portrait, her handbag, or her glasses tucked away on a nightstand. She died at home with me, her last days peaceful and unconscious. I keep her flowery shawl draped over her favorite chair, next to the cupboard that holds Tatia’s cup.
In a way, a teacup is just a conduit, an unobtrusive presence around the tea. What matters is the taste inside it, the hot steam that rises from it. But not this cup. When I make tea in this cup, it’s different; even touching its smooth surface or hearing it rattle quietly against the saucer conjures up memories. I use it only on special occasions—my mother’s birthday and her death day, and of course on June 6—and I brew the tea the way my mother taught me, Russian style. I brew my loose-leaf in a simple pot with no filter, so concentrated it’s almost black, then pour a bit of the leaf-laden liquid into the cup and add boiling water to the brim. Every pour is a new brew with a new fragrance. A new dance of tea leaves.
The cup is cold when I take it out of the cupboard, but it warms up when I fill it with tea. Its bone china is thin, delicate, almost transparent, the way Tatia’s skin was in those last months. Every time I pick it up, I’m nervous that it will shatter in my hands. But then, even if this cup were broken, I wouldn’t love it any less.