You can find Part 1 here.
My patients sometimes present me with an opportunity to reflect on anthropological literature through our brief and yet candid conversations. By rule, we medical interpreters are not supposed to be friends with clients (both patients and providers), and thus we limit the amount of private time with them. Again, our fundamental responsibilities are to be a communication conduit, invisible and detached from the emotional exchanges between patients and medical professionals. It keeps us out of potential trouble, such as being asked for medical advice or personal assistance outside clinical settings (violation of HIPAA and Code of Ethics). Every time a patient asks me about her/his treatments, I have to tell her/him, “Let’s ask the doctor about it,” even if I know how I want to answer.
But when I accompany patients under long-term invasive treatments, we often end up with alone time. In such instances, I make sure that our conversation topics remain neutral and non-medical. And yet, we often develop a rapport, telling funny stories and laughing together. As I spend more time with them, some of the patients begin to confide in me about their struggles with their illnesses.
One of them, for instance, asked for my opinion on whether or not to wear a wig to cover up hair loss from chemotherapy. According to her, cancer patients in her home country typically prefer keeping their illnesses secret from people outside their families. Since her social network was mostly insulated within the community where the people speak only her native language, she was naturally inclined to follow the same trend. At the same time, crossing paths with her fellow cancer patients who were without wigs in the clinics led her to the realization that things were a bit different beyond her community. Still, she felt that going wigless would be like advertising her illness.
I found my patient’s concern quite intriguing, as she became apprehensive about the bodily manifestation of her suffering – and the public perception of it. I remember driving home with a barrage of questions in mind: What made her worry about the public perception of her visible hair loss? What would a wig accomplish for her? What would a wig mean for her pre/post-diagnosis identity? What does her body mean to her in this particular case? Does the illness represent her self through her body or vice versa? Is it a mere medium between the self and the illness or between the self and something beyond the illness? Or is the body actually the self, the illness, and whatever beyond the illness and the self altogether? After I got home, my fascination prompted me to dig out the classic piece, “A Critical-Interpretive Approach in Medical Anthropology: Rituals and Routines of Discipline and Dissent” (1996), by Margaret Lock and Nancy Scheper-Hughes.
Of course, it isn’t ethical for me as a medical interpreter to lay out my personal opinion to my patients. I did tell her though that cancer patients in the U.S. don’t wear a wig for various reasons, such as self-empowerment, financial circumstances, comfort, and so forth. Meanwhile, I kept thinking about Margaret Lock’s “Encounters with Aging” (1995). In it, Lock asserts that perspectives about illnesses vary even within a given cultural system, which illuminates the complexity (political economy, conflicts, history, etc) of the system itself. This work also warns us that the comparison of seemingly different systems can lead to gross overgeneralizations. With that in mind, I just hoped the patient would feel that it would be her own decision – to wear or not to wear the wig – as possible.
My final response to her question was: “Whether or not to keep it [her illness] secret is entirely your prerogative. These patients may not wear any wigs in the clinics but they may well be secretive in their social lives. There may also be some patients back home who are open about their diagnoses. So, it’s up to you, and you have to trust your decision.”
A week later, she showed up in a wig at her oncologist’s office. She was quite exasperated by its price tag even with the coupons provided by her social worker. But she seemed content, and looked good in the wig. She also ended up telling her close friends about her illness, since she needed their help to take care of her family. From there, she joked about the wig and her hairless head. She was a master of transforming difficult experiences into funny stories.
About a month after she moved back to her home country with her family, she sent me a message while sitting in her new doctor’s office: “I know you couldn’t medically help me, but your presence at every doctor’s appointment I had there truly got me through all the treatments. I’m sitting here alone and learning to adjust myself to this new way. I don’t like this because it’s making me feel I’m really a sick person.”
All I did was try to do my job as a medical interpreter; being that “communication conduit” they wanted us to be. But if there was anything that made me a reasonable companion for her, it was probably all the ethnographies I had read during my studies in medical anthropology. Those books helped me think about her emotional experiences through anthropological questions, which ultimately helped me respond in ways that helped her worry just a little less about what she was expected of by the U.S. society – or her own community. All of the ethnographies I have read – filled with personal stories that individuals tell researchers – helped me remember to be a good listener for my patients. I may not be an academic anthropologist, but I’m still practicing anthropology. Perhaps, that is the beauty of anthropological knowledge: its applicability to everyday lives.
“I’m an anthropologist.” When I tell this to people outside academia, all I get is the sound of crickets chirping. They awkwardly stare at me, looking puzzled, as if they just heard something in a foreign language. How is anthropology still perceived obscure and irrelevant? How can the institution of anthropology break out the shell of esotericism? I can’t offer any punchy line to answer these questions here. But perhaps, we can ask for insights from those applied/public and activist anthropologists who directly work with ordinary people on a daily basis. They may be undercover anthropologists, but they deserve more recognition.