Languaging in Hospital

09 Jul 2020

Bilingual experiences of a hospital ward.

This was not what I expected. In January this year, my partner and I became husband and wife. Norm Tovey-Walsh and Bethan Tovey-Walsh on their wedding day. He is wearing a suit, she's wearing a white dress. They are outside on a balcony with buildings and water behind them, and the wind is blowing their hair.
The happy couple, enjoying Swansea's winter weather at the National Waterfront Museum.
Photograph © 2020 Liga Stevenson Photography.
Our wedding day will probably always be the best day of my life, though I welcome any and all days that think they can compete. We took a brief honeymoon trip to Ynys Môn, and then Norm (the aforesaid husband) returned to his home in Texas while I went back to Swansea and my PhD research. The rest of the year was planned around conferences, visits to friends, and a summer in Texas together while I started writing up my dissertation. After five years of living 5,000 miles apart, we're used to this fragmentary life together. After the wedding, though, my spousal visa application was ready to be submitted to the U.S. authorities, and we were hoping that it would be no more than a year before we could live together permanently in Texas.

I really had no intention of invoking the "in sickness and in health" clause of our marriage so quickly. But, as they say, life comes atcha. You might think this is going to be a post about COVID-19. You'd be wrong. Here's how things started: Norm and I travelled to Prague for the XML Prague conference. It was wonderful. We heard some excellent talks, saw some beloved friends, and ate an exceptional meal at La Degustation. By the time we flew out of Prague, I was feeling a bit unwell, and I assumed that I was paying Conference Tax with a case of the flu. We stayed overnight at Heathrow, and the next morning, my wooziness was dialled up to 11. Still, I saw Norm off to his nine-hour flight home, and somehow got myself to Paddington and boarded the Swansea train. Luckily, my mother came to meet me, because I had such bad double-vision that I could only see to walk by keeping one eye closed. Half my face was numb, my fingers were tingling, and I couldn't quite feel the soles of my feet. Mum looked at my face, saw that my eyes were going off in different directions, and suggested that maybe it would be a good idea to head to the hospital. The car wouldn't start. Mum guided me to a taxi rank, and we headed off to the nearest A&E department, a twenty-minute drive from the centre of town.

I'm going to spare you a description of the eight-hour wait in A&E. Suffice it to say that by 7 a.m., the day after leaving London, I was in a bed being poked with needles and waiting for brain scans. Norm arrived in Texas, read his messages, booked a ticket, and flew back out of Texas with the same flight crew on the same plane that had taken him there. Over subsequent days, the diagnosis that emerged was a variant of Guillain-Barré Syndrome called Miller Fisher Syndrome. My immune system, set off by the flu, was attacking my nervous system. It took a few days for my eyes to start facing in the same direction. A few more days and I could feel my face again, which was great because (as it turns out) you bite your tongue and lower lip a lot if you can't feel them when you're eating. I stopped using a walker to get around after a week, though getting my balance back took longer, and I was still walking in a suspiciously penguiny manner when I was discharged.

A few months later, I still have loss of sensation in my fingers and feet, and my thumbs are almost completely numb. Trust me, quit your finger-chewing habit if your fingers are numb: you get no feedback whatsoever about how much finger you're biting off at any one time. Nonetheless, I'm alive, I can get around (though there's not much of that happening, thanks to Peter Pandemic), and my brain still functions just as it always did. Can I thank the NHS enough? No, I can't. This may not have been how I expected to spend my first six months of married life, but so many things could be so much worse.

Yeah, I know, you came here for linguistics content, not my autobiography. I just wanted to set up the background for you, before telling you about some aspects of being bilingual in a Welsh hospital. Let's start with an anecdote. We were waiting for my brain scan, and an elderly lady and (I think) her adult niece were sitting across from us. I've changed some of these details to protect their privacy I could hear them speaking together quietly in Welsh. A nurse came to tell the elderly patient what her next tests would be. The patient nodded and, after the nurse left, asked her niece "Be' wedws hi, de?" (What did she say, then?).

I've long been a supporter of providing medical care in the patient's preferred language, and this small moment really struck home. We assume that Welsh speakers are all bilingual and fluent in English, but discussion of this often fails to understand that "bilingual" and "fluent" aren't simple, fixed ideas. Even older Welsh speakers these days will have had to communicate in English to some extent, and will have received some English-medium education. But if their home language is Welsh and their social circle is Welsh-speaking, their ability to engage with complex information in English at times of stress may be pretty limited. I would love to see more research on this, and guidance for medical and other professionals on interacting with minority-language speakers.

Once I'd been tested and a bed became available, I was put on a pulmonary/neurological ward with four or five other patients. I have rarely before been so ill that I didn't want to read. I didn't even want an audiobook. My main occupations were listening to Renaissance choral music on my noise-cancelling headphones, and sleeping. I have a few friends who are professional musicians, and I listened to them in particular; there was something comforting about hearing their voices. It was comforting, too, to have nurses who spoke Welsh to me. I've never been able to explain why this is so soothing, but it's always been that way. Before my appendix was removed when I was 13, the anaesthetist found out I was Welsh-speaking. My mother tells me that I calmed right down when she started to speak in Welsh.

In Wales, there's a scheme for Welsh speakers to wear an orange badge or patch on their clothing, to show that they're happy to speak Welsh. One of the healthcare assistants wore one. The Welsh-speaking nurse didn't, but I was fairly confident she was a Welshie after hearing her call her patients "bach" (Welsh for "little", used as an endearment). Welsh speakers often assume that we only code-switch in one direction: English words enter our Welsh, but Welsh words don't enter our English. Yet both the Welsh-speaking staff on the ward universally called their patients "bach". My identification of the Welsh-speaking nurse was confirmed when she called to a patient "I'll be there now, bach, I'm just on half finishing this form". Welsh "ar hanner" (literally on half) essentially means "in the middle of", and the Welsh idiom must be so normal for this speaker that she's translated it into English without realising that it's not a natural English idiom.

The nurse and I spoke Welsh together from that point on, but I noticed that there were switch points where English would re-enter the conversation. Of course, this happened when someone else was present who wasn't a Welsh speaker. But in other cases, switches happened when she had to talk about specifics of my treatment and the medical equipment she was using. It occured to me that, although Welsh is clearly a fluent and frequently-used language for her, she may never have received any medical education or training in Welsh. I wonder how many Welsh-speaking medical professionals actually feel comfortable talking to patients or colleagues about their medical treatment in Welsh? And I wonder whether there are training courses available for Welsh-speaking medics to develop their language abilities in this area?

One of the big problems for minority languages is narrowness of use. The language may be widespread at home and in social settings, but not used for education; or it may be used for education up to a certain level, but not for advanced professional training. The truth is that no language is inappropriate or unable to be used for any given professional domain. It may be necessary to develop terminology, but that's a fairly natural requirement for any new technical field. English invented its medical terminology, too; it just happened so long ago, and over such a span of time, that many people imagine that these words grew spontaneously like flowers around English scientists.

Maybe this ties in with my emotional reaction to Welsh. Maybe I find it so comforting because I don't think of Welsh as the language of heart monitors and lumbar punctures and brain scans, but rather of home and hearth and heart. Truthfully, I would sacrifice the comfort if it meant seeing Welsh take an equal place as the language of healthcare in Wales. But I'd miss knowing that all I need is another Welsh speaker to be safely home again.