Updated on: May 22, 2020

Making Things “Better”

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Original story posted on: May 20, 2020

The word “better” is one of those unusual words that can function as an adjective, a noun, an adverb, and a verb. During my recent reincarnation from the administrative afterworld into clinical life as an ICU physician, I learned a fifth function of better – as an incantation. The reason it is being incanted is to ward off an evil medical spirit.

As a lifelong, exclusive monolinguist, I have always depended on the help of others when I speak with a bilinguist whose first language is not English. Blessedly, for individuals like me who are isolated in one tongue, there are electronic interpreters who can speak and listen “in tongues” – a true secular polyglossia.

Beebe Healthcare, where I work, is not a Tower of Babel, but it is a smallish tower of people fluent in several foreign (alas, foreign to me) tongues who also have a working vocabulary in English. Several weeks ago, I began to hear the same English word when I asked some patients how they were doing. Although on different floors, in different rooms, and on different days, their answer was the same: “better.”

Not only were they better, but their families were better, their co-workers were better, and their friends were better. Everyone, it seemed, was better. Like many physicians, I accepted this answer, because it is what I wanted to hear. Whatever “better” meant to the patient, to me, it meant less worry, less work.

Then, I had a better epiphany. A patient who was better the day before was telling me he was better today, but he wasn’t. He couldn’t even fake being good, much less being better. He was trying very hard to look better and was failing. So I pulled out my cell phone and got in touch with my electronic polyglot.

The phone talked to the patient and the patient talked back. The phone said, “the patient said to tell me that he felt worse, but was better.” I told the phone I didn’t understand what the patient meant.

The cell phone went back to work with the patient. The conversation went on for what seemed a long time, as I stood by feeling invisible, as do all mono-tongued individuals when a meaningful conversation is taking place nearby, but linguistically, in another universe. This effect is heightened when you are fully arrayed in every form of COVID-19 PPE.

Then the phone talked to me – instantly restoring my relevance – and said, “he doesn’t want the tube in his mouth.” In this moment, the fifth function of “better” as an incantation was revealed.

The phone went on to tell me that in the community, they warned each other that if you say you are sick, the hospital will put a tube in your mouth to breathe for you. But if you say you are better, they won’t put the tube in.

There it was, function number five – better known as an incantation against the medical evil spirit, “endotracheal intubation,” or as it was known in the community, “the tube in your mouth.”

I put the phone back to work to explain that not being better did not mean you would get the tube in your mouth, but that we had other treatments before we resorted to the tube. The phone explained what I said, and the patient said, “okay.”

I felt that I had established a bilingual beachhead with my cell phone, then the patient gestured for the phone. It was a short conversation.

I asked the phone what the patient said. The phone told me, “he wants you to know that he feels better now than when you first came in the room.”

Well, the incantation ultimately worked its magic. The evil medical spirit was averted. The patient got better slowly, like most COVID patients, one mmHg of oxygen at a time.

And as I reflected, I had another epiphany. I have being incanting “better” my whole professional and personal life. “Better,” incredibly, had a sixth function – hope. We use “better” to maintain hope when hopelessness lurks about us, as it is lurking now.

Even we monolinguists know this.

Michael A. Salvatore, MD, FACP

Dr. Michael Salvatore was a pulmonary medicine/critical care physician for 35 years. Since 2012 he has been the physician advisor and medical director of the palliative care team at Beebe Healthcare in Delaware. After earning his MD at the University of Arizona, he trained in internal medicine and PULM/CCM at Duke University. Dr. Salvatore is a member of the RACmonitor editorial board.

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