Essays

Unspeakable Pain

What doctors don't hear

Lina María Ferreira Cabeza-Vanegas
Illustration of three rows of chairs by Laura Padilla Castellanos
Illustration by Laura Padilla Castellanos

I am dr. smith,” I say. “I am Dr. Jones.” For five hours a day, once, sometimes twice a week. “I am Dr. Santos. Dr. Evans. Dr. Reddy,” I say, trying to become the words as I say them. To sand myself down to sea glass and sound. “I am Dr. White, Dr. Rima, Dr. Beddi.”

“What brings you in today?” I ask a man sitting on the edge of a table, a woman lying down on a stretch of brown paper. “How’ve you been since the last time I saw you?” I say to a man holding his head between his knees, a woman cradling her shoes like a new- born. “How can I help you today?” I stand in the corner, one hand inside the other, looking up, looking down, looking away and saying, “Where does it hurt?”

Outside the exam room I sit on an orange chair, in a row of other orange chairs, idling my engine beside half a dozen other volunteer translators idling just like me. On our designated days, we sit here waiting for a resident to speed past us, mumbling the words, Spanish, or Polish, or Translator, come with me. Then we chase the white coat like a white rabbit into a small exam room in a free clinic in Chicago. Then we fade into the words and into the background. Then I stand in a disinfected corner speaking in my disinfected accent to immigrants just like and nothing like me. “I prefer to avoid eye contact,” the trainer once told me. “I want to draw as little attention to my body as I can. Remember, you are not really there. For the hour, you are not really you.” I am Dr. Smith, Dr. Reddy, Dr. Walsh. “Except for when you introduce yourself, just that moment, and then—” I am Sara, Daniel, Juan, Jose, Ortensia, and it hurts right here, and it’s been hurting for a while.

So I say, “Buenos-días-mi-nombre-es-Lina-hoy-seré-su-inter-prete-voy-a-traducir-todo-lo-que-diga-la-doctora-y-viceversa-si-tiene-alguna-duda-or-pregunta-comuníquemelo-y-lo-aclararare- esta-de-acuerdo?”

And then I watch the man or woman—usually older, always tired, almost always holding a grocery bag full of small plastic orange bottles and pages of clinic-printed forms—nod silently. Then, “Go ahead doctor,” I say, and “Thank you, interpreter,” I hear.

In these moments I am not the name my mother chose for me, nor the Anglicized version English speakers mumble at airports and clinics. I am copper-wire echoes and the string tension of a tin-can telephone.

“Good morning,” I say, “I’m Dr. Smith. How are you feeling today?”

“I’m fine,” I say. “I think I’m fine.” I am the currency exchange whirring of Mechanical Turk translations, all automation, calculation, and approximation. Bien, I hear; Good, I think; Fine, I say.

“Things are better now,” I insist, “only the sadness thing.”

Then, “What is your current dosage?” Then, “Do you need any refills?”

“I don’t know,” I say, catching a glimpse of hands not my own wrapped around one another, clutching a plastic grocery bag tightly between them. “I don’t know,” I repeat, looking up, looking down. “But…yes.” I hear the patient sniffle, the sound of a hand pulling a paper tissue out of a coat two sizes too big. “I think I do need a refill,” I say while the dirty tissue is stuffed back into the pocket of a hand-me-down coat. “It’s better now. I’m sleeping now. I don’t even have to use the headphones anymore.”

I say, “Yes.” The doctor’s eyes are trained on the screen, don’t look up, don’t look down, don’t look away. “But what are your current dosages?”

I repeat, “I’m having trouble finding them here.”

I insist that the patient tell me: “What are you taking?” “Nothing,” I say. “Not now, because, well, at County they told me that it was my potassium, that that’s why I’d fainted. They said that I had to stop taking it, my potassium, so I stopped it. I’m not taking anything anymore because of my liver, you know. But it’s better now, doctor. Only the sadness thing.”


i saw a woman get mugged
while crossing a bridge over a dry canal once. Short arms, short legs, and a short neck on a short torso. A gun barrel body and the pinch of a tight skirt around hips that were not my own. I remember watching her through the cold glass of a Bogotá bus. I remember wriggling my toes inside wet tennis shoes as she walked with tired purpose toward a hive of unauthorized bus stops, and I remember that she did not see him coming until it was too late. A thin man in a black jacket who laid both hands on her purse. And I remember gasping when I saw her neck jerk back as he tugged violently. A small woman in a big sweater holding tight to an old purse as if it made any sense, as if it made any difference at all.

“I am Dr. Santos. Dr. Evans. Dr. Reddy,” I say, trying to become the words as I say them.

It was years ago, but sometimes I still glimpse the shape of her, on the edge of a bridge in the country where I was born, in the corner of a sanitized clinic, out of the corner of my eye. Grasping for a rusty railing while a busload of strangers averted their eyes. Look up, look down. You’re not really here, she’s not really there either. Still, that railing, that purse. That’s how the patient holds on to the plastic bag now.


“but,” i say
, “that doesn’t make sense. That is not how potassium works. I think you mean sodium.” While a hand that is not my own plays with the collar of a white coat: “Still, that shouldn’t affect your liver anyway. You should be continuing to take everything you were prescribed.” A pause, and I glance back at the doctor who glances back at the patient. “So, what are the dosages?”

“But”—in a voice like cotton lint that I have to pluck out of the air before it drifts away—“that’s what they told me, though, that it was my potassium, that that’s why I fainted. And I can’t take all that anymore anyway, not with my liver.”

So again, I say, “Do you know what your dosage is?” changing the doctor’s tone slightly, not “Do-Do-Do YOU know?” But “Do you remember? Es muy importante.” Because my trainer never said anything about replicating tone, especially an attending’s short-fused hyper-focus. Because it is enough, I think, to say, “I’m not going to be able to help you unless you can tell me your dosages.”

“I don’t know,” I say. Because I don’t, because we don’t. I wish we did. I wish I could say, “Thirty units twice a day,” could say, “Ninety milligrams in the morning,” to make the doctor stop his sighing, stop tugging at a white collar and clicking loudly on the keyboard. But I don’t, and it’s not my job to know. It’s my job to say, “I don’t know.” No se, no se, no se. To say it as many times as I hear it, cotton lint and tin-can telephones. I watch the patient look up, look down, and then I remember not to look at the patient at all, to act as if I weren’t really in the room at all, as if I hadn’t seen a woman on a narrow bridge years ago and again last night riding my bike through a Chicago night. “Would,” I say suddenly, “the jars know?”

“The jars? Los tarros?” I say, mostly to myself, and watch the patient nod. A distracted doctor snaps back into the conversation: “The what?”

“I’m sorry, doctor.” A mouthful of mothballs and secondhand words. “Not ‘jars.’” Tarros. Frascos. Botellas. Bottles. Bottles. “I meant bottles, doctor.” I try on the patient’s words again—one size too small, two sizes too big: “Would”—as hands that are not my own open a crumpled grocery bag—“would the bottles know?”

The doctor’s eyes narrow, and a medical sigh fills the room.

“Never,” my trainer said, “never, ever, add a single word to what is said. That is not your job."

“I have them,” I say, “I brought them with me this time,” frail hands pull out plastic bottles and hold them up to the light like counterfeit stones. “See?” Tangerine shadows on calloused hands. Look up, look down. “They’ll know,” I say. “Won’t they?” And we watch the doctor reach for the bottles to inspect the labels. “They told me not to take them anymore, though,” I say, “because of what they did to my liver,” still clutching an empty plastic bag as if it were still full of whatever it is that the bottles know. “Because of what they did to my potassium, because of what happed to my liver that time since the…um…” I stutter, one hand clasping the other—no, not me—the patient stutters, and I echo, “Well, I’m sleeping now anyway. I don’t even need the headphones anymore. Things are better now. So I guess I just need the refills then, since the bottles got emptied, since the attempt.”

I hear myself hesitate on the last sentence. One of the words is wrong.


“a si,”
I heard someone say on the bus that night, as the woman clutched her handbag as if it were hers to keep, as she clutched the rail as if she could keep herself from falling. As she clutched her chest through an oversized sweater as if she could already feel a hand tugging on that too. “A si,” I heard a man say behind me, “that bridge is dangerous,” while I watched the shape of a woman alone on a bridge disappear into a shallow city distance. We all looked away eventually as if none of us had seen anything at all, as if we hadn’t heard her scream.

“i’m sorry, doctor,” I hear myself say. “I made a mistake.” And for the first time I catch the doctor’s eyes. “It’s not since,” I say, “but after. The patient said, ‘after the attempt.’ Said that that’s why the bottles are empty now.”

I’ve broken character and I half-wait for a reprimand. For my trainer to burst through the door and demand to know, “Who is the ‘I’ in that sentence?” But instead, the doctor stares at me blankly, chin resting on a loose fist. “Uh-huh,” I hear, before watching eyes travel back to the screen. “The dosages here shouldn’t strain the liver, though. The patient shouldn’t have stopped taking them.”

Words like pennies down an empty well. One hand inside the other. Up, down, up, down.

And the patient mutters, so I mutter too: “But I don’t even need the headphones anymore.”


it was on
la Avenida Suba that I saw it. Near my grandmother’s house. Which is a detail I remember often, as if it were meaningful, though I know it is not. I was not there; it did not happen to me. I only barely saw a man yanking on a woman’s arm as if trying to start a lawnmower on la Avenida Suba. Both his hands on her purse putting his whole weight into each motion as her head jerked back and forth, and back and forth, and again, and again.


but then
: “That doesn’t make any sense,” I say again, fingers scrolling, eyes glued to the screen. “That is not what potassium does, and the dosages are fine.” Another sigh. “And I don’t see any potassium on here anyway.” The squeak of unoiled free clinic hinges and a voice insisting, “What you”—you, you, you, tu, tu, tu—“need to tell me now is why you stopped taking them, because you really shouldn’t have stopped, and I don’t know why you did.”

I stutter. I am not really here, and none of this is really happening to me, but I—I, I, I—stutter nonetheless. “Never,” my trainer said, “never, ever, add a single word to what is said. That is not your job. Just say the words exactly as they are said. No more, no less.” Still, I stutter my own stuttering, “Lo…lo…lo que necesito es—es que me diga por que dejo de tomar los medicamentos.” What I need from you. You. You. You. No more, no less, up, down, up, down.

The word feels heavy in my mouth, heavy enough to pull my teeth and break my jaw, and I don’t want to say it again.

And it begins again.

I say, “Potassium.” I say, “Potassium.” I say, “You’re wrong.” I say, “You’re wrong, that’s not how that works.”

Then I say it again, asking myself, answering myself, asking again, and failing to answer.

Then, finally, I say nothing. They say nothing. So I say nothing either, and for a moment I try to translate their silence too.

The doctor types something into a screen facing the wall. The bottles are empty, no one knows the exact dosages, no one knows how potassium works, why livers fail, why people faint, or why anyone would stop taking their pills. Fingers type, hands clutch, and a translator in the corner remembers a woman on a bridge, swears that she saw her mumbling something under her breath as the bus drove away.


i used to hide beneath my bed
when I was a child. Flat on my back, pulling at wood splinters like hangnails when I felt too full of world to be in it anymore. I’d listen to my father walking back and forth, calling out my name while I lay there bloated and quiet, thinking to myself, “This is exactly what would be happening right now, if I weren’t here at all. If I’d left yesterday. This is exactly what would be happening.” Lying still, saying nothing. Listening to my father become more and more aggravated the longer he called out my name, the longer I wasn’t there to answer. And I told myself, “This is exactly what would be happening, if I weren’t here at all,” hiding under a secondhand bed and keeping perfectly still, hoping that the silence would press down on my body until the world drained out of me.


“i’m sorry.”
My own voice startles me. Nothing has been said, so I should not hear my own voice speaking, and yet there it is. I hear the words in my head, that bridge is dangerous, not a word more, not one less, but things are better now, I don’t even need the headphones anymore. Up, down, up, down. “¿Perdóneme, pero. . .” (my own unauthorized voice speaking directly to the patient)“. . . a que intento se refiere?”

I’m sorry, but what attempt are you referring to?

I watch the patient’s eyes move up, then down, as something like shame dashes across a face that is not my own. “El mio.”

That bridge is dangerous. That’s not how potassium works. “Translator?” Scorched cotton lint and naphthalene dust on my lips. “Translator, what are they saying?”

But, “I’m sorry,” I say to the patient. “An attempt to do what?”

“An attempt against myself, Señorita.”

For a moment I say nothing, so nothing is said. Three strangers in a room tightrope-walking on the frayed string of their tin-can telephones.

“What is it?” I repeat, “What is it?” Until I realize the words are an echo, not directed at the patient, but at me. “I need to know what the patient said, interpreter.”


i imagine orange bottles
being poured out on a kitchen table, aspirin white and jaundiced yellow. Pills like puzzle pieces, like gun-metal parts. Like bits of a blunt machine you can turn with a handle, you can hand-feed your life into. You can watch as it turns slowly, crushing beads of pure life between its gears, and the lights fade away.

“Translator? Translator?”

“Suicide,” I finally say. And the word feels heavy in my mouth, heavy enough to pull my teeth and break my jaw, and I don’t want to say it again. But I’ve spoken too softly, and the doctor hasn’t heard me, so I must do it again. Though the patient has been so careful to step around the word, to not to look directly at it. To insist on “attempt,” on “tried but failed,” on “don’t even need my headphones.”

But I am making eye contact now too; I am calling on angels and patron saints of unclaimed prayers muttered on the edge of cities and on narrow bridges in the night.

I spit out the word as if I were choking on them. “Suicide.” And I hear the screech of a bus brought to a sudden stop, I feel the dry taste of activated powder in my tongue, and hear the doctor say, “Oh.”


in another hour
I will stand in a different room and say to a different patient, “I am Dr. Jones. Dr. Savage. Dr. Klein.” Wishing that I were something more useful than a body made of language, than a thing bloated with things it has pretended not to hear. And I will ask them, “What brings you here today?” And “How may I help you?” And “Tell me what hurts.” And I will tell them to take off their shirt, their pants, their socks, to lay their body down under fluorescent lights as if on narrow bridges in other towns. And I will listen while doctors press stethoscopes to wrinkled skin, press needles into sunburnt arms, will listen while patients try to read between the lines of sentences that are not my own, try to guess how many breaths are left in their lungs, how many beats inside their heart, how many steps in these immigrant feet. But before that, I will insist on existing for a few minutes more, because—“Doctor, the patient means to say ‘suicide.’ The bottles are empty because the attempt was on her own life. That’s why they told her to stop taking her pills. That’s what happened to her liver.”

Then, “Oh.” And “I see, I see.” And “That’s not in the notes.” And I will hear the patient repeat—as if every word had been understood all along—“But things are better now, I don’t even need the headphones anymore.”

And finally, “Okay then,” I say. “Okay, okay, let me go get my attending then,” I say while I picture hands that are not my own clutching plastic bags and plastic bottles. I imagine walking through deserts to get here—days, and weeks, and months, and years, alongside many, then several, then few, then none. Holding an empty water bottle, a purse, a diagnosis. Clasping my own hands in the darkness because there is no one left to hold them for me. And I will finally ask a patient in a small waiting room in a free clinic in Chicago, “So, what were the headphones for then?”

And I will answer, “To drown out the voices.”

Lina María Ferreira Cabeza-Vanegas is the author of Don’t Come Back and Drown/Sever/Sing. A recipient of the 2016 Rona Jaffe Foundation Writers’ Award, she was born in Bogotá, Colombia, and holds MFAs in Creative Nonfiction and Literary Translation from the University of Iowa. @LMFCV
Originally published:
March 1, 2022

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