Medical consent and Deafblind patients

Cathy Metcalf

21 November 2001

[Webmaster's note: This was a letter to TERPS-L that I requested the author to give permission to print]

I want to thank each and every one of you who sent me advice and encouragement for my Deafblind surgery assignment, both on-list and privately! What a wonderful help you all were, and I used as many of your suggestions as I

Let me tell you that it turned out quite well, and it wasn't the "bear" I thought it was gonna be! So the experience was, in general, a positive one, but several issues came up that I thought were worthy of mentioning.

The hospital does not deal with Deafblind very often, so that is a given. This is a relatively small/rural community, and the hospital is actually just now getting up to speed on dealing with deafness, calling interpreters, etc.

Okay, on the morning of the surgery, I arrived on time, and was led back into the patient check-in area (where the patients fill out pre-admit forms) where the patient was sitting with a non-signing Hearing family member. The necessary legal forms had already been filled out by the family member while the patient slept in the chair, not knowing what was going on. I asked if the family member could sign/communicate with the patient (no), if the patient knew what forms had just been filled out on his behalf (no), if the family member had Power of Attorney (no), and why they hadn't waited for the interpreter (Ummmmm????).

Apparently, the hospital wanted to stay on schedule, and was getting the *routine* paperwork (power of attorney, living will, and that kind of stuff) out of the way ahead of time. I mentioned that those forms may/may not be legal since the family member who signed his name to them did not have power of attorney, but it was their call. I let them know that what concerned me the most was that the patient did NOT know what forms had been signed on his behalf, and that they should have waited for the interpreter. (Geesh, I was ON TIME and everything!)

I asked what forms had been signed, then proceeded to explain to the patient what had been done on his behalf. He seemed used to others signing papers for him, and answering for him, sadly. Technically, I think the hospital probably should have gotten the patient to re-sign the forms now that he understood what they were, but it was not my place to suggest it--not professing to be a lawyer...

I don't know how the situation could have been prevented, barring education of the hospital staff. Even if I had mentioned "wait for the interpreter" when I called to confirm the day before, who knows if the message would have even gotten through???

As the procedure went on, I was on really alert for hospital staff attempting to "go around" the patient. They seemed bent on asking the family member questions about the patient rather than asking the patient himself. Whenever a question was asked (EX: What allergies do you have??), I would wait for the family member to answer, and no matter what his/her answer was, I asked the staff to wait just a second, and let me ask the patient himself. They caught on rather quickly to the scheme of things, and began asking the patient directly (OK, they said the usual "Ask him...", but it was an improvement!.) The patient was intelligent and could, indeed, answer for himself. I did my best to act professionally, not insult well-meaning staff and family members, yet get the info to the patient and let him decide and answer for himself. You guys would have been proud of me, I think, because, by the end, we even had the Deafblind patient signing the consent/release forms and other papers HIMSELF!!!!

As far as the mechanics of interpreting for the patient in the bed, it wasn't too awfully difficult. I did ask for the O2 clothespin to be clipped to the patient's non-dominant hand, as well as the IV, simply for my ease in reading his fingerspelling. The greatest problem was not with IV's, but with the side rails of the bed. At one point I asked the anesthesiologist to wait just one sec while I moved to the side w/o rails. Another source of difficulty was with the post-surgery, recovery room situation. The patient had piles of blankets on him to keep him warm, one of the blankets being an air-mattress-like thing. So here was the groggy patient, trying his best to come out of anesthesia fog, signing with one hand to me....LOL I did the best I could to understand, but ended up putting off his comments, waiting until the patient was warm, a bit more clear-minded, and willing to bring both hands out from under the mountain of covers. smile.

What was sorta funny was that the patient went through the whole procedure, then asked "so when is surgery??". Evidently he had forgotten everything that had happened, and we both had a big laugh as I informed him "surgery finish"!! He had been so heavily drugged that he was disoriented ....(kinda like me on a Monday morning before

Before the surgery I had worried about how to interpret to him, what problems might come up in connection with that. But really, what was the predominant issue was dealing with the hospital staff, since they were unfamiliar with the Deafblind. I don't mean it in a snotty way when I say that part of our "job" as interpreters is to bridge the gap and "educate" the Hearing around us. It made me smile at the innocent hospital staff responses of "Wow" and "fascinating", and "He really understands!" as I interpreted the Dr.'s commands to the patient (roll over on your left side; scoot up to the top of the bed; take a deep breath and hold it; etc.) and the patient understood and complied. I guess this was their first experience seeing(through an interpreter) that the man was intelligent, literate, humorous, and even flirtatious with the nurses and me (oops, I promised not to tell on him...LOL)!! The doctor even told the staff not to let the interpreter out of their sight....guess he was a little nervous with a Deafblind patient too. He wanted me to wait 5 hours with the patient so that if the patient had pain, they would know it...LOL. Of course, I could not, ethically stay and do virtually nothing for 5 hours, especially since I had another appt., so I did some more educating and reassurance that the patient, as well as the family member were quite able to let them know of his possible pain. I asked the nurse to explain the call button to the patient while I interpreted, and also explained to the desk not to verbally answer the call button but to go into the room to assess the patient's needs.

All in all, it was a very satisfying experience for me, and I think the patient appreciated having an interpreter and knowing what was going on around him. He made good use of me by asking lots of "who is in the room" and that type of environmental questions. When it was all over and I was ready to leave, he thanked me big time for interpreting.