Note: All names and personal identifiers have been changed for the purpose of this narrative.

When I was in medical school, I met a 35-year-old Cambodian man named Ley. He and his mother Nari lived in a small flat in Chinatown above the grocery store they owned. Ley spoke some English, but Nari did not understand a word of it. She relied heavily on Ley’s English skills to navigate existence in the United States.

One day, Ley had a grand-mal seizure. He lost consciousness, foamed at the mouth, and began shaking in a way Nari had never seen before. She was able to get him to a hospital, but when he came to, Ley was not at all himself. Nari revealed he had been increasingly confused and had lost a lot of weight in the last few weeks. His workup in the emergency department revealed a brand-new diagnosis of extensive stage small cell lung carcinoma. It was an aggressive form of cancer that had started in his lungs, but ultimately spread to multiple other areas, including several sites in his brain. At the time, I was a medical student on a radiation oncology rotation. My team was consulted on Ley’s case to discuss the role of radiation therapy for the tumors in his brain. I tagged along behind our resident and attending radiation oncologists. We happened to arrive at the patient’s room simultaneously with the medical oncologist. A translator was also present, and she informed us that Nari did not yet know anything about Ley’s diagnosis. This would be her first time hearing the results of the scans and the biopsy.

Upon entering the patient’s room, I quickly surmised that this would be a challenging conversation. Ley was extremely confused, and although he spoke English, he was not able to respond to our commands or convey any sort of understanding. His mother Nari was crying profusely at his bedside.

We first introduced ourselves to Nari in English, and the translator subsequently conveyed our words to Nari. Nari nodded, eying us all warily through a sheen of tears. And then it began. One sentence at a time, the medical oncologist told Nari, via the translator, that her son had stage IV metastatic lung cancer. His disease was very advanced, and the condition could be treated, but never cured.

Nari’s cries were heartbreaking. I could only imagine what was going through her mind each time the medical oncologist spoke, and she had to wait for the translator to speak before she could understand. How much fear lived in those moments? As the conversation continued, Nari’s demeanor gradually began to change. The news had started to sink in. She asked a question in her native language. The translator repeated in English, “How much time does he have to live?”

The medical oncologist sighed, as if she answered this question often. “Fifty-fifty, one year.”

Throughout this encounter, I had been an observer, a mere medical student among much more powerful resident and attending physicians. I continued to observe, as the translator conveyed her interpretation of the oncologist’s answer, and Nari closed her eyes and nodded. In that moment, I felt that something was off. I cannot explain what struck me — was it the translator’s relatively ambivalent demeanor, or was it Nari’s lack of immediate despair? I had an indescribable instinct that something had quite literally been lost in translation.

Still, I stayed quiet. The medical oncologist had moved on, and I did not want to rudely interrupt.

I did not feel it was my place. I was, after all, only a medical student, the lowest-ranking member of the healthcare team in the room. Besides, no one else had noticed anything wrong. Maybe I had misunderstood.

My instinct continued to nag at me, however. After another ten or fifteen minutes, when we exited the room, the translator came with us. My attending announced that we would bring Ley to our department later in the afternoon for a whole brain treatment planning scan. At this point, I found a pause to respectfully interject.

“Sorry, Doctor, but I have a question.” I looked at the translator. “When Nari asked how much time Ley has left, did you tell her that he will live until he is fifty to fifty-one years old?”

The translator nodded, wide-eyed and suddenly afraid.

I looked at my resident, and then at my attending. “I was afraid of that.” Again, I looked at the translator. “I think when the medical oncologist answered that question, what she was trying to say was there is a fifty percent chance that he survives even one year.”

The translator gasped, her fears confirmed. “Oh dear. I did not translate that correctly. I said fifty, fifty-one years, so his mother thinks he has fifteen years left.”

There was a bleak silence. “We should correct that,” the resident noted. “We need to tell her there was a mistake.”

The attending smacked his lips irately. “And this is why I never tell my patients exact timeframes.”

“When should we tell her?” I asked. The attending glanced at his watch, and the growing list of patients he needed to see. “We can tell her this afternoon, when he comes for the planning scan.”

Again, a knot twisted in my stomach, and my instinct was to protest. Nari deserved to know now. We could not leave her with a false sense of hope until this afternoon. But, my training had allowed me to become somewhat deferential. I did not want to contradict the attending, so I stayed quiet.

“No,” the translator objected, rather vehemently. “We need to tell her now. This is a big deal.”

The attending reacted as if he had snapped out of a reverie. He shook his head, as if to say ‘What was I thinking?’ “You’re right. I was wrong. Let’s fix this now.”

And so we did. We reentered the room, and the translator corrected Nari’s understanding of Ley’s life expectancy. There was the cry that I had expected, the complete despondency. It hurt to witness, but it is what needed to happen.

It has been years since this encounter, but I will never forget the lessons it taught me. Differences in rank within the healthcare system can often silence our better instincts. Especially as a student, but sometimes even down the road, it is tempting to stay quiet and observe, out of respect for and sometimes fear of our superiors.

I am so glad I thought to say something that day, even if not at the correct moment. My instinct had been right, and somehow, I had caught a miscommunication. However, in a second opportunity to advocate for Nari, I stayed silent and almost let us delay the righting of our wrong. That day, the translator showed the courage to respectfully contradict our attending, and at once, she changed his perspective.