SCENARIO: A 29-year-old Congolese refugee at 34 weeks gestation presents to labor and delivery with severe headache, visual changes, and RUQ pain. She speaks Swahili and limited French; her husband interprets but frequently answers questions himself without translating to her. She spent three years in a refugee camp before resettlement eight months ago. Her prenatal care has been fragmented, with only two visits documented. Blood pressure on arrival is 178/112 and urine protein is 4+.
Before You Read
What to Look For
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What the Body Knows First: The SOAP note records the interpreter switch as protocol compliance. The prose captures what it actually changed: 'Her shoulders drop two inches' — an autonomic finding no form has a field for, yet arguably the most important physical exam of the encounter.
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The Shape of What Was Released: Amina's history of sexual violence is a single SOAP clause for care planning. The prose shows its clinical consequence — a female examiner arranged 'without my needing to explain further.' The poem never names the violence; its river 'when the dam gives way' holds only the shape of it.
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Power Written in Language: The poem writes 'a chart she cannot read / in a language she does not speak / in a country she did not choose.' This makes visible the asymmetry the SOAP note enacts but cannot see: the entire medical record is institutional authority exercised over a patient with no access to it.
Lens I
SOAP Note (EHR)
AI-generated for educational purposes. Not a clinical document.
SUBJECTIVE:
Via professional Swahili interpreter (phone): 'My head has been hurting for two days and getting worse. This morning I started seeing lights.' Reports pain in her right upper abdomen and says the baby has been moving less since yesterday. Denies bleeding, leaking fluid, or contractions. This is her third pregnancy; both prior deliveries were uncomplicated vaginal births in the DRC. No history of high blood pressure. Only 2 prenatal visits at the community health center — says transportation has been a barrier. Husband was initially interpreting but redirected to professional interpreter per policy; patient became visibly more forthcoming. With professional interpreter, disclosed history of sexual violence in the refugee camp; has not told her husband. No known allergies.
OBJECTIVE:
VS: T 37.0, HR 102, BP 178/112 (repeat 174/108), RR 20, SpO2 98% RA. Wt 71 kg. Gen: anxious, grimacing, holding R abdomen. 3+ patellar reflexes bilaterally with 2 beats clonus. RUQ tender to palpation. Gravid uterus consistent with dates. FHR 155, moderate variability, no decels on 20-min strip. Cervix 1 cm/50%/-3. Labs: plt 89k (H), AST 142 (H), ALT 118 (H), LDH 486 (H), Cr 1.1 (H for pregnancy), uric acid 7.8 (H), urine P/C ratio 4.2. Peripheral smear: schistocytes present. Fibrinogen 188 (low-normal for GA).
ASSESSMENT:
29-year-old G3P2 Congolese refugee at 34+2 weeks gestation, presenting with severe headache, visual changes, and RUQ pain. 1. Severe preeclampsia with HELLP syndrome (hemolysis + elevated liver enzymes + low platelets) at 34+2 wks. 2. Indicated preterm delivery - meeting criteria for delivery given HELLP at viable GA. 3. Language/communication barrier - professional interpreter essential; husband should not serve as sole interpreter given pt's disclosure and observed communication dynamics.
PLAN:
1. MgSO4 4g IV bolus then 1g/hr continuous for seizure ppx. Labetalol 20 mg IV, may repeat q15 min per protocol, target BP <160/110. 2. Betamethasone 12 mg IM x1 now, but will not delay delivery for steroid course given HELLP severity. 3. Plan for induction of labor vs C-section depending on cervical response and clinical trajectory - discussed with pt via interpreter. 4. Anesthesia consult - regional preferred but plt trend concerning; will recheck in 2 hrs. 5. NICU notified for 34-wk delivery. 6. Professional Swahili interpreter to remain available continuously - documented in chart that husband is not to serve as interpreter. 7. Social work consult for refugee resettlement support and trauma-informed care planning. 8. Type and screen, 2 units pRBC available. Strict I&O. Foley catheter placed. Continuous EFM.
Lens II
Narrative Medicine: Prose
Preeclampsia at Thirty-Four Weeks, Interpreter on the Line
AI-generated for educational purposes. Not a clinical document.
The professional interpreter's voice comes through the phone speaker with a warmth that changes the room. Amina's shoulders drop two inches when she hears her own language spoken by someone who is not her husband. She begins to talk, and I understand from the length and urgency of her response that she has been holding a great deal back. Her husband stands by the door, and I watch the shift in his posture when he realizes the conversation is no longer passing through him.
Her blood pressure is the number I must attend to, and her platelets are falling in a way that narrows the window for regional anesthesia, and the baby will come tonight whether or not we are ready. These are the clinical facts. But the other fact, the one I carry as I draw up the magnesium, is the sentence the interpreter relayed to me privately before I entered the room: that Amina spent three years in a camp where terrible things happened to her, and that she has never been examined by a male physician, and that she is afraid. I asked the attending if Dr. Okafor, the female resident, could take the lead on the exam. She agreed without my needing to explain further.
I check the fetal heart tracing and it is reassuring in the way that only a fetal heart tracing can be reassuring: a thin green line that says alive, alive, alive, while saying nothing about what kind of life awaits on the other side. The magnesium drip starts and Amina closes her eyes. I do not know if she is resting or praying. The interpreter stays on the line.
Lens III
Narrative Medicine: Poetry
AI-generated for educational purposes. Not a clinical document.
The interpreter's voice arrives
through a speaker the size of a playing card
and Amina begins to speak
the way a river speaks
when the dam gives way
three years in a camp
I write in a chart she cannot read
in a language she does not speak
in a country she did not choose
the magnesium hums into her vein
her platelets fall like a slow weather
and the baby's heart
traces its green refusal
to be anything but alive