The Patient Was…

The patient was a Mexican national in his late twenties, traveling with a male friend from Miami to New York. About an hour into this, his first-ever flight, he developed a sharp pain in his upper chest and became very alarmed. He called for a flight attendant who, in turn, asked over the PA system if a doctor was on board.

I had been in Miami on a medical business trip and had visited with my daughter and her family, who had moved there from New York. My son-in-law was born in Mexico City and did business in Latin America with companies most of which had offices in Miami. He had been educated at an American school in Mexico City, and graduated from Beverly Hills High School after his family moved to Los Angeles.  While his English was impeccable (except for referring to “homemade” cookies as “housemade“), he spoke only Spanish to their two children, hoping they would be comfortably bilingual.

I loved hearing the Spanish when I visited, and I picked up a few phrases. My grandson was an extremely active and energetic boy and his father often said, “Tranquilo” (meaning “calm down”). But he always extended the phrase with an endearment, “Tranquilo mi amor” or “Tranquilo mi rey” (“calm my love” or “calm my king”). The expressions became fixed in my mind.

When the request for a doctor aboard the Miami-to-New-York flight was made, I responded. The flight attendant told me the patient had chest pain and I told her that I was a cardiologist, so this was clearly in my comfort zone. She also said that the man spoke only Spanish and I told her confidently that I was sure I could manage.

When I saw the patient was a young man, I was immediately relieved. While not impossible, a coronary (heart attack) cause of chest pain in someone in his twenties would be quite unusual. What was most striking was how anxious and agitated he looked. On closer observation, I noticed that he had a single finger pointing to where his chest hurt, and the seemed to wince every time he breathed.

Pain so localized and timed with breathing often means a localized area of pleuritis or inflammation of the pleura which is the lining over the lung. As the inflamed surface moves with each breath, it rubs against adjacent structures which is painful. One crude but quick test is to immobilize the inflamed area so it doesn’t move as the patient breathes. You can do this by pressing firmly right over the sore area, and if taking a breath no longer causes the pain, you can be pretty sure of the diagnosis.

Taking notice of the young man’s obvious anxiety, I thought I could both relax him and do the little pressing test on his chest. I sat next to him in the seat that his friend had vacated, put what I thought was a reassuring arm around his neck, slipped my other hand under his shirt and pressed over his breast, and softly said, “Tranquilo mi amor.” 

The young man reacted almost violently, pushing me away and trying to get out of his seat. I didn’t understand it, and encircled him more firmly, repeating “Tranquilo mi amor” and “Tranquilo mi ray.” The more I tried, the more resistant he became; I think if it were possible he would have tried to jump out of the plane.

His friend standing nearby saw immediately what I didn’t, and he started to laugh out loud. Then it hit me. I was embracing the patient almost as a lover might, and cooing endearments in his ear. I was violating his sense of “machismo” and in the presence of both friend and strangers.

Machismo, a sense of masculinity and male dominance, while found in many cultures around the world, is certainly prominent in Hispanic cultures and notably in Mexico. The concept includes masculine pride and virility. And I was challenging it directly and publicly.

When I realized what was happening and what I was doing, I tried to explain it to the patient. He was having none of it. He couldn’t get far enough from me. My Spanish, which had betrayed me with “mi amor” and “mi rey” was not even close to adequate for the job. Mortified, I slunk away and back to my seat.  

I had thought, but without really thinking, that I knew more than I did. I didn’t pay attention to my limitations. The words inscribed on the ancient Greek Temple of Apollo, and often quoted, are meaningful in many contexts: “Know thyself.”