When the patient arrived by ambulance, he was frail, elderly, and alone in a hospital that spoke a language he could not understand. He had been transferred from a neighboring hospital across state lines due to concerns of malnutrition and pain. The initial CT scans were alarming—multiple lung masses, highly concerning for metastatic cancer. Yet, despite the grim prognosis, there were still barriers to giving him a definitive diagnosis, and even more barriers in simply understanding his needs.

The barrier of language

The most immediate challenge was communication. He did not speak English, and his daughter, who had brought him into the outside emergency department, struggled to articulate his symptoms in a way that the medical team could understand. The hospital didn’t have an on-site Vietnamese translator, so they resorted to a tele-translation service via the iPad. While functional for some cases, it proved inadequate here. The patient could not hear the translator clearly, and his daughter, overwhelmed by the situation, resorted to summarizing his condition in the simplest terms: “He is in pain.”

At first glance, this seemed reasonable. But as I stood there listening, I realized something critical—he was not saying that he was in pain. He was saying that he was tired. Tired of the hospitalizations, the uncertainty, the slow erosion of his independence. “Mệt quá,” he said. And more than anything, he was hungry. His discomfort was not solely from cancer; it was from exhaustion, from weakness, from simply being unable to eat. However, this distinction was lost in translation, both linguistically and medically.

The health care system is structured around efficiency, but in moments like these, efficiency can come at the cost of true understanding. Without the right words, without a cultural context, his suffering risked being misinterpreted. This is particularly true in rural America, where resources for non-English-speaking patients are limited.

Bridging the gap

I spoke to him in Vietnamese. Though I am not medically certified to practice in the language, sometimes hearing familiar words from someone who looks like you, who understands the cultural nuances of your experience, makes all the difference. A formal interpreter remained on the call, but my presence reassured him in a way that a screen never could.

My Vietnamese was imperfect, tainted with the American twang of someone who grew up among refugees speaking 1970s Vietnamese while also navigating a world that did not always welcome bilingualism. I was awkward and clumsy, but his eyes opened just a fraction wider when I squatted down and said, “Xin chào ông.”

His expression softened—not because I had said anything profound, but because in that moment, he was not entirely alone.

The daughter’s burden

While the patient grappled with his illness, his daughter faced a battle of her own. She was doing the best she could, but the strain was clear. She lived two hours away, had recently opened a nail salon, and was raising a young child as a single parent. She wanted to be present for her father, but she also had responsibilities she could not simply ignore.

The weight of those obligations was evident, and I understood her unspoken struggle—balancing family and work, trying to do the right thing while feeling as though no choice would ever be enough. I knew what it was like to feel pulled in every direction without relief.

As the eldest Vietnamese daughter, I am well acquainted with the cultural familial duties—the expectation that family should be preserved and supported above all else. But here she was, torn between the man who raised her and the child she was trying to raise. She wanted to do right by both, but that is not how the system works.

An impossible choice

The most heartbreaking aspect of his case, however, was the impossible situation he faced. The standard course of action required a biopsy before formally diagnosing his cancer, despite the overwhelming radiographic evidence. Once confirmed, treatment options would be discussed. But the logistics of his care created a cruel dilemma: if he pursued treatment, he would not be accepted into a nursing facility. His daughter could not provide 24/7 care, and they were not wealthy enough to afford full-time home help.

And so, in the face of limited options, he began making concessions.

He wanted to live with his daughter, but when he realized it was not feasible, he said, “It’s OK.”

He wanted treatment, but when he learned it would complicate his ability to receive care at a nursing facility, he hesitated.

His daughter argued that they should continue treatment, clinging to the hope that he might be the one in a million who beats the odds. He doubted it but did not say.

Insurance denied their nursing facility request. She would have to pay out-of-pocket.

And when he was told he could not have both—aggressive treatment and the ability to remain in a structured care environment—he made the choice that so many others in his position have made before him. He chose his daughter’s peace of mind over his own desires.

Autonomy, in theory and in reality

It is one thing to discuss autonomy in medicine as a principle; it is another to watch a patient relinquish their own desires for the sake of those they love. In the end, he did not choose treatment because he believed it would save him. He chose it because he did not want to burden his daughter.

I left that encounter with a profound sense of unease. I could not change the outcome, nor could I alter the systemic flaws that placed him in this position. But I could advocate for him, push for faster pathology results so that he would not spend unnecessary days in a hospital bed, and ensure that he had the opportunity to make informed decisions about his care.

Lingering thoughts

I do not know what happened after he left our service. I can only hope that his oncology team spoke honestly with him about the reality of treatment, about how limited his time truly was, and about whether extending life by a few months was worth the immense physical toll.

I still think about him. About his daughter. About the many patients who face similar dilemmas, whose voices go unheard due to language barriers, cultural differences, or bureaucratic obstacles.

Medicine often emphasizes the importance of communication, yet fails to acknowledge that true understanding requires more than just words—it requires listening, patience, and the willingness to meet patients where they are.

That day, I was able to hear him. But I am left wondering: How many others never have the chance to be heard?

Thanh Phuong Nguyen is a medical student.