"What year is it?" we ask the patient.
"Nineteen ten hundred," he says.
"Nineteen ten hundred."
"Okay, was this guy altered before?" asks the attending. "You want to call neuro and get a consult and see what's going on?"
"Wait," I pipe in. "Qué año es?"
"Dos mil diez."
"He's not demented, he just doesn't speak English."
"Well why didn't he say so?" says the attending.
"Maybe he doesn't know how."
And we leave. Scary enough, this is the highlight of my day. This is the moment of my day when it really crystallized for me-- I am a resident. I can do things. As an intern, it would have been hard to build up the courage to question the attending, hard to even suggest that this stupid little thing-- his assumption that the guy must be altered, which wasn't some big opinion the attending had formed, wasn't some big deal thing I'd be questioning, wasn't anything at all to the attending-- might be wrong. I would have waited until the end of rounds, then mentioned it to the resident, and hoped maybe she would say something to the attending, but then I'd have to follow up, I wouldn't want to make waves, it would turn into a whole big deal when it totally isn't.
But as a resident, hey, I know at least a little bit! I can make guesses. I can have opinions. And even though the attending is still technically my boss, I'm not scared of the attendings anymore. We're actually on the same team. We're colleagues. I'm just trying to help. I'm not afraid to be wrong-- if the guy had answered some crazy year in Spanish, I can just shrug it off and say, hey, thought maybe it was just a language thing, and we'd move on.
The interns, meanwhile, are looking at me like what I just did was crazy. Showed up the attending? That's crazy, weren't you worried, how did you know he didn't speak English, do you really speak Spanish, wow, that's amazing--
I don't speak Spanish. I speak fifty words of Spanish. How can you not speak fifty words of Spanish after a year in this job? I speak ten words of Chinese too. And three words of Tamil, I think.
Guaranteed I will have to convince at least five more people this guy isn't demented before he leaves the hospital... I should just hang a sign over his bed-- "Mental status: thumbs up. English: thumbs down." You know, I really should, it would help.