Lost in Translation

My intention was to place a new post weekly but with such an intense first week, I decided to post a bit extra. I am told I will settle-in, which seems unbelievable at this point.
The patients sometimes stay on their casualty stretchers for days and I've had conflicting explanations for this. One morning I walked in to a full house with some familiar faces from the days before.
From one of the doubled-up stretchers a thin young man would periodically moan. I heard these moans on more than one occasion throughout the morning. Quiet moans.
In the afternoon when the stretcher was singly occupied by that same young man, I took a closer look at him. His chart said he was 19 but he looked 13. He was fully dressed but through his partially unbuttoned shirt I could see his ribs. His chart also reflected that he had not been evaluated by a doctor. I examined him quickly and asked someone to help me ask him a few questions. The gist of the story was 3 weeks of cough, fever and loss of appetite. What bothered him most and caused his moans was the pain in his chest when he breathed. He said his father was receiving treatment for TB. His chest x ray was suspicious for tuberculosis and I arranged for his admission.
This morning I looked at the chart of a young boy sitting quietly on a stretcher with someone I presumed to be his father. His father pointed at his left arm. On that arm he had a plaster splint from shoulder to wrist along the back side of his arm wrapped in kling(gauze). I could see the flex of his elbow seemed swollen and blistered and was covered in gentian violet. His father began to speak to me and I now know how to say "I don't understand Kiswahili" in Swahili so I shared this bit of information with him and went on my way. This afternoon I noted the surgery interns taking off the splint while the boy screamed in pain. The interns told me that he had had the splint placed a week ago for a fracture of his proximal radius and ulna(forearm close to the elbow). The skin about the elbow was markedly swollen and bleeding. I could feel what I thought was a faint radial pulse. The intern said he thought the kling had been wrapped too tight. I suggested that a hospital admission might be a good idea and went home for the weekend.
When you are a U.S. E.R. doctor it is crammed in to your head that you are the captain of the ship and responsible for everything that happens in the department. In order to accomplish this task, it is necessary to know what is going on with all the patients.
I have used the language barrier as a rationalization for failing in this task this week. But the moans and the gentian violet covered blisters required no Swahili expertise to understand.
I share this not with the intent of beating myself up.
There are indeed further rationalizations that the half-day waits that each of these suffering patients endured in the casualty bay will not contribute to adverse long term outcomes. TB will respond to treatment in the afternoon as readily as it would have in the morning and the damaged arm had sustained it's damage for many days.
But I can't help but think and feel that these cases are microcosms of the response to suffering in the world. How often do we use similar rationalizations for a failure to respond?