Sink or Swim: Cancer as a Second Langauge

Caregiving often feels like drowning.  Tips to help you learn to swim.

There aren’t many ‘lifeguards’ in hospitals, but these five tips can help you learn how to swim.

When cancer strikes, it’s rather like being deposited into a foreign country (where no one speaks your native language) with nothing more than a small suitcase and none of the local currency. Just like they say about language immersion programs, you have two choices: You can sink, or swim.

Evidently, I’m a good swimmer, because within three months of Pedro’s initial diagnosis, hospital personnel would ask me, “So, are you a nurse?” Or even, if I sounded particularly bright, “Where did you do your residency?” I even received the employee discount at the local hospital because the cafeteria workers assumed I worked there (I found this out when one of the cashier asked for my employee card and when I told her I didn’t work there, my cinnamon roll cost seventy-five cents more than it had the previous week).

My basic survival skill, being quiet and trying to look intelligent, evidently fooled a lot of people. Soon, I could toss words like ‘intrathecal,’ ‘monoclonal antibodies,’ ‘methotrexate,’ and ‘Rituxan’ around as if they were part of everyone’s vocabulary.

But deep down inside, I felt like an imposter. I had no idea what was going on even though I knew exactly what was happening. Learning the lingo allowed me a sense of control, but in reality, I reminded myself of a hopelessly lost ESL student.  But I swam, I acquired and I ‘learned cancer.’


In fact, I reminded myself of one of my students, who stared at me out of brown eyes widened by fear.  Her gaze bounced between me and the other students seated in a circle.  I glanced at her chart—Rats, her native country was Bangladesh, and there was nothing I could do to help ease her transition into her new classroom in her new country.

As her ESL teacher (English as a Second Language), all I could do was radiate love, repeat instructions with patience, and hunt for some way to connect.  Over the next three years, I knew this child would learn to speak social English—she would quickly make friends and within a year would sound as if she were a native speaker.

This phenomenon is something language experts call ‘Basic Interpersonal Communication Skills, or BICS, for short.  But I knew, unlike the casual observer, that it would take up to six years for this young lady to acquire her cognitive English—Cognitive Academic Language Proficiency Skills—CALPS (educators love acronyms).  This poor girl would struggle in school until she learned the nuances of English and the unspoken text of teachers’ instructions.


That was me.  I had learned the ‘BICS’ of cancer, but I didn’t really understand everything–and I let people assume that I did.  I realize now that I looked like I ‘knew cancer’ because of the new vocabulary I’d picked up and because we seemed to fit right in to hospital life.  Pedro rarely stayed in the hospital room without a family member for more than a few hours at a time. He only spent a handful of nights alone. When he was neutropenic, those that could, donated platelets and blood. We bathed him, fed him his meals (which could take hours), and played endless games of UNO and Phase 10 with him. Someone was usually there when the doctors did rounds, and we reported to each other daily.

We grocery shopped for prepackaged frozen meals that were nutritious and tasted better than institutional food for the times he wanted to eat. We coordinated work times and travel times and in-between times so that Pedro didn’t have to face cancer alone—and I guess our constant presence made it appear that we’d adequately acquired Cancer as a Second Language.

Unfortunately, there were plenty of times when I had no idea what was going on. I couldn’t understand the subtext of the medical profession and was too afraid to know the answer. “It’s a race to see if the white blood cells come back.” Who’s racing? What is the prize? “We’re thinking about a white blood cell transplant.” Sounds reasonable to me, sign me up. How do I find a donor?

“We’re giving salvage chemotherapy.”

Pedro seemed to understand that one. “It’s the last thing they do,” he told me. I nodded my head wisely, pretending to understand when I absolutely wanted to cling to my belief that what the doctors were doing was working. Maybe I wasn’t so far different from my ESL students—bravely clinging to the few words I understood while helplessly ignoring the waves that washed over me as I struggled to keep my nose above water.

Five Tips for “Learning Cancer” (aka Things I Wish I Would Have Realized at the Time)

1. When I teach English as a second language, I draw a lot of pictures so my students understand. Don’t be afraid to ask a doctor to draw a picture or a procedure or a problem to help you understand it better. I’ll never forget a physician at Children’s Hospital in San Diego taking the time to diagram our daughter’s heart murmur problem for us. It made all the difference in our anxiety level.

2. ESL students are often afraid to ask questions because they think they’ll look stupid. Don’t be afraid to ask. Health care professionals should remember that you’re just a confused and frightened newcomer to the classroom. It’s ok to ask a doctor or a nurse to spell out then names of drugs used in treatment so that you can research them later on.

3. Create your own dictionary. I always have ESL students create their own dictionary with words and phrases that they’re learning and using. You don’t need an exhaustive medical dictionary, you just need one that helps YOU remember and understand what YOUR loved one is going through. So, grab a notebook or start a document that helps you keep track of what you’re learning.

4. Second language learners learn through action. If you’ll be responsible for changing a dressing or administering a drug therapy, make sure you practice until you’re comfortable BEFORE you leave the hospital so that you can act with confidence once you return home with your loved one.

5. ESL students often have to ask, “Could you please repeat that?” It’s ok to ask for clarification. With insurance companies demanding shorter and shorter stays in the hospital, medical professionals realize that caregivers are an important part of the team.

Have you discovered any coping skills?