In Medicine in Translation, Danielle Ofri, a professor of internal medicine at NYU, shares her encounters with several of her patients that have come from other countries and had the greatest impact on her. Some come from her weekly half day clinic at Bellevue Hospital for members of the Survivors of Torture Program, including the university student from Nigeria whose story opens and closes the book. Other patients come from her regular clinic, residents' clinic, or from her months spent on the inpatient medicine service at Bellevue. Many of these patients speak little or no English, but language is but one of the barriers that must be overcome to provide effective doctor-patient communication and adequate medical care, which Ofri describes throughout the book.

Many of her patients are Spanish speaking, and Ofri has some familiarity with the language. However, she realizes that she is not fluent, and that this may actually be harmful to her patients:

"I sweated over my Spanish—beginning in my internship year with a one-week crash course in Guatemala—knowing that I needed it for survival, knowing that it was unlikely that I'd ever navigate it smoothly. By now I'd reached a precarious middle ground in which I spoke well enough to carry on a conversation, well enough for my Hispanic patients to assume they could talk to me in Spanish. But I lacked the agility to field unexpected linguistic turns. What I could say, I could say well—but beyond the circumscribed field of comfort, I was at a loss. I had a fluency, but I was not fluent, and that could be a dangerous state of affairs."

This quote hit home for me, as a nonfluent Spanish speaking physician, as did her quote about the differences between inpatient medicine and practice in the clinic setting:

"Inpatient medicine had a different rhythm than outpatient medicine. On the surface, it was more active—sicker patients, acute illnesses, rounding on patients spread throughout the hospital, going up and down the elevators to the ER, to radiology, to the prison ward. But strangely enough, it felt less discombobulating than the clinic. Clinic, with its ostensibly less ill patients, was traditionally considered to be the milder of milieus; in fact, it was an open-ended maelstrom of ceaseless patients, desultory and scattershot clinical conundrums, never-ending time crunches, plus chaotic scheduling that led to a different medley of interns and residents each day whose names I could never hope to muster."

Because of her desire to become more fluent in Spanish, Ofri decides to take a one year leave from medicine to move to Costa Rica with her husband and two young sons. Her often hilarious and touching account of this time comprises the second section of the book. In the third portion, she returns to her post at NYU/Bellevue, and we meet the same patients that she described earlier, along with several new ones. Their stories are powerful, and their perseverance and ability to juggle the demands of chronic illness in the face of a large and often unfriendly and unforgiving health care system in an unfamiliar country and language is inspiring yet nearly impossible to comprehend.

Medicine in Translation is an excellent book about the challenges of multicultural medicine and the lives of struggling immigrants in the United States. The book is written for the lay reader, but medical practitioners can also enjoy and learn from Dr. Ofri's sensitive accounts of her own successes and shortcomings as a clinician. ( )

About: New York's Bellevue hospital doctor Ofri tells the stories of several patients of hers. They are all from different cultures, with vastly different backgrounds and languages, some survivors of torture, some loving America, some who can't wait to leave. All get treated by Dr. Ofri.

Pros: One of the better medical narrative books I read. The patients are different yet memorable. Ofri does a great job of weaving them all together, going from one patient to another but always returning to continue the sagas of each one. Descriptions of her own thoughts as well as tales of her family fit in well. Good job avoiding confusing medical jargon.

Cons: A few grammatical things. Uses the lesser accepted term "northeaster" to describe a storm.

Grade: B+ ( )