Narrative Inquiry in Bioethics

My parents are low-income, Medicaid-dependent Vietnamese refugees with limited English proficiency. Regardless of the situation, when asked, "how are you doing?" in English, their inevitable response is a tight-lipped smile, slightly downcast eyes, and a polite, affirmative nod of the head. This is always a perfunctory response, never an actual description of their emotional or physical wellbeing.

When my father was taken to the ED a couple of years ago for worsening chest pain and difficulty breathing, his answer to the physician's question of "how are you doing?" was a tight-lipped smile, slightly downcast eyes, and a polite, affirmative nod of the head. Though Vietnamese is a top-5 spoken language in Southern California and interpretation was indicated in his chart, my father knew from his prior interactions with the healthcare system that this request often caused delays in his care and seemed to frustrate his providers. My father had my brother accompany him to the ED to help him navigate his care. To their surprise, they were told that my father would need to be admitted. Prior to transfer out of the ED, my brother left to go to work and called my mother to update her.

My mom called me the next morning to tell me that my father went to the ED overnight and was admitted to the cardiac intensive care unit (CICU). When I spoke to my father, he said he wasn't sure why he was admitted since they were speaking to him in English, but he thought it was to observe his chest pain. He was near certain he would be discharged later that day. I told him that he needed to request a Vietnamese interpreter and to call me immediately when a member of his medical team entered the room so I could get an update.

Despite the medical team checking in multiple times throughout the day, my father said that no one was providing him with any updates. After numerous attempts, I was finally able to get connected to the resident on-call. I found out that there was never a plan for my father to be discharged, but rather, they were waiting on a bed for him to be transferred to the university hospital. The resident disclosed that my father had suffered a severe myocardial infarction and required an evaluation by a cardiothoracic surgeon and an interventional cardiologist. The resident told me that this information was shared with my father. I immediately informed the resident that my father was not aware of this information and requested that a Vietnamese interpreter explain this information to him as soon as possible.

It was quite obvious my father was unaware of the seriousness of his condition. It fell to me to break the news. After I told him over the phone, there was a prolonged silence. My father prided himself on his health, intelligence, and independence. My father experienced many challenges in his life, including being jailed following South Vietnam's loss in the Vietnam War and two additional incarcerations after being caught trying to flee post-war Vietnam. He finally escaped political persecution with my [End Page E1] mother and two-year-old brother as stowaways on a fishing boat. After escaping, they resided in a refugee camp in Indonesia for years before coming to the United States. Despite the frightening stories I heard about his life, this was the first time I ever heard fear in his voice. My father was a take-charge person and the head of our family. His reliance on others to keep him informed about his care and interact with his medical team on his behalf left him feeling powerless and ignorant, two states he loathed.

Despite my request for a Vietnamese interpreter, he was transferred to the university hospital the next evening without ever hearing his diagnosis or prognosis from his medical team in a language he understood. Frustrated by the lack of communication from his team, I told my father that I was going to find coverage for my upcoming shifts and planned to...