I was right in the midst of a hectic afternoon clinic when my pager went off—an inpatient consult request. The situation seemed complex: Chronic pancreatitis that had taken a sudden turn for the worse. A new, substantial mass was present in the pancreatic head; tumor markers were elevated. Two endoscopic biopsies had been unsuccessful, and surgery appeared far too dangerous for this fragile patient. Cancer appeared to be the only likely explanation.

Rheumatology—my specialty—was consulted because her ANA was weakly positive (1:40). In our field, that titer is barely significant, yet we weren’t irritated. We asked ourselves: Could a rare mimicker like IgG4-related disease possibly be present?

She was a divorced, single mother of three, of Bangladeshi descent like myself. Her sole means of support: Working as a home-health aide for her 20-year-old autistic son. Now, she was deteriorating—gaunt frame, unspoken fear, and a throat constricted by communication barriers. She spoke almost no English. When I spoke to her in Bangla, she breathed out as if a window had been opened.

Following the examination, I posed the usual question: “Who will take care of you at home after you are discharged?”

With a disarming sense of faith, she smiled. “Doctor, my eldest son will. And Allah is always there. With his assistance, I will be alright.”

Something within me questioned whether that was the complete truth. The following day—and the one after—I kept revisiting her support network. Always the same courageous response.

On the day of discharge, her voice finally faltered.

“My son can only assist me to the bathroom. Beyond that, I am powerless. Actually… I have remarried. My new husband is still in Bangladesh, awaiting his visa. If you could compose a letter, perhaps immigration would expedite things.”

I paused. “Why didn’t you mention this earlier?”

Gently she replied, “In our Bangladeshi culture, people judge a divorced woman who marries again—especially at my age. I wasn’t certain how you would react.”

I smiled. “Your health is my primary concern; social stigmas are secondary.” I informed the primary team. Together we crafted a humanitarian letter—one delicate link so a seriously ill woman wouldn’t confront a potentially terminal diagnosis alone.

Now I find myself pondering: If I hadn’t spoken her language, if I hadn’t asked, “Is there anything else you’d like to share with me?” every day, would this essential fact—her remarriage, her distant partner—have come to light at all? She could have left the hospital marked safe for discharge but entirely unsupported.

Tele-interpreters are incredibly vital, but would a distant voice have perceived the shame surrounding remarriage—the subtle hesitation that ultimately melted only after days of direct, shared-language dialogue? How can we, when depending on tele-interpretation, grasp those cultural subtleties and establish trust quickly enough to reveal critical truths before it’s too late?

*Syed Ahmad Moosa is a rheumatology fellow.*