Editor’s Note: A wonderful story of determination and resilience that was necessary to obtain an orthopaedic education. It culminated in triumph and a meaningful career.
“I was an anglophone thrown into a francophone pond.” This occurred during my training.
As a junior orthopaedic resident training in a bilingual medical system, I was accustomed to speaking both English and French with my patients, but charting and communicating with hospital staff, fellow residents and my attending surgeons in my native English. Because one of my fellow residents did not show up for a rotation at a French-speaking hospital in our system, I was asked “can you go?” Of course, I said yes without realizing the level of challenge I would encounter.
There are number of ways to think about language. Conversational language works for speaking and listening to patients. In fact, like “Spanglish” in the United States, “Franglais” exists in Montreal, the largest city in Quebec which is the mostly French speaking province in Canada. This way of speaking allows one to merge two languages in conversation without misunderstandings among those with the knowledge of both. The most important aspect of conversational language in medicine is that both patient and physician understand each other.
In medicine and especially in orthopaedics, there is also the technical language that must be learned. The French names of bones, anatomic parts, anatomic positions, medical tests, etc. are based in Latin and not at all like their English counterparts which are of Greek origin. It is necessary to switch from one nomenclature to another in order to be understood.
I had passed the French language test required for my general-Quebec medical license, so I could do some moonlighting as was common at the time. Encountering the need to begin to use the French technical terminology so early in my orthopaedic training was unanticipated. I was just learning the basic concepts in English and then was asked to begin to think, speak and write using the French terminology.
In the French hospitals, office notes and orders were handwritten in French. These were the days before use of computers in clinical health care. Operative dictations were spoken in French as well. This was before “autocorrect” and translation Apps. An English French dictionary was a necessity.
In another interesting set of requirements, French orthopaedic residents had to study from English textbooks to learn orthopaedic concepts but speak and write using the correct French terminology. In other words, we were all challenged.
Some amusing anecdotes from this time are as follows:
- I was to speak at a teaching conference about hand fractures associated with human bites, commonly known in English as “fight bites.” As is well known, if the bite is overlooked, a serious infection can result at the fracture site. I intended to say, “be careful about human bites while treating hand fractures.” Instead, even after using my dictionary to help me prepare, I said “be careful of human mouthfulls while treating hand fractures” to the amusement of all in the room.
- When dictating an operative report at a French hospital I intended to say, “the raw bone was smoothed with a rasp.” Instead, I apparently said, “the uncooked surface of the bone was smoothed with a rasp.” The transcriptionist must have been rolling on the floor.
Interesting cultural differences were noted in the English and French hospitals. In the French system, I worked directly with the staff surgeon and informally interacted very little with the nurses and support staff. In the English hospitals, as a resident, I was relegated to work with the nurses and had less attending surgeon interaction. The French experience was more pleasing and enriching.
What did this bilingual and bicultural experience teach me? It helped me become comfortable in difficult situations. It was very challenging, but the sense of accomplishment after becoming competent in my responsibilities in both systems was immense. I learned that people really do want you to succeed and are supportive. Being at least bilingual is quite normal throughout the world with the exception of the United States.
As a Canadian, I’d like to emphasize how critically important it is to pass the Royal College examination in Orthopaedic Surgery. The written component of the exam is taken before the applied, and only those candidates passing the written examination will be invited to the applied examination. The pass score is 70% for each component. Orthopaedic practice in Canada is not a possibility without passing both parts, there is no such thing as “board eligible.”
What would I change about my career? Very little. It has been satisfying and as I close in on retirement, I can say that I have accomplished my goals. The road to full professorship has been long, nonsensical and somewhat frustrating. But, I persisted, and in the end my goal has been achieved.