As the attending physician in the ED, I have already heard the case presentation from the resident. “Doctor,” the patient says, “there’s something wrong with my blood.” I notice the patient’s gestures, his hand movements. His filler words are ‘eh’ and ‘esto’ rather than ‘um’ or ‘well’, the melody of his speech not unlike the sounds of my own childhood. His facial expression tells me he is searching for a word.

“Dígame,” I offer, a Spanish term that is an invitation to tell me more. It takes him a moment to register the change in language, and when he does, he sits back and continues describing his symptoms, but this time in a seamless, natural and effortless rhythm, sometimes in Spanish, sometimes in English, depending on what feels just right.

“Could it be from the veneno in my blood, Doctora?” he asks. Confused by his question about veneno, the Spanish word for poison, I pull up a chair. My mental differential diagnosis starts to churn. Could he be ingesting a toxin? Could he be delusional? Could he be using the word in gest as a reference to one of his medications and its side effects?

“Le enseño,” he says, using the word enseñar which means ‘to show’ but also ‘to teach’. He deftly pulls up the electronic health record on his phone and finds the panel of routine blood tests from his last check-up. He points to the term ‘venous blood’. For the next several minutes, I explain what the word ‘venous’ means …