WHERE WORDS FAIL | Avina Rami
The morning air is thick with the scent of damp earth and citrus, the sun just beginning to burn off the mist that settles over the hills at dawn. As I walk towards the clinic, the streets pulse with life—vendors arranging pyramids of mangoes and avocados, the rhythmic slap of tortillas forming between practiced hands, a chicken bus rattling past in a blur of color and sound. I pass our local tienda and call out “Buenos días” across the street to the vendor, receiving his familiar greeting in return.
In the weeks I’ve been in the Guatemalan Highlands, each day has carried something new—moments of wonder, of uncertainty, of quiet lessons tucked between patient visits. Yet, there are unwavering constants: the giggles of children at each home visit, the warmth and vibrancy of the Mayan communities that call these hills home, the quiet strength of each patient I have had the privilege of meeting.
When I step into the clinic, Claudia is already there, perched on the edge of a plastic chair near the front of the waiting room. She holds a child in each hand while a third sleeps in a sling against her back. She’s 27—my age. Her milky brown eyes, the same shade as the café con leche I had with breakfast, are framed by lines carved from years of laughter. Her hair, dark and long, is tied neatly into a braid, with a few loose ends framing her face. Dark circles shadow her eyes, and her face is etched with worry. When her name is called, she rises with practiced efficiency, balancing the sling across her shoulders before following us inside.
She lowers herself into the chair in front of our desk and adjusts the child in her arms. “No quiere dormir ni comer… No sé qué está pasando.” ("He doesn’t want to eat or sleep. I don’t know what is happening.")
I lean forward and take a closer look at him. His cheeks are flushed, a thin sheen of sweat glistening at his temples. He cries out, shifting uncomfortably, his small fingers grasping at Claudia’s blouse. We reach for the thermometer and gently place it under his arm, watching as the numbers climb—102.5°F.
“¿Cuántos días ha estado enfermo?” we ask. (“How many days has he been sick?”)
Claudia glances at the floor before answering. “Cinco días.” Five days. She hesitates, then adds, “Pero no podía venir antes.” But I couldn’t come sooner.
I nod, though my throat tightens at the quiet reality of her words. The clinic is in the village, yet for many, access isn’t as simple as distance. Work, transportation, money—countless barriers stand between their door and ours. More than once, I’ve met patients who wait until symptoms become unbearable before making the trip to the clinic.
As we ask more about their home and support system, Claudia shares pieces of her life—she had her first child at 18. The children’s father is around sometimes, but not always. “Él hace lo que puede,” she says with a small shrug. He does what he can. There is no resentment in her voice, just quiet acceptance. She has learned to manage on her own when needed. Today is no different.
When we hand her the prescription, she hesitates, her eyes flicking toward the paper but never quite settling on the words. A brief silence lingers between us. She tilts the page slightly, studying it—not reading, but searching for meaning. I wait, expecting her to ask a question, to trace a finger over the text, but she doesn’t. Instead, she exhales softly and meets my gaze. “No sé como leer.” I don’t know how to read. Her words settle between us—gentle yet unwavering.
I think back to the early days of training, when medicine felt like a foreign language—dense textbooks, complex diagnoses, the unspoken rules of the hospital wards. How many times had I stared at a page, struggling to decipher meaning from symbols I did not yet fully understand?
Throughout the years, I’ve realized that communication is not always about words—it lives in the pauses, the gestures, the quiet signals that speak volumes. The way a patient shifts in their seat before admitting pain. The flicker of hesitation before answering a question. The unspoken concerns that linger in the space between our words. Being an effective physician isn’t just about mastering terminology; it’s about listening beyond words, seeing beyond what is written, and meeting patients where they are.
And so, we adapt. Instead of written instructions, we draw—a sun for the morning dose, a moon for the evening. We demonstrate how much medicine she should give, marking the small plastic cup with a Sharpie. We place the bottle in her hands and ask her to explain it back to us. She does, first hesitantly, then with growing confidence—her voice steady, her grip firm.
I think about how we are the same age, yet how differently our lives have unfolded—not as a gulf between us, but as a reminder of the forces that shape each of our paths. Circumstance, geography, history—each thread weaving its own story. I don’t know all that Claudia has carried, but I see the quiet weight of her responsibilities, the resilience in the way she moves through the world. She doesn’t frame her life in struggle or sacrifice; she simply does what must be done, with a strength that doesn’t need to be spoken to be understood.
Before she leaves, I touch her arm gently. “Con cuidado,” I say. Take care.
She offers a small smile. “Gracias, doctora.”
As Claudia steps through the clinic door, she shifts the prescription paper to her other hand, tightening the sling around her sleeping child. The morning sun catches her hair as she disappears into the rhythm of the village— the shuffle of footsteps on packed earth, the distant laughter of children, the low murmur of voices weaving through the crisp air.
I watch her go, reminded that while some lessons are taught in classrooms, others unfold here—in the spaces where worlds intersect, in the silences that speak louder than words.
Avina Rami is a fourth-year medical student at Harvard living in Boston, Massachusetts. She loves going on long runs, discovering new local bakeries, and stopping to meet every dog she comes across.