Blog — Clinical Spanish

Spanish for dialysis nurses: the patient who asks if he can pause his treatments for three weeks to visit family in Mexico, the travel dialysis coordination conversation, and the patient who went anyway and is calling from Guadalajara because he can only find a center that wants cash

Aurelio Ramírez is 71 years old. He has been on hemodialysis Monday, Wednesday, Friday for eight years. He has family in Michoacán — his sister Esperanza, three nephews, two nieces, and a great-niece named Valentina who was born in 2022 and he has never met. He has not been to Michoacán since 2019, when his mother was dying and the dialysis unit said they could not discharge him for more than four days. He stayed. His mother died in Morelia while he was in the chair. His sister called. He did not go to the funeral. On a Wednesday in May, Aurelio asks the nurse connecting him to the machine: “¿Si me voy a México tres semanas, puedo pausar la diálisis?”

Eight years on dialysis and one missed funeral

Aurelio was diagnosed with end-stage renal disease in 2018 at age 63. He had worked in the fields in the San Joaquin Valley for twenty-two years before his knees gave out and he took a job at a packing shed, which he worked until the fatigue from his kidneys made it impossible to stand the full shift. His wife Dolores died in 2020. He lives with his son Ernesto in Stockton. Ernesto works Mondays, Wednesdays, and Fridays and cannot drive his father to dialysis. Aurelio takes the transport van.

He is a good patient by every clinical metric. His Kt/V is 1.5. His hemoglobin runs between 10.2 and 11.1. He knows his potassium limit. He does not drink juice. He has missed three sessions in eight years, twice for illness and once for his wife’s funeral.

What the clinical chart does not record: that Aurelio has been thinking about going to Michoacán since 2019. That his sister Esperanza sent a video of Valentina saying “tata” for the first time and he watched it eleven times. That Ernesto has a month of vacation in July and has offered to drive if Aurelio can figure out the dialysis. That Aurelio does not want to ask because he already tried in 2019 and the answer was four days and his mother died while he was in the chair.

This is what arrives at the nurse’s chair in the form of a logistical question about pausing dialysis.

Failure mode 1: The “no” that closes the conversation

The nurse connecting the line hears “¿Puedo pausar la diálisis?” and answers without looking up: “No, señor. Usted no puede pausar la diálisis. Si usted para los tratamientos, los desechos se acumulan en la sangre y en cuatro o cinco días puede haber consecuencias serias.”

Everything she said is clinically accurate. None of it is what Aurelio needed to hear.

A patient with ESRD on hemodialysis knows that he cannot stop dialysis. He has known this since 2018. He did not ask because he forgot. He asked because the word “pausar” was the only word he had in that moment for a question that is actually: “¿Es posible para alguien como yo ir a ver a su familia?” (Is it possible for someone like me to go see his family?)

The nurse who answers the logistical question — no, cannot pause, toxins accumulate — has closed the door on the actual question. Aurelio nods. He does not ask again. He does not tell his sister Esperanza. Ernesto uses his vacation in July to fix the car and they do not go to Michoacán.

Or: Aurelio goes anyway without telling anyone, because he has been on dialysis for eight years and he knows the routes and the risks and he has decided that this is the trip he is going to take regardless of what the chart says is optimal. This is also common.

The conversation that opens correctly:

“Señor Ramírez — está pensando en ir a México. Cuénteme más. ¿Tiene familia allá? ¿Cuánto tiempo lleva pensando en esto?”

(Mr. Ramírez — you are thinking about going to Mexico. Tell me more. Do you have family there? How long have you been thinking about this?)

He will tell her about Valentina. About Esperanza. About July. About 2019.

The nurse then:

“Eso tiene mucho sentido. Y ese viaje es posible. No es sencillo, pero hay pacientes de diálisis que viajan a México y reciben su tratamiento allá. Lo que necesitamos hacer es coordinarlo con tiempo para que usted vaya tranquilo y con su tratamiento asegurado. Déjeme hablar con el doctor y con nuestro trabajador social. ¿Tiene ya una fecha en mente?”

(That makes a lot of sense. And that trip is possible. It is not simple, but there are dialysis patients who travel to Mexico and receive their treatment there. What we need to do is coordinate it in advance so you go at ease with your treatment secured. Let me speak with the doctor and with our social worker. Do you already have a date in mind?)

The difference between these two conversations is not just tone. It is outcome. The patient who hears the first version does not tell the clinic he is going. The patient who hears the second version is partnered into a coordination process that gives him a real chance of getting his treatment safely in Michoacán.

Failure mode 2: The travel coordination that gives a list without structure

Aurelio is referred to the social worker. The social worker is good. She pulls up the resource sheet the unit uses for out-of-area patients and tells Aurelio what he needs to do:

“Necesita buscar un centro de diálisis en México. Necesita una carta de su doctor. Necesita sus laboratorios recientes. Necesita saber sobre el pago. La mayoría de los seguros de aquí no cubren allá.”

Aurelio leaves with four things he needs to do and no idea how to do any of them.

The social worker was not wrong. She was incomplete.

What the travel coordination conversation needs to provide is not a list. It is a structure: who does what, in what order, by when, in language Aurelio can act on.

The full structure, delivered in Spanish:

Step 1: The nephrologist visit before the trip. “El primer paso es hacer una cita con el doctor para actualizar su prescripción de diálisis. Esto es importante porque el centro en México necesita saber exactamente qué tratamiento usted recibe hoy — no el de hace seis meses. También vamos a pedir laboratorios recientes para que los tenga al día. ¿Tiene cita con el doctor este mes?”

(The first step is to make an appointment with the doctor to update your dialysis prescription. This is important because the center in Mexico needs to know exactly what treatment you receive today — not the one from six months ago. We will also order recent labs so they are up to date. Do you have an appointment with the doctor this month?)

Step 2: The record packet. “Vamos a prepararle un sobre que usted va a guardar en su equipaje de mano — no en la maleta que va abajo, porque si esa se pierde, usted llega sin documentos. El sobre va a tener cinco cosas: su prescripción de diálisis, que dice cuánto tiempo dura la sesión, cuánto líquido le quitamos cada vez, la velocidad de la máquina, y el tipo de membrana. Sus laboratorios de los últimos tres meses, sobre todo el potasio, el fósforo, la hemoglobina y la PTH. La información de su acceso — si es fístula, cáter, o injerto, y si hay algo especial que el enfermero necesita saber al conectarle. Su lista completa de medicamentos con dosis y horarios. Y sus alergias. Nosotros preparamos el sobre aquí. Usted solo tiene que llevarlo.”

(We are going to prepare an envelope that you will keep in your carry-on luggage — not in the suitcase that goes below, because if that gets lost you arrive without documents. The envelope will have five things: your dialysis prescription, which says how long the session lasts, how much fluid we remove each time, the machine speed, and the type of membrane. Your labs from the last three months, especially potassium, phosphorus, hemoglobin, and PTH. Your access information — whether it is fistula, catheter, or graft, and anything special the nurse needs to know when connecting you. Your complete medication list with doses and schedules. And your allergies. We prepare the envelope here. You only have to carry it.)

Step 3: Finding the center. “Para encontrar un centro en México, hay dos caminos. El primero: preguntarle al doctor si tiene contacto con algún nefrólogo en Michoacán. A veces hay conexiones entre centros. El segundo: hay agencias de diálisis de viaje — en inglés se llaman ‘travel dialysis services’ — que tienen lista de centros en México que atienden a pacientes que vienen de los Estados Unidos. Nosotros le podemos dar una lista de esas agencias. Una cosa importante: algunas ciudades en México tienen más opciones que otras. En ciudades grandes como Morelia, Guadalajara, o Monterrey hay más centros privados. En pueblos más chicos es más difícil. ¿Dónde exactamente es la familia de usted?”

(To find a center in Mexico, there are two paths. The first: ask the doctor if he has contact with any nephrologist in Michoacán. Sometimes there are connections between centers. The second: there are travel dialysis services that have lists of centers in Mexico that treat patients coming from the United States. We can give you a list of those agencies. One important thing: some cities in Mexico have more options than others. In large cities like Morelia, Guadalajara, or Monterrey there are more private centers. In smaller towns it is more difficult. Where exactly is your family?)

Step 4: The insurance conversation.

This is the conversation the social worker mentioned but did not give Aurelio the language to process.

“Hay una cosa importante que tiene que saber sobre el seguro antes de hacer los planes. La mayoría de los seguros de los Estados Unidos — incluyendo Medicare — no pagan por diálisis fuera del país. Eso quiere decir que el centro en México le va a cobrar a usted directamente. El precio varía mucho. Algunos centros privados cobran entre $100 y $300 por sesión — en dólares o en pesos, dependiendo del centro. Para tres semanas, eso son nueve sesiones. Si calcula $200 por sesión, son $1,800 para los tratamientos solamente. Eso es dinero real que usted tiene que tener antes de salir. Ahora bien: hay algo que vale la pena revisar. ¿Usted trabajó en México antes de venir a los Estados Unidos? Si usted tiene historia laboral en México y cotizó al IMSS, puede ser que tenga derecho a atención en los centros del IMSS a mucho menor costo. No es seguro, pero vale la pena verificarlo porque puede cambiar mucho el plan.”

(There is something important you need to know about insurance before making plans. Most US insurance — including Medicare — does not pay for dialysis outside the country. That means the center in Mexico will charge you directly. The price varies a lot. Some private centers charge between $100 and $300 per session — in dollars or in pesos, depending on the center. For three weeks, that is nine sessions. If you calculate $200 per session, that is $1,800 for treatments alone. That is real money you need to have before you leave. Now: there is something worth checking. Did you work in Mexico before you came to the United States? If you have work history in Mexico and contributed to IMSS, you may have the right to care at IMSS centers at much lower cost. It is not certain, but it is worth verifying because it can change the plan significantly.)

Step 5: The timeline.

“Para que todo esto funcione, necesitamos por lo menos seis semanas, y ocho es mejor. Si el viaje es en julio y hoy es principios de mayo, el tiempo está bien. Si ya es junio, todavía es posible pero tenemos que empezar hoy. Si el viaje es en dos semanas, vamos a intentar pero es muy difícil y hay riesgo de que llegue sin centro confirmado. ¿Cuándo es el viaje que está pensando?”

(For all of this to work, we need at least six weeks, and eight is better. If the trip is in July and today is early May, the timing is fine. If it is already June, it is still possible but we need to start today. If the trip is in two weeks, we will try but it is very difficult and there is a risk you will arrive without a confirmed center. When is the trip you are thinking about?)

Aurelio’s trip: what the full coordination produces

The nurse flags the charge nurse. The social worker meets with Aurelio the following week. The nephrologist writes the prescription summary and current lab values into a one-page document formatted for easy handoff to a receiving center. The social worker contacts a travel dialysis service that has two centers in Morelia on its approved list. One center responds within a week with a confirmed slot and a quoted rate of $150 per session for US patients. The social worker calls Aurelio with the quote.

Aurelio has been saving. $1,350 for nine sessions is within what he and Ernesto put together between the two of them.

The document envelope is prepared: the dialysis prescription, labs from April, fistula notes, the medication list, the allergy list. The social worker also includes a one-paragraph letter in Spanish, typed on clinic letterhead, introducing Aurelio as a reliable hemodialysis patient with eight years of treatment adherence and requesting cooperative care for the dates specified.

Aurelio and Ernesto drive to Michoacán in July. Aurelio meets Valentina. He receives his Monday, Wednesday, Friday sessions at the center in Morelia. He comes back to Stockton with labs within his normal range.

This is the trip that becomes possible when the nurse does not say no.

Failure mode 3: The patient who went without telling anyone and is calling from Guadalajara

Not every patient asks. Not every patient who asks takes the social worker’s help. Some patients — especially patients who have been told no in prior conversations, or who have learned that the clinical system’s answer to questions about their lives is a lecture about their disease — make their own arrangements and go.

Felipe Guerrero, 63, has been on dialysis for six years. He has a brother in Guadalajara he has not seen in five years. His brother called in June to say their father was declining. Felipe bought a bus ticket. He told Ernesto, his son, that he was going to visit his brother for a few weeks. He did not tell the dialysis unit.

Felipe arrived in Guadalajara on a Thursday. His Monday session was missed. His Wednesday session was missed. On Thursday he found a private clinic near his brother’s house that treats dialysis patients. They told him the rate is $250 per session. Felipe has $400. He paid for Thursday. His session is tomorrow — Saturday — and he has $150 left.

He calls the dialysis unit at 4:15 PM on Friday.

The Friday call from Guadalajara

The nurse who takes the call has two tasks in the first ninety seconds, in this order: clinical assessment, then logistics.

They cannot run in parallel. A patient who has missed two sessions and is calling from another country may be in a medical emergency. The logistical problem cannot be solved if the patient is acutely volume overloaded or hyperkalemic.

The clinical screen:

“Señor Guerrero, primero necesito saber cómo está usted en este momento. ¿Cuándo fue su última sesión de diálisis?”

(Mr. Guerrero, first I need to know how you are doing right now. When was your last dialysis session?)

“El jueves.” (Thursday.)

“Bien. ¿Y cómo se siente ahora mismo? ¿Tiene falta de aire? ¿Le cuesta respirar cuando está acostado? ¿Tiene los pies o las piernas hinchados? ¿Siente el corazón acelerado o irregular? ¿Tiene dolor en el pecho?”

(Good. And how do you feel right now? Do you feel shortness of breath? Is it hard to breathe when you are lying down? Are your feet or legs swollen? Do you feel your heart racing or irregular? Do you have chest pain?)

If Felipe says yes to any of these — especially orthopnea, irregular pulse, or chest pain — the conversation stops.

“Señor Guerrero, lo que me está describiendo necesita atención hoy, no mañana. Necesita ir a urgencias del hospital más cercano ahora. Dile a su hermano que lo lleve. No espere la sesión de mañana. ¿Hay un hospital cerca de donde está?”

(Mr. Guerrero, what you are describing needs attention today, not tomorrow. You need to go to the emergency room of the nearest hospital now. Tell your brother to take you. Do not wait for tomorrow’s session. Is there a hospital near where you are?)

If Felipe is clinically stable — no orthopnea, no chest pain, mild ankle swelling he has had before — the nurse now has a window to address the logistical crisis.

“Bien. Me alegra que se sienta bien. Ahora hábleme del problema del dinero para que podamos ver qué opciones tiene.”

(Good. I am glad you are feeling okay. Now tell me about the money problem so we can see what options you have.)

The nurse’s next steps, parallel:

While the nurse keeps Felipe on the phone, a colleague flags the charge nurse and the social worker (or leaves a voicemail if it is after hours).

The nurse asks: “¿Usted trabajó en México antes de venirse a los Estados Unidos? ¿Tiene o tuvo número del IMSS?”

(Did you work in Mexico before you came to the United States? Do you have or did you have an IMSS number?)

A patient who worked in Mexico and contributed to IMSS may have residual coverage that entitles him to treatment at IMSS facilities at no cost. This is not a guarantee. IMSS dialysis slots are limited and often require a referral from an IMSS-affiliated nephrologist. But it is the first question because it is the only option that is both fast and free.

If Felipe has an IMSS history:

“Eso es importante. Su hermano puede ayudarle a ir mañana por la mañana a la clínica del IMSS más cercana y preguntar si hay posibilidad de una sesión de emergencia. Lleve todos sus documentos — el IMSS le va a pedir su prescripción y sus laboratorios. ¿Lleva consigo sus documentos médicos?”

(That is important. Your brother can help you go tomorrow morning to the nearest IMSS clinic and ask if there is a possibility of an emergency session. Bring all your documents — IMSS will ask for your prescription and your labs. Do you have your medical documents with you?)

If Felipe does not have IMSS history, and does not have documents:

“Voy a hablar con la trabajadora social para ver si hay algún fondo de asistencia que pueda ayudar a pagar la sesión de mañana. También voy a ver si el centro donde usted está atendido puede enviarle sus documentos directamente al centro en Guadalajara. Mañana por la mañana llame al centro donde tiene la sesión y explíqueles la situación — a veces los centros pueden hacer arreglos cuando el paciente es honesto sobre la situación. Y si usted llega mañana y no puede pagar, deles este número — es el número de la trabajadora social de aquí y ella puede hablar con ellos directamente.”

(I am going to speak with the social worker to see if there is an assistance fund that can help pay for tomorrow’s session. I am also going to see if the center where you receive treatment can send your documents directly to the center in Guadalajara. Tomorrow morning call the center where you have your session and explain the situation to them — sometimes centers can make arrangements when the patient is honest about the situation. And if you arrive tomorrow and cannot pay, give them this number — it is the social worker’s number here and she can speak with them directly.)

The nurse documents the call. The session information, the clinical screen result, the plan communicated. She flags the nephrologist. She leaves a detailed voicemail for the social worker.

The social worker calls the center in Guadalajara on Saturday morning and explains the situation in Spanish. The center agrees to treat Felipe on a deferred-payment arrangement with the understanding that the balance will be paid when Felipe returns to Stockton and can wire the funds. The social worker faxes the dialysis prescription and the medication list to the center in Guadalajara.

Felipe receives his Saturday session.

He receives his Monday session. His Wednesday session. He comes home the following Friday with two sessions remaining that his brother paid for from money Ernesto wired to Guadalajara.

None of this was clean. None of it was the right path. But it worked because the nurse on Friday afternoon did not lead with blame and did not lead with logistics. She led with a clinical screen. Then she led with concrete next steps, in specific language, in the right order.

The phrase Aurelio needed in 2019

Aurelio Ramírez did not go to Michoacán in 2019 because someone said four days was the limit and he heard that as the answer to the question he had not yet learned to ask correctly.

The question he did not know how to ask in 2019: “¿Hay alguna forma de ir a despedirme de mi mamá y seguir recibiendo mi tratamiento?” (Is there any way for me to go say goodbye to my mother and still receive my treatment?)

The answer, if the coordination had been started in time: yes.

Morelia has private dialysis centers. His mother was in Morelia. His mother was dying slowly enough that there was a window of two or three weeks in which he could have been there and received treatment and held her hand and gone to her funeral.

Whether the clinical system would have offered this is a different question. Whether anyone asked him what he was actually asking is a different question.

The nurse who asks “cuénteme más” before saying no does not guarantee a different outcome for every patient. She guarantees that the patient is not turned away from the conversation he came to have.

Aurelio is asking about three weeks in July. He is asking about Valentina saying “tata.” He is asking about his mother’s funeral and the chair he was sitting in when Esperanza called.

“Cuénteme más.”

That is the phrase.

Practical Spanish for travel dialysis coordination

The following phrases are organized by the sequence of the coordination conversation. Each phrase can be used directly or adapted to the patient’s specific situation.

Opening the conversation:
“Ese viaje es posible. No es sencillo, pero es posible. Lo que necesitamos es coordinarlo con tiempo.”
(That trip is possible. It is not simple, but it is possible. What we need is to coordinate it in advance.)

Explaining the coordination timeline:
“Lo ideal es empezar por lo menos seis semanas antes. ¿Cuándo planea irse?”
(The ideal is to start at least six weeks before. When are you planning to leave?)

Explaining the documents:
“Vamos a prepararle un sobre con su prescripción, sus laboratorios, la información de su acceso, sus medicamentos, y sus alergias. Gúardelo en el equipaje de mano.”
(We are going to prepare an envelope with your prescription, your labs, your access information, your medications, and your allergies. Keep it in your carry-on.)

Explaining insurance coverage:
“La mayoría de los seguros americanos, incluyendo Medicare, no cubren diálisis fuera del país. Es probable que tenga que pagar directamente al centro en México. Queremos saberlo antes de que salga, no después.”
(Most US insurance, including Medicare, does not cover dialysis outside the country. You will likely have to pay directly to the center in Mexico. We want you to know that before you leave, not after.)

Asking about IMSS history:
“¿Usted trabajó en México antes de venir aquí? ¿Tiene o tuvo número del IMSS? Si cotizó, puede que tenga cobertura allá.”
(Did you work in Mexico before coming here? Do you have or did you have an IMSS number? If you contributed, you may have coverage there.)

Confirming the center before departure:
“Antes de salir, necesitamos tener confirmado el nombre del centro, la dirección, el teléfono, y las fechas de sus sesiones. No salga sin eso.”
(Before you leave, we need to have confirmed the name of the center, the address, the phone number, and the dates of your sessions. Do not leave without that.)

Phone clinical screen (patient calling from Mexico):
“Primero nécesito saber cómo está usted ahora mismo. ¿Tiene falta de aire? ¿Le cuesta respirar acostado? ¿Piernas hinchadas? ¿Corazón acelerado? ¿Dolor en el pecho?”
(First I need to know how you are right now. Do you feel shortness of breath? Is it hard to breathe lying down? Swollen legs? Fast heartbeat? Chest pain?)

If the patient needs emergency care:
“Lo que me describe necesita atención hoy. Vaya a urgencias ahora. No espere la sesión de mañana.”
(What you are describing needs attention today. Go to the emergency room now. Do not wait for tomorrow’s session.)

What this conversation is really about

A nurse in a hemodialysis unit will have the travel conversation many times over a career. The patients who raise it are rarely asking about logistics. They are asking about what it means to have a life inside the schedule of a chronic disease that requires three four-hour sessions every week for the rest of their lives.

For patients who emigrated from Mexico or Central America, the family who is still there represents a version of continuity that the clinical system interrupts. Baptisms. Funerals. The first grandchild who says “tata.” A father who is declining.

The nurse who opens the conversation correctly — “cuénteme más,” “ese viaje es posible,” “vamos a ayudarle a planearlo” — is not compromising on clinical care. She is extending it into a part of the patient’s life that the clinical chart does not track but that shapes everything about whether the patient is honest with the clinical system, engaged in his care, and still in the chair three years from now.

Aurelio has been in the chair for eight years. He has never missed more than three sessions. He does not need to be told what happens when dialysis stops. He needs someone to help him figure out how to get to Michoacán before Valentina grows up without knowing who he is.

“Cuénteme más.”

Practice this conversation at ClinicaLingo clinical scenarios. Download the 50-phrase PDF for bedside reference.

Frequently asked questions