Nosebleeding in English

Yes, I have been raised bilingual. Yes, I have been instructed in English since I've been old enough to read. Yes, I have used it in academic discussion for just as long and everyday conversation for even longer. And, yes, I probably read and write better with it, maybe even express myself with it, than I do with my native tongue - and I have a body of work, a thriving blog, and academic IELTS scores to prove it.

But my first month abroad is quickly teaching me that despite my background, I am, as someone who uses English as a second language in an English-speaking land, still prone to frequent "nosebleed*" moments.

Despite having fair command language, I often find myself suddenly bereft of words to express certain thoughts or questions quite unexpectedly. I find myself stopping at mid-sentence when I would frantically grab for an English word in my otherwise good vocabulary only to find Filipino words floating to the surface instead. At times, when my mouth is running faster than my brain, the occasional Tagalog integrates itself into my stream of thought, only to be met by puzzled glances.

In fairness to me, I've been complimented quite often at how fluent I am in English relative to how long I've actually been living here. My English has been good enough to get me through the basics of day-to-day interaction - asking for directions, following instructions, striking up conversations with complete strangers at bus stops (yes, this actually happens quite often in Australia). This country has become such a multi-cultural place that Aussies take my occasional grammar and pronunciation flubs in stride - and are often way more forgiving than many people are back home would be if they heard me.

But the biggest adjustment so far has been in my interaction with the patients I see at work - something other overseas-trained doctors who work in English-speaking countries probably grapple with as well. Although I was taught medicine in English and my conceptual understanding of medical knowledge is in English, I have gotten used to conducting interviews and asking questions in a way that would be better understood by the patients I used to see back home. All of a sudden the metaphors and the analogies that have served me well for so long no longer work. Explanations of common conditions I've used for years quite effectively must now be reworked for my English-speaking audience. New subtleties and nuances have to be relearned.

I don't think that makes me a worse doctor than I used to be. It just means that, for now, I have to make more of an effort to be understood and to understand. Knowing that I have to keep on my toes works in my favor, and it's that effort that I put in that closes the gap. It's slow going, but I like to believe I'm getting there and getting better every day I come into work, every patient that I interview. It's all just part of the growing pains of practicing medicine in a foreign country.

Nonetheless, no matter how fluent I get at speaking English, I know the nosebleed moments will probably remain a fact of life. And while I may have no real, formal knowledge of Filipino and my actual Tagalog vocabulary is shallow at best, not speaking it for long spells has made me realize that a heart-deep connection with it exists - and I miss using it, in a major way.

(*For people not in the know, the term "nosebleed" is Filipino slang for something exceedingly difficult or takes so much effort that it makes your nose bleed. It is often used in the context of someone trying to conduct a conversation in straight English and struggling mightily with it. I don't know how widespread the term's use it and how accepted is the term's use is in this context - so please free to correct me by posting a comment if I am wrong. :))