Medicine came to me in English. In India it has long been taught that way, through English textbooks, English lectures, English examinations and the English shorthand of the ward round, and that was the language of my medical education at Sri Guru Ram Das Institute of Medical Sciences and Research in Amritsar, from 1997 to 2002. The people in the hospital beds of Punjab, meanwhile, very often described their illnesses in Punjabi. Any medical student in that position becomes a translator in both directions long before he becomes anything else: hearing a complaint in one language, reasoning about it in a second, and writing it down in the abbreviations of a third, which is not quite a language at all.
Consider, as an illustration and not a memory, how a single complaint might pass through those three vocabularies. A hypothetical woman in an outpatient hall says: ਮੈਨੂੰ ਘਬਰਾਹਟ ਹੁੰਦੀ ਹੈ, mainūṅ ghabrāhaṭ hundī hai, which is roughly ghabrāhaṭ comes over me. That is the first vocabulary, hers, and it is complete; she has said what she means in the way she means it. The student hearing her translates, and his translation is already a hypothesis: palpitations, anxiety, breathlessness, a choice among organ systems made in English, inside his head, in under a second. Then he writes, and the third vocabulary takes over. If he is careful, the note says c/o ghabrahat × 2/12. If he is hurried, it says c/o palpitations, or anxiety? By the time it reaches a senior colleague, the woman’s word may have vanished altogether, and what remains looks like her complaint while being, in fact, his reading of it. Nobody has lied. Something has been substituted.
That substitution is the subject of this essay. Punjabi is my first language; I also speak Hindi, Urdu and English, and I have practised medicine since 2010 in California, where the record, at least, is kept in English. When I call Punjabi a first language of medicine, I mean more than the order in which I learned things. I mean that care is spoken in ordinary language before it is spoken in any professional one, and that the ordinary language goes on doing its work after the professional one arrives: in the patient’s mouth, in the physician’s head, and, if the record is allowed to keep it, on the page.
The Language of the Lecture Hall #
The classic account of what happens when the language of the classroom is not the language of the home is Ngũgĩ wa Thiong’o’s Decolonising the Mind (1986). Ngũgĩ, who had written his early novels in English, describes a colonial schooling in Kenya in which a child caught speaking Gikuyu near the school could be caned, fined money his family could hardly spare, or made to carry a metal plate whose inscription declared him stupid, or a donkey. The cruelty is what one remembers. The argument lies in what the cruelty produced: a separation between the language in which a child learned to reason and the language in which he lived, ate, was scolded and comforted. Ngũgĩ’s image for the result has an almost anatomical force when a physician reads it: “bodiless heads and headless bodies.”
I must be careful with the analogy. Medical students in India at the turn of this century were adults who had competed hard for places in English-medium colleges, and comparing them with colonial schoolchildren punished for their mother tongue would overdraw the case. But the structure Ngũgĩ describes is recognisable in medicine. The language in which a student learns to think about the body is often not the language in which the body’s owner speaks of it. In English the student learns the heart as a four-chambered pump with a conduction system and a coronary supply. In Punjabi the ਦਿਲ, dil, is also where one keeps courage, grief and longing, and ਦਿਲ ਘਬਰਾਉਂਦਾ ਹੈ, dil ghabrāundā hai, the heart is agitated, can describe a racing pulse, a dread, or both at once. The physician is trained to hold these apart. The patient, quite reasonably, does not.
Whether medicine in India should be taught in the languages its patients speak is not an abstract question. In October 2022 the state of Madhya Pradesh released Hindi textbooks for the first year of the MBBS course, in anatomy, physiology and biochemistry, and the state’s chief minister explained that technical terms would be written as they are pronounced in English. That detail interests me more than the policy. Even a deliberate effort to bring medical education into a mother tongue kept the professional vocabulary in English, carried in another script. Medicine’s words had become a third language that both Hindi and English could transport, and that neither quite owned.
That third vocabulary, for that matter, is not the English that patients speak either. An English-speaking woman in California who says she gets short of breath on the stairs will find, if she reads her chart, that she has dyspnoea on exertion, a Greek word for bad breathing joined to a Latin-derived one; her indigestion may become dyspepsia, her pins and needles paraesthesia. Medicine everywhere translates its patients into a learned dialect assembled from Greek and Latin roots, and for defensible reasons: the learned word is meant to be more exact, and to mean the same thing in every hospital. The Punjabi speaker’s experience is a sharper case of something every patient undergoes. Her word has two distances to travel, from Punjabi into English and from English into the dialect of the chart, and it can lose something at each crossing.
I would be a hypocrite to treat English only as loss. The language that separated head from body in Ngũgĩ’s account also carried me to Little Rock and to Fresno, and it lets me read the research of my profession on the day it is published. Ngũgĩ himself bade English farewell as a language for his fiction; a physician who has to read the literature cannot. The question for someone in my position is how to keep the two languages in working contact, so that the language of reasoning answers to the language of experience instead of quietly overwriting it. That contact happens, or fails to happen, at the level of single words.
Heartache #
There is a familiar claim that every language holds words for pain, fever and worry that English can never quite translate. I am wary of it. It flatters the language one loves, and it is mostly untrue. ਦਰਦ, dard, is pain, and so, with a slightly different weight, is ਪੀੜ, pīṛ. ਬੁਖ਼ਾਰ, bukhār, is fever. ਚਿੰਤਾ, chintā, is worry, a word with a history of its own that I have written about elsewhere. English handles every one of them without strain. A Punjabi speaker who says dard and an English speaker who says pain are, in the great majority of cases, telling a doctor the same thing.
What does not always cross is range: the territory a word covers in actual use, and what the speaker is doing by choosing it. That is a different problem from untranslatability, and a more interesting one, because no dictionary can solve it.
Range is not an exotic property of Punjabi. Consider the most famous complaint in English poetry:
My heart aches, and a drowsy numbness pains / My sense, as though of hemlock I had drunk
So begins Keats’s “Ode to a Nightingale,” written in 1819 by a man who had trained at Guy’s Hospital and qualified as an apothecary before he gave medicine up for poetry. A cardiologist reading the first three words would reach for an electrocardiogram. Keats means something else: a pain in the heart that is also a pain of the heart, a numbness that is also rapture, a poison that is also a figure of speech. The opening lines make it impossible to say where the body stops and the feeling begins, and they do so on purpose. Ordinary English does the same thing every day. People speak of heartache, of a sinking feeling, of butterflies, of a lump in the throat, of being sick with worry; each phrase gives an emotional event a bodily address. When a Punjabi speaker locates distress in the heart, she is doing what English speakers have always done, and doctors in both languages have always had to ask which heart is meant.
Punjabi’s own literature goes further than Keats in one respect, and a physician who grew up inside it should know where. Its oldest surviving poetry, the couplets of Baba Farid, some of which are preserved in the Guru Granth Sahib, gives a central place to ਬਿਰਹਾ, birhā, the ache of separation from the beloved, who for Farid is God. In one couplet he addresses birha as a sovereign, and says that a body in which it never arises should be counted a cremation ground. The claim is startling to a clinician. Here is a pain that is not a symptom of anything going wrong; its absence is the sign of death. The line of that feeling runs through the qissas and the Sufi kafis to the twentieth century and Shiv Kumar Batalvi, whom admirers have called the sultan of birha. I do not suggest that Punjabi patients come to clinics describing spiritual longing. I suggest that the language they speak has an old and honoured vocabulary for suffering that asks to be witnessed rather than removed, and that English has one too. A physician in either language has to tell those kinds of suffering apart without romanticising the first or medicalising the second, and he cannot do it by vocabulary alone.
The same breadth runs through the plainest clinical words. Dizzy in English covers a spinning room, a light head, an unsteady walk and a vague sense of unreality, and they have very different explanations. Weak can mean tired, low in mood, or genuinely unable to lift an arm. Punjabi’s ਚੱਕਰ, chakkar, a circle or a turn, as in ਚੱਕਰ ਆਉਂਦੇ ਨੇ, chakkar āunde ne, turns come over me, is no narrower than dizzy, and ਕਮਜ਼ੋਰੀ, kamzorī, weakness, is no wider than weak. The work of unpacking them is the same in either language. What a physician who shares the patient’s language gains is the ability to do that work without a third person in the room. What he risks, as I will come to, is the belief that the work has already been done.
Galen’s Fossils #
The breadth of these words owes something to inheritance, and the inheritance is shared, because Punjabi and English both carry in their everyday words for the body the remains of the same ancient medicine.
Unani medicine, the system of healing still practised across South Asia, takes its name from the word for Greek, and it traces its doctrines, as the Encyclopaedia Britannica summarises them, to Hippocrates and Galen, whose teaching passed into Arabic during the Caliphate and was developed there by physicians such as Avicenna. Its four humours appear in Unani practice as dam, blood; balgham, phlegm; safrā, yellow bile; and saudā, black bile. Its temperaments are hot, cold, moist and dry, and health is their balance. A Punjabi speaker who coughs up ਬਲਗਮ, balgam, is using the humoral word for phlegm with no thought of Galen, exactly as an English speaker does who calls a calm friend phlegmatic, an irritable one choleric, a hopeful one sanguine, a sad one melancholy, which is Greek for black bile, or says that someone is in a good humour.
The parallel goes deeper than a shared list. The Urdu saudā, which Platts’s dictionary of 1884 defines first as black bile, then as melancholy, hypochondria, frenzy, madness and love, is the same humour that gives English its melancholy, and both words have travelled the same road from a fluid in the body to a state of the soul. Modern psychiatry still describes certain depressions as having melancholic features, a black-bile adjective kept on for a modern category. The vocabulary of bodily heat runs through both languages as well. When Krause’s informants in Bedford, of whom more below, named heat among the causes of a sinking heart, they may have been drawing on a way of speaking about the body that is old in the region; English speakers who say that a fever burns, or that a man is hot-headed, are drawing on one too.
None of this means that Punjabi patients are humoralists, any more than an English speaker complaining of a chill believes in Galen. Words outlive the theories that coined them. It means that neither vocabulary is a clear window onto the body. Each is layered with older medicine, older moral judgments and older guesses, and a physician cannot strip those layers from his patient’s language while pretending that his own has none. The task in either language is to notice the theory buried in a word and to ask what the speaker means by it now.
A Word at Several Boundaries #
ਘਬਰਾਹਟ, ghabrāhaṭ, is the hardest of the common words, and the most instructive. A dictionary offers nervousness, agitation, unease, panic. The word lives in Hindi and Urdu as well as Punjabi, so it sits at a boundary between languages before it reaches any boundary in the body. In a clinic it can point toward the heart, toward the mind, toward something a medicine is doing, or toward several of these together. Outside the clinic its range is wider still. The verb ਘਬਰਾਉਣਾ, ghabrāuṇā, is what a student does before an examination, what a host does when guests arrive early, what anyone does on a crowded platform when the train is late; ਨਾ ਘਬਰਾ, nā ghabrā, is what one says to a nervous child. The same word that covers those ordinary flutters can be brought, unchanged, to a doctor to describe an experience frightening enough to seek help for. Its ordinariness is part of the difficulty. A patient reaching for it may be understating, and a listener who knows the everyday uses may hear less than is there.
In 2025 Rahul Garg and Anmol Thakre, of the Department of Medicine at FH Medical College in Agra, reported in the Journal of the Association of Physicians of India a questionnaire survey of 107 clinicians, 48 faculty members and 59 postgraduate trainees, at several tertiary care centres. All but two had encountered the word in practice, most of them frequently. Asked which body systems it involved, 86 per cent named the cardiovascular system and about three-quarters the psychological; nearly a third mentioned drug side effects and almost a quarter the endocrine system. Asked what symptom it described, most said anxiety or nervousness, about 60 per cent palpitations, and about half restlessness. More than three-quarters thought it called for further investigation, and more than half reported deaths that they attributed to it. The authors concluded that the term urgently needs standardisation and should not be dismissed as a mere manifestation of anxiety.
One should be exact about what such a study can bear. A hundred and seven respondents is a small number; the paper does not say how they were recruited; they worked in tertiary hospitals, not in primary care; the analysis is descriptive. The authors work in Agra, in a Hindi-speaking region, and the survey says nothing directly about Punjabi speakers in Amritsar or Fresno. The deaths are the respondents’ recollections, not the findings of a mortality study, and they establish only that clinicians have reason to take the word seriously. Above all, no patient was asked anything. The survey measures what listeners believe speakers mean.
Read that way, it is less a dictionary entry than a portrait of disagreement, and that is where its value lies. Here is a word that nearly every clinician surveyed had heard and that they could not agree about. A word in that condition should be heard as an instruction to ask another question. The authors would like a standard definition, and I see why: a shared definition helps teaching and research. But a standard tells a doctor what the word usually means, and the woman in front of him is not usual; she is herself. A definition can tell the listener which questions are worth asking. It cannot ask them for him.
The Patient’s Own Account #
Some words carry not only a symptom but a theory of the symptom. In 1989 the anthropologist Inga-Britt Krause described, in Social Science & Medicine, what Punjabis living in Bedford, England, called a “sinking heart”: physical sensations in the heart or chest that people attributed to excessive heat, exhaustion, worry or social failure. Krause compared it with Western ideas of depression, with medical models of heart disease, with the “Type A” behaviour pattern and with stress, and found that it matched none of them exactly. It most resembled the Western idea of stress, she concluded, in form rather than content. The English rendering of the phrase was easy. What did not translate was the account folded inside it, in which the weather, fatigue, worry and a family’s standing could all register in a single organ.
That paper is easy to misuse. It describes one community, in one English town, in one decade, through one ethnographer’s fieldwork, and it was addressed to the carers and practitioners of that community. It does not establish a universal Punjabi concept, and it is not a diagnostic category. What it establishes is narrower and more useful: that patients bring explanations with their symptoms, and that the explanation is itself clinical information. A decade earlier, the psychiatrist and anthropologist Arthur Kleinman and his colleagues Leon Eisenberg and Byron Good had argued in the Annals of Internal Medicine that clinicians should ask for exactly this. Their questions are disarmingly plain: what the patient calls the problem, what she thinks caused it, why she thinks it began when it did, what she fears most about it. None requires an anthropologist. All of them require the physician to stop, for a moment, being the person with the answers. Asked what she thinks her ghabrāhaṭ is, the hypothetical woman from the outpatient hall might say tension, or gas, or that her heart is weak as her mother’s was. Each answer opens a different conversation, and the last one delivers a family history and a fear in a single sentence.
The traffic between languages runs both ways. Tension, an English word, has been absorbed into Punjabi as ਟੈਨਸ਼ਨ, ṭainshan, and into much of South Asia, and it has come back to medicine wider than it left. In 2022 Lesley Jo Weaver and Alison Karasz published a systematic review in SSM – Mental Health of 122 records concerning “tension” in South Asian populations, gathered from eight databases. Most of the studies were from India. The word was used for everything from everyday hassles to severe distress and suicidality. It was often described in what the authors call a hydraulic way, as pent-up emotion that emerges as bodily or emotional symptoms, and often placed between outside stressors and illness proper. Researchers had not agreed whether to treat it as an idiom of distress or a cultural syndrome; the reviewers proposed a broader umbrella, a cultural concept of generalised psychosocial distress. And several sources reported that sufferers thought only a real change in their circumstances could resolve it.
That last finding seems to me the most important thing in the review. When someone says tension, the word is perfectly English, but its use carries a theory: that the trouble lies partly outside the person, in a debt, a land dispute, a child far away, a household under strain. A physician who hears anxiety disorder has narrowed the word. A physician who hears nothing medical has dismissed it. The question that keeps faith with the speaker is simpler: tension about what?
The Hazard of Fluency #
Sharing a language with a patient is a real gift in a clinic. A person can speak without first performing her own translation. The idiom lands and the pause is understood. I would not give that up.
But recognition carries a hazard of its own, which is that it lets the listener finish the sentence. A physician who shares a patient’s language can hear ghabrāhaṭ and write anxiety, or write palpitations, and close a question that has barely been opened. Familiarity rewards speed. Medicine has a name for the resulting error, premature closure: the habit of stopping thinking once a plausible explanation has appeared. Fluency does not cause it. Fluency makes it feel like competence. There is an odd advantage in not understanding a patient’s language at all. A physician working through an interpreter is reminded at every sentence that meaning is being carried from one place to another and may be dropped on the way, and so he checks. The physician who shares the language gets no such reminder. Nothing in the conversation tells him that a translation has occurred, because it occurred inside his own head.
Shared language is also less shared than it looks. Punjabi is spoken differently in the Majha around Amritsar, in the Doaba, in the Malwa and in the Puadh; differently by a grandmother and her grandson; differently in Amritsar and in a Central Valley farm town two generations on. A word I learned to hear one way in one city may be doing different work in another mouth. Every speaker, in the end, has a vocabulary shaped by a single life, and no amount of common ground relieves the listener of finding out what this particular speaker means.
Even the choice of language belongs to the patient. A Punjabi-speaking physician in California may meet a recent arrival who is visibly relieved to be addressed in Punjabi, and the grandchild of an earlier arrival who would find the same greeting presumptuous, as though her name or her face had been taken as a statement about her English. Where there is any doubt, the courteous first question is which language she would like to use, and the answer is itself information. Some people describe symptoms in English because that is the language in which they have learned to talk to doctors, and move into Punjabi only when the conversation turns to family or to fear; some do the reverse. A physician who notices where the switch happens learns something about which parts of an illness live in which language.
A careful reader may already be uneasy with this line of thought, and the unease is justified. To dwell on the ambiguity of Punjabi words for distress risks making Punjabi patients sound exotic, as though they were incapable of describing a symptom plainly and needed an anthropologist to decode them. Worse, it can be clinically dangerous. A physician who has read a little about idioms of distress may hear ghabrāhaṭ and think cultural expression of stress, and in thinking so he may miss an irregular heart rhythm. The clinicians in the Agra survey who recalled deaths they attributed to the word were, whatever the limits of their recollection, warning against exactly that. Cultural sensitivity that substitutes an anthropological explanation for a clinical assessment is only a more sophisticated form of premature closure.
The objection is right, and it sharpens the argument rather than refuting it. The proper answer to ambiguity is the set of questions one would ask anybody, asked with the same patience in either language, and no cultural theory of the patient can take its place. Where do you feel it? When does it come, and what are you doing when it comes? How long does it last? What comes with it? What does it stop you doing? What do you think it is? Those questions do not assume that the heart is a metaphor, and they do not assume that it is not. The word ghabrāhaṭ itself refuses to choose between the heart and the mind. The physician should refuse with it, until the evidence chooses.
Two Lines in the Chart #
A useful translation sometimes needs two lines where a hurried note would prefer one. The first preserves what the person said. The second records what questioning established. Keeping both makes the clinician’s interpretation visible instead of letting it pass unnoticed as the patient’s original account.
Return to the hypothetical woman from the beginning. Writing anxiety immediately settles several questions that have not yet been asked; writing palpitations settles a different set. Either may eventually be supported, but neither follows from recognising the word. A better note, still hypothetical, might read something like this:
Patient’s words: “ਘਬਰਾਹਟ” (ghabrāhaṭ), “comes over me,” most evenings for two months.
On questioning: a fluttering in the chest lasting minutes, sometimes on climbing stairs; separately, lies awake worrying about money. Has to sit down during episodes. Her own view: “tension.”
Working assessment: episodes of palpitation, cause not yet established; cardiac and non-cardiac explanations both under consideration.
The order matters. The patient’s expression comes first, in her word. Its features come next, as she reported them. The physician’s working assessment comes last, labelled as his. Another reader can see how the conclusion was reached and reconsider it if later information changes the picture. The same discipline applies when doctor and patient speak only English. I feel weak deserves the same two lines as ghabrāhaṭ. Punjabi makes the problem personally recognisable to me; it does not own the problem.
The order has also acquired a second audience. Since the federal information-blocking rule under the 21st Century Cures Act took effect in 2021, most patients in the United States can read their clinicians’ notes, and many do; I have written about that change elsewhere. A woman who said ghabrāhaṭ and reads a week later that she has anxiety has been told something about herself that she did not say and may not accept. A woman who finds her own word, followed by what was found and what remains uncertain, can recognise her account and correct it if it is wrong. The two-line note is more accurate, and it is also more answerable to the person it describes.
There is a further reason to keep the patient’s word on the page, and it has to do with the standing of languages. Punjabi has a long argument with itself about its ਮਾਂ ਬੋਲੀ, māṅ bolī, its mother tongue, and the argument has rarely been only about grammar. In Indian Punjab, the census of 1951, in which a large number of the state’s people recorded Hindi rather than Punjabi as their mother tongue, became a political event, and the dispute fed the long agitation that ended in the reorganisation of the state in 1966. Across the border, Punjabi is spoken by a great many people in Pakistan’s Punjab and has had, as the writer Safir Rammah has observed, only a marginal place in its schools. In both places the question of which language counts has decided which words get written down.
Gurmukhi, the script in which Punjabi is written in India, has its own history of standing. Its name means, roughly, from the Guru’s mouth, and tradition credits Guru Angad, at Khadur Sahib, with giving it a settled form, and a script is, among other things, a promise that speech can be kept. A chart is a much humbler document, but it makes a similar promise or breaks it. When a clinician writes a patient’s own word into the record, transliterated if need be, he gives that word a small standing in the official account of her illness. When he replaces it with his translation, the record keeps only his voice.
Even transliteration makes choices. In most Punjabi speech, as the linguist Tej K. Bhatia described in 1975, the old voiced aspirates at the beginning of a word have become plain consonants followed by a low tone, so that the word for horse, written with ਘ, is said with a k and a low pitch. ਘਬਰਾਹਟ, in a Punjabi mouth, begins the same way. The Latin letters gh-a-b-r-a-h-a-t record something closer to the Hindi or Urdu pronunciation. The Gurmukhi spelling keeps the historical letter, which a Punjabi reader turns into the tone without thinking. A word written in Latin letters in an American chart has therefore already moved a short distance from one language toward another. I would still rather see it written than replaced. But every written form of a spoken word is a decision about what to keep, and it helps to know that the decision has been made.
James Baldwin, arguing in The New York Times in 1979 that Black English was a language and that the contempt it met was a contempt for its speakers, wrote: “Language, incontestably, reveals the speaker.” His subject was not medicine, and I borrow only the sentence. Language reveals the speaker, but only to a listener who is willing to be shown, and only in a record that keeps what was said.
After Ṭhīk Hai #
The everyday Punjabi greeting ਕੀ ਹਾਲ ਹੈ?, kī hāl hai?, asks, word for word, what the condition is. Hāl means state or condition, and it is a word one could use of a patient. Every day, across Punjab and wherever Punjabis have settled, people put the opening question of a medical history to one another without expecting a diagnosis in return. The usual answer is ਠੀਕ ਹੈ, ṭhīk hai: fine, all right. Another reply one often hears, especially from Sikh speakers, is ਵਾਹਿਗੁਰੂ ਦੀ ਮਿਹਰ ਹੈ, Vāhigurū dī mihar hai, it is by God’s grace, which turns a report on one’s condition into an act of gratitude. I have great respect for that answer. It declines to make a complaint the centre of a greeting, and it carries a whole outlook in which what comes is to be met with acceptance. A physician has to honour it without letting it close the conversation, because gratitude and chest pain can live in the same person on the same morning, and a grateful patient is sometimes the one least inclined to mention the second.
Every physician learns that fine is where a history begins. The hypothetical woman in the outpatient hall probably said ṭhīk hai to someone on her way in, and meant it as courtesy, and then sat down and said ghabrāhaṭ, and meant that too. Between those two phrases lies most of the work of medicine in any language: the willingness to ask again after the polite answer, and to ask what a word means even when one is fairly sure one already knows. Asking gives up the small pleasure of appearing instantly fluent. In exchange, the account stays with the person who owns it.
Hāl is also a word that refuses Ngũgĩ’s division. It does not ask after the body or after the mind; it asks after the condition of the whole person, and leaves the person to decide which part to report. A physician who hears the answer and then asks again is, in a small way, putting the head and the body back into the same sentence.
The first language of medicine, in that sense, is not a glossary of symptoms. It is the ordinary question, asked with enough patience to hear what follows. Punjabi is the first language in which I knew that question. I would like my medical vocabulary to widen what I can hear rather than narrow it. A person should not have to give up the texture of her own speech in order to become intelligible. The listener has work to do as well.
Evidence and Editorial Note #
Documented findings. Public biography: Punjabi as first language; Hindi, Urdu and English also spoken; upbringing in Amritsar; MBBS at Sri Guru Ram Das Institute of Medical Sciences and Research, 1997–2002; training in Little Rock and Fresno; practice in California since 2010. English as the medium of medical education in India: general, well-documented fact. Ngũgĩ wa Thiong’o, Decolonising the Mind: The Politics of Language in African Literature (James Currey, 1986): the school punishments as quoted by Petina Gappah in The Johannesburg Review of Books (November 6, 2017); the separation of the language of conceptualisation from daily life, “bodiless heads and headless bodies,” and his farewell to English, as summarised in the Wikipedia entry on the book. Madhya Pradesh Hindi MBBS textbooks (anatomy, physiology, biochemistry) released in Bhopal on October 16, 2022, with technical terms written as pronounced in English: Onmanorama (October 16, 2022). Keats, “Ode to a Nightingale” (1819), public domain; Keats’s training at Guy’s and qualification as an apothecary: standard biographical reference. Baba Farid’s couplet on birhā as sovereign and the body without it as a cremation ground, preserved in the Guru Granth Sahib: described, not quoted; Shiv Kumar Batalvi’s popular epithet as the poet of birha: general literary reference. Unani medicine’s derivation from Hippocrates and Galen via Arabic scholarship, the humours dam, balgham, safrā and saudā, and the four temperaments: Encyclopaedia Britannica, “Unani medicine”; the name’s meaning “Greek” and the Greek etymology of melancholy: standard etymological reference. Platts’s definition of saudā (black bile; melancholy; hypochondria; frenzy, madness, insanity; love): as quoted on Frances Pritchett’s Ghalib site (ghazal 113, verse 8). The “melancholic features” specifier for depression: standard psychiatric nomenclature. Punjabi tones arising from the old voiced aspirates, with word-initial gh becoming a voiceless unaspirated stop with low tone: Tej K. Bhatia, “The Evolution of Tones in Punjabi,” Studies in the Linguistic Sciences 5(2) (1975). Patients’ access to clinical notes under the 21st Century Cures Act information-blocking rule (compliance date April 5, 2021): standard regulatory reference, described only in general terms. Garg R, Thakre A, “Decoding ‘Ghabrahat’: A Cross-Sectional KAP Study of Healthcare Professionals’ Understanding and Management of a Complex South Asian Medical Term,” Journal of the Association of Physicians of India 73(8):40–42 (2025), read in full: sample, affiliations, percentages, stated limitations and conclusions. Krause I-B, “Sinking heart: A Punjabi communication of distress,” Social Science & Medicine 29(4):563–575 (1989), abstract. Kleinman A, Eisenberg L, Good B, “Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research,” Annals of Internal Medicine 88:251–258 (1978), and the explanatory-model questions as reproduced in a Tanenbaum handout. Weaver LJ, Karasz A, “’Tension’ and distress in South Asia: A systematic literature review,” SSM – Mental Health 2:100092 (2022), abstract. The 1951 census and the Punjabi Suba agitation ending in the 1966 reorganisation: Kuldip Singh Dhir, review of B. S. Thaur, Formation of Punjabi Suba and its Fallout, The Tribune (June 12, 2016). Punjabi’s marginal place in the schools of Pakistan’s Punjab: Safir Rammah, The Friday Times (June 3, 2024). Guru Angad’s association with the settled form of Gurmukhi at Khadur: standard Sikh historical reference. James Baldwin, “If Black English Isn’t a Language, Then Tell Me, What Is?”, The New York Times, July 29, 1979. Regional dialects of Punjabi and the glosses of dard, pīṛ, bukhār, chintā, ghabrāhaṭ, ghabrāuṇā, dil, chakkar, kamzorī, balgam, ṭainshan, māṅ bolī, hāl, ṭhīk hai and Vāhigurū dī mihar hai: standard Punjabi usage. Vendor representations. None.
Recollection and tradition. The author’s languages and education are his published biography. The woman in the outpatient hall, her answers and her chart note are explicitly hypothetical; they do not describe a real patient, encounter or record, and no remembered clinical scene is asserted. The physician meeting patients who prefer one language or another is a general illustration, not a recollection. References to how words are used in clinics are general and drawn from the published studies named above.
Analysis and forecast. The distinction between untranslatability and range, the readings of Ngũgĩ, Keats, Farid and Baldwin, the account of humoral vocabulary in both languages, the critique of the survey’s reach, the argument against premature translation and the two-line note are the author’s interpretation as of November 6, 2026. Independence. This essay is not sponsored by any institution, company, health system or technology developer. It is personal reflection, not medical advice; readers seeking care should contact their own physician’s office.
About the Author #
Kanwar Partap Singh Gill, MD, traces his family roots to Khadur Sahib in Punjab’s Majha region and grew up in Amritsar. He attended Spring Dale School and completed pre-medical studies at Khalsa College in 1994–1996. He earned his MBBS from Sri Guru Ram Das Institute of Medical Sciences and Research in Amritsar in 2002.
He completed PGY-1 at the University of Arkansas for Medical Sciences in Little Rock in 2007–2008, and PGY-2 and PGY-3 with UCSF Fresno at Community Regional Medical Center from 2008 through 2010. He has practiced medicine in California since 2010.
His career has crossed four distinct information eras: predominantly paper-based medicine, early and fragmented electronic records, the integrated-EHR era, and the emerging age of generative and agentic artificial intelligence.