“English or Spanish?” — What Dr. Ricardo Nuila Taught Me About Listening, Language, and the Soul of Care

In The People’s Hospital, Dr. Ricardo Nuila—a physician at Houston’s Ben Taub Hospital—shares a moment that stayed with me far beyond the page."The first important question I ask the patient," he writes, "English or Spanish?"

He goes on to describe how even his “horrendous Spanish” often feels like “music to their ears” for his Hispanic patients. That line hit me with surprising force—not because it was poetic, but because it was deeply human. As someone who has long been drawn to the intersection of culture and care, I realized: this is what cultural competency looks like when it’s real. Not a checkbox on a hospital form. Not a seminar or module. But a question asked with humility. A willingness to meet someone in their world.

Reading that moment made me think of my own experiences—of visits to clinics where my loved ones, unsure of the language, sat in silence as care was delivered at them, not with them. I remembered the fear in their eyes, not from the diagnosis, but from not understanding what was being said.

Language isn’t a tool—it’s a lifeline. And when that lifeline is missing, so is dignity. What Dr. Nuila does in those first few seconds with a patient—by asking, “English or Spanish?”—is more than translation. It’s affirmation: You are welcome here. I’m willing to try.

As someone who has studied narrative medicine, I’ve come to see that the stories people carry are just as vital as their symptoms. Narrative medicine teaches us to listen not just for data, but for meaning. To hear what isn’t said. And often, language is the first portal to those deeper stories.

In asking about language, Dr. Nuila is doing narrative work. He’s not just checking for comprehension—he’s opening space for the patient’s story to be told in the language it was lived. He’s saying: Tell me your truth, and I’ll meet you there—even if my words stumble along the way.

That’s narrative medicine in action. Not only does it build trust, but it reframes the clinical encounter from transaction to connection. And connection, as we now know, can shape everything from adherence to healing.

We don’t need to be fluent in ten languages to practice cultural competency. We need to ask, to listen, to try. We need to understand that culture shapes how people express pain, how they describe illness, how they make decisions—and ultimately, how they heal.

Sometimes that starts with a question as simple as, “English or Spanish?”And sometimes, that question is the beginning of a story waiting to be heard.