One Word. Two Worlds: What a Single Urdu Word Taught Me About Listening

What a Single Urdu Word Taught Me About Listening

 

She sat in front of me in the clinic room, hands in her lap, along with her husband.
She was one of the Muslim Aunties from my South Asian community, poised and proper in her lavender cotton salwar kameez. As a physician fluent in Hindi, Urdu, and English, I have had the privilege of caring for many Indian and Pakistani patients. Despite being born and raised in the United States, I pride myself on my ability to navigate different languages, cultures, and faith-based traditions. I can have a nuanced conversation about fasting for Karwa-Chauth (the Hindu one-day fast) as easily as I can about Ramadan (the Muslim 30-day fast from sunrise to sunset).

I will refer to her as Aunty, as this is the term we use to address older ladies in our community with respect.  Aunty is in her 70s, an authentic product of her conservative upbringing. She didn’t talk much. She would often pause before she spoke, as if measuring every single letter before it escaped her lips. She was always put together and well-groomed. Under the surface, however, she suffered bouts of depression and anxiety, having lost her son in his 20s. She came for her 3-month follow-up visit. I proceeded to check in about her Diabetes, heart disease, high cholesterol, and bipolar disorder medications. She reported adherence to them all. I didn’t doubt this one bit. This Aunty is a rule follower.  She isn’t like my grandmother, who collected all her pills in one bottle and then got confused. She trusted me.

So, when she presented with a new complaint of “ghabrahat”, I honed in. I knew what this meant.

Ghabrahat is directly translated as a feeling of worry or nervousness. When asked about specific symptom presentations, healthcare providers associated “ghabrahat” with anxiety, nervousness, palpitations, and restlessness (JAPI, Aug 2025). I was aware of the direct translation of “worry” or “nervousness”.  However, not having been raised in South Asia, I was NOT aware of its association with palpitations.

Her husband chimed in that he felt her anxiety had been worse lately. I latched onto the mental health definition of the word and proceeded down a path focused on depression, anxiety, sleep, and symptoms of panic.  She did not endorse any such symptoms. She also didn’t endorse chest pain or shortness of breath. I moved on to the next topic, assuring her that this indeed was anxiety related. She dutifully complied, without pushing back or adding more information.   I completed the visit and moved on to the next patient.

One month later, I ran into my Pakistani Cardiologist colleague in the hospital. She informed me that Aunty was admitted to the Coronary Care Unit.

“What happened?” I asked, anxiety rising in my throat.

“Acute coronary syndrome,” she replied.

Aunty had suffered a heart attack.

“Fortunately, her heart is healthy, and she was given a second stent to open the blockage. Glad we caught it quickly.”

I was shocked. She had just seen me and didn’t endorse any typical or atypical cardiac symptoms.

“What was her presenting complaint?” I asked.

“Ghabrahat, especially when walking up hills,” she answered, code-switching throughout the conversation.

I felt as if the floor had been removed from underneath my feet.

As I processed my clinical failure, I reflected on what happened. Something got lost in translation.  Urdu is a rich and layered language. One word can have multiple definitions. For example, there are eleven Urdu words that translate to the English word “desire.” I called my mother, who understood the complexities of Urdu like no other. She had instilled in me a love of the language since childhood, teaching me about the famous poets Ghalib, Allama Iqbal, and Maqdoom. She understood linguistic nuance in a way that few did. She reminded me that Urdu is a multilayered, rich language developed over 800 years and an amalgam of three major world languages: Hindi, Farsi, and Arabic. She was able to share the expanded definitions of ghabrahat with me.

I was intrigued to learn that this one word, “ghabrahat,” wasn’t just a problem for American-born South Asians. It had no direct equivalent in medical terminology. It could also be used to describe “discomfort” and “palpitations.” I had always understood it to solely mean anxiety.  According to the literature, the term’s ambiguity can lead to over-testing or, in my case, misdiagnosis. The strong associations with both the cardiovascular and psychological systems (86% and 73.8%, respectively) suggest that “ghabrahat” may represent a complex psychosomatic manifestation that requires a multidisciplinary approach to diagnosis and treatment. This piece of information provided me with some comfort.

I took away three lessons from Aunty’s condition.

The first is that cross-cultural fluency is not a fixed destination. Language, like medicine, demands humility and constant learning. I had spent years building confidence in Urdu, collecting its words the way others collect stamps. But confidence can quietly calcify into assumption. I assumed I knew what “ghabrahat” meant because I had always known what it meant — to me, in the context I had inherited. What I missed was the context Aunty had inherited. Her body spoke a different dialect of the same word, and I wasn’t listening for it.

The second is that over-confidence in language — or in anything — can be its own kind of blindness. The very fluency I prided myself on narrowed my clinical lens. I heard “anxiety” and I stopped listening. A less confident physician might have asked more questions, dug further, stayed uncertain a little longer. Uncertainty, I have learned, is not a weakness in the exam room. It is often the most honest clinical tool we have.

The third is the simplest, and the one I return to most. I can always care a bit harder and listen a bit closer. Aunty paused before she spoke. She measured every letter. She was telling me something in the only way she knew how, and I was already composing my next question. Medicine at its best is an act of translation — not just between languages, but between the word spoken and the word meant. That translation requires a particular kind of stillness that I had neglected in the moment.

Aunty recovered.  Her heart, it turned out, was stronger than the moment that had threatened it. I am not sure I can say the same about my certainty — but I think I am better for it.