On the Frontline. 2 AM in the ER
I’m starting a series of conversations with healthcare actors on the frontline.
When you build technology that aims to change how clinicians deliver care, there is a responsibility that comes with it. The least we can do, with some humility, is to stay as close as possible to the reality of the people actually delivering that care.
On March 24th, I had the opportunity to speak with Sam Frenkel, MD. Sam is an emergency medicine physician. And in emergency medicine, everything comes down to immediacy.
Sam is also an early adopter of the No Barrier solution. He uses it directly on his phone. More importantly, he was willing to share how it fits into his day to day. Not as a concept but as something that can shape what happens in the ER, especially when it comes to language access.
So here we go. Let’s step into the ER.
2 AM. When Nothing Slows Down
It is 2 AM. The kind of hour where the hospital is everything but slower. In the emergency room everything still moves fast. It has to.
A patient arrives. She feels weak. That is the word that comes through. Weakness.
She speaks Portuguese. Very little English. Sam does not speak Portuguese. Spanish is not close enough here. Not for medicine. Not for something that could be serious.
At first glance, weakness could mean many things. Fatigue. Exhaustion. Something that can wait.
But in this case it does not.
What the patient is trying to say is something else. Something more precise. Something more urgent. Something closer to the early signs of a stroke.
And in the ER, time is not abstract. Time is brain cells. Time is outcome. Time is whether someone walks out or not.
When Language Becomes the Bottleneck
Sam shared this moment almost casually. Not because it is insignificant but because for him this is daily reality. This is what frontline medicine looks like. Small gaps in understanding that can become very big, very quickly.
The challenge is not only medical. It is linguistic. It is about getting to the truth fast enough.
“Instant is key,” he said.
Not convenient. Not nice to have. Key.
In many settings, you can wait. You can schedule. You can call an interpreter and hold the line. In the ER, that model starts to break. You do not always have those minutes.
So clinicians adapt. They use what is available. Increasingly, that includes tools powered by AI.
Patients, Technology and Trust
There is often a question that comes up around this. How do patients feel about it.
The answer is less dramatic than one might expect.
Patients are used to technology. Hospitals are full of it. Machines that monitor, scan, measure, operate. Over the years, care has always evolved alongside new tools. For many patients, this is just another sign that someone is investing in their health. That effort is being made.
Some even "feel empowered". There is a sense of access. Of being understood when language would otherwise be a barrier.
Who Carries the Emotion
There is a common belief that only a human interpreter can carry emotion across a conversation. Especially in the hardest moments. Delivering bad news. End of life discussions. The fragile edges of care.
Sam sees it differently.
“The emotion is not from the translator,” he said. “It is from the doctor.”
The interpreter, whether human or AI, is a bridge. A tool. The voice that carries meaning across languages. But the responsibility for tone, for empathy, for presence, stays with the clinician.
There is even a subtle risk with human interpretation. Interpreters are human. They feel. They react. Sometimes they adjust. Sometimes they soften or reshape what is being said. Not out of bad intent. Just out of being human.
But in medicine, precision matters. The doctor needs to stay in control of what is communicated. Not only the facts but how those facts are delivered.
What Matters at 2 AM
AI is not perfect. It does not fully understand emotion. Not yet. But it has moved beyond simple word for word translation. It is becoming more contextual. More aligned with meaning.
And in certain moments, especially when speed is everything that can be enough to make a difference.
Back in California, where Sam practices, many patients speak Spanish. It is part of the everyday flow. Different dialects exist (Dominican Spanish, Puerto Rican Spanish, Mexican Spanish) but in practice a standard version is often sufficient. What matters is that communication happens clearly and quickly.
Because at 2 AM, in a crowded ER, with a patient in front of you, what matters is not what is ideal. It is what is practical.
There is only reality.
A physician trying to understand. A patient trying to be understood. And sometimes, a technology helping close that gap just in time.
Not replacing anyone. Not solving everything.
Just being there. Close enough to the frontline to matter.
Based on a conversation between Sam Frenkel, MD and Rivka Allouche, on March the 24 2026
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