Words can relay many things, but they only share a part of the message.  Even when words aren’t understood, or are unspoken, we can still communicate.  I recently made a visit to a patient who lay in his bed, able to whisper soft responses during our discussion of his health and care needs.  His spouse was sitting nearby, quietly waiting.  At this first meeting, the patient was able to tell me what was on his mind, but his wife had suffered a stroke and could only repeat the same word—just one word— over and over, for everything in her world.  The inflection might be different, the number of times she spoke the word might be more or less, but the word was the same.  It was the entirety of her spoken vocabulary.

This makes me think of Barbara, a patient of mine many years ago, whose frustration level with aphasia had created “behavior issues” for her with the staff at the facility where she was a resident.  As people hurried about her, it was rare that she had a say in what was done to her, or the timing of events in her daily life.  Something as simple as “I don’t want to wake up yet” was unable to be spoken, and she would lash out when staff were insistent that she get up for breakfast.  Over the time I knew her, she and I found ways to understand each other.  It was often guessing on my part, gesticulating and repeating on her part, but I learned to care deeply about communicating with her, to be sure her needs were met and let her know that she was valued.  She could have a say, even though she wasn’t able to speak it.  Some of us would listen.  Some of us  would try our best to understand.  Some of us would advocate for her.

I realized as I left this visit the other day, that Barbara had taught me that lesson all those years ago: Understanding doesn’t always need words.  It wasn’t hard to recognize that this wife, sitting at her husband’s bedside, was worried about him.  I had said a few simple words to her with some reassurance that he was doing well today, and her eyes lit up with pleasure.  She could nod her head to answer me, and we could look at each other, hold a hand, and share compassion and interest without words being spoken.  It is the human language of touch, of seeing and understanding that can be found when we take some time to really listen to each other.

Thank you again, Barbara, for showing me how it is done.

“The message behind the words is the voice of the heart”  Rumi