Eleanor looked up at me with glossy, deep-set blue eyes. The corners of her pale lips were downturned, wrinkling the soft skin between her eyebrows. The rest of her body lay still on the thin mattress — the blankets remained neatly laid over her small legs, undisturbed since the nurse tucked her in hours earlier.
I sat down on a chair next to her bed and introduced myself. For a while she didn’t look at me, so I settled into my seat and opened my computer. The room was quiet, and the sound of my keyboard filled the space. It wasn’t until I stopped typing that Eleanor finally gazed over to me.
I closed my computer and met her eyes. The frown on her lips seemed to deepen, and I couldn’t help but feel that I had done something wrong. I smiled at her, and she weakly threw her arm toward me as if reaching out.
Eleanor’s inability to verbally communicate made it difficult to determine the meaning of her tossed arm. I held her gaze for a moment longer, gently reassuring her that I was there to keep her company and not to disturb her, and I returned to my computer.
The sound of my typing provoked Eleanor to reach out again, this time letting out a sigh. Eleanor was not my first patient to lack the ability to speak, but she was the first who struck me as frustrated with her disability. Her eyes held mine, this time unmoving and with a vehemence that willed me to feel her sadness.
Eleanor noticed that I saw her heartache and threw her arm out again. I felt I understood the words she hoped to express: see me, hear me, be with me. I slowly reached my hand toward her, giving her the opportunity to signal that I had misinterpreted her expressions, but she leaned in, and her sighs ended when I held her hand in mine. Though I couldn’t be sure this is what Eleanor meant, I was compelled to believe it was the right action.
From the hallway, the four hours I spent with Eleanor sounded like a one-sided conversation. Sometimes it felt like that from within the room as well, but quality care doesn’t end if I’m uncertain if the care is being received. I’ll never find out if Eleanor was comforted by my presence, but even a small chance that she felt seen was worth the time and effort.
When I saw Eleanor the following week, she had lost the ability to move as well. She lay still with only her chest slowly rising and falling with her soft breaths, gazing absently at the wall in front of her. I chose to sit quietly this time. I didn’t want to risk hurting her or pushing boundaries she wasn’t able to set.
•••
As premedical students enter their careers in healthcare, their youth – and temporal distance from death – tends to create a belief that death is tragic which makes it confusing when a patient passes away quietly with no drama or pain. The evident intensity of trauma and the quiet rage of silent battles are distinct kinds of suffering that cannot be compared because they represent two different phases of life: a life cut too short and a life long-lived, respectively. Eleanor, over 100 years old, had outlived her family and passed away without her loved ones to support her. Her efforts to communicate were subject to the interpretation of her caregivers at the hospital, isolating Eleanor from the world around her.
I believe it is vital for family members, volunteers, and physicians to advocate for patients who struggle to advocate for themselves. The act of listening might seem insignificant in comparison to more concrete actions such as running diagnostic tests, administering life-saving medicine, and performing CPR. These exams can identify injuries or underlying biological causes for illness, but listening to a patient’s story can offer insight into lifestyle and habits that are developing or worsening symptoms and suffering. It is essential for patients to be involved in their own health outcomes by leading healthier lives, but caregivers cannot know if a patient is aggravating their illness through their lifestyle if physicians don’t stop to ask them. .
Eleanor was silenced by illness, and it may have caused her more pain that she would’ve faced if she could communicate; other patients are silenced by treatment, injustice, and ignorance. Whatever internal or external battles a patient may encounter, listening to their words — spoken or not — ensures that both a patient’s outward and inward struggles are addressed to the best of our abilities as providers.