Hearing the unspoken

Hollis Roth

doi:10.46747/cfp.7010642

In palliative care, much of what we aim to teach our learners is grounded in what medical culture has traditionally viewed as soft skills. This can include developing rapport quickly in high-stress situations, reading nonverbal body language, being comfortable with silence, and adapting communication to meet a patient’s needs. In this poem I explore a teaching moment, which occurred during a patient interview where a trainee missed a nonverbal cue. The patient described within is theoretical.

The pause

You paused and the resident barrelled ahead
no doubt focused intently on their internal, infernal checklist
which, to be fair, mutates every few weeks
(and on a daily basis amidst picky attendings
a club to which I sometimes shamefully belong).

You paused
and in that moment, something invisible slipped away
now far downstream, and out of reach
so intent they were on measuring your symptoms
locating, categorizing, and storing data
instead of pausing to admire your soft and quiet tenacity.

You paused, and in that moment,
were cut down and measured against a yardstick of disease
instead of the fuchsia-streaked sunrises that bring you joy
your grandchild’s berry-stained fingers and
the first-hand fear slumbering deep within your bones
a now solemn bedmate of those pesky cancer cells which dance nightly in your sleep
now eternally entwined.

You paused and I saw it
I saw you.

And not for the first time I despaired
for how do we teach the magic
contained within a pause
when we have failed to teach our students
to see each other as human?

Footnotes

Competing interests Dr Hollis Roth receives compensation for teaching Learning Essential Approaches to Palliative Care at Pallium Canada in Ottawa, Ont. Dr Roth has worked on a pilot project in a palliative care and heart function clinic at Chinook Regional Hospital in Lethbridge, Alta, which has received funding from Boehringer Ingelheim. She also sits on the Medical Advisory Board of Oneday Dreams, a national nonprofit organization dedicated to fulfilling end-of-life wishes for terminally ill adults in Canada.