Author’s Note: The name and identifying information in this essay have been changed to protect the identity of the individual described.
With her back turned toward me, Mrs. Brown propped her head in the palm of her right hand. Her eyes looked lifeless as she stared out the window. When I first entered her room and introduced myself as a volunteer, she barely looked at me and never spoke a single word.
During my undergraduate career, I volunteered at a nursing home. Many of the grandparents at the nursing home were in their 70s and 80s who had chronic diseases and were sent to the nursing home because their family members could not afford the time to take care of them. The nurses and caregivers would often organize some social activities for the grandparents, such as playing board games and cooking, to prevent their cognitive function and motor skills from deteriorating. During my first week of volunteering, I was assigned to visit Mrs. Brown every week. She had recently moved from New York to live with her daughter, and was sent to the nursing home after her daughter accepted three new job offers and could not visit her often. She had mild dementia, and loved reading and creative writing.
Over the next several weeks, Mrs. Brown began displaying some erratic behavior. Sometimes, she would quietly stockpile pencils and crayons while on other days, she would grab fistfuls of tissue paper and start shredding them. The nurses told me that she often dreamt of her neighbors stealing her car, even though she had not driven it in 20 years. Her hair was usually messy, and she constantly scratched her skin, especially when she was agitated, leaving deep red scars and bruises on her body. Whenever I tried to get Mrs. Brown to talk to me, she merely looked out the window and avoided my gaze. Her caregiver told me she often withdrew herself from social events, and refused to accept any requests to shower. She was particularly drawn to shiny objects, and would hide sparkly pins in her closet. The doctors and nurses tried to get her to listen, but she often denied having displayed such behavior and would have sudden fits of rage whenever someone brought up the topic.
As a student volunteer, I often pondered about the reasons behind Mrs. Brown’s behavior and thought about how I could communicate with her. Although I have some previous experience interacting with patients, I quickly found that much of what I had learned became irrelevant when it comes to elderly patients with difficult behavior. Nobody has taught me how to communicate with someone who has lost the words to express their thoughts, someone who has lost the concept of space and time altogether. I soon realized communicating with elderly patients requires creativity and extreme patience.
Over the next few months, I tried to communicate with Mrs. Brown using different techniques to no avail. I tried writing on a notepad and using hand gestures, but she never bothered to look in my direction. At that time, I could not understand why she was behaving the way she did, and soon lost interest in communicating with her.
One day, as I came to visit Mrs. Brown for my volunteering session, I saw her flipping through the pages of an old photo album. She paused for a few minutes as she saw a picture of her and her family at their old apartment in New York. I immediately wondered whether her fear of adapting to her new life at the nursing home could explain her erratic behavior. Although Mrs. Brown smiled politely and said “No, no” when I asked her whether she missed her old life in New York, her tears and grimace unveiled her pain and fears. I then encouraged her to talk openly about her feelings. Through time, Mrs. Brown opened up gradually and disclosed her fear of her family abandoning her at the nursing home. She also regaled me with tales of her fond memories of cooking for her friends and her cross-country trips to Canada and Michigan with her family. She explained she started collecting sparkly pins ever since her grandson gave her one before she left New York. Although she consistently repeated certain phrases, I tried my best not to say a word, and listened not only for the content of her stories, but also the ways in which she presented them. For the first time, her past actions and behavior made sense. I finally saw a passionate woman who had a knack for telling stories.
Through trial and error, I eventually learned how to speak to Mrs. Brown. I found I had to constantly adapt my approach to figure out what she was saying, and opened my eyes to the ways she conveyed her vulnerability. Every gesture and facial expression became a valuable clue to understand the humanity within her. By allowing her to narrate her stories, I was able to pay attention to the emotions and implications associated with the stories, and help her find meaning in her suffering. Although it took months and extreme patience to figure out why she was behaving erratically, a small clue that I obtained from listening to Mrs. Brown’s stories helped me understand her background. It also strengthened our connection and provided me the opportunity to help her adapt to her new environment.
One day, as Mrs. Brown’s family came to visit her, Mrs. Brown handed me one of her sparkly pins she had in her closet and thanked me for visiting her these past several months. I did not accept her offering and gently asked her to keep it. She gave me a half-smile and placed the pin on her desk. Becoming a physician fundamentally means looking for clues that could help patients find meaning in their suffering through their stories, and I could only hope Mrs. Brown realized how much I have appreciated her for teaching me the healing power of storytelling.