She sat quietly, hands folded in her lap, watching. The conversation was lively and fast. The occasion: a visit to a cherished grand-daughter's new apartment, following a celebration restaurant dinner with two of her daughters and grand-daughter. Everything had been seen and admired, house warming gifts received, flowers carefully put in water and prominently placed on the piano. Dinner had been lovely; the restaurant not too loud early in the evening. Now there was some catching up to be done; what the various cousins were doing, summer plans, family gossip.
It was nice to be there, but at 80-and-a-bit it had already been a long outing. She said, "I'm not hearing all you're saying!" The daughters heard, and for a few minutes directed the conversation to their mother. They had heard this many times before. It often meant, they knew, "I don't understand." Talk of emails, Facebook postings, computers, travel plans swirled around her, confusing in their unfamiliarity. But some of this talk was expected, the daughters reasoned. Not often did they see each other and surely topics could include things not everyone was interested in? The daughters and the grand-daughter were so careful to help: guiding her on stairs, bringing groceries, calling, visiting, making sure she knew she was loved.
She couldn't hear all that was being said. And she wanted to, even if she didn't understand. She was interested, She was as sharp as ever. She was not content to let the tide of conversation wash over her with no discernible form. Her eyes started to water. She felt alone, isolated. The conversation faltered as the tears, hastily brushed away, were noticed. "I couldn't hear you." she said. "I was trying so hard to be a part of it all, but I couldn't hear you enough. I think I am just tired" Everyone was immediately contrite, apologies were made, goodbyes, hugs and congratulations passed around and the evening was over.
The daughters were kind, solicitous, careful as they tucked her into the car for the ride home. Next time, they suggested, please say, "I can't hear you well, I need to see your faces." She nodded, embarrassed. The elderly woman had picked a comfortable chair arranged around the coffee table with the others. But she was not seated where she could see everyone's faces as they talked. The light cast shadows on the faces she viewed from an angle. Had she been sitting facing the sofa, the light behind her on the other side, she could have heard more words, felt more involved. That small modification and perhaps slightly louder voices, more careful speech, could have made the difference.
These environmental modifications and communication oriented strategies are part of our treatment plans. In some cases, these are the only things we can change for our patients. Small things can have powerful impacts on communication and also social-emotional well-being. But they are not always easy to put into effect, with all the best intentions, care and love a family has. We clinicians need to be patient and understanding. We need to provide patients and families with as much explanation, repetition, modeling and support, for all strategies or techniques we provide, as they need. There is no room for judgment. No timetable for mastery.
I, of all people, should have known better. I didn't. I'm sorry Mom.
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