Friday, July 16, 2010

"The Patient Is Deaf"

At my ER computer station, I signed on to treat my next patient, a 42 y.o. woman who had presented with abdominal pain and, just prior to arrival, had noticed some blood in her stools. Despite her complaints, her vital signs were stable.

I went to pick up the clipboard for Room 31, her room, when I noticed a bundle of 8 1/2" by 11" white copier paper trapped under its metal clip, the top page of the pile covered with a lot of rushed handwriting. Stuck to this top page was a pink Post-it.

I grabbed the clipboard, with all of these extra papers and pink Post-it, and walked to the station counter, setting the clipboard down on some open space. I grabbed the Post-it and read. "The patient is deaf." This explained all of the writing on the top page. Between our triage nurse and this patient's room nurse, a conversation must have occurred where the patient wrote all of her answers to the various questions asked on the paper.

I smiled to myself about how great our nurses are. Not only did they save me time by saving the written responses of the patient, but they also gave me a "heads-up" Post-it. In the event the nurse and I hadn't yet had a chance to talk about a patient, I welcome when they let me know about a patient's special needs or circumstances this way.

Reviewing the top page, I appreciated just how in-depth the nurses asked their questions. There was not much more I would need to review with this patient.

I walked into Room 31 to find a middle-aged woman lying on her left side, eyes closed, with her hospital gown loosely-tied at her back's nape. A scratchy, white hospital blanket covered her up to her elbows. Her hair was flat and matted, as if she had spent the last few days in bed with her pillow. An empty chair had been pulled up beside her cot on the side she was facing. The room was dimly-lit and, since the TV was off, a calming quiet pervaded the space.

Since I wasn't sure if she was napping, I gently nudged her toe until she opened her eyes and looked at me. I could see her initial fog of "Where am I?" lift before me.

"Hello, maam," I said, paying special attention to enunciating my words, "do you read lips?" She nodded her head "yes." I smiled at her and continued. "It's nice to meet you. My name is Dr. Jim," I said, pausing to spell out J...I...M in sign language for her, "and I will be your doctor today."

She smiled at me and asked for the clipboard. She wrote out "Do you sign?"

I nodded "no." "I can spell my name," I spoke, giving her my undivided attention, "and I can sign all the words to 'You Are My Sunshine'." I did a little of the first verse for her, which revealed her hearty, guttural, infectious laugh, the first verbalization I had heard from her.

I thought back to my kids' preschool teacher, a wonderful woman who had the foresight to recognize sign language as a fantastic learning tool at their age. Because Ms. Denise's own son was deaf, she had made learning sign language one of her top teaching priorities, a priority she has carried with her to her new elementary job. My kids are a part of a group of lucky kids who have benefited from her forward thinking.

After a few minutes of general conversation, with me speaking and her writing, I began asking her a few more detailed medical questions. She grabbed the clipboard and flipped over the first page, now writing on the second, clean page. "Can you wait until my husband comes out of the bathroom? He can speak." She continued writing. "He just got here."

I nodded my head "yes" while I spoke. "Absolutely." As if on cue, the curtain pulled back to the room and a middle-aged, medium-height man in jean shorts and a t-shirt with wispy thinning hair walked in. He gave his wife a genuine smile before turning his attention to me. "Hello, sir," I said, approaching him with my hand extended, "I'm Dr. Jim and I will be your wife's doctor today. Nice to meet you."

He too had watched my face intently as I spoke, but it wasn't until he answered me that I connected the dots. Slowly, with thickened syllables and deliberate slowness, he answered me back. "Nice to meet you." The patient's husband was deaf, too. Like his wife, he could read lips and sign. But when he answered, unlike his wife, he verbalized his words alongside his signing. Very impressively and adequately, I might add. After just a few words, I was able to adapt to his speaking skills.

Between the small-talk, the rest of my history-taking, and the physical exam, I was able to witness the magic of their relationship unfold. It was extraordinarily ordinary, watching this couple interact. I don't know what exactly I had expected, since this was the first time I had interacted in the ER setting with a deaf couple, but they were a typical married couple who, through their various forms of conversation, skillfully interrupted and joked with one another.

Standing on the patient's right side of her cot, with her husband on the left, I was pleasantly reminded, yet again, that we fellow humans, despite our individual differences, are more similar than what we sometimes recognize. That, in the end, we all want nothing more or less than our neighbor.

It was during the explanation of the rectal exam, between the husband and wife, that I saw just how typical and ordinary this couple was. With the nurse now in the room, I explained to both the patient and her husband the necessary reasons for the exam. I explained how the exam would be done and what we would be looking for. When I was done speaking, as the nurse and I began preparing for the exam, the husband began gently teasing the patient about the exam, making a ring with his left thumb and index finger and sliding his right index finger through, mimicking the exam. Laughing the whole time he was doing it.

Well, the patient (probably nervous about the exam) did not seem to appreciate her husband's attempts at humor and, before we knew it, there was a flurry of hand movements between these two that could only be interpreted as a full-fledged argument. It was fascinating to watch. Despite our presence, they argued for about twenty to thirty seconds before their hands calmed down. The husband, after giving his wife the last signed-word, spoke clearly to her. "I'm sorry." He wouldn't be teasing her about this exam again. Ever.

Tenderly, they entwined their hands. The same hands that had just finished an argument.

I walked up to both of them, smiling, my gloved-hands ready for action. Before initiating the exam, though, I held up my right index finger to them, asking them to wait. When, at last, the room's calm returned, I did what I knew would make us all smile again.

I signed "You Are My Sunshine." Laughter filled this deaf couple's room.

This patient ended up having a lower GI bleed. As a result of this, we admitted her and she had a colonoscopy that revealed a bleeding polyp that responded nicely to the GI team's interventions.

Sometimes, I can only shake my head at how lucky I am to be doing this ER physician thing. I signed up for this job, yeah, but I had not expected my personal interactions with patients and their families to be as fulfilling as it has been in my career. Maybe even more fulfilling than providing good emergency care. Sure, like any other job, there are times through a shift when the hassles can outweigh the good. But, after the privilege of meeting this amazing couple as well as similar patients, you tell me how the rest of that shift could be a bad one?

It couldn't.

As always, big thanks for reading. I hope you all have a great weekend. Emma update--today is day 11 of 17. Yesterday was Kakadu National Park and today she continues the visiting and learning of the Aboriginal people and their customs. How lucky is she! See you early next week...


AtYourCervix said...

Thank you for being so patient with this couple. You wouldn't believe how difficult it is to a deaf person to try and have a line of communication with a health care provider. Many providers simply do not take the time to make sure that the deaf patient understands things completely. (I have a deaf partner - we do not sign - he reads lips, but most people do not enunciate well enough for him to understand, so the communication goes through me at Doctor visits.)

Kate said...

As always, I loved this story. I have taken some minimal spanish to help our the doctor in our office, but I'm not very good at it. We usually all end up laughing because I'm slaughtering it so badly. But the laughter is good medicine, too.

Fordo said...

I'll echo what Kate said. Laughter is good medicine. Then too, have you ever gone to a foreign country and attempted to say a few words in the foreign language? Usually people are very appreciative and kind at our attempts to communicate to them in their language. I think this woman may have felt the same way. Tickled that you were willing to look foolish for her sake.

The kindness you show to your patients is delightful. Keep up the good work.

Karen said...

This is a really nice story. Several years ago I dated a man who was profoundly deaf since the age of 4. He never learned to sign, saying he "didn't need to" Apparently he thought that his speech was much better than it really was. It took a lot of time and patience to have a conversation with him.

AfterGirl said...

I love reading your stories. My Mom and I have both had trips to the ER with in the past year and I like to think you were both of our doctors. Of course you weren't but we both had lovely (as possible) trips to the ER and everything was handled beautifuly. I got to go home after several shots of morphine and a cat scan (sudden onset miagrane) but mom had to stay several days and had a partial hip replacement.

Have Myelin? said...

Oh I love this story! I am deaf and fluent in ASL (American Sign Language) and "You are my Sunshine" was one of those songs my kids and I sang (signed) together all the time when they were young. =)

I'm used to seeing post-it notes on my chart with new doctors, lol. I can't say I've had one react the way YOU did. Most of them ask the nurse who then asks me the same question...hey I'm in the room! I'm not invisible!

Once I had a doctor say "your ear canal is normal??" as if perhaps being my deaf was not possible. I said well...I have nerve deafness. Caused by streptomycin. OHHHH. LOL.

Nice story. Enjoyed it. =)

The Hopeful Elephant said...

You should totally look up the Signing Time videos...seriously. That's how we learned ASL for Jack and I use it A LOT within the medical and special needs community.

Try it, you'll like it!

Tell Rachel that I sent you!

WrightStuff said...

I thought of you today - no don't worry, I haven't gone all stalker on you... it's just that I was in a shop that sold American food and the words 'Taffy Laffy' jumped out at me. For a moment, I couldn't quite understand why... then I remembered your post on the subject a month or so back. I just had to buy some. Tried a fizzy cherry and a watermelon. Verdict? Bit on the sugary side... yet strangely addictive.

Empress Bee (of the high sea) said...

i watched a couple in a restaurant obviously arguing in sigh language. it was amazing. i never forgot it. i tried not to stare but it was hard.

i don't know why i feel like telling you this but years ago (many many years ago) i thought about inventing braille porn. i still think it's funny. someone should do it. just not me.

smiles, bee

Katie Axelson said...

This makes me want to jump up and down and cheer!!! Really, I might do it. A fist pump sufficed.

A few hours ago I logged onto blogger for eight seconds and saw the title of this post. I'll be honest, it made me nervous. The medical world gets SUCH a bad rep when it comes to Deaf culture. The ER physician in the movie Sweet Nothings is causes the inciting incident and in this case, that was not a good thing. It's a good and educational movie but yucky, yucky, yucky.

As someone who signs, I've seen the impact my effort makes among the Deaf. (Deaf=culturally Deaf; deaf=physically deaf). Just yesterday I saw a girl's face light up when she learned I could sign. Those three finger-spelled letters, that one verse of "You Are My Sunshine" made a HUGE impact on that couple. I am so impressed! Not that I really expected anything less.

And THANK YOU for not using the term "hearing impaired" because to most deaf and hard of hearing individuals, this is an offensive term.

Oh, and that sign you mentioned has a couple of different meanings...

Now that I've written a whole novel... Back to my crayons,
<>< Katie

Have Myelin? said...

FYI- I have a post on my blog entitled "American Sighhhhh Language" featuring a youtube signer "singing" a song called I Want Candy and he is fantastic! He is a native signer (meaning he has deaf parents, deaf siblings and he's hard of hearing- I read his bio) and if you watch the whole video you will see how he uses his whole body as well as his facial expressions. That guy is very, very good. =)

Anonymous said...

Age 42 is middle-aged?!? What the what? Oh my word, I am in such denial! Lovely post by the way! I work in health care too, and I have had many written conversations with some of my patients.

Maha said...

This is such a heartwarming post. I'm glad you took the time to understand the couple and they were lucky to have such a caring doc at their service. All the best to them and you :)

myonlyphoto said...

Oh Jim, we need more doctors like you. BTW at least you explained the exam, when I was going to my OB and had similar exams, lol, just in the front hole, he wasn't really detailed, so there is me and my husband asking: will you be using a finger or the whole fist? We still laugh at that after few years, don't know why we asked silly questions like that, but then it forced the doctor to explain more, lol. Jim you are the best ... Anna :)

MC said...

Wow, great story and post, and great way to handle communication and respect the Deaf couple. I've heard of so many bad stories of when Deaf people were treated poorly because of their Deafness, but you did a good job. :D
I enjoy reading your posts.

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