You Don’t Say: Knowing When to Just Listen to Patients, Families Trying to Cope

As the meeting continued, my mind was filled with ideas of what I might say to get Mary Jane to listen. Surely there was something. If I concentrated, I’d find just the right thing to say and somehow it would make her adjust her attitude. Surely it was fixable. But I spent so much time thinking about what I wanted to say to neutralize her toxicity that I missed the chance to truly listen to her. Which meant I was not as tuned in to the situation as I needed to be.

Ignoring what she said and instead formulating a response was easy. Yet this was more about what I saw as she spoke than it was about what she said. Body language. Mary Jane’s body language was screaming at me, but I was only listening to her words. If I’d paid attention to what I saw, I’d have noticed the set of her jaw. She was desperate to hold on to her perception of what was going on with her sister. Letting go of her belief would leave her with nothing. I might have noticed her shoulders as she leaned forward, might have seen the tension she held in them. If I’d listened to her body language, I might have seen that her darting glances were because she knew if she looked me in the eye she would see that I knew things she did not want to admit to.

Of course, her body language was subject to my interpretation. I might have been mistaken. However, by failing to fully appreciate the context of her statements I missed the other cues, the subtext.

Mary Jane and her sister grew up in Eastern Europe and were on the brink of being teenagers when World War II started. They relied on each other to survive and immigrated to the United States at the end of the war. Neither had married and so they lived their entire lives together. With her sister clearly in decline, I wondered how much of the anger and argumentative style was driven by their shared history. When her sister dies, Mary Jane will be the lone survivor of her family of origin.

DISCUSSION

“You don’t say,” was one of my grandfather’s favorite sayings. He used it the way we might say whatever or really. It was a verbal place holder, a way of showing surprise or a new understanding of the circumstances. And of course, there is also the literal definition: don’t speak, you do not say anything.

I had my own “You don’t say” moment with Mary Jane. It happened near the end of our meeting, when I shifted my focus away from getting even verbally and really stopped myself. I kept myself from eye rolling or my own expressions of disbelief. I’m not sure what made me stop. It might have been a flash of vulnerability I saw in her, but I settled back in the chair and just watched. Mary Jane’s confrontational style and words were meant to do exactly what they did: keep us away and allow her to keep her denial intact so she could protect her sister. We were the enemy because, to her way of thinking, we — all of us involved in her sister’s care — were forcing her to accept the unacceptable.

The purpose of our meeting was not to convince Mary Jane of anything. We were there to support her and to help her make sense of the situation, neither of which she would allow. At the end of the meeting she thanked us, which was a nice surprise, then tempered her gratitude by saying, “it was a waste of time though.”

I could look at this story of Mary Jane and her sister as an example of a communication challenge that failed. But I learned something about my own practice from Mary Jane. I realized that even with many years of experience and a certain level of expertise, I can learn more. I can open myself up and look past words. I knew all of this before because I have done this before. But Mary Jane’s level of vitriol blindsided me, and I reacted to her words. I have Mary Jane to thank for teaching me, once again, the absolute importance of listening and not talking. You don’t say.