大象传媒

鈥淗i there,鈥� said the resident who gently tried to wake the woman.

In the bed before me lay an elderly woman who looked even smaller in her hospital gown. She matched the familiar image of the sweet old lady鈥搒omeone鈥檚 grandmother perhaps.

The resident introduced herself and allowed me to introduce myself before asking the basic questions that constitute the history of present illness: how she ended up here, how she had been doing at the previous facility, etc.

鈥淪orry, what was that again?鈥�

Speaking up helped her answer the questions, but I couldn鈥檛 help but feel as though we were talking down to the feeble woman.

My turn: I had to assess her cognitive function using the Mini-MOCA (MOntreal Cognitive Assessment). I felt uneasy, as though I had to subject someone to cruel and unusual punishment as I stood there nervously with the clipboard in my hand.

鈥淎lright, we鈥檙e just going to ask you a few questions to see how you are thinking, okay?鈥�

She stared back at me, 鈥淎lright.鈥�

And so I began with the questions:

鈥淐an you draw for me a clock that reads ten past eleven?鈥�

She tried quite diligently to draw the circle and numbers but could not draw the hands.

鈥淗ow鈥檇 I do?鈥�

鈥淣ot bad,鈥� I tried to say genuinely, 鈥淣ow, can you please name the animals drawn on this page for me?鈥�

鈥淯m, let鈥檚 see here鈥� a lion鈥� a rhino鈥� and a camel.鈥�

鈥淕reat work!鈥�

鈥淎re there more?鈥�

We finished altogether all eleven items, but as soon as I stepped back from the bed, she uttered a few words that froze me.

鈥淚 didn鈥檛 do so well did I?鈥�

Noting my silence, the resident added, 鈥淲ell, it was a tough exam. Don鈥檛 feel bad about it because a lot of folks struggle with it. You did fine.鈥�

The woman smiled as we left the room, but deep down, I had to wonder if she had managed to piece together the truth from my body language 鈥� her lifetime of wisdom over mine. Aside from what she disclosed in the room, the only other piece of information I had was why she was here:

Patient is a 90-year old woman who came in from an assisted living facility after she stuck her head out of the window and expressed an active desire to kill herself.

I walked into that room knowing to use a MOCA out of concern for her cognitive function, but the woman had enough understanding of my body language to read the assessment herself. Her insight rendered my knowledge lame.

The awkwardness that first comes with talking to patients takes time to overcome, especially as we develop our knowledge, and I realize now that I must also develop the ability to tap into the non-verbal exchange. These hidden cues guide the immobile information stored within the recesses of my mind and aid in providing closure to the patient鈥檚 concern.