It’s not uncommon to hear that a loved one has been transformed by their illness. Physical and physiological transformations aside, something happens when the expected course of life is slowly and gradually pulled away from center. Personal identity is redefined and repurposed – there is a subtle attrition of traits that renders us, in many ways, a patchwork of our former selves. In some cases we become known more by our disease than by our dreams and desires. “I am Cancer,” a young woman told me once, “and nothing more.” It was heartbreaking to hear.

I see this transformation most often now with indolent cancers, and with dementia. It’s as if a person’s life – once full bodied and intricately carved – gets whittled down to the bare essentials. We recognize that we are looking at a life, but the finer details – those unique and storied elements – have been scraped away.

Several weeks ago I helped care for an elderly woman with dementia. She had developed pneumonia, and was slowly climbing out of a devastating delirium. Her family shared that over the past three years she had been changed by her disease – she was no longer outgoing and social, she no longer loved to play cards or tell jokes. Even her face was more sallow in parts, as if what defined her personality had been drawn out of her skin. Discarded in a syringe.

I’ve seen this pattern many times before – a terrible chronic illness leads to an infection which leads to a hospitalization then a nursing home then another infection and so on, sometimes for years on end.

And life is suddenly redefined by lengths of stay.

But this family asked me something I wasn’t expecting. “How do we talk to her?” they asked. “It’s like she’s a completely different person, speaking a completely different language.”

I didn’t have a good reply. I think I said something about sharing a few of her favorite memories, speak to her in a way she would appreciate and find comfortable, bring in her favorite music, decorate the room to look more like home.

But if effective communication is about adapting our style to match how our loved ones best communicate, how do we do this when they are transformed by an illness? When the person before us is different from the person we knew? When the way they communicate is changing with time?