communication

Moments Matter 64: Believe That You Can Learn

Believe, deeply and truly, that you can learn something from every person you meet.

I’ve seen variations on this theme, but they usually involve what others can teach you, which I think puts the emphasis of learning on the wrong person. Some people are teachers whose role is to teach, most people are not. It’s up to us to learn from everyone, regardless.

It doesn’t mean you absolutely will learn something from every person you meet. It might take time, or the lesson might be hidden from sight or you won’t realize it until years later. But believing that you can learn something – that the potential exists and that you welcome it – is key to being a lifelong learner, and to lifelong growth.

Believe, deeply and truly, that you can learn something from every person you meet.

I recently met someone struggling with addiction. I learned that sitting down and maintaining eye contact, not just making eye contact but holding it without breaking, can make someone living a life full of labels and assumptions and judgment feel heard. Feel seen, and respected.

I learned that most people never looked him in the eyes, never shook his hand, never spent more than a few minutes talking to him. I learned that he never realized how much he needed someone to just sit there, and listen, and look him in the eyes while he shared his story.

I learned that he felt, for a moment, connected again to something he assumed was lost forever.

Believe, deeply and truly, that you can learn something from every person you meet.

Moments Matter 62: It’s Not Just a Matter of Time

I feel like we spend a lot of energy thinking about prognosis in terms of time, but it’s not always a matter of time. In fact, for many of my patients, “how much time do I have left” is often less important than “can I feel, in some way, like myself again?”

This is a pretty well-understood concept in palliative medicine, the concept of quality of time vs quantity of time. And yet, when we discuss prognosis with our patients, we tend to speak in hours to days to months or years – we tend to assume that the most important, or relevant, aspect of prognosis is time.

Reframing prognosis in terms of what matters most is often helpful. Temporal Prognosis may take a back seat to Functional Prognosis, or Identity Prognosis, or Legacy Prognosis. This is something we consider quite a bit in our inpatient rehab and stroke units where physical function and independence are typically affected. A REMAP headline may become less about “time is short” and more about what it is, or is not, possible looking ahead.

And if you’re unsure about which type of prognosis matters most to your patient? Then the best thing to do is explore with empathy and curiosity (an “I wonder” statement may work well here!).

a metamorphosis

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?

our time spent talking

A good deal of what we do in life is talk. The typical person speaks 16,000 words a day (1) at roughly 150 words per minute. With average life expectancy in the United States nearing 80 years (let’s say 75 spent really talking), the average person spends 3,000,000 minutes talking over the course of a lifetime. That’s 50,000 hours, or 2,083 days – almost 6 entire years spent in the act. This is only a rough estimate, of course – politicians probably speak much more, mimes much less – but still, that’s quite a bit of talking.

A lot can be said of what we say, but perhaps even more can be said of how we say things – the way we communicate, our non-verbal cues, our temperament in turbulence. Our messages may change with time and experience, but how we communicate reveals a lot about who we are as individuals. It speaks to our priorities in life, our patience, our generosity at times – at others, our insecurity. Our fear. 

If we could somehow be more aware of how we communicate, perhaps we could communicate better – and perhaps those 3,000,000 minutes could be time spent, not only sharing our thoughts and dreams with others, but bettering ourselves as well. 

My hope is that this site can be a forum to explore how we communicate with each other about the things that matter most – a place to share stories and experiences, and perhaps learn a bit about ourselves along the way.

1) Matthias R. Mehl, Simine Vazire, Nairán Ramírez-Esparza, Richard B. Slatcher, and James W. Pennebaker. Are Women Really More Talkative Than Men? Science 6 July 2007: 317 (5834), 82.