When Patients Can't Speak: Listening Beyond Words

 It sounds impossible, right? Trying to care for someone who cannot verbalize what they need from you. In today’s day and age, we have become used to always receiving instructions. People tell us what they need from us, and we act and deliver results. We receive texts and emails with direct requests, fully spelled out for us, without any thinking needed on our parts. Our managers at work call us with any new tasks, or when they need us to pick up a shift. As a CNA, about 20-30% of my patients either did not speak a language I spoke or did not speak at all. I was left with the impossible task of trying to read their mind. 

I’m joking, of course. Most people don’t realize that when one sense fails, the other four strengthen. Similarly, when one is no longer about to speak, they find other ways to convey their needs. The burden is almost never on the CNA to figure out what the patient wants, because they will find some way to tell us what they need. Some patients will point to objects in their room that they need, like a box of tissues or their phone charger. Some patients will mouth things out, and some will use noises instead of words. For example, if they are not comfortable in the way you position them on their bed, they will groan or shake their head. 

Body language is one of the most important things to notice as a CNA. A patient may nod their head and indicate that they are comfortable, but they may have a sad or disappointed expression on their face and a constantly shifting posture. That would indicate that they are not actually comfortable, but they may be too tired or too frustrated to continue communicating with you. Body language tells you what someone who can’t talk is actually feeling, and if we do not make an effort to understand their body language, we are not making enough of an effort to care for them, because that is quite literally their only way of communicating. 

I had a patient who was admitted to the facility with around 10 suitcases worth of personal items. The protocol is that as a CNA, we are supposed to help them unpack and catalog everything on a sheet, marking everything they bring into the facility, down to every pair of socks. However, she was bedridden and nonverbal. It took three hours to unpack all of her things and arrange them in her room, and we did everything only by pointing. I would show her an item, and she would point to a drawer or cabinet to put it in. That patience is exactly what nonverbal patients need. They need to see that someone is making an effort to understand them, no matter how tedious or time-consuming it may be. 

One thing I found helpful is to keep talking. Even though they cannot talk back, I would always be asking them yes/no questions, or just filling the silence with random conversations. I would verbalize every task I did, so that they were always in the loop with what was happening in their space. Mind-reading may seem impossible, but you’d be surprised at the superpowers you possess.