We All Need to Know How to Sit and Talk Through a Time for Which There are No Words

Because that time is coming

Photo by Kelly Sikkema on Unsplash

How do I know this? Because our mortality is 100%.

If you are not the one dying, you will witness it. A close relative, friend, partner, or someone you don’t really care about but you will be caught in the middle. As sure as rain, that time is coming.

When I first joined medical school, the first day at the gross anatomy lab was worth remembering. Several students fainted. They couldn’t imagine they would be standing next to a cadaver to learn about the human body.

Others opted not to eat meat until their stomach could contain it.

A good number quit the course.

A dead body is already dead. Reports of accidents are a distant event and often, if it doesn’t have anything to do with us, it hardly matters. But when the hammer strikes home, words can fail you.

While picking a conversation with one of the senior-most physicians in the country, he told me about one of the leading psychiatrists in the country when he was still a youngster.

Whenever a patient was diagnosed with a chronic disease, he would saunter to the bedside, and bluntly lay the fact:

You know what X is, yes? You know what it would do to you, yes? You’re going to die. Plain and simple.

Before he could give the patient a chance to talk, he would be on his way. I wondered what kind of psychiatry he practiced.

Words are medicine that don’t find their way into the prescription pad. We all need to know how to sit and talk through a time for which there are no words.

When ‘I Love You’ does not suffice

On the mornings when I walked into the department, the ICU unit, she would be seated outside.

Unafaa kuongezwa mshahara

She would joke. She found it difficult to begin her day without knowing how her father was faring.

He was intubated, getting ventilator support. Her blood pressure was high, but her father’s was struggling. So his vessels too needed constant support through an infusion. We were rapidly progressing to maximum doses.

He also needed regular dialysis sessions, so his renal system was also shutting down.

Most of his children were outside the country. When they heard that their father was on the brink of death, they canceled everything and booked the closest flight they could to get home.

At one point he had self-extubated. That means the pipe connecting him to the ventilator machine to support his breathing had come out of the windpipe. We tried to evaluate if he could comfortably breathe for himself but the exertion was extreme. He had to be re-intubated.

While he struggled, he asked for his son. The daughters knew it whenever he squeezed their hands at the mention of his name. He wanted his son.

The family told us everyone would be flying in that week, including the son, due to arrive on Sunday. The team on the ground took it upon themselves to try as they could to preserve the fighter’s life for as long as they could.

Everyday, the wife would visit him. She would hold his hand and he would squeeze it. That was all she needed. After a few minutes, she would leave.

A gentle palm squeeze carried much more meaning than words of affection.

‘I love you’ couldn’t suffice.

The family was one of the most cooperative you could ever meet. They understood the high-octane environment of the department and never wanted to feel like a bother during emergencies.

In essence, what was going on was a distribution of the pain.

Taking away the pain

In the ICU, we don’t treat patients — we treat families.

A patient may need as much urgent support as possible, but the patient might not know their life hangs on the line.

The family does.

Burdened by worry, they will never stop asking the classical questions.

How is he doing? Will she make it? Based on your experience, how long do you estimate he will stay in this unit? How many similar cases have you encountered that pulled through?

These questions lack a definite answer. They are, however, asked from a point of pain.

Attempting to answer these questions, the team tries to ease the worry and reduce the pain.

The word ‘ICU’ or ‘HDU’ is heavily packed. If a family member announces in their group that one of them is in the ICU or the HDU, everyone thinks the worst is yet to come, even if the patient is only there for observation.

I once read somewhere that the body does not know how to process the absence of information. Confusion means there are some ideas you’re considering. Frustration means there are bad outcomes you’re trying to sidestep. But pain can be the processing of the absence of information.

That could be the state these families are in when one of them is admitted into our unit.

They often need moments to have their pain taken away.

Recently, while sitting down with one of the cardiothoracic surgeons, I discovered that my level of communication will always need iterative improvements. He had mastered the art. I still have much to learn.

He reassured the family. However, a talk only reduces the pain, it doesn’t eradicate it.

The family also tries as much as they can to take away the pain from their loved ones by visiting regularly. They will touch them, talk to them, sing to them, and remind them of past shared experiences all in an effort to relieve their patient of pain.

And when they are close to dying, all a family wishes is, if not to postpone death, then to relieve their loved one of the pain.

While we wait for their time to come, ours too nears by the day. If you’re not busy getting born, then you’re busy dying.

The only group of busy fellas busy being born are the foetuses, even though they too are busy dying, but you get the point.

Standing can be difficult. Sitting helps. Sitting with your thoughts can be burdensome, but we all have to do it. Nas echoes this sentiment:

I had to sit with my thoughts

And when the time comes, we all need to know how to sit and talk through a time for which there are no words.

What I’m trying to say is…

When your time comes, you would want next to you someone who is not uncomfortable with silence.

Someone whose presence is enough.

But should they talk, they need to weigh their words carefully. As demanding as this may be, frustration can make us pick words unfiltered and unmeasured. Not everyone is comfortable with silence.

Tears might be shed. Tears can be enough. Tears show that you care.

But best believe, the time is coming.

For each of us.

It is best for us to brace ourselves for that moment.

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This song inspired some of the lines used in this article. Source — YouTube