How to Stop Talking

I have a vivid memory of being in class in fourth or fifth grade. The teacher kicked me out of class for talking. This was a common experience for me, I was always getting kicked out of class. I remember thinking that this was some gross injustice. I didn’t feel that I deserved to always be in trouble, always in the hallway, always in the principal’s office. But somehow, that’s where I was.

I asked the teacher why she kicked me out if everyone in the classroom was talking.

“You were talking the loudest”.

There it was, irrefutable.

She didn’t realize that she was dealing with a budding professional talker.

I am a professional talker. I talk for a living. All day long, I talk. I give short speeches and long speeches. Both formal and informal. Sometimes I talk to large crowds and sometimes to one or two people. As I spend hours in my car every day, sometimes I even talk to myself. When I want to relax I listen to podcasts and audio books-more talking. Some of my favorite podcasts are topics in nursing, writing, and beginner Spanish. More talking and how to talk. My favorites.

Over the years as a homecare nurse I have developed some pretty standard stock speeches. I have the diabetes speech (sugar is sugar, even natural sugar is sugar, carbohydrates are sugar), the hypertension speech (anything in a can is bad, salt free food tastes terrible, low salt options, TV dinners are death), the constipation speech (more water, no rice, Colace is your friend), the why-you-shouldn’t-be afraid-to-take-pain-medications speech (no you won’t become addicted, taking less isn’t better, seeing how long you can go without it is bad), the how-to-eat-less speech (I never give this speech, that may make me a bad nurse but the patient has heard it all before), the how-to-eat-more speech (high quality foods, water will fill your stomach, drink after meals, eating less makes you less hungry which causes you eat less which causes you to be less hungry…) the stop smoking speech (I recommend one less cigarette per week or per month, whichever is most realistic, I preach any change is better than nothing, I wonder if anyone listens), the you’re-the-patient-so-you’re-the-boss speech (you have the right to question and refuse treatments and medications at any time) the I-know-you-worked-your-whole-life-and-now-medicare-doesn’t-cover-all-of-your-medical-costs (all I can be is empathetic to this one), the healthcare-system-isn’t-what-it-used-to-be (the doctors don’t give you enough time, mistakes are made, illnesses are overlooked or misdiagnosed).

I don’t do anything during my visits without asking permission or explaining what I am going to do.

“Would it be ok if I put my bag here?”

“Where would be the best place for me to sit?”

I always explain the services we will be providing, when the approximate date of discharge will be and possible inevitabilities of their disease can we anticipate and prepare for. I ask what they know about their diagnoses and medications. I always offer to answer any questions. I was taught to ask, “Is there anything else I can do for you?” And I always explain that they should contact us with questions or concerns.

That is another speech I give. The please-let-us-know-if-you-have-any-complaints-or-questions-of-any-kind-we-truly-prefer-to-address-them-immediately-instead-of-having-you-hold-it-in-for-weeks-or-months. I tell people that they are not a bother, not getting anyone fired, not complaining, not rocking the boat, not messing with a good thing.

I wonder about people who worry about speaking up. These people are like mysterious creatures to me. There is not one leaf in my entire family tree who is quiet, shy or timid. I come from a long line of outspoken men and women. The women are particularly notable. The women in my blood line run from strong willed to overly opinionated to downright pushy. My husband and I are personally responsible for creating several more of these specimens. Of course my husband’s maternal and paternal grandmothers where no different, both of whom clearly live on through my extremely strong willed children.

Of course for some patients and their families complaining is not an issue, all they do is complain. I actually like “those” people. They’re a challenge. I like that. I enjoy finding the real complaint, the real root of the problem. It’s often surprisingly easy to fix.

This is when I stop talking.

Sometimes just apologizing and promising to work on the problem solves the problem. Even if there is no solution, just listening and identifying the bottom line, can be the solution.

When I first started to work in hospice nursing my instructor told me I had to stop talking, stop giving speeches. I had to just listen. This was a life changing moment for me. Because I was doing so much talking I was missing out on the opportunity to listen. It’s hard, and I catch myself about to start one of my speeches and I stop. I ask the patient what she thinks would be the right thing to eat/correct medication to take/best way to solve the problem at hand. I put the responsibility on them.

It’s easier for me to just talk and talk. And it’s easier for them to just let me talk and talk. The hardest thing for me, as a nurse, is to do nothing. Listening can feel like I’m doing nothing. I know this is not the case. But when I’m talking I feel like I am really “doing” something. When I am listening appropriately I am also “doing” something. That’s why it’s called active listening. Listening is an interaction, therefore it is not a passive act.

My silence is a signal that the patient recognizes. The patient understands that she has to be accountable. This is not a one way street. This is a collaboration that will fail without the patient playing her full role.

Lessons I’ve learned

  1. There is a time, a place and a limit for talking/preaching/lecturing patients.
  2. Listening is a valuable tool that is underutilized, especially by me.
  3. Talking is “doing” but listening is “doing” more.

What not to say

I’m never going to say it again.

Ever.

I thought I was being a good nurse by reassuring my patient. I never once considered that I was making a terrible mistake. My patients trust me to be an expert, a professional and generally infallible. But in this moment, I violated that trust.

I had an excellent relationship with my patient and her daughter. Let’s call the patient Mary and the daughter Ann (not their real names). I visited them in their home after Mary was discharged from the hospital after a serious health problem. Mary was significantly weaker then she was previous to the stroke and was having trouble adjusting. Ann had her own physical and emotional problems and was adjusting to having her mother live with her and the constant help she needed. They were both worried and scared that they were not going to be able to manage.

I spent a lot of time with Mary and Ann during my first visit and I did what I do best. I reassured, smiled, chit chatted, educated and made sure that the visit was not only clinical but truly a positive experience for the patient and the family.

I feel that my job is to gain the trust of the patient and provide them with a comforting moment. One that would change their life a little bit and possibly even prevent an immediate re-hospitalization, which so often occurs. I hope to help the patient make some small change in their health which will hopefully take them in a new direction. I do firmly believe that I am making a difference in their lives. This is the belief that makes me happy and excited every day to do my job.

“There is something wrong with my mother”.

I went to see this patient for a follow up visit and Ann met me at the door and told me this. I was not worried, because the daughter definitely seemed like an over reactor. I went to look at Mary and she seemed weaker. I asked her several questions and she told me that she had a low grade fever and general achiness.

Of course Mary was “between” doctors…she couldn’t get to her regular doctor because she couldn’t leave the house safely. They had called a doctor that makes home visits but were told they need a referral. I called the visiting doctor’s office and they were closed for lunch. I called one of the doctors on her cell phone and she said she would take care of the referral. I explained the symptoms to her and she said she would not be able to see the patient until she was in the system, hopefully tomorrow. I called my office and spoke to manager and she said she would also call the visiting doctor’s office.

Ugh. I hate this part of the job. I hate feeling helpless, like the system is working against me.

I sat down with the patient and I put my hand on her shoulder and tried to calm her down. She was afraid she was dying.  I told her that her symptoms are significant, but were not going to kill her. I told her she may have an infection, that she is sick, but “regular people sick”. I actually said that. I was trying to convince her that yes, she felt like crap, but no, she wasn’t going to die. I held her hand and smiled.

“You’re going to be ok”, I said.

We chatted a little bit more, talked about her family, talked about my family, then I left.

When our physical therapist went to see her the next morning, she was unresponsive and EMS was called. She was diagnosed with a serious infection, treated and discharged several days later, weak and scared from the experience. My manager told me that Mary was requesting that I not return to the case. Ann said I was so busy showing them pictures of my new baby and I should have done a better job of taking care of the patient.

At first I was hurt, but then I just felt bad. I felt terrible even though there was nothing more I could have done. I couldn’t send the patient to the hospital for increased weakness and a low grade fever.

But there was something I could have said. There was something I SHOULD have said.

“I don’t know what’s wrong”.

It seems so small.  I thought I was doing the right thing, I was sure I was being a good nurse. But I was so wrong. I took it really hard. Not because I never make mistakes, but because I truly felt that I had failed my patient. My only consolation was that I knew would take this experience and try and learn from it.

Lessons I learned:

  1. I need to stop talking about myself and my family. The patient wants to focus on themselves.
  2. When a family member says there is something wrong, I need to listen.
  3. I will never again tell a patient “you’re going to be ok”. It discounts their feelings and it’s disrespectful of their situation.