Communication.

Mr. A comes to the outpatient clinic for routine check-ups. He has a laundry list of ailments and a two-page laundry list of medications and supplements he takes for those ailments. He generally comes to visits alone. A caregiver brings him to and from the clinic. About a year ago he added a wheelchair to his routine following an eighth fall and an eighth trip to the emergency room in so many weeks. He is very lucky none of those falls resulted in catastrophic injuries.

“A cat,” he once told me. “I am a cat and I have used my eight lives. Now I will need a wheelchair to preserve the ninth.”

One of his ailments has affected his ability to speak. He can speak but it is garbled and mixed and it takes time for him to form the words and get them out into the world. Sometimes the words are like alphabet soup and he puts them back in the bowl and rearranges them. Then he tries again. Sometimes I write the words down to clarify. He nods yes or no for answers. We work our way through each visit. It takes time. It takes patience. I do not mind.

One day he came with his caregiver. And his wife.

In all the years I have been seeing Mr. A in the clinic I had not previously met his wife. We have spoken on the phone numerous times. She manages the two-page laundry list of medications. She makes sure he takes those medications on time. She makes sure he does not get bed sores and checks his skin. She schedules appointments for all his specialists and makes sure he does not miss one. She manages his healthcare with precision. She has been lovely to talk with on the phone. She knows exactly what is happening at all times. Mr. A has remained healthier, more viable, with far fewer complications, than many others would be in his position and I believe a lot of that is due to his wife.

On the day, when they both came into the visit, I introduced myself. We got down to business. There is much to cover in twenty minutes but we usually get through it. I asked Mr. A how he had been feeling after an adjustment we made a month ago. He looked at me and started to speak, one word, then the next, but slowly. Deliberately. His words take time. His wife launched in over the third word and answered the question. Her answer was exactly the information I needed clinically.

I asked Mr. A another question about his appetite to determine if there had been any changes. He started again, word salad this time, then paused to start over. She told me he had not been eating much, some changes in taste, he had lost a few pounds, she was adding a protein supplement every other day. She was clear and accurate.

Mr. A looked down. I felt the first twinges of irritation. Deep breath. Refocus. I looked at Mr. A again and asked about his activity level, had he been able to get out and walk with his walker in the yard? Had he been doing his exercises? He got out one word, “yes.” Then he paused to breathe. And she was off and running again. Telling me about how many steps he was getting, when he napped, how long. I looked at Mr. A. He looked at me. Then I looked at her. She smiled. And so it went with every question I asked and every piece of the day’s conversation.

I felt irritation shift towards frustration towards anger. Let him talk. Let him talk. Let him talk. I wanted to say but did not. I wanted to yell it. I wanted to stand up on my chair and roar it.

Let him talk.

She was giving me all the answers, all the information I needed to make clinical decisions, write orders, and finish the visit efficiently. So much of her life was spent managing his medical ailments and medications. I knew this from talking with him in previous visits and her on the phone. She is his nurse and his caregiver and his wife and his manager all in one. She never has a day off. She has kept him healthy and minimized complications for so many chronic illnesses and done it extremely well.

And here I was wanting to yell at her. Yet I could not. I could not figure out how to tell her it was alright (and good) to let him talk without causing offense or hurt or dishonoring what she has done for him. Let him answer these questions in his own halting, messy, start-over-again-and-again way. Let him muddle through it. Let me muddle through it. That’s what we do.

I know you know all the information. I know you can communicate all of it much more clearly and precisely but sometimes that is not the point. Sometimes the point is to let the mess be the way it is. Embrace the slow and impractical and uncomfortable. Because that is where the connection is. That is where the caring is, for me.

I respect this woman so much for what she has done. I know Mr. A would not be as healthy as he is today without her. In truth, he would most likely not be alive. And for that I am so very grateful for her. But also in truth, there is the other side of the coin. I hope she does not come to the next visit. Because even though it was really efficient and smooth, I missed the mess and the struggle. I missed letting him speak.