The Art of Communication

photo-for-art-of-communicationWalking home from work one day, a man riding a bicycle locked eyes with me.  He wore a hard hat and had concrete dust caked on his smock.  I didn’t know him, but he stared at me, swiveling his head to keep eye contact as he rode by until, distracted, he sideswiped garbage cans, teetered, and fell.

Long stares were common in the village in southwest China where I lived. This was the first time it caused an accident, but it wasn’t the last.  

In this rural mountain outpost near Burma and the Mekong River, many people had never met a foreigner. They were not bashful about their surprise, pointing and giggling at me.

Slowly, I became accustomed to the attention my physical presence brought, being over six feet tall with blue eyes, but the conversations kept me guessing.

In the slow-paced countryside life, long nights were spent talking, roasting meats, and drinking beers.  The conversations were in Mandarin, of which my knowledge was limited. I would invariably be asked the following:

  1. What country are you from?
  2. What is your salary?
  3. How tall are you?
  4. Can you use chopsticks?

After stereotyped exchanges, the conversation would break into new, unpredictable territory.  My vocabulary was limited to that of my seven-year-old tutor.

Speaking slowly, using plain words, we covered the details of our lives.  Sometimes sparse exchanges lent a poetic quality.  I did not have the vocabulary to hedge with qualifiers.  My neighbors understood my language limitations and simplified their language.  We did not have the luxury of being able to ask or answer questions obliquely.  We became simple and direct, with sparks of childlike wisdom.

For example, after sketching out my family my neighbor said, “Your parents have good jobs and comfortable lives.”  

“Their lives are not comfortable.  My mother is sick,” I responded.  I checked my dictionary and said, “Parkinson’s disease.”

“Your mom is sick—being far away is worrying,” he said after pause, looking up, puffing his cheeks in sympathy.  

Plain language allowed my neighbors and myself and to bridge the divide —of culture, of experience, of situation— and to inch closer.  We were raised a world apart but our simple communication permitted us to grow together.  

Years later as a medical student starting my rotation on the inpatient psychiatry unit, the distance between patients and providers felt as wide as with my neighbors in China.  How can I understand the trauma of an old man in snap-on pajamas with the drawstrings removed for his safety?  Or of a young woman whose only certainty in life is that she’ll kill herself?  

The answer, to the extent that there is an answer, is in simple language.  The bridge between patient and provider can be so tenuous that a simple, sturdy foundation is best suited to weather the gusts and gales of the therapeutic relationship.  

As a medical student, it initially feels deeply uncomfortable, even violating, to ask certain questions, like are you thinking of killing yourself?  How would you do it? 

Mr. F was the first patient I admitted.  A middle-aged Navy veteran, he began using heroin after his son was struck dead by a train.  Soon, he went to prison, then methadone maintenance treatment, and finally, to the hospital seeking detox.

He was slight, with a quick smile and a big problem:  over 20 drinks a day, a history of complicated withdrawal with seizures, and a wound from punching his hand through a car window while drunk.  

He said that he liked drinking and was not interested in rehab, meetings, or meds.  He stopped short of saying that he wanted to detox and then go back to drinking.  

I began to feel defeated.  I realized that lending insight is probably the most technically difficult skill in medicine—by comparison, a craniotomy suddenly seemed controlled and tidy.  I floundered.  How was I going to tell this patient that alcohol was dictating his life?  

My resident jumped in. “It seems like alcohol is controlling your life,” she said.  

“Well,” he said looking from his feet to his hands and to us, “I guess it is.”  

This insight was an anchor for more reflection throughout his admission:

“When you are drinking, are you the father you want to be?”

“How will you stay sober after this detox?”

Initially, these questions seemed blunt, even crass, but I began to appreciate that the goal was to hold a plain mirror up to Mr. F so he could see himself clearly. Our mirror was made of simple questions free from the distortion of qualifiers, clauses, or medical-speak.

In both China and the psychiatric inpatient unit, the stories of people’s lives added new depth to my understanding of the human experience, and in both settings, simple language was a key to bridging gaps of culture and experience.

Originally from Canton, Ohio, Christopher Magoon moved to China after graduating with a degree in History to work for a rural education nonprofit.  He plans to return for a year after completing medical school to continue school-based public health research.  

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