Her daughter, Sylvia, was dying from metastatic cancer. There were no words for her anguish. The fact that she did not speak English was secondary. Each time I went into the room she glared at me. I thought of her as someone from the old country and not just because she fit the picture of an old world widow—she wore a loose fitting black dress over a sturdy frame—but because she had a severity that was palpable whenever I was near her. I suspected she had seen much in her life. Her distrust of western medicine was obvious; she did not believe her daughter was as ill as she was, nor did she embrace the notion that we knew what we were doing. Each day she occupied the same bedside chair, sitting like a guard in a gated community, gruff and dubious of all who entered. I believed I could soften her with subtle overtures—a warm smile, touching Sylvia on the arm, being extra sweet to her grandson when he visited. But I always got the same cool response and no eye contact. I told myself not to take it personally and part of me didn’t, but another part of me felt it was very personal as she scrutinized everything I did. I was doing a good job caring for Sylvia and I wanted her mother to see it. I wanted her to trust me.

When I think about Sylvia, there are many things I remember: the room she was in, the lightness in her voice, the relentless progression of her disease. Even with a memory of those small details, I realize I never found out what her mother’s name was. Not that I have forgotten her name; somehow in the course of my care of Sylvia, perhaps because of how formidable her mother was, I never stopped for the common courtesy of asking her name. After awhile it was too awkward to ask, so I ended up never asking.

Her silence challenged me. I wanted some acknowledgement like a nod or a smile, but I failed to make any progress. When I entered the room, she never looked up. One day Sylvia asked me, “Do you have children?” I am cautious about discussing my personal life with patients, feeling it can border on unprofessional. And, I have barriers of my own. But Sylvia’s question was direct and innocent at the same time. I answered, “I have three boys.” She smiled at me, and I was encouraged by her openness. “I call them my boys but they are all grown up. They are men really.” The words were out of my mouth before I took the time to gauge their impact. I bit my tongue. Sylvia was not going to see her son become a man. But she didn’t focus on that, instead she asked how old they were and what they were doing. She responded, “Oh, how wonderful,” when I told her. I felt guilty for reminding her that she wasn’t going to see her son grow up.

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My communication challenge with Sylvia was more than my hope that she would forget how thoughtless I was when I spoke about my children; it was also about my failure to connect with her mother. Interestingly those two barriers were connected. The comments I made about my own family had the opposite effect from what I feared. The next time I entered the room Sylvia and her mother both looked up and smiled. Sylvia’s smile was ear to ear while her mother’s was a slight curl of her lips and a flash of eye contact. But it was something. It was more than anything so far.


What strategies do you employ to connect with patients and their families when language is a barrier?

How do you develop a therapeutic relationship with patients or families who are suspicious of your care?

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