A Hospice Volunteer Breaks Barriers with Bubbles

by Sherry Rayner, Pathways Hospice Volunteer

The most heart wrenching yet fulfilling cases I’ve had as a Hospice volunteer has been with Pathways KIDS. During this time, I have learned that flexibility is the key and there is always a way to communicate.

My last case was with a Vietnamese family in East San Jose. Their youngest son, Jefferson Vu, was a 4-month-old patient who had a rare genetic disease. My job was to entertain his energetic 3-year-old brother, Truman, so their mother, Tam Vu, could get some much-needed rest and tend to her baby without interruption.

My initial contact by telephone was with the father, Ho Vu, who spoke English fluently. I knew he would be away when I visited each week. My concern was how I would communicate with the patient’s mother and brother, as I knew their English was limited.

As my first visit approached, I felt both anxious and excited. I carried a huge canvas tote bag filled with lots of toys, books and videos. Upon knocking on the front door of their condo, I was greeted by a sweet, smiling young woman and her active and excited 3-year-old son, Truman. Leaving my shoes at the door with families, I was graciously welcomed in.

I was then introduced to their precious baby boy, Jefferson. He was lying very still on a pink satin pillowcase in the middle of their big bed. In direct contrast to the rambunctious Truman, Jefferson was very still, tiny and fragile. He sounded like a wounded baby kitten when he cried. When he opened his eyes you saw big brown eyes looking back at you. His face would light up with the most radiant smile when spoken to softly.

Meanwhile, Truman anxiously eyed my canvas bag to see what I’d brought. Not being able to contain his curiosity any longer, we opened the bag. Out came a small nerf ball and a suction – cupped basketball hoop to put on their closet door. Truman was soon animation in action as he jumped and leaped trying to make a basket. When he made a basket, his Mom and I would clap with joy. During this time, Jefferson, the baby, slept soundly. There were two completely different worlds going on in one small bedroom.

Each week Truman would discover a new item in the canvas bag. Soon, he was helping me carry the bag up the stairs. The biggest hit of all was the “Bubble Machine.” Truman and I would go outside to the porch and play with a battery-operated bubble machine. At the flick of a switch, hundreds of tiny iridescent bubbles filled the air. Soon an excited little boy, ran, jumped, and squealed with joy. The smile on his face was only outdone by the sound of his giggles. He’d race around trying to catch every bubble, breaking it or holding it, letting them crash into him with glee. Needless to say he was hooked on the bubble machine and caught me by surprise when in English he’d ask for bubbles every visit.

One particular week, we were lying looking through his English/Vietnamese Kids Picture Dictionary when he focused on the medical page. He quickly pulled up his pant leg and showed me his scratch. I then showed him a scar I had on my leg. Much to my surprise he leaned over and kissed my “boo boo.” Tears welled up in my eyes as I held him and said, “Thank you, it’s all better now.” I was no longer worried about how we would communicate.

We played together for six months and in January 2007 Jefferson peacefully passed on, at home, in his mother’s loving arms with his brother and Daddy close by. What a cherished journey, never to be forgotten. I’ve learned there are always ways to reach out, but never imagined a bubble machine would be one of them.

About Sherry Rayner

Sherry Rayner has volunteered with Pathways Hospice for over 20 years. With her art teacher education and professional graphic design experience, Sherry is known for the creativity that she brings to her volunteer work. She began volunteering with Pathways after raising a family, care giving for several family members and volunteering with several other organizations. Known for brightening the days of patients of all ages, Sherry has recently specialized in the unique concerns of Pathways KIDS and their families.

Communicating with Residents

Be Heard Better

They are just little things, but they make a difference in reducing frustration for you and your residents.  We’re talking about techniques you can use every day to make communication smoother and more satisfying.

First let’s look at body position.  Standing over a resident who is sitting or in bed may feel threatening, especially if you are very close.  Research has shown that patients thought that their doctors stayed longer at the bedside than they actually did when the doctor sat down.  So try sitting down to appear less hurried. 

When people have hearing problems, as many older adults do, it is important to face the person directly and have your face at their eye level.  The shapes our lips make when speaking and expressions give residents a lot of clues to what we are saying.  It should go without saying that we should make sure hearing aides are in place, are turned on, and have fresh batteries.

Next we should speak slowly and clearly, enunciating our words precisely—slow down.  Older ears need more time to decipher what you are saying.  If you also have an accent, slowing down your speech will help older, hard-of-hearing adults understand you better.  It also helps to use gestures to supplement what you are saying.  For example, if you want the resident to sit in a chair, pat the chair or sit down to demonstrate what you would like.

By paying attention to the little details in our communications with the elderly, we can make the interchange more satisfactory for them and us!

This article was originally published in Pathways & Partners Newsletter - Issue 24.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

What You Say Without Speaking

It’s estimated that up to 93% of all communication exchanges are nonverbal.  That means facial expressions, gestures and the way we stand all say something—of which we are often unaware.

For nearly 20 years medical schools have been required to teach communication skills, mainly due to research that links physician-patient communication with patient satisfaction and health care outcomes.  They offer everything from courses on lectures, video recording and self-assessments.

But, writes New York Times columnist Pauline Chen, few schools offer courses on facial expressions and body language, “despite a growing body of research suggesting that nonverbal communication may be as important as verbal communication. Important nonverbal cues in physician-patient interactions can include subtle body gestures, body positions, eye contact, facial expressions, and touch.”

One of the most powerful tools we have is eye contact, and how much we are willing to give to patients.  It tells patients they are being listened to (a great satisfier in patient interactions).  Do you nod to let them know they have your full attention, or does it look like you are a million miles away while they tell their story?

A recent study in the Journal of General Internal Medicine (JGIM) found that black physicians used positive nonverbal cues better than white physicians, although they sometimes gave contradictory nonverbal signals.  A 1994 study had shown that women physicians tend to give male patients conflicting nonverbal cues, like smiling while speaking in an anxious tone of voice.

Experts suggest physicians note their body language: Do you cross your arms, look away or make notes while the patient is speaking?  Or do you look engaged, touch the patient’s hand, and appear unrushed? Experts say nothing is more powerful than imagining yourself in the patient’s place to put things in perspective.  

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 23.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.