The Listener

Listen: I am a speech pathologist. Hardly anyone knows what I do.

For some of my patients, our sessions are an afternoon at the beauty salon; they gossip about a patient down the hall while I try to redirect them to a higher-level cognitive task – organizing medications, scheduling appointments, tallying finances. Even patients who struggle with speech and language deficits always have something to express, even if it’s just anger at their limited language. When I was a student, my first patient once threw a pen at the wall; we watched it fall to the floor, both at a loss for words.

I have always been impressed – haunted – by the eloquence of patients, even in the most dire circumstances. A patient with an inoperable brain tumor, frustrated by her gradual loss of awareness of the right side of her body, asks me if I’ve read Flowers for Algernon. “It’s like that,” she says, “that guy who starts to forget everything he knew. Unlearning.” I nod, helpless. Sometimes I think this is all I do: watch, listen, nod. And when, days later, she beats her fists against her hospital bed and sobs, “This can’t be how it ends,” I sit and nod again. My listening changes nothing, and yet I don’t know what else to do.

Sometimes patients thank me, in a way, for listening. One patient tells me that when she lived in Los Angeles she worked as a housekeeper for Michael Jackson. “Sometimes Michael and I would just talk for hours; he was the sweetest man. You remind me of him,” she says.

I blink. “I remind you of… Michael Jackson?”

 “Yes,” the patient says. “He was a good listener.”

Today, my schedule directs me to evaluate a patient who is status-post brain surgery. The chart says that he is a young patient – mid-thirties – and that the prognosis is poor: it was a high-grade tumor that could not be fully excised. When I arrive to his hospital room, he is sitting by the window with a tray table in front of him, watching the snow fall outside. I introduce myself, inform him I’m there to do a reading and language assessment. He nods.

The first task is to match words to pictures. A wagging dalmatian fills the page. The patient’s eyes shift between four choices: DOOR   DOG                    KEY                       CAT

Several seconds elapse. The patient shakes his head, unsure.

“We can move to the next one,” I say. It is a standardized assessment; a patient must hit a ceiling, or fail multiple times, in order to end the section. The next picture is a pair of glasses. This time, after a few seconds, the patient winces. He points to his chest. “Me – me –” He gropes for the words. “Smart.” He gestures to himself, then down to the page. “Read,” he says, nodding.

“I know,” I say. “I know you can read –”

He gestures at me: Listen. “Me,” he says, pointing to his chest again. “J – D. Just – finish.”

“You just finished your law degree?”

He nods vigorously.

“Congratulations,” I say. “That’s a huge accomplishment.”

He starts to cry.

“We can be done with this for today,” I say, closing the assessment booklet. He rattles the tray table, just once, with his fists. Then we both sit in silence for a minute, watching the snow, thinking of things we don’t know how to say.

At lunch, in the bathroom, I catch my own eye in my reflection. I have been thinking of applying to medical school. I will be in my mid-thirties when I’m finished.

There is a part of my brain that is always thinking, always wondering, about what more I could have said. What more I could have done. But then it’s time to square my shoulders, smile, introduce myself to the next patient.

I am a speech pathologist. I listen, even when there are no words.