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Rushil Patel, MS2

“Hi there,” said the resident who gently tried to wake the woman.

In the bed before me lay an elderly woman who looked even smaller in her hospital gown. She matched the familiar image of the sweet old lady–someone’s grandmother perhaps.

The resident introduced herself and allowed me to introduce myself before asking the basic questions that constitute the history of present illness: how she ended up here, how she had been doing at the previous facility, etc.

“Sorry, what was that again?”

Speaking up helped her answer the questions, but I couldn’t help but feel as though we were talking down to the feeble woman.

My turn: I had to assess her cognitive function using the Mini-MOCA (MOntreal Cognitive Assessment). I felt uneasy, as though I had to subject someone to cruel and unusual punishment as I stood there nervously with the clipboard in my hand.

“Alright, we’re just going to ask you a few questions to see how you are thinking, okay?”

She stared back at me, “Alright.”

And so I began with the questions:

“Can you draw for me a clock that reads ten past eleven?”

She tried quite diligently to draw the circle and numbers but could not draw the hands.

“How’d I do?”

“Not bad,” I tried to say genuinely, “Now, can you please name the animals drawn on this page for me?”

“Um, let’s see here… a lion… a rhino… and a camel.”

“Great work!”

“Are there more?”

We finished altogether all eleven items, but as soon as I stepped back from the bed, she uttered a few words that froze me.

“I didn’t do so well did I?”

Noting my silence, the resident added, “Well, it was a tough exam. Don’t feel bad about it because a lot of folks struggle with it. You did fine.”

The woman smiled as we left the room, but deep down, I had to wonder if she had managed to piece together the truth from my body language – her lifetime of wisdom over mine. Aside from what she disclosed in the room, the only other piece of information I had was why she was here:

Patient is a 90-year old woman who came in from an assisted living facility after she stuck her head out of the window and expressed an active desire to kill herself.

I walked into that room knowing to use a MOCA out of concern for her cognitive function, but the woman had enough understanding of my body language to read the assessment herself. Her insight rendered my knowledge lame.

The awkwardness that first comes with talking to patients takes time to overcome, especially as we develop our knowledge, and I realize now that I must also develop the ability to tap into the non-verbal exchange. These hidden cues guide the immobile information stored within the recesses of my mind and aid in providing closure to the patient’s concern.