“Do you speak Greek?

 –No I don’t. What are you looking for?

–I wanted to see Mrs. D., but I don’t understand what she says. It is all in Greek.

–Mrs. D.? She speaks very good English. Let me introduce you.”

We turn towards Mrs. D. who is seated at a big table. While walking around Mrs. D.’s back, the visiting nurse asks:

“Do you have any pain?”

Mrs D. does not react.

Annoyed, I stop the nurse:

“Let’s get ready for communication. You are going to sit down and establish eye contact.”

I grab a chair for the nurse and invite her to sit down. Bending over the table, to enter the field of vision of Mrs. D., I say:

” Mrs D. I would like to introduce you to a friend.”

Mrs D. smiles:” Yes, sure.

–Can I move your chair?

–Yes, go ahead.”

When the two are facing each other I make the introductions:

“Mrs D. this is my friend. She needs your help. She does not know about here. Can you help her?”

Mrs D. was the manager of four franchise restaurants. She likes to be consulted and take charge. The nurse smiles and asks again:

“Do you have pain? Do you sleep well?”

Mrs D. answers in English. Some of the answers are quite creative and go on and on. I am not sure what the nurse is testing. Finally she grabs the stethoscope hanging from her neck:

“Can I listen to your heart?

–Yes you can.”

I had spent the previous evening with an occupational therapy student. Her internship is based in a nearby hospital. She is developing a protocol for interactions between OT, PT and ST providers and disoriented older adults admitted for acute care. I was happy to share my experience and techniques with her. Sadly I witness daily the negative results of this missing piece in health care education. If communication in a residential setting, where elders’ history and preferences are known, is already challenging, how bad can it be in acute circumstances when no one is familiar with the patient?