Abstract
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Throughout my training in primary care and now palliative medicine, I have also discovered the importance of another form of nonverbal communication, The Palliative Sigh©. Although not taught specifically in any communication workshop, nor honed with the use of standardized patients, the Palliative Sigh is a powerful communication tool that allows the most talkative and chatty providers to say so much while still being able to take advantage of the power of silence. As a physician who enjoys talking, I have a burning desire to verbally respond to my patients and their loved ones' concerns and statements. Silence is not something that comes easily to me. The Palliative Sigh bridges that gap. One of my worries in using overt silence is that patients and their loved ones may feel as if I am ignoring them. The Palliative Sigh is versatile—it can affirm, show compassion, give reassurance, but it can say so much more. In fact, The Palliative Sigh can often say much more than we can put into words. Throughout my fellowship, I have used The Palliative Sigh in many different scenarios; here are some of my most memorable:
The long deep sigh given with a forced frown to hide your chuckle when your patient's old blind dog runs into a closed sliding glass door to chase a bird outside that says, “bless that poor, sweet puppy.” The quiet groaning sigh made when during a home visit, a patient's wife blames her husband's terminal cancer on his infidelity 30 years ago that says, “I am more than happy to help, but please don't rope me into this right now.” The higher pitched inquisitive sigh made with a turning of the head sideways as a patient describes his or her life's passion for something that is a small niche of a subculture you never knew existed that says, “that is so weird, but I'm dying for you to tell me more.” The silent sigh you make to yourself when the family at high risk for a grief reaction asks whether their father has died when there is a children's choir visiting your inpatient unit that says, “I want to be honest, but I really want to wait until the children's choir leaves to tell you.” The deep repeating frowning sigh made at bereavement groups, as members there try to win The Mythical Grief Championship by trying to justify that they deserve to have more grief than the other members that says, “I am so sorry, but grief is not a competition.”
These examples show that The Palliative Sigh can be useful when words you may want to say would be neither appropriate nor helpful. However, The Palliative Sigh is best used when faced with situations when the graceful poetic words required escape you. A few of my favorite examples are as follows:
The high pitched sigh, with an associated ear-to-ear smile when the spouse of an actively dying patient tells you how his or her dying spouse made him or her on his or her first date 67 years ago that says, “teach me your secrets, I want this kind of love with my spouse.” The deep sigh with the permanent frown when the young couple inform you of their loving decision to withdraw life support on their dying son, so they can bring him home that says, “there are no words in our language to express your hurt and love.” The loud high-pitched sigh when a patient beams and says that due to good symptom control he or she were able to play with his or her grandchildren for the first time since before diagnosis that says, “I am so happy for you.” The slow soft sigh right before you tell one of your favorite patient's families that their loved one has died that says, “Your loved one was so special to all of you wonderful people, I am so heartbroken for you.” The reflective exhausted loud sigh, often with tears, you make when you have time alone, either in your office or with a recently deceased patient that says, “I know and love that I am doing great things to help people, but these losses really hurt.”
The next time you are communicating with a patient or family member, keep note of all the times that you use The Palliative Sigh. Always remember that even if you cannot think of the right thing to say, The Palliative Sigh, along with some silence, can say it for you.