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The silent world of speech therapy in hospice

By Maggie Vescovich, SLP

In a world of many different voices and languages, there is yet another world where people live, a world where they’ve lost their ability to communicate as they once did. As a speech therapist, it is a special privilege to be consulted to see individuals on hospice care, to be a part of that person’s life at a time where they, and their loved ones, particularly desire to maintain a sense of closeness, communication, and connection for as long as possible.

It is an honor to sit down and spend significant time with this voiceless person, and enter into their silent world.  It’s a place I’ve been many times before, with other voiceless people just like them.  There’s the 88-year-old grandmother who is in the end stages of dementia.  There’s the 50-year-old father of two, who is on a ventilator due to the progression of ALS.  And there’s the 68-year-old college professor who has cancer of the larynx.  All these individuals have lost their ability to communicate as they use to.  Sometimes, we can find an alternate way to communicate, that may work for a while.  Technology has provided some easy to operate and affordable devices to facilitate communication.  Maybe a picture or a letter board works.  More often than not, however, I sense a strong desire for these patients and their families to restore communication; namely, that person’s lost voice, be “just like it was”.  Anything less than that feels like a failure, and a rejection for all involved.

I’ve often asked my voiceless patients and their loved ones if their desire to restore their voice is always the goal.  Sometimes, the realistic goal is to instead slow down and sharpen our skills of listening, rather than speaking.  After spending most of our lives focused on impressing others with words that reflect how much we know, we have trouble adjusting when words fail us.

In this silent world of evolving neurological events and emotional upheaval that end-of-life care often brings, I’ve chosen to give my patients and their loved ones training in something other than the voice that’s been taken away from them.  I encourage the voiceless to listen, and to take comfort in the non-verbal.  I teach caregivers that the look of compassion, the touch of love, the comfort of another’s presence becomes the language that is magnified for those in this silent world.

Many of us are uncomfortable in the presence of someone who can’t talk.  Is it because this silent world calls us to slow down, to listen in a new way, and to interpret not what we hear but what we see, should we choose to look?  It’s too easy to miss the person behind the silence.  I know this, not only from a professional point of view, but also from personal experience.  My 83-year-old father was on hospice care in 2007, slowly declining from the progressive nature of his metastatic colon cancer.  During his last two weeks of life, he was unable to talk.  I spent a lot of time holding hands, rubbing his legs, and telling him how much he meant to me. Maybe it was my imagination, but I sensed he knew I was there.  The nurses told me that even when one is in a coma, one’s hearing is still intact.  I’d like to think my words to my Dad penetrated his silent world.

I was recently talked to a gentleman whose brother was rendered virtually speechless due to a major stroke.  Home with his wife, any attempts at speech were noticed only during prayer time.  After his “Dear Lord,” the broken words and slurred sounds were unintelligible, except to God.  His story captures the silent world that also includes God’s presence.  My heart is comforted to know that our relationship with God can never be broken, no matter how well we can speak.  That’s because He knows our heart.

Lest you think I’m the only one who enters this silent world, observe nurses who have been working for a while.  It’s always my delight to hear one of them exclaim, “Oh, I don’t have any trouble understanding Mr. Jones.”  I know that Mr. Jones isn’t able to speak. They haven’t been exchanging words.  It’s the heart-to-heart talk they just had.  I can’t wait to go into that room to see Mr. Jones myself, to see what he has to say.  Or rather, what he doesn’t say.

Maggie Vescovich is a Speech Language Pathologist that works for Holy Redeemer HomeCare and Holy Redeemer Hospice. We are blessed to have access to this therapy for our patients that are unable to communicate or are having difficulty communicating or swallowing.

4 Comments Post a comment
  1. that was very informative. we are not there yet with my brother, he still speaks, but the PD causes his to delay his speech and stutter

    October 15, 2012
    • Thank you for telling me about your brother-Parkinson’s Disease does affect one’s speech over time, but I’m so glad you are still able to understand him, even though there is a delay with him saying what he wants to say.

      October 15, 2012
      • terry1954 #

        will my brother’s speech get worse?

        October 15, 2012
  2. In my experience, I’ve found it hard to generalize and predict how quickly or to what extent someone’s speech may be affected with any disease progression. Each person is different, and other co-existing health issues often contribute to one’s ability to communicate the way they use to. In my experience with Parkinson’s Disease, however, the muscles of the throat, tongue and mouth can be affected, causing the delay and the stutter-type speech that you described. These same muscles also facilitate swallowing, and sometimes both changes with one’s ability to swallow, as well as one’s ability to speak, can be observed. To what extent swallowing and speech will be impacted by Parkinson’s Disease will vary from person to person.

    October 15, 2012

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