I GENERALLY PREFER visiting hospice patients in their homes rather than in long-term-care or assisted-living facilities. But one morning, by the luck of the draw, my flex-pool assignment was to see patients in several long-term-care facilities. So off I went.
My morning rounds were uneventful. After lunch, I approached the nursing station at the third facility of the day and asked about my patient. The charge nurse replied that I must not have seen Sam before. Responding to my puzzled look, she told me that Sam was known in the facility as "Silent Sam," because he hadn't spoken a single word for more than 2 years. He was considered almost catatonic, spending every day sitting quietly by the side of his bed. He didn't resist personal care, and took food and fluids with assistance, but he never spoke to anyone about anything at any time.
A quick review of his medical record revealed that Sam had a stroke four years ago, leaving him partially paralyzed on his left side. Sam's wife of 41 years had died the year before he was admitted to the facility. He had one son who lived in Chicago. The son had power of attorney and paid for his father's care, but never came to visit. Over the years Sam had a few visitors, but they stopped coming when he didn't acknowledge their presence at his bedside.
It occurred to me that because I shared his first name and had lived in Chicago, I might be able to make contact with Sam.
Getting the silent treatment
When I entered Sam's room, I saw a rather thin man sitting on the side of the bed staring at the wall. He made no eye contact with me and didn't respond in any way to the news that we had the same first name and were both from the Windy City.
He allowed me to obtain his vital signs and he sat passively as I auscultated his heart and lung sounds. After my assessment was completed, and I determined that Sam's clinical status was stable, the patient visit was essentially over.
As I was packing up my equipment, I spotted a guitar through the open door of his closet. Although Sam didn't respond to my request for permission, I retrieved it and dusted it off. The steel strings were old and rusted but they were all there. I've been playing guitar for over 50 years, and I couldn't resist taking this old guitar for a ride. I tuned it and broke into a rendition of an old Chuck Berry rock-and-roll number. I did all three verses like I was playing at Carnegie Hall. When I finished, Sam turned his head, looked me in the eyes, and asked, "Do you know 'Red River Valley'?"
An impromptu duet
I caught my breath. Of course I knew the old classic. As I started playing, Sam sang along in a surprisingly clear and strong baritone.
As we finished our song, I heard a burst of applause from the doorway behind me. I looked over my shoulder and saw almost every staff member on the unit, from the charge nurse to housekeeping personnel, clapping and smiling. Sam and I quickly followed with an encore of "Big Rock Candy Mountain," much to the delight of our audience.
After our impromptu performance, each and every member of our audience came into the room and complimented him on his singing, but Sam had returned to his normal silence, and never responded. I told him how much I loved making music with him, and thought I saw a fleeting gleam of pride in his eyes. Then I placed his old guitar beside his bed and reluctantly got on with the rest of my day.
I was never assigned Sam again, but I'll never forget our special duet in Room 116-B.