Lip-reading really should be a course in medical school. Or if not it's own course, at least its own unit as part of the course "What-you-never-thought-you'd-need-to-know 101". It could be taught along with holding-it-for-13hours-straight, confidence-when-you're-completely-clueless, and how-to-find-your-patient's-nurse.
With the amount of lip-reading I've attempted over the past 6 years, you'd think I'd have gotten kind-of, maybe, semi-good at it. Nope. Still don't understand a thing. When a patient has a tracheostomy air is diverted via the opening in their neck and thus does not pass by their vocal cords rendering them unable to vibrate and a patient unable to phonate. For 99% of the cases, a tracheostomy is not permanent, and as patient's mend and heal the trach tube and/or opening is covered allowing the air to once again pass by the vocal cords and the patient to talk. However, during that in between time, between super sick in medical coma and all better again, there is a period when the patient is awake again and interactive yet not well enough to breath on their own. These are the patients that badly want to tell you their foot is twisted and needs repositioning, and you badly want to understand what is wrong and fix it, and unfortunately it just all gets lost in translation. Often times we can provide patients with paper and pen, or picture boards. Other times we rely on charades and guessing. Somehow the information is finally exchanged about the twisted foot and movement is provided until the patient nods in relief.
All of the patients my team has been able to discharge from the hospital to long term care facilities are still in that in between time. We get them down to minimal settings and then send them to vent weaning facilities where, when they are ready, they will make that final step of covering the trach and breathing 100% on their own again. We wouldn't send them if not positive they could make that last step on their own at the facility. But it means that, I have never gotten to hear my patients speak. Granted some, still lack the mental awareness to communicate, but there have been a handful which you could have a lengthy one-sided conversation trying to figure out the aches and pains of the day. One of my patient's tried to inform me about the diarrhea he had just committed. When I wasn't understanding his lips well enough, he gave me a look like, "c'mon doc, you're smarter than that" then pursed his lips and blew a low slow raspberry imitating the culprit. I got it then, I got it!
That same patient tried to give us all heart attacks that night as well. The most he could tell us was that he couldn't breathe. Unable to get any more information from him, all I had to work with was numbers. Spent hours by his bed starting with worst case scenario and as quickly as possible ruling them all out one by one. I had no intention of having to code yet another patient who is supposed to live. I think one of his nurses felt the same way. If I left his room, not 30 seconds later she'd come running out calling for something that I needed to come check or verify, etc. I'd check and it would be fine, but I caught on and just stayed in the room after awhile. That whole episode with the diarrhea happened at the end of that night, a long night. And it made me laugh. It was a laugh at myself, and inability to lip-read, but it was also a laugh of relief. If he was in a state that he could joke with me about diarrhea.... we were all good.
Much love and prayers.
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