Entering my second year of hospice volunteering, I thought I already understood what presence meant. During my first year I spent time with a patient who was almost completely silent. He was nonverbal and had significant hearing loss. At first I felt unsure about how to interact with him because so much of what we think of as communication depends on conversation. Over time, however, I realized that communication is not always about speaking. Sometimes it is about simply sitting beside someone and letting them know they are not alone. With him, presence meant stillness. I walked into my second year expecting a similar rhythm, but my experiences with two new patients, “Tim” and “Tom”, completely changed that assumption. They showed me that if medicine is a science, communication is an art that constantly shifts depending on the person in front of you.
“Tim” and “Tom” were the opposite of my first patient. Both of them were social, curious, and eager to talk. They wanted to know about my life and were interested in building a relationship rather than just sitting quietly together. At first I thought that meant the approach with them would be the same, but I quickly realized that even between the two of them the kind of communication they needed was very different.
“Tim” was mentally sharp but physically declining. His body was failing him, but his mind remained strong and active. Conversations with him often centered on ideas, memories, and questions about the world. What mattered most was acknowledging that although his physical independence was fading, his intellectual independence was still very much alive. Respecting that was important. Our conversations were engaging and thoughtful, and I learned that preserving a patient’s dignity often comes from recognizing the parts of them that illness has not taken away.
“Tom’s” situation was very different. He was older and struggled with memory loss. Some days he remembered certain details clearly, and other days he did not. Talking with him meant letting go of the need for factual accuracy. Instead of correcting him or steering the conversation back to the present, I learned to meet him wherever his memory happened to land that day. If he spoke about a moment from decades ago as if it were happening now, then that was the reality we shared for that conversation. What mattered was not the timeline of the story but the sense of connection it created.
These experiences reinforced an important lesson that I will carry into my future career as a physician. Communication with patients cannot be standardized. Each person requires a different approach depending on their background, personality, and cognitive state. A doctor may spend years learning anatomy, physiology, and pharmacology, but in the exam room those facts must be translated into language that makes sense for the individual patient. In that sense, medicine requires adaptability as much as knowledge.
This year also changed the way I think about who the patient really is in hospice care. I began to notice that the family members around the bed were often carrying their own emotional weight. One family member in particular spent most of the day alone caring for their loved one. During my visits I sometimes found myself talking with that person more than the patient. Those conversations were not clinical, but they were meaningful. Offering companionship or helping with a small task around the house gave them a brief moment to breathe.
Those moments helped me understand that healthcare does not exist in isolation. Every patient is part of a larger ecosystem of family members, caregivers, and relationships. Supporting that ecosystem can be just as important as addressing the illness itself. My first year of hospice volunteering taught me the power of quiet presence. My second year taught me the value of adaptability. Together they have shown me that the most important part of caring for someone is learning how to meet them exactly where they are.