The Quiet Power of Pulling Up a Chair

Amelia

Wait, is that a heating pad on your shoulder? On the air, in Phoenix?

Tyrone Wigfall

My arthritis does not care what the weather app says. It has opinions. Loud ones.

Amelia

Okay, okay. But hold on, that's actually where I wanted to start. Picture a student, a made up one, a composite. Their first week of clinicals. Scrubs still creased from the package. And they push open a door, and there's a resident in the bed, just staring at the ceiling. Not at them. At the ceiling.

Tyrone Wigfall

Oof. Yeah.

Amelia

And the voice in the student's head is going, um, do I belong here? Do they know I've done this, like, twice? That's the sixty second standoff.

Tyrone Wigfall

Good morning, by the way, to the whole Innovative School of Health family across Phoenix. Night shift CNAs, I see you winding down, shoes off, hopefully. Family caregivers at the kitchen table with cold coffee. And the students on the commute, hands at ten and two, listening to us instead of the traffic.

Amelia

Hi, all of you. Seriously. Okay, so back to our student. What do they do?

Tyrone Wigfall

They panic and perform. They, they, they start reciting. Blood pressure, temperature, pulse, I'm here to check your vitals, all in one breath. Because they think competence means speed.

Amelia

Right, like if I say enough clinical words, nobody will notice I'm terrified.

Tyrone Wigfall

Yes. And the thing is, it backfires. The faster you talk, the more the person in that bed feels like a, a, a checklist with a pulse. The tension climbs and the student reads that tension as proof they're failing, so they go even faster.

Amelia

Ooh, that's a loop.

Tyrone Wigfall

I know that loop from the other side. I live with sickle cell disease. I've been the one in the bed, staring at the ceiling, more than once. And when somebody rushes through me, it feels transactional. Cuff, number, gone. Like I'm a parking meter.

Amelia

Mm.

Tyrone Wigfall

But I remember the other kind, too. Somebody walks in, and they just... stop. One pause. Doesn't say anything clever. And the whole room changes from, uh, from scrutiny to safety. I can feel my shoulders come down.

Amelia

One pause did that?

Tyrone Wigfall

One pause. That's all the resident is asking for. Not a performance. Proof that you see a person.

Amelia

Okay, so I went looking, because I'm nosy. There's a review from the American College of Physicians, written by Dr. Janaki Deepak, an assistant professor at the University of Maryland. And she draws on a 2020 paper in JAMA by Zulman and colleagues about how clinicians show presence with patients.

Tyrone Wigfall

Okay, and what's the, the actual advice?

Amelia

Her list includes this line, and I'm reading it: use body language that communicates that you care by sitting down, unfolding your arms, and making eye contact. And she says the single most important piece is listening without interruption.

Tyrone Wigfall

Sitting down. Unfolding your arms. That's it?

Amelia

That's literally on the list. She also says lean in with an open posture when they talk. And, this one got me, don't just touch a patient's head or leg, because that can read as condescending. A gentle touch on the hand or arm lands better.

Tyrone Wigfall

Yeah, that's right. Don't pat my head. I'm a grown man.

Amelia

But, okay, can I be the annoying one? Because that all sounds beautiful from a faculty office. Sit down. Linger. Meanwhile your CNA has eight call bells going, a diaper change waiting, and a charting system that's tracking her like a delivery driver. Who has time to sit?

Tyrone Wigfall

That's fair. That's a fair hit.

Amelia

I'm not trying to be mean. I just, I know people who work those floors.

Tyrone Wigfall

So here's my rule of thumb. And that's all it is, it's my rule of thumb from living in these beds, not a study. The forty five second chair pull. You sit at eye level for forty five seconds, you ask one real question, you listen. And I'd bet that buys back twenty minutes later in the shift.

Amelia

Twenty minutes how?

Tyrone Wigfall

Because a person who feels processed hits the call bell again. And again. They're not being difficult, they're saying, hey, did anybody hear me? The person who felt heard? They relax. Fewer bells, fewer de-escalations, less of the, the whole shift going sideways.

Amelia

Hmm. Okay. I'll give you that the bell isn't always about the bell.

Tyrone Wigfall

Exactly the point. Sometimes the bell is a question mark.

Amelia

Okay, that's good. But I still want to protect the person who truly can't do forty five seconds on a hard day.

Tyrone Wigfall

And I'll give you that. Some days it's twenty. Some days it's just sitting on the edge of the chair. The point isn't the stopwatch.

Amelia

What about the tiny stuff? Because the same review has a bit about that.

Tyrone Wigfall

Go.

Amelia

It says pay attention to comfort details. In a hospital, straighten their bed, ask if they need more ice. That kind of thing.

Tyrone Wigfall

Oh, man. A cold blanket, adjusted. Fresh ice water. Those cost nothing, and they say, I noticed you. When you're in pain at three in the morning, that is, that is the whole ballgame.

Amelia

And before the tablet comes out?

Tyrone Wigfall

Before the tablet, before the chart. One open question. How are you feeling, what would make this easier? Then you chart. The screen can wait ninety seconds. The person can't.

Amelia

Mm, I like that. Person first, screen second.

Amelia

Okay, but now the student who did all that and still felt slow. Behind. Everyone else is zipping through, and they're sitting in a chair feeling like a fraud.

Tyrone Wigfall

Ugh, I hate that feeling. Yeah. And I want to say it plain: slow is not the same as unsafe. Careful communication is a safety skill. You catch things when someone feels safe enough to tell you.

Amelia

So it's not an efficiency failure.

Tyrone Wigfall

No. It's, it's the skill. Speed comes later. Presence is the hard part, and you've already got it.

Amelia

And can I say something about the drive home? Because this part gets skipped. A lot of caregivers walk in their own front door completely empty. And then they feel guilty, because the people at home get the leftovers.

Tyrone Wigfall

Oh, that one's real.

Amelia

So here's my trick, and it's mine, from friends and from my own mess. The three minute doorway reset. Before you go in, you stand right there. Breathe. Name one thing from the shift out loud, even just in your head. Then you leave it on the porch. Like a pair of muddy boots.

Tyrone Wigfall

Muddy boots. I like that. Wait, does it work if you've got a toddler screaming behind the door?

Amelia

Three minutes becomes ninety seconds, and you do it anyway. The toddler survives.

Tyrone Wigfall

Fair. Alright. Roll call?

Amelia

Roll call.

Tyrone Wigfall

To the students with skills exams this week, the ones practicing hand washing in the bathroom mirror at midnight. You know the steps. Breathe, sit down, look at the person.

Amelia

To the adults starting over. The second chance learners who thought that door closed years ago. It didn't. You're allowed to be new.

Tyrone Wigfall

And to the healthcare workers quietly holding whole communities together, with sore feet and no applause. We see you.

Amelia

And maybe the thing to carry out the door is this. If the room goes quiet, what if the quiet isn't a test? What if it's the part where you pull up the chair?

Tyrone Wigfall

Yeah. That's it for me. Go be human today.