Takeaway
Even when patients can't respond, they may still hear and understand. Position yourself in their sight line and explain your plans and actions clearly and respectfully.
Connecting with patients | July 10, 2026 | 2 min read
By Sebastian Stein, MD, Centro Latinoamericano de Economía Humana, Montevideo, Uruguay
The hardest conversation I’ve ever had was the one where I was the only one speaking.
Medicine and teaching share the same core demand: taking something impossibly complex and making it simple, accessible. I first learned this skill in front of medical students and carried it with me to every patient’s bedside. Then I met a patient for whom no explanation would be enough—not because he didn’t understand, but because he had no way to tell me.
The code
The shift had been going well, not too busy, until we got the call: CODE STROKE. The patient arrived within minutes. I’d participated in stroke codes before, but this one was different. I introduced myself: “Hi, my name is Sebastián, I’m a final year medical student and I’ll be participating in your care. Could you tell me your name?”
No response. No movement. Nothing at all. His eyes moved slightly, pupils constricted. Were the eyes tracking me? I couldn’t tell.
My brain switched gears: this wasn’t the typical stroke presentation. This patient was likely having a pontine stroke—possibly locked-in syndrome. He was aware of everything but unable to express himself at all.
Finding connection without words
With most patients, I’d ask “How are you feeling?” But this time was different. While taking the patient to an emergent brain CT, I recognized desperation in my patient’s eyes.
“We’re going to do everything we can as a team to help you,” I said. Were my words really reaching him? I had no idea.
I continued talking and relied on what felt natural: teaching. I began explaining: “What we suspect is that there’s an obstruction in the blood vessels of your brain, and because of this, your brain can’t carry out its normal functions—letting you walk, speak, and so on. We’re going to take an image to rule out other causes and give you medicine to dissolve the obstruction.”
I placed my hand on his. He almost certainly couldn’t feel it, but he might have been able to see my hand on his, and hopefully that helped.
What I learned
A great teacher meets students where they are. A great doctor, I learned, must do the same—finding the window to connect when connection seems almost impossible.
Practical strategies for communication when patients can’t respond:
1. Position yourself in their line of sight.
If eye movements are preserved, let them see your face and gestures.
2. Narrate what you’re doing.
Explain each step, even if the patient doesn’t acknowledge what you’re saying. A calm, clear voice provides orientation and reassurance. You can also say directly: “I know you can hear me and understand what’s happening. We’re here to help you.”
3. Remember they’re a person, not a disease.
Locked-in doesn’t mean locked away from dignity, respect, and connection.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.