Takeaway
Patients sometimes wait until a conversation seems over before sharing what's most important to them. Resisting the urge to fill the silence—and staying present a little longer—may help them feel safe to say what they've been holding back.
Connecting with patients | August 7, 2026 | 4 min read
By Nettie Reynolds, MDiv, interfaith chaplain
Before I became a hospital and hospice chaplain, I spent years as a technology journalist. On paper, those careers have very little in common. One was spent interviewing entrepreneurs about software, startups, and emerging technology. The other brought me into hospital rooms and hospice homes where conversations centered on illness, loss, hope, and the ordinary courage it takes to face another day.
Yet both professions taught me the same lesson: the most important part of a conversation often comes after you think it’s over.
Learning to wait
Early in my reporting career, I discovered that if I resisted the urge to fill every silence, people almost always kept talking. I would finish my last question, close my notebook, and wait. At first the quiet felt awkward. Every instinct told me to thank them for their time and move on. But after a few seconds, something unexpected often happened. The person sitting across from me would lean forward and say, “Well, there’s one other thing.” After which I’d learn critical insight or information from them.
Years later, I learned to rely on that same technique in patient care. A patient and I might spend 45 minutes talking about family, fear, faith, or whatever had brought us together that day. Eventually the conversation would begin to wind down. I would close my notebook, thank them for trusting me with their story, and start to leave.
Over time, I learned not to hurry those last few moments. Sometimes I remained seated a little longer. Sometimes I paused before reaching for the door. More often than not, that was when the conversation truly began.
“One more thing”
“Can I ask you one more thing?” a patient would say. It didn’t take long to realize that “one more thing” was rarely one more thing. It was usually the question that mattered most.
The questions or new worries patients saved for last were almost never medical. One afternoon, a man recovering from a kidney transplant looked at me and quietly said, “My wife just told me she wants a divorce.” His surgery had gone well. His new kidney was functioning beautifully. The physicians were pleased with his progress, and plans were underway for him to return home. But home had changed while he was fighting to stay alive. He had survived one crisis only to discover another waiting for him.
Another patient waited until I stood to leave before saying, “I was an alcoholic for over a decade. I left my family. Can you call my son? I haven’t talked to him in 20 years, and I’m dying.”
A woman with advanced cancer looked at me and asked, “How do I tell my adult daughter I don’t want any more treatment? I just want to live with whatever time I have left. I don’t want to come back to one more hospital.” She wasn’t asking me to decide for her. She had already made peace with her decision. What she needed was the courage to speak it aloud to the person she loved most. And I helped her cultivate that courage.
Other questions came almost as whispers. “Do you think dying hurts?” “What happens to my body after I die?” “Do you think God caused this?” “Am I ever going to feel better?”
The question beneath the questions
When I think about those conversations, one question still returns to me with surprising regularity. “Did my life matter?”
Journalism taught me silence that often invited the next sentence. I tried not to rush in with answers and instead leaned into presence. Not every silence needs to be filled.
Looking back, I don’t believe patients waited until the end of a visit because they suddenly remembered something they’d forgotten to ask. I think they waited until they felt safe—safe to say they were frightened, safe to express regret, safe to wonder if they’d failed the people they loved, and safe to ask questions that had no certain answers.
By the time our conversations began winding down, we had usually talked about children and grandchildren, jobs and marriages, favorite meals, old neighborhoods, beloved dogs, military service, church, baseball, and gardens. We had become, if only briefly, two people sharing the same room instead of a patient and a chaplain carrying out assigned roles. Trust rarely appeared all at once. It accumulated quietly, one conversation at a time, until finally the question beneath all the other questions found its way into the room.
Presence as care
I’ve come to think of presence as its own kind of care. It doesn’t require eloquence or perfect words. Sometimes it means pulling up a chair and staying a little longer. Sometimes it means allowing silence to linger.
The longer I worked in the hospital, the more I realized I wasn’t the only one paying attention to those moments. Nurses paused to hear one more story. Nursing assistants stayed for another minute. Phlebotomists gently drew yet another blood sample while listening as patients talked about what worried them most. Food service workers remembered a favorite dessert or asked about the grandchild whose photograph sat on the bedside table. None of those moments appeared in the medical record, yet they were part of the care patients received just the same. Those moments reminded patients they were more than a diagnosis. They were still someone’s parent, spouse, teacher, mechanic, musician, neighbor, or friend.
Sometimes the most compassionate thing we can offer isn’t another question or a better answer. Sometimes it is simply our willingness to stay in the room long enough for what matters most to finally be said.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.