A Wordless Conversation

by C. Gourgey Ph.D., MT-BC, LCAT
 

Elizabeth lived on the floor of the nursing home that is reserved for people with dementia. Hers was severe, most likely due to multiple strokes. The nurses told me she was completely nonverbal. They also described her as deaf. She never talked, she would just sit in her wheelchair and stare.
 

Each week I would meet her in the dining room and take her to her room for a session. At first she didn't respond when I spoke to her, and singing to her got me no farther. I felt invisible in her presence.
 

Then one day I gave her a maraca.
 

She tapped it against her thigh to the music of my guitar. Then she tapped the palm of her other hand. Every now and then she would giggle. And then came her first words to me: "So what are we supposed to do?"
 

During our next session Elizabeth said nothing. Again I provided musical support with my guitar, but her maraca playing was halfhearted. The guitar wasn't working. I took another maraca and played a duet with her, rhythms only. I would give my maraca a shake, and she would shake in response. Eventually she got the courage to shake first without waiting for me.
 

When the session was over I took her back to the dining room.
 

"I don't dance here" she said. (Where is "here"? I wondered.)
 

"I want you to marry me."
 

I explained that I was already married, but would love to visit her again.
 

Elizabeth befriended the maraca as she became more familiar with it. She would shake it or tap it on her thigh or on the side of the wheelchair. She liked discovering new sounds, and I asked if it made her feel happy. She seemed to want to speak, leaning forward in her chair and looking at me, but no words came out. Sometimes she would only smile.
 

I continued to sing and play the guitar to provide Elizabeth support for her maraca playing. Her responses were halfhearted at best. Most of the time she held the maraca lifelessly in her lap. But when I put the guitar aside and took a maraca myself she would come to life: she would imitate me, shaking her instrument in the air after mine, tapping it on the table or on her chair or on her knee in response to my own playing.
 

Why did it take me so long to see it? To Elizabeth the maraca was not just a musical instrument. It was her voice! She had found her voice, and was waiting for me to speak to her. I put the guitar away; from now on it would be only our two maracas speaking to each other. In the beginning she seemed content just to answer me, imitating what I did. Several times I shook my maraca behind my back, out of her sight, and every time she answered with a shake of her own. So she really could hear! She was not deaf, and if she did not speak it must have had some other meaning. Perhaps she wanted others to learn her language, instead of her having to adapt to theirs.
 

I thought I would raise the stakes now, and began bringing two extra maracas, so each of us would have two. Again she would shake her maraca in response to mine, and would tap the table in front of her. I took a chance and tapped one of her maracas lightly with my own. She just kept tapping on the table, avoiding a direct engagement.
 

But then things began to change. She became territorial, and would whack my maraca when I approached. She would let me get only so close before giving me a good fat smack. She looked so determined, a dark intensity in her eyes. I asked her if she enjoyed playing that way. She spoke, only to say she couldn't hear me! I began to understand this pretense of deafness. Elizabeth was telling me she needed to protect herself.
 

She became even more aggressive. She would no longer simply wait for me to approach. Now she would seek out my instrument and hit it. Then she would tease me by quickly withdrawing before I could retaliate. She did this repeatedly, keeping herself just barely out of reach. But one day at the very end of a session she allowed me to tap her maraca gently with my own. I was surprised by the intimacy.
 

One day a nurse walked in while Elizabeth and I were in the midst of a raucous clash. This must look pretty funny, I thought. I told her that Elizabeth and I were having a conversation. The nurse said she could see that, and noted that Elizabeth was smiling.
 

At first so reserved and defensive, now Elizabeth would wheel herself right up to me when I entered the dining room. She was the initiator now, and would waste no time banging my maracas with hers. She would hit, then quickly withdraw, daring me to pursue. She loved making me miss, but seemed not displeased when I scored an occasional hit. She enlarged her territory: I could tap safely on my half of the table, but if my maraca ventured even slightly into her half she would attack it with a passion. When I asked her if she enjoyed our sessions, she tapped vigorously on the table. Later, in the dining room, she shook my hand and smiled.
 

The nurses noticed her smiles, and told me that was something they hadn't seen in her for years.
 

And then I saw a different kind of change. Elizabeth greeted me by holding my hand in both of hers for several moments. For the first time her approach was not aggressive but gentle: while we each tapped our maraca on the table, she inched hers slowly closer to mine until it made a whisper of a contact, like a kiss. I placed a tambourine on the table. She nudged it with her maraca, and we began to push it back and forth. I tapped it on the inside, and sometimes she would meet me there. Still, she did occasionally give my instrument a good aggressive swipe.
 

There was some ambivalence to her changes. Occasionally she allowed the maracas to contact softly, but just as often would come back with a combative strike. But even in her aggression I saw an increasing playfulness. Again I put the tambourine in the middle of the table, and this led to a game of seeing who could push it farthest toward the other. At the end of that session she rewarded me with a coherent sentence: "Do you want to go back now?" I offered her my hand. She held it warmly in hers, then covered it affectionately with her other hand. She was smiling again.
 

A pattern to our sessions evolved: she would begin very tentatively, tapping her maracas, touching mine, exploring the territory. Then she would become more aggressive and start hitting me, often trying to catch me when I wasn't looking. By the end of the session she was really ready for a fight. Once when I put a tambourine between us, it became reverse tug-of-war until she finally pushed it over my side of the table.
 

The moments of intimacy increased. During one of our last sessions she forgot the maracas and just tapped her fingers on the table, palms down. I did likewise. She reached toward me and tapped my fingers with hers, sometimes letting her hands rest on mine in a friendly, even affectionate gesture. During those last few sessions she would sometimes give me a meaningful sentence at the very end: "Do we have to go now?" "Are you going home now?"
 

Then one day the nurses informed me that Elizabeth had suffered a stroke. When she came back from the hospital I saw she had markedly deteriorated. She died not long afterwards.
 

Elizabeth told me more with her maraca than is often revealed in many words. She told me of her fears and of her limits. She told me of her isolation and of her need to reach out in spite of it. And finally she expressed her capacity for warm human feeling. Her last severe stroke took her away from me, but not before she once again learned how to trust.