I began my journey with the Deaf community before coming to medical school starting with a basic American Sign Language class just to learn a few routine signs. I continued with the American Sign Language Club at Geisinger Commonwealth School of Medicine, hoping to learn more medical signs for any future interactions with Deaf patients. Through the club, I recently met an incredible four-year-old boy named Kase at a local community event to meet Peppa Pig.
Kase is small for his age, has short, curly brown hair and wears bright blue glasses that accentuate his brown eyes. Meeting Peppa Pig was extremely overwhelming for Kase, who has a complicated medical profile, including polymicrogyria, cortical visual impairment, absence seizures, in-utero drug exposure, expressive language disorder, global developmental delays and Autism. No, Kase is neither your average four-year-old nor an average four-year-old who is hard of hearing. However, Kase is extraordinary, and through him I found the truest joy.
When I sat with Kase and asked him if he was excited to meet Peppa Pig, Kase responded with a script from his favorite YouTube video about coloring: “Today I colored with orange. I colored a pair of cozy orange socks and an orange bouncy basketball.” He didn’t answer my question, but he was able to repeat word for word that video he watched one week prior. I then asked him if orange was his favorite color. He responded with the exact same script about the color orange. It was easy to pick up on this behavior, but difficult to fully engage and connect with him.
After the twentieth time I heard Kase’s story about the color orange, I decided to try connecting a different way; this time using American Sign Language. With the help of his family, his teacher, and his school counselor, we tried to pause Kase’s script as I used American Sign Language to spell a word and have Kase voice each letter. When he talked about the orange bouncy basketball, I would fingerspell “B-A-S-K-E-T-B-A-L-L.” He would stop, concentrate and spell basketball with me and then continue scripting. The best way to describe the change I saw in Kase was relief. When he was able to pause his mind and concentrate on my hands as they formed each letter, it looked and felt like Kase had temporary relief from the busyness surrounding him. American Sign Language was the key to not only communicate with Kase but also to connect with him.
Communication plays an extremely important role in all aspects of medicine, including patient interviews, shared-decision making, and working with other healthcare professionals. Through meeting Kase, I found that communication serves a greater purpose in that proper communication can be inherently therapeutic.
Kase’s reality is much different from my reality. For Kase, he is constantly stimulated by his environment, and due to his medical condition, he is unable to process that environment and then verbally communicate his feelings or desires. However, he does have the incredible ability to remember every little detail from every video he watches, and this scripting is how he copes with sensory stimulation. Instituting sign language into Kase’s experience clearly helps coordinate his processing, turning an overstimulating situation, into a more manageable experience. American Sign Language helps Kase become less overwhelmed and more in control of his environment, serving its therapeutic purpose. Now, I recognize that American Sign Language is not just a means to communicate, but an emotional, human experience that allows for genuine connection with some of the most complex, vulnerable individuals like Kase.
The art of American Sign Language transcends the dysfunctional neurological pathways to create genuine human connection. Therefore, it is important for healthcare professionals to identify individuals with hearing impairments and help get them and their families to receive the proper services they need. There is growing evidence that intervention at no later than 6 months of age for infants who are deaf or hard of hearing greatly helps language development, social-emotional skills and other school-related measures. One of these interventions could be introducing sign language at an early age, giving these infants a form of communication that can transcend their impairments. With this language, greater connection and engagement can be achieved. The simple task of fingerspelling the word “basketball” was truly transformative for Kase and could be for any child who is Deaf or hard of hearing.
Every time I see Kase and interact with him, I know how to aid his vulnerability and act compassionately towards him through language. When I think about Kase and the impact sign language has on his everyday experience, I wonder how his development could have improved if sign language was introduced to him at an earlier age. For those who are diagnosed with a hearing impairment, who are nonverbal, who are hard to connect with and engage with, American Sign Language could serve as an extremely powerful tool that we can continue to support in healthcare. American Sign Language epitomizes the idea of humanism in medicine for an extremely vulnerable population, and my experience with Kase, the young four-year-old boy who fights every day, helped me come to this realization.