Details changed and composited to protect privacy. The truth of it is intact.
She spoke for forty minutes straight. I never said a word. That was the day something shifted — not for her, at first, but for me.
She had come in with three things: fatigue that no amount of sleep touched, a mind that wouldn’t stop running, and a stomach that clenched without reason. Her workup was unremarkable. And from the moment she sat down, she talked. Rapidly, brilliantly, without a single pause long enough for me to enter. She narrated her symptoms, her theories, her schedule, her childhood, her last three doctors.
A performance of total disclosure that somehow disclosed nothing.
For weeks I had tried to redirect her. I asked targeted questions. I interrupted, gently. I tried to move her toward the data I thought I needed. None of it worked. She absorbed every intervention and kept talking, the way water moves around a stone.
That day I tried something else. I simply stopped trying to get in. I let the silence she was so afraid of sit in the room between us. And I watched what she did to keep it from arriving.
What the talking was for
Here is what I came to understand. Her language was not communication. It was armor. As long as she was speaking, she could not feel. The flood of words was a wall she rebuilt, sentence by sentence, against something underneath that she was certain would overwhelm her if it ever reached the surface.
This is the part medicine rarely teaches: a symptom can be a strategy. The racing mind was not random noise to be sedated. It was doing a job. It was protecting her from a grief she had never let herself carry.
The turn
When she finally ran out of words, she went quiet. And in that quiet, for the first time, her eyes filled. She said, almost surprised: “I haven’t stopped talking since my mother died.”
Three years. Three years of filling every silence so the silence couldn’t fill her.
And people always do run out of words — if you can tolerate not rescuing them from it. That is the whole skill. Not technique. Tolerance.
We did not fix anything in that visit. But we found the door. The body scan, the breath work, the slow rebuilding of her tolerance for stillness — those came later. And they worked, because we had finally named what the talking was for.
The lesson I keep relearning
The most important thing I bring into a room is the willingness to stop filling the silence myself. Sometimes the clearest signal a patient gives is the thing they are working hardest not to say.
The body keeps that score too. Not just the grief. The effort of keeping the grief buried.
These are the stories that taught me how to actually listen. If this one found you, the next one will be in your inbox.
Dr. Shiv Kumar Goel is a board-certified physician practicing internal, functional, and aesthetic medicine in San Antonio, Texas. He is the founder of Prime Vitality Care. He is the author of the forthcoming book Healing the Split: When Your Biology Is Fighting Your Biography, hosts the Healing the Split podcast, and writes the Healing the Split Substack at healingthesplit.com. His work appears in KevinMD, Op-Med, Medium, Elephant Journal, and San Antonio Medicine.