Communication problems in the intensive care unit

Hospitalization in an intensive care unit is often physically uncomfortable and socially disorganizing. The ordinary forms of conversational participation that generate and sustain a sense of agency are breached when the patient cannot communicate in socially consensual “real time.” Using my own experience in an intensive care unit, I describe how delayed speech, through the use of an alphabet board, frequently leads to a host of interactional problems and mutual accusations about character. I attempt to show that the fabric of self and the perception of quality of care are achieved through “real time” communication. I also describe the differential communicative structure of those who will not and those who will use my alphabet board. Those using the board exhibit, through board employment and through the “local” topics discussed, a depth of common culture between them and me.