lucky to get a one-word response

A young postnatal Aboriginal inpatient was referred for physio for assessment/treatment of engorged breasts. Reading her notes revealed complicated social issues, and the likelihood of a difficult subjective examination. When I knocked and asked to enter, there was no reply. I entered to check if it was empty but she was standing quite close to the door expressing milk (for those unfamiliar... its like a gentle human milking machine). Despite a stranger entering with an apology and an introduction (and she was exposed), she didn't look up. Initially I thought this might be due to cultural differences we learnt about in previous years: that eye contact is disrespectful. However, it became clear that this wasn't the main contributing factor when answers were often with-held. My presence wasn't acknowledged. It required 3 repetitions (not impatiently) of request for consent before I could asses the breasts. They were severely engorged and lumpy... ultrasound treatment was indicated, but is most effective just prior to breast-feeding or expressing. I treated the breast she hadn't yet expressed, and attempted to develop some rapport to encourage trust and avoid awkwardness. (10 minutes of treatment in silence can seem to last for eternity). After some silences and one word answers, I thought she might feel I'm prying into her personal life (eg whether she is from Perth), so I tried going through some of the post-natal education routinely offered. A mixture of uncooperativeness and inattentiveness eventually lead me to give up or risk angering her. I left the room feeling very dispondent and pessimistic about my chances of alleviating the atmosphere when I returned later to treat the other breast. 

When I returned, something inspired me to keep trying my best. After some less successful attempts, I brought up the topic of a certain colleague of ours who was from her home town of Geraldton who now plays AFL. She piped up after this, and we started having normal conversations. Whether she's a footy fanatic or was simply in better spirits after a visit from her family, I'm not sure. In any case, she came out of her shell, which wouldn't have occurred without persistence. This lead to her asking questions and learning about important postnatal information.

I'm not saying we should harass every patient into constant chatter. If she had given the impression verbally or with body language that she preferred silence, that would be a different matter, but the patient appeared purely uncomfortable. Had I followed my initial desire to give up, I never would have known such a change in 'personality' could occur. This experience has taught me that I should always strive for rapport or at least trust, no matter how impossible it seems. It has also taught me that attitude problems on a first impression may not be an issue at all, its just that the invasion of privacy might be more intimidating for one particular patient than another.