Call Terri Jacque, RN, to break the uneasy silence when a deaf person arrives at the ER unannounced and in crisis at East Texas Medical Center in Tyler, Texas.

"Most deaf people realize that when they're sick, they need somebody to help them," Jacque said. "But that doesn't always happen and they just have to rush themselves to the hospital. I don't want to take money out of an interpreter's hands, but in those types of situations, it's not fair for [deaf people] to not know what's going on and not be able to ask questions."

Jacque's self-taught fluency in American Sign Language stems from her days as a child growing up in Fremont, Calif., with a deaf boy as a neighbor.

She came to nursing later in life, always dissuaded by her mother who would have preferred that she pursue a career as a professional interpreter. Jacque, 40, flirted with that idea, taking two years of sign language in college before becoming an RN nine years ago and fulfilling a dream that began as a girl with a split lip and a trip to the emergency room.

She is pursuing a master's degree at the University of Texas at Tyler, with plans to teach med/surg. From the classroom, she would like to remedy a nagging problem she's seen on nursing floors: green and overconfident RNs.

"I'm the type of nurse that there isn't a day that goes by that I don't ask questions," Jacque said. "These students that come out on the floor and think they know everything or they don't need help, they scare me. You can't just know everything. In nursing, my gosh, it changes every five minutes."

In conjunction with Wanda Lord, an interpreter friend, Jacque has conducted free continuing education courses in which nurses learn basic signing so that they can ask deaf patients for key information: whether they are experiencing pain, on medication and have a family member available to bridge the communication gap.

"I'm not an interpreter," Jacque said, and she always advises staff to call one from a list circulated to hospitals in the Tyler area, physicians and businesses by East Texas Deaf and Hearing Association, an organization of hearing professionals that arranges interpreters for appointments and events. In the interim, though, American Sign Language-which is more expedient than Signed English, upon which certification is based-serves Jacque and patients well.

"I can fully understand what they're saying and they can understand what I'm saying," she said. In Signed English, one would sign "Today, I bought a new car. It is blue." The American version is "New car bought today. Blue."

"It's very brief. It's quick and it's easy," she said.

Still, don't expect to learn it too quickly, especially the nuances, Jacque said. A facial expression or slight difference in moves can mean radically different things. For example, putting your right wrist on the back of your left wrist means "work." The same move, but with palms facing each other, means "rape," she said.

In most communities, the deaf are close-knit, almost invisible to outsiders. They stick together because they understand each other, not because they're standoffish, Jacque said. In fact, it's her experience that deaf people are awed when a hearing person cares enough to learn their language.

Nowhere is that more evident than with hearing-impaired pupils at Tyler's Clarkston Elementary School, where Jacque occasionally appears for first-aid and other health-related presentations. "They're always very excited to know any hearing person that can do sign language," she said. "They say 'You can talk? You're hearing? And you sign?' "

It's the same with adults.

Because an interpreter cannot be on hand round the clock, most hospital floors have visual aids: pictures of a bathroom, telephone, pitcher, etc., to help patients communicate. But as Jacque has become familiar to the deaf community, they are quick to let her know via text telephone that someone they know who is deaf is hospitalized.

"I will go to the room and ask if there is anything they need, if there is anything that nobody can seem to understand," Jacque said. "Little things: Is the room the right temperature? Is there a certain juice that they prefer?"

Her best advice for RNs interested in acquiring sign language skills is to get to know a deaf person. If you're not going to do that, have patience with yourself. "You can't learn French overnight and you're not going to learn sign language overnight," she said.

Contact Phil McPeck at getpjm@aol.com.