Monday, March 14, 2011

Fractures, earthquakes, and tsunamis

Friday morning turned out to be more eventful than I had anticipated.

Here I was, looking forward to sleeping-in for my Friday morning off from work. Ha! Alex decided his arm hurt badly enough (he rated it an "8" for pain) from a soccer fall the night before that he needed me to take him to Kaiser for an x-ray.

While trying to wake up, I logged in to Facebook. I have this theory that looking at computerized screens helps to wake me up. I decided this based on non-scientific readings I have done in magazines like Real Simple and Oprah telling me not to watch TV or use the computer within 2 hours of bedtime, as the visual stimuli interrupts natural sleep patterns. I, in turn, interpret this to mean that the visual stimuli will also serve to wake me up in the morning. Hence my early morning interface with FB for iPhone. I take notice of a couple postings - one from one classmate to another in Hawaii, asking if she's alright; another from a lady on the Oregon coast referencing evacuation; and yet another publically mourning Japan. Japan? Why? I don't yet know. While Facebook didn't provide me with the newsy details, it did inspire me to check the morning news.

Japan. Earthquakes. Nuclear power plants. Fires. Tsunamis. Devastation.

As I watch the live news coverage, my mouth agape, I'm appalled at what unfolds before me. I'm immediately struck by my own wave of compassion, with a tsunami of fear hot on its tail.

Then I remember Brian and Katie. On an island, sunning themselves and getting massages. In Indonesia. Bali's kinda near Japan, right? I mean, if Hawaii is threatened to be washed over, then I'm sure Bali's under some sort of threat.

I call Brian to check in, and thankfully he answers on the third ring. He seems a little hopped up on the adrenaline that must accompany a natural disaster threat such as this one, but it seems they are in the clear. First of all, the surges would have come and gone by the time I'd called. And second, they were fortunately protected by the other islands and land masses north of Bali.


Then again, Alex still has a broken arm and is whimpering in pain. And there's the mess the size of Japan to clean up. But, I can only be responsible for so much. I lean over, kiss my husband on the forehead and remind myself, and him, how lucky we are. To be together. To be alive. It's only a broken wrist.

Thursday, March 10, 2011

Communicating Without Words: Take II

Mr. K had an 8 a.m. appointment. We were running late. He arrived in his motorized wheelchair, wearing pilly sweatpants, a sweatshirt and vest, with a camelback of water and a belt pack circa 1980's. He had wavy grey hair and wore thick eyeglasses. His wheelchair was covered with carabeners, attaching five different bags and backpacks, carrying his camera, laptop, snacks, a jacket, and who knows what else. He had an iPod hanging on a cord around his neck, playing Florence and the Machine. He looked like he was ready for anything.

His mouth was permanently open, and his right eye partially closed, with his upper lid drooping down. I wondered how much he was really able to see. He moved slowly, almost robotically. I introduce myself, and ask him a bit about himself. Only, I can't really understand a word he says. He speaks as slowly as moves, making an obvious effort to enunciate his words, but to little avail. His medical records report that he sustained two different brain injuries, from falls while skydiving. I can't imagine.

Eventually I learn that he likes to stroll along the park blocks. Meanwhile, Dr. S talks aloud to himself while programming a computer. This new software will be Mr. K's alternative means of communicating. He has a severe dysarthria, which is an acquired neurological speech impairment. His speech is about 10% intelligible, even with his best efforts. He has poor breath support and speaks on the tail of his exhalations.

Dr. S takes forever to program the software. And he barely acknowledges the two of us, patiently waiting. One hour passes. Then two. I make eye contact with Mr. K a couple times. Raise my eyebrows as if to say "sorry it's taking so long, but it's not me, it's Dr. S." Mr. K offers me a tic-tac, but I decline.

He's now been here 3 hours. I am sure he's hungry. I know I am. And lunchtime has come and gone. He reaches into one of the re-usable grocery bags attached to the side of his wheelchair and pulls out a half-muffin. One of those huge Costco muffins, chocolate-chocolate chip. He starts to pick at it, but his hand and arm movements are as spastic as his speech. His fingernails are long, with the white showing, and he has dirt, or other food parts, caked beneath each nail and in his dry cuticles. He has such little control over his muscles, the small act of snacking appears to require a great deal of coordination. Needless to say, he's messy.

Dr. S takes pause from his programming, looks at Mr. K, smiles a half-smile, with a subtle hint of irritation. "Your hands are dirty, maybe you should go down the hall to wash your hands." The poor guy didn't even get to finish his muffin. He heads out to wash up, as I stare at my shoes, embarassed by the rude interaction that just unfolded. I can't imagine this is the worst that he gets, but still, I feel awful.

Wednesday, March 9, 2011

BC is so OVER

I finally decided to go off birth control. TMI? Probably. It's liberating to kick the Nuva Ring to the curb and feel like I'm throwing caution to the wind. Really though, it's just a treat to not be the one to take responsibility for contraception. Because I've got the feva (baby fever), it doesn't seem like too big of a risk. Am I absolutely 100% sure I'm ready to be a mom? Hell no. Is it sort of exciting to think about the fact that it might happen, and maybe even soon? Hell yes.

Tuesday, March 8, 2011

You just never know

Five or 10 years ago, I never would have guessed I liked hanging out with seniors who can't talk. It goes without saying, but so much can be communicated in the absence of actual words. A grimace to show me getting out of bed is painful. An expression telling me a naming activity is too damned frustrating. A gesture to say the breakfast this morning tasted like burnt cardboard. A dentured smile and old-man eye-twinkle in an effort to flirt. This is how some of my patients communicate with me. It's because they have aphasia.

According to, aphasia is from the Greek root word, "aphatos," which means "speechless." Aphasia is an acquired language disorder in which language - speaking, understanding, reading, writing - is impaired. These guys, who are usually survivors of stroke, have lesions in the parts of their brain that control these language modalities. The language parts of the brain get deprived of oxygen, and essentially die. For some patients, it's just a matter of re-activating these damaged networks. For others, it might be necessary to find compensatory ways of communicating.

One of my first real patients in a hospital setting, let's call him Mr. C, was a 60+ year old man with global aphasia - meaning he didn't have any real strength in any language modality. I don't know whoever said you shouldn't play favorites, because Mr. C was definitely one of my favorites. He was an apple-shaped man, usually dressed in khaki cargo shorts and a yellow polo, despite the fact it was winter outside. He was always smiling, except for the one time he got ill, with an infection. Every morning when I picked him up from his hospital room, he was waiting for me in his wheelchair, his eyeglasses and freshly sharpened pencil in his shirt pocket. Just prior to his stroke, he worked as an editor, of a small newspaper or something. He hadn't even retired yet.

At first, he wasn't able to say much of anything at all, with the occassional "yes," "no," or "here we go" when I started to push him in his wheelchair. As his brain healed itself from the stroke, he exhibited some "spontaneous improvement." His spoken vocabulary expanded to include a whole lot of "god dammit," still with a paucity of any functional communication. He wrote his name with his non-dominant left hand, "Lyche." None of the letters were in his real first name.

His auditory comprehension wasn't any better. He failed to respond correctly to personal yes/no questions, and couldn't match basic spoken words to a picture. But let it be said, this aphasia business has nothing to do with Mr. C's intellect. Inside his own head, he's the same person he was before the stroke. He has his same thoughts, his same feelings, his same personality, and his same smarts. But he no longer has access to the pathways that let us communicate with him. Both the entrance and the exit had been damaged.

He worked really hard in therapy with me, despite significant difficulty saying "boy," even when asked to repeat after me. He made great improvements in his understanding of nouns, verbs, and even two-step directions. But his spoken language remained severely impaired.

That's when I introduced him to the wonderful world of Apple. He'd never seen an iPod before, and his manual dexterity was quite poor at first, but boy did he think that thing was cool. We downloaded an application, Proloquo, to supplement what little he had by way of speech. Mr. C pressed the icons. "Hi. My name is ____." "How are you?" He looked up at me and smiled broadly each time he found something new to say. "I would like a glass of water." "I'm tired." "I have pain in my arm." "Breakfast. I want a bagel. Butter." "I have two sons. Two grandchildren." You get the picture.

From the outside, it seemed like Mr. C got robbed. He could no longer express himself verbally. He had a difficult time understanding what others were saying if the sentences were long or complex. He could no longer write. But he didn't appear to see it that way himself. He got discharged to his own home, able to continue living independently. He regained his ability to walk. And he got a cool new toy to help him communicate. At his last session with me, I told him what fun it had been to work with him. And I meant it. He was the first person to help me feel comfortable in the silence that exists around a person with aphasia. He helped me, I told him. He smiled back at me, put his cold, wrinkly, age-spotted hand over mine. Then grabbed his rolling walker and headed out my office door.

I still have worlds to learn about language processing and the brain, but I guess I do know a thing or two about the importance of listening, even to those who don't really seem to be speaking.

Monday, March 7, 2011

Getting back on the horse

I don't know much. Although my husband would accuse me of thinking I know everything. That said, maybe it'll take a load off him if I impart some "readers" with my apparent know-how. No really, I don't know much. But I did used to fancy myself somewhat of a writer, and I guess I'm starting to miss those days. One glaring difference between then and now: I used to have real, live readers. Or townsfolk who at least claimed they read the news. Public utility districts, fire safety, and random human interest stories about a lady who saves bears. Awesome. But now, maybe my dad will check out what I have to say once in awhile. Mostly just because I'm about to (finally) move out of my childhood home, and he might just miss hearing me babble about inanities. And then there's my brother, who might read this only when he's out of the country. Or single. As that's the only time he engages with the online world. His Facebook picture has been the same for about three years. Enough said. And my husband, Alex, maybe he'll check out what I have to say. Just out of fear that I'll embarass him. Or myself. But it's time I stop thinking about things that would be cool to write, and start writing them. I did, after all, just receive a $150 check from Tahoe Quarterly for a short article I wrote for them. Four years ago. But hey, between my pal Libba's blog and that check, I'm inspired to get back on that horse.

Anyway, here are some of the things I think about.
Oscar movies. I call them "films." True Grit was a surprise favorite.
My husband. The shape of his shoulders, the color of his hair, the adorable way he smiles and hugs me like the T-Rex character from Toy Story.
Shopping for furniture and home decor. That is, if Craigslist counts as "shopping." And if browsing but never buying counts as shopping.
Brain injuries. Stroke. Assessing brain injury. Treating stroke. Language. Cognition. Swallowing. Babies. My friends' preggo tummies. My hypothetical future babies. Baby names. Baby blankets. This comes in lunar cycles, I think. It seems my "What to Expect Before You're Expecting" book only lands on my bedside table toward the beginning of every month. Much to Alex's chagrin.
Job hunting.
Where to live. Portland near friends and family, or mountains near nature?
My awesome girlfriends.
Books. Books on tape.
Resort towns.
Sewing and paper crafts.
Parenthood; this time I mean the show.
My bucket list. Only a few things completed so far - and so many more to go. Especially before the babies thing. I mean, "Visit Portland strip club" and "Stay at a themed motel" aren't exactly suitable for life as a new mom. Then again, I can probably save "Milk a cow" for when I have kiddos around.
I also think a lot about money and weight. How to spend less and earn more. How to eat less and exercise more. Neither of which have been very fruitful. My appetite for things, experiences, tastes, and feelings far outweigh my inclination to be restrictive. Then again, my husband likes me a whole lot better sans rigid budget and rigid diet. I guess I am more fun this way. And who cares if I have $400 fewer in savings and 15 extra pounds if I'm enjoying myself, right? Right?!? I'm practicing the mantra, at least.

Never know what I'm going to say. Likely to read more like a "Dear Diary" than a witty blog with creative observations of the world around me. We shall see ...

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