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.