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 Wikipedia.com, 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.