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The man who lost his ability to comprehend language

I met a woman earlier this year (a chance conversation with a friendly stranger in a coffee shop) whose husband had a stroke 20 months ago. When you hear “stroke” you may think facial paralysis, a limp, or perhaps worse – coma, complete disability, utter dependance.

But it seems that a stroke can be many things. Essentially, it’s a brain injury. A small part of the brain dies because of a blood clot and a lack of oxygen. I watched both my parents have minor strokes. It’s a scary thing, but can reverse itself quickly if the clot is treated immediately.

I suppose that any part of the brain can be affected, so the disability can be to just about any aspect of human function. In Sandra’s case, her husband lost his verbal language function, but not his ability to hear or make sounds. His stroke killed the little part of his brain that permitted him to understand language, and also the reverse process, to forumulate his thoughts, order them and communicate responses back to the outside world. There’s a medical term for this  — aphasia — and it sounds like he had both the “receptive” and “expressive” forms of the disability.

Things could be worse, right? He wasn’t crippled. His face was still symmetrical. He was continent. He could move, walk, lift, see, listen – in fact to the casual observer, he appeared completely normal. Two days after his stroke, the hospital informed Sandra (not her real name) that they were sending her husband home.

She was dumbfounded.

The stroke had been an utter shock to her. Her huband was 66, fit, a runner, cyclist, lean build, no history of heart disease or other health problems. After the stroke, he seemed almost a vegetable to her – not physically, but in terms of human interaction. At first, she couldn’t tell what was going on in his head. She assumed very little because he had no way to communicate his thoughts or feelings. But in the weeks following his return home she deduced more and more about his condition.

He could see perfectly well, and could even recognize printed words. But he couldn’t process or understand oral language or answer questions, even though he could make vocal sounds. She came to understand that for him, life was now occuring almost in a foreign language that he could neither understand nor speak.

Gradually, he learned to make the most of his strengths. He re-learned how to do crosswords puzzles. He began by studying the puzzle answers and comparing them to the previous day’s questions. Eventually, he could tackle the current day’s puzzle without seeing the answers. His written language skills were still there, even if speech eluded him.

At first, television was hopeless – he couldn’t decode what was being said. But as his reading skills improved he began to watch TV with closed captioning. Sounds promising, right? Is he much worse off than, say, Stephen Hawking, with his severe ALS, who communicates only through a complicated computer assistant?

Yet, Sandra says that her husband wishes to die, his isolation is that severe. He is violent towards himself, though never towards her. He communicates (in writing) that he wishes to end his nightmare. Sandra says to him, “then let go.” But he’s stuck, trapped in a body that is incapable of the sort of everyday communication that makes us human and connects us to the people around us.

Luckily for Sandra, she now has a new grandchild, who was born not long after her husband’s stroke. She babysits several times a week for her daughter and son-in-law. Newly retired, Sandra started looking after her grandchild one day a week when her daughter returned to work this year.

Sandra needs stimulation, conversation. She never stayed at home with her own daughter, returning to work when she was just four months old. She delights in her new granddaughter and is surprised at how strongly attached she is to the young girl.

What’s more uncertain is what will become of her life with her husband, who gives her less stimulus than her granddaughter. How long will he live, and can she continue to care for him at home, even if his physical demands are modest?

I sense her loneliness. She has perhaps decades of life yet to live. She has a darling granddaughter whose photo adorns the home screen of her iPhone. I know that the brain can sometimes heal itself, even if very slowly. That’s what recent research shows.

Can Sandra and her husband find the work-arounds necessary to permit peace and comfort at home, for as long as his day’s last? Or will she need to have him cared for elsewhere, which would leave her alone in their family home? Neither option sounds ideal for Sandra.

The brain is a mysterious thing. It takes the wisdom of a lifetime to cope with the surprises and challenges of aging.

This story first appeared as a column in the Guelph Mercury, April 2, 2015

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