Tuesday, May 29, 2012

I Love Aphasia

I love aphasia. Actually, that's a lie. Because aphasia really sucks. Aphasia is a communication disorder that is the result of some kind of neurological trauma. It most commonly results from strokes and traumatic brain injuries, and robs people of their ability to speak, understand spoken language, write, read, or all of the above. So I hate aphasia.

But I do love working with people who have aphasia.  There are varying degrees of disability that depend on the severity and location of the trauma that occurred to the brain. In my experience, aphasia is like snow. I have never seen 2 examples of aphasia that are exactly alike. In my perfect job, I would work with individuals with aphasia all day long.

Now, many of my healthcare co-workers don't share this opinion. It can be extremely frustrating to try to help a patient get dressed, walk, find food they want to eat, and express what is causing pain or anxiety when there's a breakdown in simple communication. Because aphasia can impair pointing. And gesture. And the other myriad ways we try to get our point across when we can't get the right words to come. And it can also prevent a person from even knowing that they don't make sense. Imagine how frustrating it must be to make perfect sense (to yourself, at least...) and have people staring at you like you speak Martian instead of handing you that sweater hanging in that closet over there like you've been asking for for the last 10 minutes.

But I have the luxury of sitting down and just trying to work through the communication piece. And I find that most patients are relieved to have someone who can take the time to try to communicate, especially when that person also has tricks to help recognizable words actually come out.

So I was reminded today at work how much I love working with people with aphasia when I sat down with Mr. Jones. Of course his name is not really Mr. Jones, because HIPAA would hunt me down and have me de-licensed. Well, HIPAA's just a law, it can't hunt. But someone would hunt me down... But back to Mr. Jones... He's a gruff elderly gentleman, shaved bald with a wicked potbelly and dry sense of humor. My favorite kind of patient. I sat him down in the vacant dining room (his room was too noisy) and offered him a drink:
Me:  "What can I get you to drink?"
Mr. J:  "Eh, anything."
Me:  "Well, we have lots of things in the kitchen, coffee, tea, juice, soda, water... What would you like?"
Mr. J:  "Coffee... with Splenda."
Me:  "How many Splendas?"
Mr. J:  "One."
Me:  "Any cream or milk?"
Mr. J:  "No no no!"

I was quite pleased with myself. Our significantly aphasic gentleman just very clearly told me that he wanted coffee with Splenda. So I poured him a cup of coffee from the kitchen, stirred in one packet of Splenda, and proudly placed it in front of him on the table in the dining room. I was not prepared for what came next.

Mr. J:  "What the hell is this?!?!"
Me:  "It's coffee. With one Splenda."
Mr. J:  "I can't drink this sh*t!"
Me:  "What's wrong with it? It's just what you asked for! Coffee with Splenda!"
Mr. J:  "NO!"
He pushed the cup away with a look of disgust.

Now, I happened to know that Mr. Jones can read better than he can understand, and once he reads the word, he's able to say it out loud. (Aphasia is funny like that.) So we went through a 10 minute process of me asking questions in multiple-choice format, all written on paper, until I finally understood what he really wanted.

A diet gingerale.

You can't make this stuff up. His speech errors are usually well-articulated real words that are somewhat appropriate for the situation. They're just the wrong words.

But we worked together for an hour, and did get some of the right words to come out. And there were moments of joy when they did. Mr. Jones was able to laugh at himself a bit, and I was able to tease him a bit. I have no problems laughing at speech errors (technical term:  paraphasias) and help my patients do the same. Sometimes the substitutions are just downright funny. And in the midst of all of the frustration of ideas locked in a brain with an uncooperative speech system, I assume that they need more opportunities to laugh.

So the next time you find yourself annoyed, trying to get the word out that's on the tip of your tongue, imagine that all of your words were like that. And pray for individuals with aphasia!


  1. I was teaching Lamaze when my fibromyalgia started. It was initially diagnosed & treated as rheumatoid arthritis which led to a high aspirin intake. I realized I had reached the toxicity level when I was teaching & couldn't say the word "contraction". I knew it started with a c but I couldn't think or say the word...which is an important one in Lamaze!