Sunday, August 9, 2009

From the Files of "Things They Never Told Us in Grad School"

Recently I did an evaluation with a new patient - I could hear him and his girlfriend arguing fairly loudly in the waiting room while filling out the registration paperwork and grimaced when the front desk person brought the completed chart into my office, my signal to get started, and said, "Good luck".

He had had a tough life and was rough around the edges, as was his companion. He had a fluent type of aphasia, which means that words come without struggle and sound like they should make sense but they don't (i.e. very little content though normal sounding syntax and rhythm, vs. a non-fluent aphasia where the content is high but the structure of sentence isn't there). These folks often also have significant difficulty understanding spoken language, so my first order of business was getting his mile-a-minute girlfriend to s l o w d o w n.

In the first session I did what I could to educate her about her boyfriend's aphasia, assuring her that it is a real problem and that he's not just ignoring her. As they came back for further sessions, she delighted in the small things that were improving but based on the questions she asked still was struggling to understand this aphasia business (which is okay, as I am too).

She asks a lot of questions, which I love, and it always makes me giggle a little to myself because she starts every question with "Hey Brooke" even though I'm sitting across the table from her.

This week, we were near the end of our time when she says, "Hey Brooke, let me ask you something".

"Ok, go ahead".

"Why is that he can't say anything about anything but when he wants sex it comes out just fine?"

"Um, well... we're kind of hard wired for things that go on autopilot, like counting, saying the days of the week, or cursing..."

"So he can say it cause he likes it so much?"

"Um..." (turning purple). I looked to him and kinda shrugged.

Then he says the only thing that's been clear all day - "The stroke didn't affect everything".

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