Wednesday, February 28, 2007


I have worked as a speech therapist for about 20 years. I assess and treat adults who have difficulties with communication and swallowing following strokes, head injuries etc.

In that twenty years, I've seen a lot of patients. There are some that have truly inspired me with their courage and determination. I am seeing a patient now who had a brain tumor. The radiation and chemo treatments have taken a toll on his body and his mind. But he marches into our therapy sessions every week with no complaints. When I ask him how he is doing, he always smiles and says "I'm happy to have another day!"

But, I really wanted to post on another patient I saw today. A 90 year old woman who had a stroke a few days back. I was asked to see her for a speech evaluation. I went over her chart, reviewing her history and physical, read the doctor's notes, the physical therapist's notes, the nursing notes and so on. The MD reported the pt was quite aphasic, meaning she was having trouble understanding and verbalizing. The PT notes indicated she wasn't walking and couldn't follow commands. The RN charted the pt was not able to eat, had a nasal gastric tube for nutritional support and was essentially non verbal.

I wasn't expecting her to be able to do too much. It seemed like a pretty routine evaluation.

She did respond to a few one step commands appropriately. She was not able to answer simple yes/no questions, And even though she was trying to talk to me, her speech was garbled and completely unintelligible. I pulled out my speech therapy bag of tricks. I tried to get her to sing with me in unison. I tried having her count 1 to 5 in imitation. I tried getting her to imitate simple greetings like "hi" and "bye". We tried imitating simple vowels and syllables. Nothing worked. I mean nothing.
That didn't stop her from smiling at me and laughing with each new task I presented to her. She continued to try to get me to understand her. Each mumbled sentence punctuated with a wave of her hand and a little giggle.

When I felt I had gathered all of the information needed to write up my report, I got up to say goodbye. She shook my outstretched hand as I told her it had been really nice meeting her. I thanked her for her time and was halfway out the door when I heard her reply, "You bet." Clearly.

I turned around to see her getting teary as she realized I had finally understood her. As she reached out for my hand again, I also came to a realization. I should never think of any of these encounters as routine.