My day as a speech pathologist began like any other. I reviewed charts, completed two bedside evaluations, and was headed to the intensive care unit (ICU) when my phone rang. It was my mother. “I think Carolyn is having a stroke. She can't talk. We're on our way to the hospital.” Numbly, I told her I'd be there as soon as I could.
A thousand thoughts raced through my mind during that three-hour trip to New York City from Saratoga Springs. How could my 26-year-old sister be having a stroke? For the past seven years I've worked in acute care and rehabilitation. I knew it could happen to a 26-year-old. But my sister? My tall, athletic, insanely smart sister? My opinionated, feisty best friend who joked that she would even argue with the pope? I couldn't wrap my head around that.
When I arrived at the hospital, Carolyn was in the ICU after undergoing tests. (We would later learn that her stroke was caused by a blood clot.) She smiled when I walked into her room, but she didn't respond when I said hello. Nor could she answer any questions. When I asked her to write her name, she drew circles and smiled instead. For the next three days she couldn't communicate at all.
On day four, she said a few words here and there. She could intermittently name an object in the room. When my fiancé walked in to see her, she smiled and said, “Ollie,” which is the name of our dog. I was thrilled. She knew who he was and had just proved it. She just pulled the wrong word out of the right filing cabinet.
I often use the filing cabinet analogy to explain aphasia, the inability to understand or express language. We spend our lives organizing words into filing cabinets in our brains. In the food file, for example, we have folders for fruit, vegetables, meat, dairy, and so on. When the language center of the brain is affected by a stroke, the filing cabinets open and empty. As the brain tries to put the words back into the cabinets, some end up in the wrong place. In Carolyn's case, when I'd show her pictures of places she'd lived or traveled to and ask her to identify them, she would often misname objects or places. For example, when I showed her a picture of the Eiffel Tower, she called it the Statue of Liberty. She laughed, then said Paris. With some help from me, she was finally able to name the Eiffel Tower.
When she was ready, Carolyn was transferred to an acute rehabilitation hospital, where she received one hour each of physical, occupational, and speech therapy daily. As much as I wanted to work with her constantly, I knew she needed rest to let her brain heal. By the time she was discharged, Carolyn could walk and dress independently and express her wants and needs. She was still forgetting or substituting words, and she had trouble following a conversation, but her progress was noticeable.
Once home, the real adjustment began. Before the stroke, Carolyn was an accomplished professional. Now she couldn't climb stairs, shower, or make a sandwich on her own. Almost a year later, she still receives outpatient physical, occupational, and speech therapy, but she works a few hours a week.
Our family's experience has helped me appreciate the full ramifications of a stroke and how much life changes for patients and their families. It also has made me more empathetic—I see a bit of Carolyn in every aphasia patient—and more attuned to the challenges of the recovery process.
And Carolyn and I are closer than ever. We're more open and honest. She appreciates my expertise and knows I understand her daily frustrations better than anyone and am here to help her through whatever lies ahead.
Christina Damo is a speech-language pathologist at an acute care hospital in upstate New York. She lives in Saratoga Springs, where she trains for triathlons and spends time with her family, friends, and dog.