Broca's Aphasia, a personal essay by John Malone

Why was Rosie the dog scratching at the closed bedroom door? Or, rather, why was the white, furry thing with the licking tongue and anxious, pawing feet trying to get into our dark bedroom? Because I did not really think of the word “dog.” Somehow I knew I had to open the door to stop the commotion outside. But why did getting up and opening the door require so much effort? I felt so heavy and weak, unsteady on my bare feet on the cold hardwood floor. I groped in the dark for the door handle for what seemed like a long time, fumbling first on the wrong edge of the door, the one attached to the hinges. Finally, my fingers closed around the cool, smooth metal, or were they my fingers? Was it a “handle?” The door opened, and Rosie came bounding into the room, jumping into our bed. She was frightened, I knew, but why? I climbed back into bed beside my sleeping wife, with Rosie in the middle between us. She began licking my face and exploring my body with her paws, as if trying to find something wrong.
Finally she calmed down, and we all went to sleep again. But I could not really sleep. Something was wrong with me, I knew. I couldn’t think straight. Every movement took a lot of concentration and effort, as if I were moving my body by remote control from a long way off. I began to panic. I got up again and went to the bathroom, only to discover that I had soiled myself. Take off clothes. Get in little glass room with water coming down. Clean myself. Back in bed. Try to sleep.

We were awake, and Christa was worried, I could tell. Or was she “Christa?” And who was I? Where were we? What day was it? I had no idea. Christa asked me if she should call 911. I couldn’t reply but simply nodded, tears forming in my eyes. I was scared. She helped me to dress and we went out to the front porch to await the EMS ambulance. Feeling unsteady on my feet, about to tip over, I practiced walking up and down and up and down the long porch while we waited, being very careful not to fall over the edge. Finally they arrived, a man and a woman, both large, strong, gentle people. He was “Michael,” he said, and he gave me an aspirin with his latex-encased fingers. He kept trying to get me to talk, but I couldn’t remember any words. The woman drove the ambulance while Michael wired me up to his computer and began talking on the radio to the new ER at Haywood Regional Medical Center. I guess Christa followed us there in her car, because there she was when we arrived there. I began to feel relieved.
But there was no neurologist at HRMC that day and none on call. I later learned that the hospital had an MRI machine, but no neurologist would be on duty until Friday, two days later, to read the images. The nurse started an IV and put me on oxygen. We waited for what seemed like hours while different people came in and either checked me or ignored me. Finally, a nice ER doctor in a white coat with “Dr. Kelley” embroidered on it in dark blue, showed up. Christa was talking to the doctor and calling people on her cell phone. I knew who they were, but I couldn’t think of their names. Someone asked me what my mother’s name was. I couldn’t say. I felt ashamed. Christa was crying. She asked me what color her eyes were. It was a memory test, but I cheated. I looked into her red-rimmed eyes and said, “They’re sort of pink!” She and I both laughed for the first time. She sat beside me and fed me pieces of my lunch from a white Styrofoam take-out box. A pork cutlet, mashed potatoes, gravy and corn with a soft roll. I chewed some gingerly, afraid at first to swallow. As we shared the lunch, I felt the nourishment and her love enter me, warming and strengthening me, easing my fear. Doctor Kelley returned. Good news. Another ambulance was coming soon to take me to Mission Hospital in Asheville.

As the ambulance bounced along I-40 East, the EMT, this time a woman, kept up a steady conversation, trying to engage me. I did the best I could to reply, but kept hitting blank spots. Did I know what day it was, what year? No. But a few names were slowly coming back to me, emerging from the fog in my brain. The children, my sisters. Lying on my back, I watched beautiful fall leaves, clouds and sunshine rolling by the ambulance windows while the woman kept talking and checking my vital signs. It was a strange, blowing, blue and white sort of a day out there, promising some rain at last.

I arrived in room A-625 at the Stroke Unit on the sixth floor of Mission Hospital at 2:30 pm on Wednesday afternoon, November 14, 2007. I only know this now because it was printed on the ID bracelet attached to my wrist for two days. Christa came a little later, as did Dr. Alex Schneider, Director of Mission’s neurological services. Yes, I could have an MRI, and Dr. Schneider would read it, but the busy machine would not be available until late that night or the small hours of Thursday morning. No, I could not have a glass of water or anything else by mouth until the busy speech therapist could come and watch me swallow, maybe later in the evening. The doctor began a full neurological workup. Penlight shining into my pupils, switching up and down, side to side. More questions with no answers. Squeezing the doctor’s fingers. Pushing against his hands. Touching the end of my nose with my eyes closed. Another IV. A wireless heart monitor stuffed into the breast pocket of my hospital gown. Blood pressure 145 over 96, too high. Risk of another stroke. While all this was going on, I was still struggling to speak, to remember, anything. Did I know where I was? Painfully, I made another effort to speak. Mission Hospital? Yes! Christa smiled at the doctor. He smiled back and patted me on the shoulder.

Evening descended, and Christa, satisfied that I was finally in good hands and receiving the attention and care I needed, went back to Waynesville to feed the cats and walk the dog. The orange street lights of Asheville winked on outside the big window, which spread across the entire outside wall of my room. Strange, big sausage-shaped clouds scudded across the sky, hanging dark and low above Haywood Street on the horizon. I couldn’t have said in what direction I was looking, but the eeriness of the fast-moving storm clouds and the twinkling lights framing Asheville’s skyline mesmerized me. A nurse entered the room to take my vital signs again and offered to close the drapes. But I wanted them open, not really knowing where I was but fascinated by the tableau created by the winking lights and their reflection in the low-hanging clouds. As I lay there attached to the IV drip, it was like looking at a version of El Greco’s “Storm over Toledo” with bright orange street lights added. Finally, I slept.

The night nurse switched on the light. Time to go down for my MRI. But what time? Where? How to get there? Christa had taken my watch, along with my keys and wallet, but there was a large clock on the wall, showing that it was almost five o’clock in the morning. I had only slept an hour or two. A husky young man pushed a Gurney into the room as the nurse disconnected my IV. Then I awkwardly slid myself onto the Gurney for the ride down to the first floor. Two different elevators were required to make the transfer, first from six to three, then from three to one. Finally we arrived in the MRI suite, a chilly, humming place two floors below ground level with heavy metal doors, its walls plastered with high voltage warning signs. A cheerful young woman gleefully informed me that I was about to hear noises like I never heard before. She helped me move from the Gurney to a long metal tray a bit like the ones they use to load the big shells into the eighteen inch guns of a battleship. She strapped me down tight, put plugs in both my ears and encased my head firmly in some kind of helmet that reminded me of the thing they use to execute murderers down in Florida, whatever it’s called. Then she gave me a little rubber squeeze bulb on the end of a wire.. “If you have any problems, just squeeze this bulb, and I’ll stop the scan.”
For the next thirty minutes, in spite of the ear plugs, I was bombarded with bumps, grinds and various loud noises while my tray moved slowly in and out of a smooth white tunnel just large enough to hold my shivering body. I was afraid to squeeze the little bulb for fear that it would fire me out of the tunnel like the man fired from a cannon in the circus or eject me like the pilot of a jet fighter. I could just see the top of the woman’s head in a kind of rear-view mirror in my headgear. She was sitting inside a sound-proof control booth at a safe distance from the magnetic monster that held me in its clutches. Then, after the longest half hour of my long life, it was over, and I was gratefully on my way back to my room on the sixth floor.

My new day nurse, on whom I developed an instant crush, told me her name was Heather. She was tall and slender, graceful in her sneakers, micro-fiber slacks and sweater, with a ponytail and a little pair of granny glasses perched on her long, straight nose. Not really pretty, but very attractive. I noticed the little diamond solitaire on the third finger of her left hand. I was definitely returning to my normal girl-watching mode, a good sign of health.
In spite of the IV, I felt hungry for breakfast. Heather’s orders were “NPO” until the speech therapist could come and watch me successfully swallow a cup of water, and the speech therapist was seeing patients across Biltmore Avenue at St. Joseph’s – no telling when she would return to Mission. But a student physical therapist, a petite, child-like slip of a girl named Antoinette with a heart-shaped face and blond hair done up in a tight, businesslike bun, did arrive with her trainer. He was a tall, skinny, balding, dark-haired, fiftyish man with a Slavic accent, Russian maybe. He cracked a lot of jokes, hospital humor, I thought, to help little Antoinette relax. They invited me to go for a walk with them after first making sure I could stand on my own. No problem, I was way ahead of them. Of course, I was bent on impressing pretty little Antoinette with my manly strength and vigor. Antoinette insisted on putting a thick web belt around my middle so she could hold me upright and keep me from falling. I didn’t say anything, but, as I towered over the child, I mentally compared my two-hundred-plus pounds with her one-hundred-minus and resolved not to fall on top of her. We walked one lap around the sixth-floor corridor and then found an exit staircase for the grand finale, one flight of stairs unassisted, down and up. Then I was declared fit to navigate on my own, and my brief relationship with Antoinette and the Russian ended, just as Christa appeared outside my room, giving me a big hug and a kiss and recapturing my heart from the hospital sirens.

When the speech therapist finally showed up, a woman with shiny, perfect teeth (capped?) we went through the same rigmarole as the day before: Did I know where I was? Yes, I had that one taped. What was the date? Oops, the date had gone and changed on me since the last time. I failed that one. Open wide and say aah. The penlight shining in my eyes again. Then came tongue exercises, which I really got into, imagining myself grimacing like a Maori warrior while my eyes bulged and my tongue protruded, way out, down, up, left and right. And on and on. What finally emerged from her sounded like a sales pitch for me to come in to Mission Hospital all the way from Waynesville for speech therapy sessions after my discharge. No thanks, I’ll see how I do on my own. Somewhat grudgingly, I thought, she gave Heather permission to feed me before she left to find her next sales prospect.

The hours dragged by slowly after Christa left me that afternoon. I spent most of the time staring at the damned clock on the wall or looking out the window at the rain. Heather gave me a thick “Stroke Education Packet” and encouraged me to study it. Reading was tough at first but gradually got easier with practice. I learned a lot about what had happened to me. According to the doctor, it was probably a “TIA,” which stands for “transient ischemic attack,” a kind of mini-stroke. I already knew something about those. My father had gone through a whole series of them before he died at eighty-eight in a “memory unit” down in Florida, finally unable to recognize his wife. Bad news for me, but it could have been worse. My TIA had affected only the left hemisphere of my brain, including the speech and language center, “Broca’s brain.” A blood clot, formed along the lining of my left carotid artery, had broken off sometime while I was asleep on Tuesday night and traveled up to my brain, blocking the blood flow and causing the symptoms I had. Later the tiny clot had dissolved, blood had flowed again, and – thank God – my symptoms were slowly disappearing. As I rode home from the hospital with Christa on Friday, I was cautiously happy. The storm clouds had disappeared daring the night, and fall colors vibrated in the bright afternoon sunlight, the leaves holding tenaciously to the hardwood trees following the long drought. I felt as if we were floating a few feet above the highway, buoyed up by relief.

I still had a slight touch of “Broca’s Aphasia” – knowing what I wanted to say but unable to find the words, very frustrating for a writer – but after a few days, I fortunately returned to what I had been before the stroke, an average, absent-minded seventy-two-year-old, no better and no worse, just a little bit older and wiser. My MRI showed no permanent brain damage and my cardiology workup was normal. My blood pressure was on the high side and I needed medication for that: a coated adult aspirin and a five milligram ACE inhibitor each morning. I was now somewhat more at risk for having a full stroke. I should not drive a car until my primary care doctor approved it. But, otherwise, I was fine, thank you. Just fine. (And, best of all, I could still write!)