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I will get a stroke…did I?

Olga Mištecká
Language: English
Country: Slovakia
Typology: health care professionals
Text:
Adam is in a hospital and does not understand what happened. Yesterday morning he woke up besides his wife, as usual got up and went to the bathroom. He walked with difficulties and was losing balance. He looked up in a mirror but was not recognizing his face. He wanted to call his wife but he could not speak a word. His inner voice was yelling already: “Come here, something happened…” but no voice was coming out of his mouth. He returned, sat down on a bed and waited. When his wife woke up for work and Adam did not respond to her morning kiss neither to a question of what happened, she noticed something was not right. Mr. Adam is 49 years old, he is employed as a professional driver at an international transport company. He lives with his wife, they do not have children. He gets up to the work, lives active life with his wife and friends. Since his three siblings with families and his parents live in his home country he is building a house and a garden there for vacations and lately for retirement. Adam was born in a different country than he lives in so he uses his native language only when he gets home for a vacation. He speaks language of a country he lives in well and he has been using it for 13 years. His wife speaks both languages, but now she does not understand him. When he tries to say something she can only hear some meaningless sounds, a verbal mix. The more he tries the more he feels uncomfortable. Adam is the type of a person who always did things by himself. As a 20 year old he went for a work to a different country and he succeeded. He was the one who was usually dealing with official things in the family. He was interested in computers and his hobby was building them. And now he is desperately looking at a nurse who explains to him that they will try to stand up together and get to the shower. He wanted to tell her he is confused but again only some meaningless sound gets out of his mouth. The nurse takes him under her arm and by a movement indicates him to stand up. He is barefooted so the nurse offers him slippers. Adam looks helplessly and does not know what the nurse wants from him. The nurse puts slippers at the front of his legs and indicates him to take them on. It takes a while for them to understand each other. Get to the shower at a ward, not fall, taking off his pajamas, agree on the appropriate temperature of the water, take shower, moisturize and then dress up again and get to his bed is a complicated puzzle for him in which he does not understand what will be coming next. He barely understands words and gestures of the nurse. When the nurse wants him to take his pajamas off, he looks at her hotly as if he tried to tell her why would he take off his clothes in front of a strange person. He protects his genitals and he is angry. When the nurse asks him whether the temperature of water is right he answers by nodding his head and by syllable ta, but immediately he boggles and it is obvious that the temperature is not appropriate, but it is not clear whether he needs warmer or cooler water. While the nurse is changing the temperature of water she observes nonverbal reactions of Adam and when it seems that Adam feels comfortable she asks him again. Adam nods and answers TA. She asks him again and answers instead of him YES. She looks at him and repeats the question and answer until Adam repeats YES. Similarly she lets him to choose a shirt he wants from two clean shirts. Adam’s face brightens a bit and he starts to realize that they slowly understand each other. During next days all nurses who come to Adam use the same way of communication and also rehearse with him repeating of meaningful words. After a week Adam can distinguish YES and NO. He knows how to answer the question: “Is it alright?” With better ability to communicate his mood improves. He looks forward to visits of his wife and friends who also learned the way of communication with him. That is how each interpersonal contact becomes part of rehabilitation of his speech and invigorates his linguistic memory. When Adam is released from hospital he can go to the toilet on his own and can perform self-serviced activities even though sometimes he looks helplessly at food and he does not know what to do with cutlery. Nurses always repeat the procedure of nonverbal communication and let Adam to repeat the words. Adam can express simple needs as drink or cold and always when he is angry that things are not going the way he wants nurses and relatives can calm him down and try with him again. Adam is progressing week by week. He goes to specialized spas when released from hospital. OBJECTIVES: Adam can manage to communicate after a sudden stroke, he can overcome its consequences and is ready for a long term rehabilitation. MEANS AND STRATEGY: The nurse visits Adam daily, creates therapeutic coalition, patiently looks for and creates new forms to help Adam with verbalization. Drawings, facial expressions, mime and foreign language mix in Adam’s speech now. Every day she writes even the smallest of Adam’s progress and reminds it to him on purpose. She also trains in creative communication Adam’s wife who is coming for her daily visits. The nurse uses all preserved resources available. CONCLUSIONS: Adam understands that recovery will take longer. He gets mad much less when he cannot express himself, he sees it more as a game now. He tries to win over the stroke consequences. He can communicate much better. However, he does not understand written texts at all yet.


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