I'd like You to Meet "Aphasia"

Aphasia affects around a quarter of all stroke sufferers, and means they experience problems with speaking or understanding what is said to them, or both. As a result, even the simplest daily tasks, such as shopping or making a phone call, may be difficult or impossible.

My new husband, Bruce, often uses the term "I can't read and write like I used to" whenever he can't say what he wants to say. Generally, the misunderstanding or miscommunication has absolutely nothing to do with reading and writing. In speaking, it means he cannot put words to cognitive thought. When listening, it means he cannot generate a cognitive thought from the words he is hearing. This is a simplified explanation of living with aphasia. (I should emphasize that he cannot read or write like he used to. He has yet to achieve even a first grade reading level.)

Aphasia makes it difficult to read, write, speak, or understand speech. It impairs language comprehension and expression. It often doesn't affect "thinking" and "intelligence", only language. It's as though the sufferer is suddenly in a foreign-speaking country.

When I met Bruce, nearly six years ago, he had recovered a minimally functioning vocabulary at best. He had gone through about four years of speech therapy and had spent about two years without additional help. I was working as a Pharmacy Technician when I first encountered this man - the angriest, most stressful and uncooperative customer I had ever met. He suffered obviously from both physical and speech impairment. His right arm was drawn up close to his chest in nearly a seizure posture. He walked with a limp that was very pronounced and made his progress to the counter very slow. His face was contorted in anger and frustration, with tightly squinted eyebrows and a wizened brow. The other employees ran when they saw him coming. This was my first encounter. They hid and watched.

Some stroke survivors find that their speech or understanding improves spontaneously, but many more face an uphill struggle, and some never recover, even with therapy. Nobody knows why some people make progress and some people do not. There are no drugs to improve the chances of recovery, and no one knows if current speech therapy techniques actually work, or, if they do, why.

With traditional cheerfulness, I greeted this new customer.

"Hi! Can I help you?"

"Name's Cohen. Bruce A. Cohen"

"How can I help you, Mr. Cohen"

"I am not Mr. Cohen. My father is Mr. Cohen. I am Bruce Allen Cohen."

"I'm sorry, Bruce. What can I do for you?"

"You have my medicine."

His speech was stern, emphatic and measured. It rang with an overtone of disgust or impatience. Aphasia is a disorder that results from damage to language centers of the brain. Language is affected not only in its oral form of talking and understanding but also in its written form of reading and writing. Typically, reading and writing are more impaired than oral communication. The nature of the problems vary from person to person depending on many factors but most importantly on the amount and location of the damage to the brain.

I fetched the grumpy customer's medication bag. I placed the signature stickers on the page where we had customers sign for their medications. He grabbed the signature board as soon as I had set the last sticker in place and began to write his name. The struggle was obvious as his hand held the pen with the grip of a toddler. The stroke of the pen was stilted and shaking, the ink grinding into the paper as he painstakingly drew the vertical line of the letter "B". Each successive marking was tediously slow. The pharmacy rules were such that a signature was to be requested for every medication dispensed. I was in for the long haul. A line of disgruntled and hurried customers began to form behind him.

Feelings of frustration at the inability to communicate can lead to anger and depression. Persons with aphasia may tire easily and show extreme emotional fluctuations and inappropriate emotions

"Mr. Cohen? Excuse me. I'm sorry. Bruce, it's O.K. You don't need to finish. I'm sure that the requirement can be waived."

"Everyone does this. I can do this. I WANT to do THIS."

He was now yelling at me.

I allowed him to continue until he had signed for every medication. A cashier had been paged to assist with the impatient customers behind him. When he had finished his task, he shoved the clipboard back towards me across the counter without any expression of self-satisfaction crossing his face.

To strangers, aphasic symptoms can appear as impaired intelligence, but what they are observing is that people with aphasia have trouble expressing ideas through spoken and written language.

He then proceeded to empty the contents of his bag on the counter, thoroughly investigating every bottle. He held up one of the bottles and demanded to know "what is this?"

"This is not my medicine!"

Struggling with as much patience as I could muster, using the most simplified language I could retrieve, I explained that the medicine was a new generic for his medication.

"I won't take it. This is not proper. This is not what my doctor gave me."

With that, he stormed from the store and my co-workers returned, each of them laughing at me as if they had played a marvelous practical joke. I did not comprehend what I had just witnessed. It wasn't until later, in the course of his visits, when I discovered this customer had suffered a stroke. I knew of strokes but knew nothing of aphasia until years later when we would find ourselves deliriously in love and learning to cope with each other.

Aphasia affects about 1 in 250 people making it more common that Parkinson's, cerebral palsy, or muscular dystrophy. It can make it difficult for a person to understand conversation, or difficult for a person to make others understand them, or a combination of both. Aphasia can be mild - hardly noticeable, or very severe affecting speaking, writing, reading and listening. Because aphasia affects communication, it often also affects a person's social life, sometimes causing them to become withdrawn and to feel socially isolated.

Stroke survivors tend to feel worse physically and mentally compared to people who have not had a stroke, according to a study published in Stroke: Journal of the American Heart Association. "Quality of life is an important dimension of disease today in addition to life and death," said Jipan Xie, M.D., Ph.D., lead author of the study. "This study points out that although the rate of deaths due to stroke has been decreasing in past years, health-related quality of life is consistently lower among stroke survivors compared to people who have not had a stroke."

(Recently published - Our First Date: Don't Fall Me Down)