Finding the Words

Title page-2

Ten o’clock found him donning the required white lab coat for his trip to the ninth floor of the main hospital. As he walked past the nurse’s station, a nurse looked up.

“Hi Ryan,” she said with a smile. “Here to see Mr. Thompson?”

“Yes,” Ryan replied, returning the smile.

“Well, he’s in 346. Dr. Newman is there with the family explaining things. If you get in there quick you can get credit for another miracle if the edema goes down.”

“That’s me, Annie Sullivan, Miracle Worker,” he quipped. He thought about the number of times he had been present when a patient with stroke, closed head injury or other head trauma began to spontaneously recover language as a result of reduced brain swelling. The families who witnessed these ‘miraculous’ recoveries often gave him the credit for it and heaped praise on him. It had become a hospital in-joke.

Ryan stopped at the open door to the room. He looked in and saw Dr. Newman, a woman and two teenagers. Evidently becoming aware of Ryan’s presence, the woman looked over to him. Dr. Newman followed her gaze and turned around.

“Ah, Mr. Phillips.” Dr. Newman turned to him and Ryan stepped forward. As he did, he looked beyond the group and saw the form of a man lying on the bed. His head was bandaged, an I.V. dripped into his arm and the heart monitor gave a steady beep, beep. His chest rose and fell regularly. Even at a distance, Ryan could see the man had a rugged, attractive look to him. Ryan felt himself stir in his Calvins. He couldn’t deny, despite his vow to swear off relationships which had, up to that point, only left him wounded, he still could respond to the sight of a nice-looking man.

“Mr. Phillips is one of our speech pathologists. I have asked him to evaluate your husband…”

“Ex-husband,” Mrs. Thompson corrected tersely.

“Yes, excuse me,” the doctor apologized. “Your ex-husband. Ryan,” he said, turning to him. “I was just beginning to explain what was going on with Mr. Thompson to his ex-wife and their sons, Connor and Todd.”

The young men came forward and shook hands with Ryan. Ryan judged them to be in their early to mid teens. Both were handsome. Both were clearly concerned about their father.

Facing the family again, Dr. Newman said, “Arteriovenous Anomalies are not highly unusual. They occur when an artery and vein join with few or no capillaries between them. Many people have them and live their whole life without knowing it. In some cases, as with your…ah…Mr. Thompson, they rupture and can cause damage to the surrounding tissue. Unfortunately, in his case, the anomaly was in the area of the brain that controls language and motor function.”

He paused, seeming to want to make sure Mrs. Thompson and the boys were following him. They appeared to be, so he continued.

“We went in surgically to tie off the artery to stop any further bleeding. We cauterized the vein. We did this to prevent as much damage to the brain as we could. The surgery was successful in that we accomplished this.”

“It sounds like there’s a ‘but’ in there somewhere,” said the young man Ryan thought was named Connor.

“Well, yes there is,” the doctor continued. “Whenever these ruptures occur in this area, there’s always the possibility of language and motor function loss. Right now he is in a state of post-operative trauma. His brain and the surrounding tissue are swollen. As the swelling goes down, we will monitor his condition and determine how much function can be regained.”

“Are you saying he may not recover completely?” the ex-wife asked.

“Yes. But I’m not saying he won’t recover fully, either. In cases such as these, there is a wide range of prognosis. We will be better able to assess the eventual outcome in a few days.”

“How long will he be hospitalized? And will he need long-term care if the recovery isn’t complete?”

Something about the way the ex-wife asked these questions raised a pink flag in Ryan’s mind. He had a brief inkling of why they might have divorced.

“Both of those questions will be better answered in a day or so. That’s one of the reasons I asked Mr. Phillips to come down and make an initial assessment. By comparing assessments over a period of time, we can ascertain the rapidity of recovery and project a more accurate outcome. I’ve asked someone from physical therapy to do the same later today.”

Dr. Newman looked from one family member to another. Ryan knew he was waiting to see if there were further questions. When none were forthcoming, the doctor turned to the therapist.

“Ryan, Mr. Thompson regained consciousness an hour ago. At that time he seemed disoriented and non responsive to verbal and tactile stimuli. He is asleep at the moment. I think it would be all right to try to wake him and see what you find.”

Ryan nodded. Dr. Newman turned again to the family. “If you have questions or concerns, please let me know.”

He shook hands with each of them and left the room. Ryan smiled at the family, who now looked to him for instructions.

“If you would step out of the room for a few minutes, I can start my evaluation. There is a family lounge down the hall.”

“And just why is it you want us to leave?” the ex-wife asked in a rather confrontational voice.

Ryan’s less than positive opinion of the woman deepened. “At this time, as the patient is just beginning to recover, the presence of family or friends can cause a patient to feel pressure to communicate. That sometimes makes it harder to accurately assess their current level of ability.”

“I see,” the woman said coldly.

“Come on, Mom. Let’s get out of the way and let the man do his job,” the taller of the two sons, whom Ryan remembered as Todd, said, taking her arm and steering her to the door.

The three Thompsons walked to the door. The two sons turned back and looked at their father. The ex-wife did not.

After they had left the room, Ryan stepped to the side of the bed. He carefully lowered the guard rail and looked at the man lying there. Once more, he thought him to be nice looking. But he had a professional reason for studying the man’s face. He wanted to see if there was any asymmetry as he lay relaxed and asleep. There was none. A good sign, he thought. Less chance of dysarthria.

He then took a tongue depressor from his lab coat pocket, peeled back the paper and lightly touched the corners of Mr. Thompson’s mouth. There was a slight twitch in response to the stimulation. He repeated the tactile probe in various places on the man’s face. Each time there was a response. Ryan nodded his approval: an improvement from Dr. Newman’s earlier assessment.

Ryan then placed his hand on Mr. Thompson’s shoulder. He gently shook him. “Mr. Thompson can you hear me? Mr. Thompson?” Ryan could feel a solid, well- developed muscle beneath the fabric of the hospital gown.

The man’s eyes fluttered; there was an increase in the steady beeping of the heart monitor. Ryan shook him gently again. This time he opened his eyes. At first they looked unfocused, but after a few seconds he blinked and began to look around the room. He found Ryan’s face and he looked up into his eyes.

God, he has beautiful eyes.

Ryan smiled. Mr. Thompson narrowed his eyes. He opened his mouth and ran his tongue over his lips. He made a soft moaning sound. Ryan made note of all this.

Ryan turned and picked up a cup and poured water from the pitcher on the bed table. He placed a straw in the water and held the cup to the man’s lips. He took a sip and swallowed.

Very good, Ryan thought. He has some basic reflexive function.

“Mr. Thompson, I’m Ryan, I’m a speech therapist. Do you know where you are?

The patient opened his mouth. Ryan watched to see if there was tongue movement as he tried to form a response. Mr. Thompson gave up and breathed through his nose and closed his eyes. Ryan placed his hand on his shoulder, again.

“That’s fine. It will get better. ow, try to shake your head or nod while I ask you some questions.”

Mr. Thompson blinked.

Ryan asked again if he knew where he was. This time Mr. Thompson shook his head slightly.

“You’re at University Hospital. You had surgery for a problem in your brain.”

The widening of the man’s eyes told Ryan he had understood. Ryan took his left hand and squeezed it reassuringly. The man returned the pressure.

“We’re taking good care of you. Your surgery was successful. You just need to rest and let some healing take place. Do you understand?”

Mr. Thompson nodded.

Ryan squeezed his patient’s hand again, then proceeded to ask a series of questions.

“Is your name David?”

Mr. Thompson minimally shook his head.

“Is your name André?”

He nodded.

“Are you twenty-six?”

Mr. Thompson treated Ryan to a slight smile and gave a soft snort through his nose.

“You wish?” Ryan asked.

Mr. Thompson nodded and gave a slight smile.

After a series of questions, Ryan began to ask the man to imitate simple sounds. He couldn’t and became mildly frustrated. Ryan assured him again that things would get better.

After about a half an hour, Ryan knew Mr. Thompson needed to rest.

“That’s about enough for today,” Ryan told the man. “You’re doing very well for just having had surgery.”

Mr. Thompson frowned slightly.

“I’m going to be working with you every day while you are here. Probably twice a day. How does that sound?”

Ryan received the biggest smile yet.

He took the man’s hand once more. “You get some rest. The physical therapist will be here later to see how well you are doing. Okay?”

Another nod.

Ryan started to remove his hand to leave. Mr. Thompson tightened his grip. Ryan stopped and looked down into the man’s face. A tear formed in the corner of his eye. He raised his head slightly off the pillow and nodded, his tongue against his upper lip. He blew a puff of air from his mouth.

“Thank you? Is that what you want to say?”

The man nodded again. Another tear rolled down his cheek.

Ryan took his hand with both of his. “You’re very welcome.”

Mr. Thompson nodded, lowered his head to the pillow and released Ryan’s hand.

This time it was Ryan who held on just a moment longer.