You are precious, Rachel.

I've been working with a sweet, sweet man. Mr. L had a stroke, and was quite impaired in both his language comprehension and his expression.  I had worked with him a couple weeks before he suffered a second stroke. While he was in the hospital, they discovered he has lung cancer. He's on Hospice now.

His wife, also a sweet, sweet person, wanted me to come back and work with him. Of course, a patient on Hospice isn't expected to be rehabilitatable, so my role will be limited. But I hope that I can offer some suggestions on communication to his family.

I saw him today for the first time since he came home from the hospital on Hospice. His expressive language is marked by both semantic and phonemic paraphasias. A semantic paraphasia is substituting a word that means something similar, like substituting "table" for "chair." Phonemic paraphasias are sound-alike words. For example, he named "coffee table" as "taco bell."  Some of the same sounds, a little mixed up.  He'll also use neologisms, where anything goes. His comprehension is even worse now, so communicating is very difficult. He'll say things that just don't make sense, but he doesn't understand that he doesn't make sense. Of course, question-and-answer to try to discern his meaning doesn't work well. Occasionally, he can say something "right."  His daughter said he can still tell his wife how beautiful she is. They recently celebrated their 65th anniversary!

He is depressed and quite discouraged, but still very sweet.

My favorite mix-up today was i showed him a line drawing of one of these:

I asked him to name it and he said, "Shoe Flight."  It touched my heart, and I shared the origin of my nickname with his daughter. I got the nickname "Shoe" when I was learning to say new words. When my dad tried to teach me the name of that thing, I said, "Shoe Ball!"

Anyway, one thing he was consistent about: he kept calling me Rachel!  At least three times he called me Rachel as plain as could be.  I asked his daughter, any Rachels in the family? Nope, no idea where he got that.

He was grateful for my attempts to help, but he kept calling himself "Stupid." I told him that I don't like that word and it isn't allowed.  At the end of the session as I said my goodbye and gave him a hug, he came out perfectly with, "You are precious."  I'll keep that in my heart. ♥