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. ♥

351st Bomb Group

One of the great things about my job is I get to talk (duh!) to my patients and get to know them and life and history!  I always ask where they were born, where they grew up, and I ask them what they did during the War.

One of my patients who currently lives really close to me grew up in Dayton, Ohio!  He didn't recognize the family name, and I guess he lived there later than our family members anyway.  I got to talking about the war, and I asked how he served.

"I was a navigator in a B-17," he asnwered.

"Really?  What bomb group were you in?" 

"The 351st."

Cool!  So, we talked a little about the 351st.  I told him about Jack.  "He must've been a little guy," he noted.  That's the comment I get every time! 

Again, he didn't recognize the family name, but as he said, "It was a long time ago."  I got curious and decided to do a little research and found this site:  The 351st bomb group website.  If you do a search, you won't find Jack.  Search instead for the common misspelling.  There, you'll find his missions.  I've already contacted the person in charge and asked him to correct the spelling.

My patient was in Polebrook a few months before Jack.  His last mission was in August, 1944 and Jack began in October of that year.

Hats off to the Veterans!

One hundred and what?!

I was at a patient's house the other day to check on her swallowing.  Mrs. W is a lovely lady.  She didn't say much, but she did answer questions and followed directions appropriately.  I asked her how many kids she has. "Two," she said, as she looked off in the distance to remember, "but I think my daughter died. Yes, she died."

Her swallowing was pretty good, and I chatted a bit with her husband and their caregiver.  One of the things I do during my evaluation is to see the person's mouth and teeth.  I routinely give a lecture about oral hygiene.  Mrs. W didn't need much of a lecture.  Her teeth were in great shape!  The caregiver said, "Ask Mr. W to see his teeth.... he keeps them in his shirt pocket!"  I had to laugh, and I told her about Jack.

I had been in a bit of a rush that day, and I had gone into the house without looking closely at my facesheet.  As I left the house, I thought to myself, "Gee, that lady seemed pretty old.  I wonder how old she is."  I picked up the facesheet.  Her year of birth:  1902.

"1902!" I thought.  "Wow, she is old.  She is 98!"  Wait a tick.  "1902?!  Wait.... Does that say 1902 or 1920?"  Hold on one minute....I had trouble processing this.   1902.  This lady is 108 years old!  One hundred and eight!  My oldest patient ever!

I'm always amazed at the centenarians.  They are always in great shape.  In the occasional instances that I am referred to visit one, I am very rarely needed to do any intervention.  Some people just have amazing genes. 

Knock on wood.

I'll take "Tarts" for three dollars, please, Alex.

per·sev·er·a·tion  (pr-sv-rshn) n. 1. Psychology a. Uncontrollable repetition of a particular response, such as a word, phrase, or gesture, despite the absence or cessation of a stimulus, usually caused by brain injury or other organic disorder. b. The tendency to continue or repeat an act or activity after the cessation of the original stimulus. 2. The act or an instance of persevering; perseverance. Perseveration is a common occurrance after a stroke, and I often see it in speech therapy sessions. Today I was working with a 90-something-year-old retired physician who has expressive language difficulties after a stroke.  I was having him formulate sentences with a given word.  He was tending to perseverate despite my cues to try to vary his responses.  Some of his sentences were: using hummingbird:  "The hummingbird ate the cake." using camera:  "The camera photographs the bird." using basketball: "The basketball photographed the cake." At that point I stopped him and pointed out that he was using some of the same words and the last sentence didn't make sense. So we went along and sentences seemed to be better, until the following: Me:  "Make a sentence using dollar."   Dr. S: "It's only a three-dollar doll."  Me:  "How 'bout using tart."  Dr. S: "She's a three-dollar tart." Luckily, he has macular degeneration so he couldn't see the shuddering as I tried to stifle my giggles. I love my job!

Rattlesnake Canyon Trail Clean-Up

I've taken you with me on several hikes up Rattlesnake Canyon.  A few weeks ago, I had the opportunity to go do some trail work with some other folks from the Visiting Nurse and Hospice Care, for whom I've been doing more work lately.  One of the physical therapists there is a trail crew leader, certified by the National Forest Service.  He put the call out for volunteers to help, and of course I jumped at the chance to work on one of my favorite trails.

The Tea Fire and the Jesusita Fire had both burned the area, and the trails bear a lot of the fire's effects, from greater erosion to overgrowth with the heavy rains after the fires.  We mostly tackled the overgrowth.  Dave picked out a few sections for us to work on and set us to work hacking away the growth so that the trail was more usable.

It was a beautiful evening, perfect for a hike and a little elbow grease.  After we signed the necessary acknowledgments, Dave showed us how to use the heavy hand tools. We donned helmets and gloves and started up.

Here we are at the trailhead.  Ready to get to work!

Hiking up:

Getting to work!

Izzy tossing the debris into the bushes.

A "before" picture.  The trail was really crowded by overgrowth, mostly wild mustard.

 

And "after" -- wow, good work, people!

 

The reward!  Enjoying the view after the hard work.

Another "before" picture:

And after, it was a more enjoyable trail to hike.

I learned a lot about trail maintenence in general.  Dave was a good guide, showing us where other maintenence was needed like making new berms or re-forming berms to guide the water off the trail. 

The following weekend I hiked up the trail again, and I was really proud when I came to "our" sections.  I felt a real sense of ownership!  Neat!  I told Dave I'm ready for the next one anytime.  It was a lot of fun!

Here's to a good few hours' work!  Cheers!

Mr. Z

There is a lovely, pleasantly demented man at one of my nursing homes.  He was born in October of 1905.  Yep, that makes him 104 ½ years old!

I went in to check his swallowing (doing pretty well, all things considered) and got to chat with him a bit.  He proudly told me about his coaching years, being an All-American football star at USC, owning half the land in Santa Barbara ("I'm a very wealthy man!") and that he has a building named after him at USC.  I hope when I'm 104, I will have had such a wonderful life, at least in my own mind.... none of this is true! 

After hearing about his accolades, I asked him how old he is.  He dropped his voice to a conspiratorial tone.  "I'm not supposed to tell you," he whispered.  "I'm looking for a girlfriend."

He told me, though, that the doctors have said he has another ten good years left.

Yay for oldsters!

Back from the Big Easy

I had a really good time at the ASHA Convention in New Orleans! My brain got full!

Thursday I concentrated on aphasia during my sessions, while Friday was more of a dysphagia kind of day. I packed the sessions back-to-back and really got a lot of good learning in. I also walked miles and miles! The Ernest M. Morial Convention Center is long. Very long. It seemed that each class was at the opposite end of the facility from the other.

I decided to let Saturday be a little bit lighter, so I only did 3 hours of sessions plus some poster sessions, and I visited the vendor booths. I got to see my favorite grad school professor at her poster. I had prepared myself for an older woman (it's been over 20 years!), but she looked great. It was good to see her; she had really inspired me.

I ate as much Cajun food as I could, and ate some wonderful beignets from Cafe du Monde. Good stuff!

I didn't have a lot of time for sight-seeing. The closing party was held at Mardi Gras World, where they build the floats. Here are some pictures from there. (Note that my pictures are in a different format. Clicking them will enlarge, and clicking that image will enlarge again.)

Between my hotel and the French Quarter there is a nice walkway by the river. Along the way, I got to stop and contemplate with Yaacov Agam's Holocaust Memorial. Mike enjoys his Agam piece that he acquired on one of our cruises. Agam's work is--literally--dynamic. Here are a few photos of the sculpture. You can see more photographs and an explanation here.








On Sunday I had some time before my flight, so I wandered through the French Market and then did a walking tour of the French Quarter. Cool architecture.

The Saint Louis Cathedral

Cornstalk Fence surrounding the Cornstalk Hotel

Someone's balcony decked out for the holidays.

The Eighth District Police Station.

I didn't get a chance to explore the cemeteries, nor did I go to the many museums of the area. The insect museum was tempting. Next time!

Some notes about NOLA:

• Apparently people there drink a lot of soda. Tea, hot and iced, was non-existent. Booze was not non-existent.
  
• The people are friendly, but they seem gruff at first. Then you'll get a joke, a smile, or a big thank you.
• They hose down the streets in the French Quarter every morning. Yuk!
• I saw no evidence of Katrina in the parts I visited and was driven through. I remember the news reports saying that the French Quarter was at higher elevation than most of the city, so I guess that helped to spare it.
• I want to go back, because there is a lot more to see and to do!

The Big Easy

In 10 days I'll be heading to the City of New Orleans for the annual American Speech-Language-Hearing Association convention. I'm looking forward to learning a lot and experiencing a new city!

Do you have any recommendation for me while I'm there?

No More Grocery Guy

Kevin quit his job at Vons. He decided he wanted to do other things with his summer. I'm sad. He's not.

Grocery Guy

Kevin now works at Vons! Come visit and maybe he'll bag your groceries and help you to the car!

Take Me Home!

I was at the nurses' station yesterday and I overheard:

"I want to go home! There is no one to take me home."
(pause)
"I'll take you home."
"OK."
(pause)
"When care you going to take me home?"
"Now."
"OK."


Ah, Mrs. B! I suppose it is good to be your own best friend.

Keep your thumb inside!

I was walking down the hall at one of the skilled nursing facilities that I work at, and I heard one of the elderly ladies sitting in a wheelchair talking to a gentlemen, sitting in his wheelchair.

"No, no! Keep your thumb inside! Keep it in!"

Curious, I turned to look. She held up her hand to demonstrate. "You tuck your thumb inside here, like this," she explained. "See, that way, when you punch someone in the face, you don't break your thumb!"