by JoAnn Durgin
“I see.” If any one or more of his bids were accepted, she had to wonder how soon he’d leave town. And how long he’d be gone. Not your concern, Vara. At the moment, her priority was to discuss how he could help Charlotte in the here and now.
“I realize this is a crucial time,” he said. “I want to be in Cherish as much as I can until I know she’s well on-the-road to recovery. Meaning I won’t bid on a project that could potentially take me out of the country. When I do accept my next assignment, I’ll try to fly home on weekends as much as possible.”
“That’s wonderful that you’re keeping her needs in mind, but please know Charlotte’s recovery could take an indeterminate amount of time—weeks, months, or even longer.” Vara kept her tone soft, her voice gentle. “We simply don’t know. Some patients make remarkable progress in a relatively short time, especially when they’re back in their normal home environment, but that’s not something we can predict with any degree of certainty.”
“I understand that,” he said. “This experience has been a personal wake-up call. Please know my grandmother’s health is the most important thing in the world to me. However, Charlotte would be the first person to tell you that she doesn’t want to keep me from continuing my work.”
“I don’t need promises, Thornton. What I need is your commitment to helping her as much as you’re able when you are here. I don’t mean to put unnecessary pressure on you, but family support can be one of the most effective components—if not the most important—in the recovery process.”
Sadness washed over his handsome features. “I know Charlotte considers Rosalinda her family, and I feel the same, but your point is taken. I’m sorry I wasn’t around when she was in the hospital. The fact of the matter is, I wasn’t made aware of her stroke because neither of those two scoundrels wanted me to know. I called several times, but when I checked in with Rose, she always had an excuse as to why my grandmother couldn’t come to the phone.”
He shook his head. “It probably should have bothered me more, and maybe I should have pressed to speak with Charlotte, but I trust Rose implicitly. She’s been housekeeper, cook, part-time nanny, driver, and an overall close loyal friend to my grandmother since not long after I was born. It never entered my mind to think they might be keeping something this important from me.”
Vara lowered her gaze, ashamed for her earlier thoughts. “I wasn’t aware you hadn’t been told, Thornton.” His explanation filled in some blanks. Also, based on what she’d learned at the coffee shop, he traveled extensively and had only returned home in the last few days.
She’d discussed Charlotte’s case with the two prior SLPs, as well as her doctor, and not one of them mentioned a grandson. From the beginning, Vara understood Rosalinda was Charlotte’s caregiver. However, even if she had known about Thornton, she wouldn’t have thought twice about his lack of involvement. Many family members preferred to leave such matters to trained professionals. In some cases, that was for the best. For now, she needed to keep the focus pinpointed on moving forward.
“I’m thankful I was able to wrap up my last assignment and come home earlier than expected,” Thornton said. “God’s timing, I’d say.”
“I think it was. I’m sure I don’t need to tell you how wonderful Rosalinda has been with her. Everyone should be so blessed as to have such a dear friend.”
He nodded. “It’s been a relief knowing she’s here for Charlotte. Not to sound ungrateful, but neither one of them are getting any younger. When I first arrived home and heard about the stroke, I’ll admit I was angry. I said a few things I shouldn’t and slammed a few things around. I’m not a violent person, but I was…perturbed. Actually, that’s an understatement.”
“I understand, given those circumstances,” Vara assured him. “No one wants to feel they’ve been excluded from the truth, especially when it concerns a loved one.” She hesitated, measuring her words carefully. “Not that I’m defending them, but I believe it’s possible the ladies thought that by not telling you, they were actually protecting you. They know how important your work is and didn’t want to worry you.”
Thornton looked away for a long moment before returning his gaze to hers. “What if she’d died in the hospital, Vara? What then?” He visibly swallowed. “If anything had happened to her, I’d always regret that I didn’t have closure.”
Vara met his gaze. There were certain things too personal even for her to ask. She had to remind herself she’d only met this man a short time ago. “That’s one of those what if questions none of us can answer.”
“I didn’t see my mother at the end of her life because I was being protected, and I was away when Dad passed.” Thornton stared at the fire, his lips set in a thin line. “Not that I’m blaming anyone for that, including God.”
She understood his pain. She’d seen this response quite often when stroke patients passed away. “Many people never get closure, unfortunately. What we need to do is focus on the facts and move forward. In this case, Charlotte survived the stroke, and our goal now is to help her recover as best she can.”
“Right. Sorry.” He pushed up straighter on the chair. “Let’s get started. I’m here now, and I want to help.” The seriousness of Thornton’s tone, combined with the concern etched into his features, reinforced the sincerity of his words.
“First of all, do you know much about what happens when a person suffers a stroke?”
“I’ve done some reading on the subject, but I’d like more specifics pertaining to my grandmother’s situation.”
“Of course. Let me give you some general information, but as part of that, I’ll update you on Charlotte’s case as we go. Is that all right?”
“Whatever you’d like. I’m all ears.”
“One of the first things to know is that speech and language are among the most complex of all human behaviors, and they’re involved with virtually every part of the central nervous system.”
“That makes sense, but it’s not something I’ve thought about before,” he said.
“You’re not alone. Most people don’t. A stroke is the fifth leading cause of death and disability in the U.S.,” she said. “Approximately 795,000 Americans suffer a new or recurrent stroke every year, and it kills more than 137,000 of them. On average, a stroke occurs every 40 seconds, and a stroke victim dies every four minutes.”
Thornton nodded. “The statistics I read said it’s one in every 18 deaths, but it’s 60/40 with more women dying from strokes than men.”
“That’s correct,” she said. “A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a blood clot or the vessel bursts. When either of those things happens, the brain can’t get the oxygen-rich blood it needs. As a result, brain cells begin to die quickly. Thankfully, in your grandmother’s case, Rosalinda recognized the signs and was able to call for help immediately when she noticed a change in her behavior.”
“I’m very grateful,” Thornton said. “Her stroke was considered ischemic, as I understand it. Am I pronouncing it correctly?”
Vara nodded, pleased. “It’s caused by a clot, and it’s the most common type of stroke, accounting for 87 percent of all cases. When a person suffers a stroke, it’s about so much more than the inability to communicate. There’s an almost immediate feeling of isolation that quickly becomes frustrating when the person realizes how dramatically their world has been altered. They’re suddenly living in a world without words.
“In Charlotte’s case—as with most stroke patients—she was understandably disoriented, confused, and worried. For a woman who’s always been in control, the loss of speech was terrifying. Some patients react by lashing out physically—flailing arms, spitting, biting, kicking, name-calling, and so on.”
Thornton’s brown eyes widened. “Please don’t tell me Charlotte spit on you.”
“No, but even if she had, I’m used to dealing with all kinds of reactions. Charlotte is definitely stronger than she looks.�
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He leaned forward, concern etched on his forehead. “She didn’t physically hurt you in any way, did she?”
“Not at all, Thornton. Please don’t worry. A diagnosis as soon after a stroke is imperative in order to start therapy quickly. One specific speech and language disorder following a stroke that occurs in more than a third of patients is called aphasia, which is impairment in the ability to use or comprehend words. Sometimes it can mean a partial or complete loss of speech, but it generally refers to comprehension issues—difficulty in understanding words, finding the right words to express a thought, and reading or writing words or sentences.”
“That’s not Charlotte’s diagnosis, is it?”
This man had done his homework. “It’s not, but I wanted you to be aware of aphasia in order to explain the difference between the two. Charlotte’s doctors diagnosed her with apraxia. In some ways, it’s a poorly understood neurological condition that’s often confused with aphasia, and the two conditions can often occur together. Apraxia is a condition where—even though there’s no paralysis or weakness of the speech muscles—the patient has difficulty initiating and executing voluntary movement patterns with her mouth and tongue. Which means it’s hard to produce the desired speech sounds or use the correct rhythm and rate of speaking.”
Thornton ran a hand over his brow. “I’ve seen how frustrated Charlotte gets, but I’m glad there’s no paralysis. So, your therapy approach is to help her relearn how to form and speak words and sentences?”
“Exactly,” Vara said. “She remembers the words and comprehension isn’t an issue. We’re focused on teaching Charlotte sound production. To do that, we’ve been working on a lot of word repetition. We’ve also used a metronome and finger snapping to keep time and practice the rhythm and pattern of words. I’ll be discussing alternative methods and activities today if you can stay for our meeting.”
“I plan on it,” Thornton said. “Can you tell me what to expect in terms of her recovery?”
“As long as she stays as healthy as possible, maintains a positive mental outlook, and continues her planned therapy, it’s possible for Charlotte to regain most, if not all, of her speech capabilities. But again, please keep in mind there’s no timetable, and the recovery rate can be unpredictable.”
He appeared visibly relieved. “I’ll remember, but overall, I’d say this is encouraging news.”
“Most definitely,” she agreed. “Rosalinda seems to fully understand the challenges during the post-stroke recovery process. Being a caregiver starts on day one after the stroke, but it’s never too late to join in, especially since you’re close to your grandmother and determined to help her.”
Thornton slapped a hand on his thigh. “You can count on me.”
Vara gave him a bright smile. “With the work I do, I always appreciate a spirit of optimism. I can’t tell you how good it is to hear you say that. We’re almost done here, but there are some other important considerations, and I’d like to make you aware of them.”
“Of course.”
“A stroke survivor isn’t alone in experiencing stress. As I mentioned, it’s a sudden and unexpected life change, and a major disruption of routine, but it’s not limited to the stroke victim. It’s completely normal for their families and caregivers to feel overwhelmed, upset, disappointed, or angry.”
She softened her tone. “Many caregivers are so busy taking care of their friend or loved one that they don’t take adequate care of themselves. Which, in turn, brings even more distress—emotional, mental, and physical.”
“Rose has been helping Charlotte for so long that this probably isn’t as much of a disruption for her as it might be for others,” he said. “But this is good information since there are ramifications I never would have considered. I’m glad you told me, and I’ll check with the ladies in town. I’m sure some of them will be willing to sit with Charlotte a few times a week so Rose can catch a break.”
Vara’s heart swelled at his willingness to help. “That’s a terrific idea. I understand this is all new, Thornton. One of the biggest changes for now is that Charlotte’s in the wheelchair because of her weakened condition. Rosalinda and I have shared several discussions about what to expect in that regard, as well. If you’d like, I have some documentation I can give you.”
“Do you have it with you now?”
“I do.” Vara opened her bag. “If you’re interested, the National Stroke Association and the American Stroke Association have educational programs and resources to help navigate Charlotte’s post-stroke journey. There’s also an online social network designed for caregivers and family members.” She pulled a folder from her bag and offered it to him.
“Would you recommend that I join an online support group?” After taking the folder from her, Thornton opened it on his lap. “Hang on a second. I need to run and get my glasses.”
Vara watched as he darted from the room, appreciating how well he moved. Ahem. She averted her gaze as he returned, wearing his glasses.
“Sorry about that. Please continue.” Thornton dropped back down on the chair.
“No problem. If you’re willing, I’d definitely advise you to join an online support group. It’s a great way to connect with others in the same situation and share stories, advice, thoughts, feelings, emotions.”
“Right. Something men love to do.” Thornton darted an amused glance her way. “I’ll check it out.”
“Technology has helped the health care system tremendously. The online support groups are usually a good mix of men and women, ages, and races, so you’ll get a broad perspective of viewpoints. A stroke can affect anyone, and that’s one of the major ideas they reinforce. While you’re on the road or on assignment, you could join in on the discussions. We also have a support group that meets at Mercy Grace as well as a number of other groups in the Minneapolis area. Some meet twice a month, some more frequently, and we’ve started doing live podcasts. I believe Rosalinda has signed up for the next one.”
“Excellent. What can you tell me about Charlotte’s physical therapy?”
“Part of her long-term rehabilitation plan in the hospital focused on Charlotte’s regular home routine. For now, a physical and occupational therapist team comes to the house once a week to check on her progress. If they believe it’s warranted, they can come more often, and then they’ll reduce the number of visits as she improves.”
“Why a team?” Thornton’s brows lifted.
“The physical therapist works with her on exercises to strengthen her muscles. Because a major goal of rehabilitation is reintegration into society, the occupational therapist works with her to practice standing up and maintaining that position, climbing in and out of bed, walking with the aid of handrails and around tables, attending to bathroom habits, and other normal and familiar activities. The same two individuals started her therapy in the hospital, and that’s what they’ll continue to do with her here.”
Thornton scrubbed one hand over his face. “Things most people probably take for granted and don’t ever consider until their physical ability is limited or diminished.”
Vara nodded. “That’s why I’m here. There are professionals available at Mercy Grace and elsewhere to answer all your questions and provide you with assistance. All you have to do is ask.”
“Thank you, Vara. I’ll read through the material in the next couple of days.” He sat back in the chair again, propping one elbow on the arm of the chair. “You seem personally invested, and you’re not spewing a rote speech. I appreciate that. If it’s not too personal, has someone in your family ever suffered a stroke? Is that how you became interested in this type of work?”
“Yes,” she said softly. She was surprised by his question, but then again, this was a man who’d asked about her name and freely espoused his thoughts on love during their very first conversation. Inhaling a quick breath, she began her story.
“When I was sixteen, my Grandpa Alexandris, my papús, suffered a major stroke. My gr
andmother worked relentlessly with him, and Dad and Mom did as much as they could to help. One day, I found my yayá crying. I sat down beside her, took her hand, and just let her cry. I understood it had to be something very serious to burden her heart so deeply. Finally, she looked over at me and said she felt helpless, a failure because she couldn’t snap her fingers and make everything better for him. Although she didn’t say it, I could tell she was exhausted in every way possible.”
A tear slipped down her cheek and Vara wiped it away, embarrassed for Thornton to see her moment of weakness.
He started to lift out of his chair. “I’ll get you a tissue.”
“No, please. I’m fine.”
Lowering back onto the chair, he waited.
“That conversation planted a seed in my mind. I wanted to be able to give comfort and hope, not only to the one who’d suffered, but for their family. Through my position at the hospital, I’ve worked closely with all ages and all kinds of speech and language issues. The older stroke survivors tend to be my favorite cases.”
“Any theories on why that is?”
Vara considered her answer. “I like hearing the stories about their lives from the family members and caregivers. Everyone’s history is interesting, but there’s something special when I hear where they’ve been, what they’ve done, what they’ve learned, and especially about the people they’ve loved and lost. That makes them more special and imprints them on my heart.”
“Has Rose told you some of those things about my grandmother?”
“Not much, but I’m already learning quite a bit from you today.” Vara smiled. “When my patients begin to make progress and can communicate with me more directly, that’s an incredible feeling of accomplishment. I guess it’s also a feeling that they might not have as many years left, and I want to help—in some small way—to make those last years for them more productive and meaningful.” She realized what she’d said. “I hope that doesn’t upset you. I’m sure Charlotte has plenty of years ahead of her, but some of my patients are in their late 80s and early 90s.”
