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COPYRIGHT 2005 All rights reserved. Reproduced by permission of The Condé Nast Publications Inc.
Patricia H. was a brilliant and energetic woman who represented artists and ran an art gallery on Long Island, and was a talented amateur painter herself. She had raised her three children, and, nearing sixty, she continued to lead an active and even, as her daughters put it, "glamorous" life, with scouting expeditions to the Village and frequent soirees at home--she was a great cook, and there would often be twenty people for dinner. Her husband, too, was a man of many parts--a radio broadcaster, a fine pianist who sometimes performed at night clubs, and politically active. Both were intensely sociable.
In 1989, however, Pat's husband died suddenly, of a heart attack. Pat herself had had open-heart surgery for a damaged valve the year before, and had been put on anticoagulants. She had taken this in stride--but now, with her husband's death, as one of her daughters put it, "She seemed stunned, became very depressed, lost weight, fell in the subway, had accidents with the car, and would show up, as if lost, on our doorstep in Manhattan." Pat had always been somewhat volatile in mood ("She would be depressed for a few days and take to her bed, then leap up in an opposite frame of mind, and rush into the city, a thousand engagements of one sort and another"), but now a fixed melancholy descended on her.
When, in January of 1991, she didn't answer her phone for two days, her daughters became alarmed and called a neighbor, who, with the Long Island police, broke into Pat's house to find her lying in bed unconscious. She had been in a coma for at least twenty hours, the daughters were told, and had suffered a massive cerebral hemorrhage. There was a huge clot of blood in the left half of her brain, the dominant hemisphere, and it was thought that she would not survive.
After a week in the hospital with no improvement, Pat underwent surgery as a last-ditch measure. The results of this, her daughters were told, could not be predicted.
Indeed, it seemed at first, after the clot was removed, that the situation was dire. Pat would "stare . . . without seeming to see," according to one of her daughters. "Sometimes her eyes would follow me, or seem to. We didn't know what was going on, whether she was there." Neurologists sometimes speak of "chronic vegetative states," zombie-like conditions in which certain primitive reflexes are preserved, but no coherent consciousness or self. Such states can be cruelly tantalizing, for there is often the feeling that the person is about to come to--but the states may last for months or years. In Pat's case, though, it lasted for two weeks and then, as her daughter Lari recalled, "I had a Diet Coke in my hand--she wanted it. I saw her eye it. I asked, 'Do you want a sip?' She nodded. Everything changed at this moment."
Pat was conscious now, recognized her daughters, was aware of her condition and her surroundings. She had her appetites, her desires, her personality, but she was paralyzed on the right side, and, more gravely, she could no longer express her thoughts and feelings in words; she could only eye and mime, point or gesture. Her understanding of speech, too, was much impaired. She was, as neurologists say, aphasic.
"Aphasia" means, literally, a loss of speech, but it is not speech as such which is lost but language itself--its expression, or its comprehension, in whole or in part. (Thus congenitally deaf people who use sign language rather than speech may get a sign aphasia following a brain injury or stroke, an aphasia in every way analogous to the aphasia of speaking people.)
Aphasia is not uncommon--it has been estimated that one person in three hundred may have a lasting aphasia from brain damage, whether this be the consequence of a stroke, a head injury, a tumor, etc. Many people, however, have a complete or partial recovery from aphasia, and there are transient forms that may occur during a migraine or a seizure.
There are many different forms of aphasia, depending on which part of the brain is involved, and a broad distinction is usually made between expressive aphasias and receptive aphasias--if both are present, this is a "global" aphasia.
In its mildest forms, expressive aphasia is characterized by a difficulty finding words, or a tendency to use wrong words, without compromise of the over-all structure of sentences.
In more severe forms, a person may be unable to generate full, grammatically correct sentences, and may be able to utter only isolated words ("telegraphic speech"); if the aphasia is very severe, the person may be all but mute, though...
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