Communication at Work: SLPs Share Patient Communication Stories— Five Miles with Kurt Keena
As a part of our SLP Better Speech and Hearing Month celebrations, we asked some of our SLPs to share their inspirational stories of working with patients on their communication journeys. The road back from a traumatic event or injury can be arduous, but these stories illustrate the how perseverance and hard work can lead to amazing results and grateful patients.
“Five Miles” by Kurt Keena, MS CCC-SLP
This is a story about “Jack,” a patient that deeply impacted, challenged, and inspired me.
I met Jack soon after he transferred from the ED to the inpatient unit. His history wasn’t like most stroke patients. He came in with minor imbalance, no apparent muscular weakness, but major speech deficits, including unintelligible jargon and seemingly absent comprehension. His head CT was strangely unremarkable, and the MRI was pending. Before heading in to do Jack’s “speech and swallow eval,” I checked in with his nurse (“Gail”), who told me that Jack’s family urgently wanted “speech,” and that they were “unrealistic.” Though I avoid letting nurse opinions shape my views, Gail’s comment put a sour taste in my mouth. But that sour taste turned sweet the moment I met Jack.
Jack’s initial evaluation was fascinating. All he expressed was “five miles… 15 miles an hour… about 5,000 years…” and other variations of these short phrases with a multiple of five. No matter what the task or stimulus was, his responses were the same. Jack spoke fluently and with absolute certainty, showing no insight or awareness of what he was saying. He grew increasingly frustrated as I continued testing. He was unable to answer any simple questions, spoken or written. He only furrowed his brow when I showed him words and letters, and when I placed a pen in his hand, he acted as if it was some foreign object. During the swallow evaluation, I noticed that Jack was unable to use utensils and chewed on his straw. I concluded that Jack’s deficits looked like a textbook Wernicke’s aphasia, something my grad school professors said that we would never likely see.
Although daily therapy in inpatient is rare, I made time to treat Jack every day of his admission…
I got to know Jack’s wife and son, gave them information on aphasia, and tips on how to work on his communication. I learned that Jack was a retired colonel, and a passionate intellectual (at the age of 79) with several master’s degrees. Jack loved taking long (eight to 10 mile) walks every day with his loyal dog. He was an active member in his church community and he fervently loved his family.
Jack moved to the acute rehabilitation unit in less than a week. I tried everything I could in therapy to find meaning in Jack’s verbalizations and help him understand what was happening. Automatic speech tasks and patriotic music didn’t help. Assisting Jack with tracing his name and address seemed fruitless and often irritated him. In fact, most therapeutic tasks I tried led to frustration. Jack would look at me with confusion in his eyes, and utter something that I understood to mean, “Why are we doing this? Why don’t you understand what I’m saying? Why am I here? Why can’t I go outside for a walk?” To limit his frustration, most days I wheeled Jack out to the patio, where we “talked” about the weather, the flowers, and pictured scenes that I would show him. I even took him on walks outside of the hospital hoping that physical movement and new surroundings would stimulate the communication centers in his brain. I encouraged Jack to speak freely and did my best to pull meaning from what he told me.
Further testing and imaging led the medical team to believe Jack had a small stroke in Wernicke’s area. Due to several factors this diagnosis was never definitive, but it was the most “probable.” Speech therapy continued to be challenging, but I pushed past the frustrations and refusals.
And then one day, while resting on a bench outside the hospital after a long walk with me and PT, Jack had a breakthrough…
He successfully copied the first letter of his name on paper. When he did this, he looked me in the eyes, smiled ear-to-ear, and without saying a word, I could see he was realizing why this guy Kurt was bothering him for an hour a day with kindergarten tasks. From that moment on, Jack made huge leaps every day. Suddenly he was saying words and phrases that we were able to understand, he began following simple directions more consistently, and he started reading and writing short words and numbers. By the time he was discharged from inpatient rehab it seemed like getting back to his normal would be possible. I happily accepted the gratitude Jack and his family expressed to me, and thanked them for their time and dedication, for the countless hours they spent each day working on the same skills we targeted during our daily sessions.
Jack was discharged home from acute rehab still with that suspected stroke diagnosis, but that never sat right with me. I’ve seen spontaneous recovery after stroke, but how could his severe cognitive-linguistic deficits have almost fully resolved in only three weeks’ time? Maybe Jack’s deficits were a result of inflammation from an infection, but could the infection have self-resolved? I encouraged Jack to seek further testing.
Things only got better when Jack started coming for outpatient therapy…
His perseverance motivated me to find new ways to challenge his brain. I targeted several high level cognitive-linguistic goals, all of which were of the utmost importance to him. Jack begged me for “homework,” and I happily obliged. It was thrilling to see how quickly Jack’s function was returning, thanks to his motivation and his wife’s great patience.
Jack saw a neurologist who performed more brain imaging and testing. The results revealed a suspected infection in the Wernicke’s area of Jack’s brain, and he was placed on steroids. His symptoms continued to improve as my days as a travel SLP at the hospital came to an end. During our last session together, Jack asked if we could keep in touch, and we exchanged emails. My eyes filled with tears when Jack and his wife walked out of the office on the last day of my contract.
About a month later I got an email from Jack. He had met all of his speech therapy goals and was discharged by one of my colleagues. In the meantime, his neurologist diagnosed him with CAA (cerebral amyloid angioplasty), a degenerative disease that leads to a buildup of proteins on the artery walls of the brain. Despite the diagnosis, Jack remained optimistic, confident that he was in the hands of excellent doctors.
Helping Jack recover his communication skills was one of the most rewarding experiences of my career. I’ll always fondly remember Jack’s grateful smile, his love for his family, and his perseverance in the face of extreme difficulty. I haven’t heard from Jack in several months, but I like to think that he’s still around town and on the beach… walking 5 miles… 15 miles… or however far his legs are taking him these days.
You can see the fruits of Kurt’s unyielding determination in the leaps Jack made on his communication journey. The process might start out slowly and full of bumps in the road, but taking the time to learn your patient’s story and diagnosis can spur breakthroughs like Jack’s. Whether it’s five miles or fifteen, the key is to keep on moving those legs.