What Does It All Mean?

"When I first met Mr. C* in our speech clinic, he had been just discharged from outpatient therapy at the University hospital. His wife commented that Mr. C* had been three months an outpatient, after six weeks in acute rehab for his stroke, and two weeks in the acute hospital before that. Already such a long time away from home, but at least he's finished seven weeks of home health care and re-acclimated to his home. Already such a long time....12 weeks, 18 then, 20 - 27 after home health: almost SEVEN months from onset. Mr. C* still wasn't producing more than single words at this stage, so I had to rely upon the wife's commentary, as well as the case history forms she had filled out. 

 "Mr. C* had been a truck driver for nearly twenty years before his stroke. Because he enjoyed family life so much, having raised three children and now, there were six grandchildren nearby that dropped in anytime - he rarely took long haul, 'over the road' hauls. What did he carry in his trailer? Wheat, soybeans, corn, rice - it was an agricultural market that he worked...and he was home every night, after two to three loads carried to one of three grain elevators, built to accommodate river barge traffic. To keep up the pace that the grain producer demanded; that is, to get the highest number of loads delivered to the elevator per day, Mr. C* kept his schedule tight. A good breakfast at home; the usual, eggs and sausage, toast, coffee - then the rest of the day was fueled by either a package of cheese/peanut butter crackers, or a bottle of Coke with peanuts poured in, or a bag of chips. Fast, tasty and convenient! 

 "Mr. C* had worked hard, all his life....and driving and maintaining a truck was a lot of work. There was not only the routine maintenance to keep the rig running, but also there were the vigilance and energy it took to respond to surprising breakdowns during a trip; be they blown tires, burst belts, or the help it might require to straighten out a 'jackknifed' rig. Those hours where he hadn't been piecing together the well - worn cab + trailer, you could see him pushing it down the highways, and along gravel and dusty roads. When he drove home and came into his house, his body bore effects of the forces imposed by the rigid cab seat. Eating a big meal, then sinking into his high - backed recliner to watch TV immediately afterwards, he often needed a "Go to bed!" from his wife within the hour to get fruitful sleep. 

"Now Mr. C* is here, and the evaluation is almost done. I explained all my observations, and I reviewed the assessment data to draw a conclusion. 'I think that you might benefit from working with us, sir. The records from your prior treatment suggest, that the odds are fair to good that you'll continue to make progress with us for using your speech. Do you have any questions?' I looked to both Mr. C* and his wife.

"But as Sue Storm (Richards) would have said, way back in the history of the FANTASTIC FOUR comic, 'what does it all mean?'. 

"Speech - language pathologists can, with considerable skill, describe impairments of cognition, communication and swallowing, and then provide skilled interventions based upon the latest scientific knowledge about these skill sets, to help all who come to them sustain the highest possible quality of life. With Mr. C* and so many others like him, the goals of treatment are to prevent worsening of disability. But, what if Mr. C* had had the opportunity to manage his lifestyle and lower the risk of this disability? This is what we'll continue to explore."