Prior to his stroke, Fred was a hunter, a fisherman, a do-it-yourself home repairman, a cook, husband, father, and in his spare time he administered schools. His life was full, eventful, and he was unperturbed in the face of Gertrude’s occasional carryings-on. He was clearly the stabilizing influence in the pair, which had been bonded for over 50 years. They worked hard, saved through investing in property, and managed to arrive at retirement comfortably, yet certainly not well healed. A comfortable retirement, through teaching, is possible only by being debt-free when the time comes.
With two retirement homes and a motor home, they lived well many years into retirement. Then the train came off the tracks. Like the Missouri mule, Fred was struck between the ears with a board, yet he was the last to know that anything had happened. He believed that everything after his stroke was exactly the same as it was before the stroke. After five years, he still was not able to figure it out, and it frustrated the stew out of Gertrude, his wife and caretaker, who knew perfectly well that nothing much worked like it had before. Fred had a stroke while in Colorado, and after several months, the pattern of impairments appeared quite clearly and permanently. The residual was somewhat atypical, as Fred was left-handed. The brain’s right-sided stroke left residual paralysis of the left arm and leg, but his speech was unimpaired.
While Gertrude was known for carrying on with an occasional attitude well prior to his stroke, she complained bitterly that Fred really wasn’t himself after the stroke, and others just didn’t appreciate what-all she had to put up with. After Fred and Gertrude moved in with us, Bob, the son, and Lois, the daughter in law, were shocked to experience directly what Gertrude had been complaining about for five years. Fred was still fascinating company, and he managed to entertain and frustrate Gertrude, but the collection of dysfunction from the blow between the ears was monumental.
We knew that a large number of brain functions were right-sided or left-sided. A stroke brings that out as clearly as anything. Fred’s left sided paralysis was produced by an injury to the right side of the brain. As his speech was perfectly in tact, it must have resided on the left side, the unimpaired side of Fred’s brain. As nearly as we could tell, he also had a defect in the right hemisphere of the visual field of each eye, leaving him blind on the right side, when looking straight ahead. He appeared to be quite visually perverse, as he had great difficulty identifying objects across the room, like furniture or pictures on the wall. At meals, he could see the food on the left side of his plate, and would eat it till it was gone. After that, he often complained that he had not received any potatoes, or carrots. We would rotate his plate 180 degrees, and they would appear like magic. “Oh, there they are,” he would say, without realizing that we had simply rotated his plate. In five years, he never learned to turn his head to the right so as to bring the left visual field into view. It was this perverse pattern of behavior, his inability to understand his impairment and adjust accordingly, that was frustrating.
Like most folks with strokes, he was ambulatory with a walker following a long course of therapy, suspiciously with marginal value, except for the instruction of the caretaker, Gertrude. She knew he was able to get around quite well, but with considerable effort, and at some risk of a fall. Capitalizing on the situation, immediately following the stroke, and acknowledging the brain malfunction, Gertrude told Fred that he did not smoke. It had been a source of irritation for 50 years, and had she pulled it off, her house would have smelled far better. Fred smoked half a pack of cigarettes every day, and a cigar whenever he could get his hands on one. His preference for cigars, she said, was in the dead of winter in a car with the windows rolled up. He never inhaled, so the smoke in the house had not been filtered through his lungs, as with most smokers. As such, it might have been a purer form of smoke. Fred seemed to know that he smoked before his stroke, yet he knew little else. He probably didn’t realize that he was smoking far less than previously, because Gertrude would not buy him cigarettes, and in his presence would openly admit that she would not do so since the stroke. Ultimately, she altered her story that “He doesn’t smoke any more, since his stroke, because I won’t buy him any cigarettes.” This was not quite the end of the story.
On one occasion when Gertrude was getting her hair done, she loaded Fred into the car, drove up to the main street in Sunsites, and parked in front of the beauty shop. Sitting in the shop facing the street, she could monitor Fred in the car. As soon as she entered the beauty shop, she noticed some suspicious activity in the car. Fred opened the car door, got his walker out of the back seat, stood up in the walker next to the car, walked to and over the curb, across the sidewalk, and into the store next to the beauty shop. There he purchased some cigarettes, and returned to the car without incident. When she returned, he was puffing away, as though nothing extraordinary had happened, except the car smelled. At her first opportunity, she most likely hid, or threw away the cigarettes. Fred never realized that he quite suddenly quit smoking again.
When their furniture arrived from Sunsites, it was unloaded into the downstairs apartment. Fred and Gertrude sat like jailers in the large picture window above watching each item as it was carried across the patio and into the downstairs apartment. Fred’s sole concern was the safe arrival of his guns, and he had many. We only found two, and Fred figured he must have had five or six. This eventually escalated into war between Fred and Gertrude. Gertrude never had a problem with Fred’s guns, but when some were missing, it must be Gertrude’s doings. He accused her of “hiding his guns in the house south of town.” For Gertrude, this was preposterous, because she had no interest in hiding his guns, and they had no house “south of town”. She had heard this accusation on numerous occasions before, and the repeated accusation sent her into orbit. Initially she orbited around Fred, and eventually just gave up. Fred would never go hunting again, she knew, but Fred believed he could hunt any time he wished.
A few days after arrival, Fred became preoccupied with his left hand. He tended to rub it regularly, and often complained of discomfort in the left shoulder, arm, or hand. Then the discomfort became quite severe, and he complained of splinters under his fingernails. He asked if he might have brought splinters back from Arizona when they moved. We all examined his hand carefully, and assured him that nothing was visible. After two or three days of continuing pain, we concocted a magic potion in the form of a warm water soak. Assuring him that the soak would dissolve the splinters, we applied it two or three times. Like magic, the pain disappeared, and never recurred over several months.
The degree of brain impairment was clearly revealed when Lois placed Fred at the dinner table so he could write letters. He knew it would be no problem to use the typewriter. After twenty minutes of staring at the typewriter, without striking a single key, it was clear he could not take the first step in typing a letter. Then she got a large piggy bank they had used to save coins. She emptied the pig and asked him to count the money. He could not sort the coins by type, and was unable to count. In desperation, Lois sorted, counted, and totaled the coins. She told Fred there was $8.76 in the bank. His question was “Is that enough to buy a car”? For a person with a master’s degree, his ability to understand some abstract concepts, like money, was totally lacking.
His memory was a somewhat different matter. He recited a reading he had performed in the sixth grade word for word, yet his recent memory was missing. His bedroom was the second room on the right down a hallway of bedrooms, just across from the bathroom. Yet he claimed that “I have never slept in the same bedroom twice since coming to stay with you.” Of course he had slept in the same room each and every night, but the journey to the bedroom down the hallway, second door on the right was more than he could process. It may have been that his right sided blindness was a factor in visualizing the second bedroom on the right.
As for his bodily functions, he was always regular as a clock, taking his one “physic” shortly after breakfast in the morning. The ole’ anal sphincter was a relentless taskmaster, and he clearly recognized the signs that it was time to go. He would say “It’s time to go,” and off we would go. On one occasion, the sphincter did its job, Fred did his job, and then he was returned to the elevated couch for the morning. Just prior to my walking out the front door for work, Fred hollered “Bob, Come here”.
“What is it,” I asked?
“I have to go to the bathroom,” he said.
“But Fred,” I said, “You just went to the bathroom”.
“No I didn’t,” he replied with confidence.
“Well I know you did,” I said. “I know you did your usual job quite well, just like you do every morning”.
“No I didn’t,” he repeated.
“Well, why don’t you turn on the TV, and get your mind onto something else,” I said. “I will check with you at noon to see what is happening then.
After about three months, Gertrude passed on, leaving Fred alone. Throughout her life, she had documented everything she encountered religiously. On regular photographs dating back to 1920 she identified people in pictures by writing on them. She maintained a meticulous set of financial records. She kept a miniature notebook in which she had recorded all the names and telephone numbers of the snowbirds from Sunsites. This included all relatives, friends and acquaintances. The little book was about the size of a business card when opened up, and was several hundred pages, possibly an inch thick.
In early fall, on the occasion of a University of Georgia home football game, we elected to set Fred up to baby sit himself during the game. We had never previously left him alone for any length of time, but this was a first attempt. We asked him to remain on the couch, except in an emergency. He consented to do so. We knew we would be away for at least three hours during the game. On returning home after the game, we were startled to discover that he was not on the couch watching TV as we had requested.
When we entered the house, we discovered he had arisen from the couch, and with his walker he had shuffled through the living room and dining room into the kitchen, the location of the nearest phone. In four months, he had never asked to use the phone. Indeed, he was probably incapable of using a phone at all, other than to talk on it once it was dialed. The phone was on a wall divider in the middle of the kitchen, requiring an ability to stand at the phone, using one hand to hold the receiver, and a second hand to dial any number. In Fred’s case, he was standing on one leg, and had only one working hand. He clearly wanted to use the phone.
As we arrived, we saw Fred lying on the floor of the kitchen, fully conscious, and in no distress. “Just what are you doing on the floor, Fred,” I asked when I saw him.
“I’m resting,” he said quite spontaneously.
“Aren’t you uncomfortable on the floor,” I asked?
“No,” he replied. Then he pulled the miniature address book from under his head and added, “I have been resting my head on this little address book.”
“And just exactly why were you coming in here with Gertrude’s little book,” I asked?
“I was going to call Connie Rehak, and ask her to marry me,” he said quite honestly.
“And what did she say,” I asked?
“I never got the call through before I fell down on the floor,” he replied.
And so, with a brain at half-mast, two paralyzed limbs, two half hemispheres of vision, he thought it was just fine to propose marriage on the telephone. We know that he proposed marriage on at least two occasions in person, one of which was in the nursing home where he later became a resident. What is most interesting is that the answer was yes on both occasions. Of course, the weddings never came about. If there is a lesson to be learned from this, and if you must be severely impaired, it may be a lot more fun to believe you can still do anything you want to do, and behave accordingly. That may prevent more serious impairments from developing, like depression or anger. Fred was completely free of any such residual. He believed himself to be completely normally healthy throughout five years following his stroke.