Monday, 26 March 2012

Speech Mountain

On the day (Sept 1 2011) of Miranda's burst aneurysm blood probably first seeped from the left side of the brain artery to the left temporal lobe (Wernicke's area). The subsequent life-saving procedure of relieving inter-cranial pressure (craniotomy) probably caused more blood to flow and clot. The resulting haematoma was massive (57 mm widest ctscan) affecting areas that result in the condition she is in today. On the road to a very slow recovery looms a formidable obstacle - her inability to speak. Left side lesions are known to reduce recall of visual and verbal contents, including poor speech perception. Hence poor language comprehension and inability to form words. Therefore if one wishes to communicate with her two effects which we take for granted must happen: 1) Can she comprehend what you say? (she can certainly hear) and if she does, 2) Does she have the memory and its recall to form words in reply? As we proceed on the road to cognitive-ness this mountain must be breached.

The left temporal lobe is one of eight lobes making up the brain. Her infarct was in the left subarachnoid chamber. (illustrations from

Monday Mar 26 11am: She is perky today, having gotten back her sleep cycle. Have tried with some success to coax her swallowing saliva or phlegm. Tried to persuade her to utter something (anything) but failed. In the afternoon Home Nursing Foundation nurse helped changed the troublesome feeding tube. In the evening close friends came to see if she can respond to more interactions. This month we should actively try to have her utter something and encourage her vocal chords.

Tuesday Mar 27 noon: She is getting fat. The knee gaiter does not fit and the stockings are tight. Gives me a chance to joke and see if she utters something. No more afternoon snack - which is nothing more than another can of Jevity.

Wednesday Mar 28 10am: So we changed her feeding cycle to 4 hours hoping to lose some weight. Visitors can come after 10.30 when therapy, showers and feed are done. She sure looks tired but grateful to lie down after the long sessions. She did groan in relief but I was looking for something more repeatable.

Thursday Mar 29 6pm: Last night she was at her brother's home and her eyes were filled with endearment for the infant grandniece. She gazed in fascination at all the children. But once they moved off the zombie look returned. Then, like today I have to fight doubts from all directions on whether she will be conscious again. I realized that these doubts are what I hear or see externally. They say God's healing power is beyond visibility and may even be in spite of my faithlessness.

Friday Mar 30 10.30am: Even I can tell she's more alert today, having to see her everyday. No more calling her night owl nor fat lady, though certainly her diet is something I have to watch. We used to joke that Miranda watches her diet by checking my weight. Also I've detected soft whimpering whenever the therapy threatens pain. Good sign. Thank God.

Saturday Mar 31 10am:  Here is the most mentally active person I've known - she would not sit still in a room without doing 2 or 3 things at once. Watching TV, talking on cell phone and doing emails with one foot stroking the dog. But for hours yesterday she just lay there staring wide-eye at the ceiling. On seeing this I had to rush in to pat and stroke, talking about anything. Even Indonesian chatter is OK I told the maid, rather than letting her sadly idling.

Sunday Apr 1 2pm: So the maid gets off again and others get a chance to feed her. She sleeps to no end. Last night she did wake in response to JG's mad antics of cheering her up, by looking curiously at him. Once a while she wakes up with a sudden convulsion, then relaxes. Brain injury pathology?

Monday Apr 2 11am: Starting to turn her head to the right with her eyes closed. Perhaps the hemispheric response is becoming more balanced. The last EEG show a rather quiet left hemisphere.

Tuesday Apr 3 4pm: The PT put her on the ball today and gave a reversed sensation to her spine which usually sags on the bed. She groaned - at least she can feel the difference. At dinner she was able to look at the feeding canister, probably wondering for the first time what was she ingesting. Some degree of awareness is returning. But not yet to the point of watching TV, or smiling at family.

Maundy Thursday 11am: Yesterday I thought I saw her smiling at two close visiting friends. This morning I thought I saw sadness in her face, like she was crying when I tried to encourage her. We're both going through a very dry patch now.

Good Friday 11am: She must have been grieved by loneliness missing her friends and nothing to do. But a way opened. All the time I had the TV in the wrong place. Turning the bed around she is now able to look at it on her left and nearer to her. At least she can now occupy, even when doing therapy. That's one part of her back to normal. I'm thankful.

The 57mm left haematoma on the ctscan taken around 9.30pm, about 3.5 hours after the burst artery at 6pm, and not long after the relief craniotomy performed soon after admission at 7.30pm. How much her speech is impaired depends on how much damaged cells contain vocal memory.

Saturday Apr 7 8am: Must try getting the dogs on her left. She's a right-brain person for the being.

Easter Sunday noon: No she does not know the dogs. Somehow that part of her memory is lost. Later a dozen or so church members came to break bread with her. She stayed awake for the entire hour and sipped a little wine. That's a feat.

Monday Apr 9 9am: When I tried to encourage her, she cried. At least she show emotions now.

Tuesday Apr 10 10am: I heard it again last night. She uttered some sort of slurred sound when her friends came. Soft and whimpering. Keep climbing!

Wednesday Apr 11 9pm: Wednesdays are family dinners at her brother's. Tasted jello, durian ice-cream and chicken broth. Not impressed.

Thursday Apr 12 9pm: Thursdays are quiet for her and she slept most of the cool day. I am learning to take in both - moments of warm encouragement from friends, family and people surrounding, and times of dry sultry days where there's only she, me and God. But I believe she is starting to enjoy therapy on the ball.

Saturday Apr 14 8am: Not that I'm superstitious but nothing much happened on Friday the 13th, except she was again fascinated by toddlers like the grandnephews and nieces visiting from Boston. But this morning she spoke! They were slurs and it went on for a while. Starting to exercise her vocal cords, first time over 7 months. The difficult part is later when she'll have to learn basic words all over. But rejoice!

Monday Apr 16 11am: Like a see-saw the vocal jubilation on Saturday is alternated by a whole day of sleep hibernation on Sunday. Not even her best friends could stir her to recognition. Today is hard labor for therapy - stiff joints. That's another crevasse we have to cross - her motor skills. We have to climb the speech mountain and cross the motor ravine at the same time.

Wednesday Apr 18 11am: Last night we had a family dinner where Miranda met her 92-year mother again. For me to see both on their wheelchairs facing each other but not knowing, caused a gush of tears. She got her qualities of love and generosity from both parents. 8pm: Again those moments of anguish or pain appeared on her crying face that I could do nothing about. It could be a headache, gut problem or just coldness or discomfort that is not expressed. No one knows.

Why does God not open an avenue to cheer her when she is in such a distress? She was the cheerful one and a bold encourager in her youth when others were in distress. Talk to her schoolmates, netball playmates and others in her workplace where she is always helping, obliging friends and associates. Even when her father neared death she was positive. Why suffer the cheerful, generous and kind? Pray that God sends His guardian angel.

Friday Apr 20 11am: Nothing much happened Thursday, but this morning she swallowed a quarter glass of coke-flavored thickener after 2 hours therapy. That's progress. Maybe we will soon wean her off the nose feeder.

 Holding Strauss, with Sweetie and Pi, all dearly missed.

Sunday Apr 22 11am: No entry on days when she does nothing but sleep, like yesterday. I noticed when she had a good sleep the night before she'll tend to utter something, like this morning. The tendency to turn her head hard on her left is reducing - perhaps the left hemisphere is firing up more now?
Monday Apr 23 7pm: More alert today, allowing me to talk to her again, her eyes restful. She could turn her head to her friends, but still not knowing the environment.

Tuesday Apr 24 11am: So I found that her left eye was infected because of poor house-keeping - the eye-drops, though unopened was left around in un-sanitized conditions. I realized that care-givers must not only care for the sick but must also watch other helpers. At night we found crystals in the urine - probably from the sodium in the thickener.

Friday Apr 27 4pm: Her left eye got worse - not just because of infection but like most coma patients their brains do not blink the eyes as much, causing their cornea to dry out due to lack of lubricants. If this is not addressed she will slowly go blind. Thanks to her alert doctor friend another obstacle is to be overcome, hopefully.

Saturday Apr 28 4pm: Need to put swollen red left eye in a patch - cloudy cornea. Eye specialist says antibiotics drops and lubricant will help. I'm not becoming delusional, but must say that such help appear like angels to an ignoramus me.

Sunday Apr 29 8pm: Starting to utter something which I could not make out. Also sighing and soft cries. The left eye still looks bad.

Monday Apr 30 5pm: The good thing is her cries show that she's starting to express herself. The bad is it is so distressing to hear her travail.

Two are better than one - for if one falls the other will lift her up, but woe to him who falls alone. Again, if two lie together they get heat, but how can you be warm alone? And in adversity two can fight better - even better as a three-braided cord is not easily broken. (Ecclesiastes 4:9)

Wednesday May 2 3pm: Nothing much yesterday except the car broke. But this morning looking thru only the right eye she greeted me with a pleasing look - almost a smile. Despite her bad eye,  she can still be cheered.

Thursday May 3 10am: This time I had a good sleep - comforted that God is healing her. Her eye still sore is improving and therapy is keeping her limbs supple.

Friday May 4 7pm: She watches TV with her one eye. The left eye is improving, though swollen red.
Have mercy on me, O Lord, for I'm in trouble: mine eye is consumed with grief, yea, my soul and my belly. My life is now spent with grief and my years with sighing...I am forgotten for dead, like a broken vessel. But I trusted in Thee O Lord: I said, Thou art my God. My times are in Thine Hand... Oh how great is your goodness, to them that fear Thee...O love the Lord all ye saints for He preserves the of good courage and He shall strengthen your heart, all that hope in the Lord. (Psalms 31:9 onwards)

Saturday May 5 8pm: Her almost 24 hour day of sleep is troubling. I've been told that a blocked shunt will have this result. She has been due for a neurological review with the doctors on the 17th. Her road to recovery seems to have hit an impasse.

Monday May 7 8am: Just when I was about to give up she gave me hope opening her eye. Yesterday I was told she cried out and moved her right side. We will pray that she consistently improves her speech and motor movements.

Wednesday May 9 7am: I gave up trying to have her open her eye the whole of yesterday. But this morning she did. So I take it that alternate days of sleep is her brain's routine for recovery. She also cries softly (which is a good sign), but I am not able to understand the words. We have also started her on an alternative Chinese medicine first prescribed by her rehab doctor last year.

She is still not able to recognize any of her faithful MGS visitors, shown in this 2004 photo. Miranda in front row (4th from left)

Friday May 11 7pm: More alert today than yesterday - maybe the Eastern medicine is starting its effect? At 8pm she opened her eye and allowed me a one-way chat with her. Still cannot understand her utterance.

Saturday May 12 8am: Found small amount crystals in urine, probably due to  the Chinese drug. Doctor stated it is minor, but the increased sleepiness is cause for concern. Stopped Amantidine as suggested while awaiting review this Thursday on her VP shunt. Left eye getting better, thank God.

Mothers' Day 10am: Last night I was exasperated trying to wake her to chat or read. Giving up I decided to spend time myself alone, reminiscing about the life we had. The memories - lots of it, flooded back - every place we went - restaurents, roads, parks, sit-outs. And the long conversations. Most poignant of all was the companionship - now gone. Of course she spend more than half our time with others like friends and family. They were the spices. Gone also is the memory bank, for now only, I hope. Everytime I needed to recall a name or event, or even a word or what we did, she would spew it out with little difficulty. More precious have became the moments all of us used to enjoy in life when they are gone.

Monday May 14 10am: After a lonely Mother's Day yesterday, she became cheerful again, opening her eyes to greet me. The alternative medicine seems to give more cognition since she is put off Amantidine. She's begun to utter sounds again during therapy, which is good, as well as getting good sleep and not passing crystals.

Tuesday May 15 9am: The skin infection (not uti ?) which started last night is more serious - causing the left thigh to swell as the surrounding tissues affected. Two possible causes - not cleaning properly and not changing diapers fast enough. Lesson learnt. No therapy for the moment.

Wednesday May 16 10am: Miranda has received so many merciful grace all her life, including doctor friends now looking after her eye and swollen groin. It's just that she's fallen into such a deep hole now that is taking so long to extricate her up to consciousness. Left eye getting better but mystery still surrounds why abscess starting in her left groin area without any external injury.

Thursday May 17 8am: Left eye still red and wet needs about 2 months of treatment. But she opened them today! Looks like we will have to visit this mountain again - her speech still muffled and incoherent. Pray that the review will be positive.

This post ends today. Next:  Mobility crevesse - challenging the limbs