I got to TIRR this morning a little after 9 and in the middle of an initial session with the neuro-psychologist and speech therapist.
Something I had really noticed was that Pete wasn't always clear what had happened and why he was where he is. He did not really recall the stroke or anything that had happened since then in any detail. He denied that he had had any surgery, despite the reality that he had. I had explained it to him, but it's hard for it all to sink in I suppose, particularly the part about losing a couple of weeks of your life. So, without being at all scary, Pete needs to be reminded of what all he's been through so that he can work on understanding why it is that he's not able to get out of bed.
There was an initial evaluation by the occupational therapist who helped him get dressed and in a wheelchair. He said he felt better being in his own clothes and I liked the TIRR t-shirt that said, "making miracles every day". His own physical control is getting better on a daily basis. Just put yourself mentally on your back for 21 days pretty much and see if you don't feel a little wobbly, and then consider that part of your brain is not sending the right signals to your back and abdomen to work the way they should.
The physical therapists came in to see what his mobility is. One of the things you worry about with any patient that is in bed for a significant length of time is muscle "toning" (not the good kind) where the muscles tense up. Think about the person you've seen who's hand is in a fist drawn to their chest tightly. This is toning and is very hard to reverse. Pete does have some of this on his left side, but not a significant amount. He is still quite limber. He sat for a good while while the speech therapist had her way with him.
The speech therapist will do multiple things, including working with is physical speech, evaluating his mental capacities with regard to short & long term memory, sorting and ordering, and following instructions, and right now very importantly, reteaching his mouth, tongue and esophagus to process food so they can get rid of the need for any sort of tube feeding. She went through a mess of tests and Pete did amazingly well. He is quite oriented to time, knowing it was Tuesday, in September, in 2008. He didn't know what day it is, but that's pretty understandable. She read him a story and asked some questions and he did remarkably well remembering the details. Much of this he would have done the same before as after.
One thing that was quite remarkable to me is the extent of the left side neglect. I had explained it to people only in a physical way. He was neglecting the left side of his body the way you are neglecting your Siamese twin. That person isn't there, so why are you even talking about it. His eyes and head tend to look right. If you ask him to move his left hand, he moves his right hand. it is as though the left side does not exist any more than your Siamese twin exists. However, the syndrome goes farther. The speech therapist had him read some sentences. He did not read anything on the left side of the page. She asked him to sign his name and write a sentence. He did this on the top right of the page of paper she gave him. His signature is very similar to the signature he had before the stroke, if a little less compact. So we'll continue to work on his left side, or else paper will not get very well used.
The sentence he wrote at her request was "arm hurts". He told her that it felt like his funny bone had been hit. I almost fell out of my chair, because that's exactly what he said in the ER during the stroke itself. He did have some small movements with his left arm, and while he was trying to push on it for the occupational therapist doing her work, I could see flexing of his muscles. He's also paying a bunch of physical attention to his left arm and hand, holding onto both a good deal of the time. I take all of this as a very positive reaction, and ask that you all continue to pray for Pete.
Tomorrow, he will have a repeat of the modified barium swallowing evaluation to see if he's ready for "real food", which will be very pureed for a while until he gets better and better. I see good reason for hope.
Also, prayers for all the local people who have been so affected by this hurricane. There are still close to 70% of the 5 million plus Houston area residents still in the dark. We have had a very early cool front giving us very pleasant temperatures, but it could be back into the 100's again quite soon.