She has global aphasia. It's a language problem she developed after a stroke. The portion of the brain that controls speech is not working correctly. She can process her own thoughts, but the mechanism for transferring those thoughts to speech just doesn't cut it. Additionally, most of what she hears from other people is Greek to her. Basically she's trapped in her own brain. She's more there than most people give her credit for. Usually she will start a sentence with garble, the middle will be intelligible to those that care to try. The sad thing is that most people write her off as crazy simply because they cannot understand her. Cognitively she's still very much with us.
This evening, though, her speech was far easier for me to comprehend. During our walk we stood and had a conversation while looking out a window. I always thank my patients for working with me at the end of the session. Most of them will thank me in return for taking the time to work with them as well. When I helped her into her wheelchair and reset her alarm, her face lit up and she spread both arms out wide. As I leaned forward to wrap my arms around her shoulders, my eyes teared up and I wished I could tell her what that meant to me.
Rewind three years. I didn't start out wanting to work in geriatrics. I work with patients and get close to them, hold their hands when they're in pain, hold the bucket while they throw up, hand them Kleenex when they're crying. Sometimes, despite the best that they and I can do, they can't go home. Many times they go back to the hospital, or bounce between the ER and the rehab unit like a yo-yo. I've lost patients to ALS, pneumonia, cancer. I've helped families guide their way through the maze of decision-making for their loved one. That's not even counting the advanced dementia and the way it steals a person right in front of your eyes. It's like ripping your heart our every day. But some days your patients can reach right back to your heart and mend it with a smile and a hug.