43

 

The speech therapist has been working with Dad for the last hour, and I expect her to come looking for me soon so we can discuss Dad’s prognosis and his prospects for successful speech therapy.

I’ve just baked chocolate chip cookies and made some hot chocolate. It’s a cold January day, and this seems like the perfect comfort-food snack.

“Smells good in here,” Brittany says as she comes through the door.

“Cookies and hot chocolate.” I smile at her. “I thought we could indulge a bit as we talk.”

She pulls out a chair, drops her backpack onto the floor, and sits down with a sigh. “Sounds real good to me.”

After a few minutes of snacking and small talk, we’re both fortified for whatever she has to tell me.

“I wish I had gotten to Joe a few months ago,” she begins. I nod for her to go on.

“His dysarthria is progressing pretty quickly. I’m sure you know it’s due to neurological injury of the motor component of the motor-speech system.”

“Yes, I’ve read up on it. I know he drops certain words when he’s trying to speak a whole sentence, but I haven’t noticed him mispronouncing words very often.”

“Maybe because he speaks so softly, you’re not picking up on it?”

She takes a book of pictures out of her backpack and puts it on the counter between us. I pull it toward me and open it. There’s a picture of a baseball bat on the first page. I look up at her with a question in my eyes.

She nods and says, “He calls it a ‘bad.’”

Okay, yes, I have heard Dad mispronounce words, like using ‘cub’ for ‘cup.’ And there are his incomplete sentences. But that’s only been a few times. But she’s right—if Dad said ‘bad’ instead of ‘bat,’ I might not be able to distinguish the difference because he does speak so softly. I hear what I expect to hear. What I want to hear.

I look up from the book. “I’m in denial about this, I think.”

She nods. “Pretty common. Some family and friends pick up on it, but many don’t. They don’t realize it because they’ve adjusted to the changes in speech as they go along, which can be subtle, and so they tend to overlook slips like this.”

She takes a deep breath. “This is only going to get worse, Rachel, no matter what I do, because it’s organic.”

I’m dismayed to hear this. She’s an ASHA-certified speech-language pathologist. I thought she’d be able to work with Dad to get him back to his previous levels of speaking and swallowing.

“I gave you the bad news first. There’s good news, too.”

I feel a slight sense of relief and nod for her to go on.

“There are things we can do that will help Joe.” She hands me a folder. “I’ll leave these reports for you to read. They include my initial assessment, which establishes the baseline data necessary for evaluating expected habilitation or rehabilitation potential, setting functional goals, and measuring communication status at periodic intervals.”

Big words, but I follow her. “I’ve outlined a speech-language pathology goal for Joe. I may be able to get ahead of further deterioration if I can sufficiently address the apraxia—that’s motor disorder caused by damage to the brain. It won’t be restorative treatment, because the function can’t be improved or repaired. I’m opting for compensatory treatment, which aims at compensating for deficits not responsive to retraining.

“There are several treatment options for it, and I want to speak with my supervisor about which one will be best for Joe. I may need to use a combination of treatments, but I won’t know which ones until I see how he responds to them. My goal is for Joe to be able to continue to initiate short intelligible phrases with a minimum of errors.”

I hold up my hand for her to stop. “I’m feeling overwhelmed,” I tell her, “and I need some time to process this.”

“Sure you do. In fact, that’s all I’m going to cover with you today. I would appreciate it if you could read everything I’ve given you. Your input and participation will be key in this since I can’t be here every day.

“Whatever work I do with Joe, you’ll have to be a part of it. You need to understand it so you can use it—often, every day, with him. As the saying goes, if you don’t use it, you lose it. I can get the wheels moving, but if we don’t keep them oiled, he’ll regress.”

“Will this help with his swallowing difficulty as well?”

“Yes, the therapy helps with both. With your permission, I’d like to set up a fluoroscopy and an endoscopy for him.” I believe she’s willing to pull out all the stops to help Dad, and I’m grateful. I tell her this and promise to be as involved as she needs me to be.

“That’s great, Rachel. I knew you would feel that way and would want to be involved in his treatment. Not everyone does, but I can tell Joe is loved and well cared for.”

“Do you really think he can be helped?”

“I do, or I wouldn’t be making these recommendations.”

“God, I so admire you for what you’re able to do.”

“I love what I do. There’s a lot of gratification in it.”

“I’m thankful you’re the one who’s going to be working with Dad.”

She points at me and smiles. “And you.”

“Yes, I get that. I’ll be involved in every session so I can learn all you can teach me about helping him. Thanks for taking the time to go over all of this, Brittany. I promise to read every word before you come back. Can you give me a schedule so I can plan my days?”

She taps on the folder. “It’s in there.”

I offer her the last cookie on the plate, which she eagerly accepts.

She has a real sweet tooth, too. I like her. A lot. Enough to go to my hiding place in the linen closet.

“Hey, Brittany, do you like Oreos?”

“They’re my favorite. I like dunking them in milk, coffee . . .” She looks down at her cup and smiles. “But especially in hot chocolate.”

Yep, I really like her.