Language Lost

My earliest memory: I’m sitting on my father’s lap with a basil leaf in my little fist. The sun is coming in through the window casting a golden beam on the flowered tablecloth of the kitchen table. I’m watching in awe as he deals majestic-looking cards at lightening speed, scooping them under each other to flip them over. Then, I drop the basil leaf on the table and reach instead for a card that he’s discarded within my reach.

My father is quicker and thrusts the leaf back into my pudgy fist with a chuckle and pushes the card away from me. Then, he leans to the side so his eyes meet mine.

Hai quattro anni oggi, Gaia, lo sai?” he asks, raising his thumb to stroke my cheek. Then, he takes my little hand in his and begins to hum as he traces the lines of my palm and I dissolve into giggles.

I get out of the lunch line and wander into the cafeteria. It’s bustling with chatter, none of which I can understand, so I choose an empty table in the corner and sit down with my lunchbox. I’ve barely opened it up when I hear my name. I look up to see a girl from my class waving me over. Timidly, I close my lunchbox and make my way over. She moves over to make room for me and I sit down, my eyes cast downward.

I open up my lunchbox again and pull out a mortadella panino and some cheese. A small note falls from the tin-foil-wrapped sandwich. The girl grabs it before I can.

“Bona gornada poosinella!” She reads in a high-pitched voice. Everyone at the table snickers.

I keep my eyes down. “Hai mal pronuciato,” I murmer.

She turns to me. “I’m sorry, I don’t speak Italian. I speak English.”

“What are you doing, Gaia?” My mother asks as I pull a stool up to the counter and begin to climb on to it. I ignore her, balancing carefully on the top and reaching for the lazy susan.

 “Gaia!” My mother’s voice rises.

“I want medicine! My head hurts!” I whine.

“I tell you already, you cannot take more now!” She grabs me at the waist and yanks me off the stool.

“But I need medicine! It hurts!” I’m wailing.

Non si puo prendere la medicina così subito dopo l’altra!” My mother switches to Italian, as she usually does when she’s angry. Her hands are gripping my arms firmly to stop me from climbing back up on the stool. I try to twist away from her, muttering about her wishing pain on me.

Non devi essere così, Gaia! Hai sette anni adesso,” she says calmly.

I glare at her.

“I don’t understand Italian,” I say slowly, emphasizing each word and speaking the last as if it were a disease. My mother releases me and instantly I feel the sting of her palm across my cheek.

 —

I’m nervous as I pull into the long driveway like I had countless times before. But this time, it’s different.

Glioblastoma. My mother had told me over the phone last week. It’s aggressive. He’s losing his memory rapidly.

I see her now, leaning against the doorframe, smiling, but it seems forced. I get out of the car slowly, something I don’t think I’ve ever done at this house, my childhood home, and sling my duffel bag over my shoulder. My stomach is in knots.

I trail up the steps and robotically hug my mother, kissing her cheek hard so she knows I mean it. She’s aged more and he eyes are sad. I can’t tell if things are really different or if I’m just imagining it. I feel like I’m watching this family I don’t know from a distance. I feel as if we’re all just actors and actresses trying to smooth over the pain with tight smiles and bright voices.

We enter the living room, and there’s my Papa, sitting in his beige recliner, watching TV. My eyes light up at the sight and familiarity of him.

“Papa!” I shout, dropping my duffel bag and running to him. He sits up straight with a weak smile and faded eyes.

Chi è?” he asks my mother. His voice is foreign to me. My mother explains that I’m his daughter, Gaia. I take my father’s cold hand in mine as the realization washes over me. He doesn’t know me. I’ve known him for forty-eight years and yet at this moment, I am no one to him.

“It’s me, your Muffin,” I manage between tears.

He turns again to my mother. “Non capisco,” he says, his voice raspy.

I can feel tears burning behind my eyes. I grip my father’s hand tighter.

“What do you want to say, Gaia? I’ll tell him,” my mom whispers.

I shake my head. I want to scream at him. I want to tell him that he used to tell me the best stories, that he taught me how to bowl, how to make meat sauce, how to play cards, how to be a good person. I want to tell him that I love him more than anyone. I want to apologize for being stubborn as a child, for rejecting his language.

I want to, but I can’t because I don’t speak Italian. And it’s no one’s fault but my own.

Workplace Hostility

The pulmonary ICU is abuzz; monitors beeping, ventilators pumping, doctors and nurses weaving in and out of rooms. I have tuned all of it out, standing over a patient’s chart, pouring through the surgical reports and nursing notes. As a clinical fellow, I am extra vigilant during my chart reviews. I still have to prove myself.

“Ready?” Lauren is standing next to me, leaning against the nurse’s station. Her expression is one of annoyance mixed with nonchalance. As my fellowship supervisor, she is required to observe me once a month.

I nod, hoping she can’t sense my fear.

“Ok, what have you got?”

“Patient is a 31-year-old female with no past medical history. Collapsed while running a half marathon last week. Found to be in respiratory failure, emergently intubated in ED upon arrival. Intubated for eight days, unable to extubate, leading to tracheotomy placement. She is now day 1 status post tracheotomy and is currently ventilator dependent.”

“What’s the cause of her respiratory failure?” Lauren asks.

I flip through my notes. “They’re not sure, still doing a diagnostic workup.”

Lauren rolls her eyes. “Let’s go.”

We don the bright yellow gowns for contact precautions and slip on gloves before entering the room. The patient is reclined in bed, the large ventilator working loudly next to her, giving her breath.

“Hi Fiona,” I greet her. Her eyes are wide, as if fearful of what’s to come.

31-year-old. Not much older than me.

“We are from speech pathology,” Lauren chimes in. “Can you tell me your name?”

Collapsed during a half marathon. I’ve run plenty of those.

Fiona, she mouths. Then, her eyes grow wide and she attempts to cough, but nothing comes out.

Not sure what caused the respiratory failure. That could easily be me in that bed.

A wave of heat washes over me. I steady myself. Why do these contact gowns make you so hot?

“Jen,” Lauren snaps. “Can you read me her vent settings please?” Judging by her tone, she’s already asked me once.

I make my way over to the vent. This time, a wave of nausea washes over me. I rattle off the settings slowly, paying close attention to my balance. Lauren is inspecting the patient’s trach. I amble towards the door, sure I am going to fall over at any second.

“Lauren, I’m just going to be right outside the room,” I call over my shoulder. I rip the yellow gown and gloves off and feel a rush of cool air. I quickly sink into the closest chair to avoid collapsing. Slowly, my eyes begin to refocus and my heartbeat slows.

“You all right, Jen?” One of the pulmonologists is hovering over me.

“Oh, yeah, I’m ok. Just forgot to eat breakfast,” I lie. He puts a hand on my shoulder.

“Do you want a granola bar or something?”

“Oh no, thank you. I’m ok.” I force a smile.

“So what did you think of our lady?” He asks, nodding towards the patient’s room.

“She wouldn’t know because she didn’t stay long enough to assess her,” Lauren’s voice is sharp and staccato. She turns to the pulmonologist. “Dr. Monzi, we will continue to follow the patient and monitor for readiness to take PO.”

“Great, thank you.” Dr. Monzi smiles and turns.

Lauren turns to me. “What the hell is going on?”

“I’m sorry, I started to feel lightheaded,” I say in a near whisper.

“Are you not capable of seeing this type of patient?” She snaps.

“No, that’s not it. It’s just…she’s so young…and on the vent…” I struggle to piece together a coherent sentence under Lauren’s angry stare.

“You need therapy,” she asserts. “I recommend you find a psychologist and rectify this issue as soon as possible.”

I nod, looking down. Lauren turns, irritated. “I’m going to write up her note. I suggest you see a patient that doesn’t make you sick.”

I nod again, fighting back tears. It isn’t until the end of the day, when I get into my car and close the door, that I allow myself to sob.

Brooke's Brain

It was already pitch black outside at 5:00 pm on a Tuesday evening. I used my cell phone light to illuminate the pavement as I made my way down the long driveway. The house was large and stately; it was hard to tell which door was the main entrance. I picked one and knocked tentatively.

A small woman with wiry blond hair opened the door.

“Hello, I’m Kara, the speech-language pathologist with Gladeview Hospital Homecare,” I rattled off my introduction.

My boss Jennifer had called me, desperate. We have a homecare patient. Can you take her?

I had hesitated. I was already working over 50 hours a week at the hospital, between inpatient and outpatient. Burnout was a very real possibility.

She’s a high school kid, Jennifer implored. Seizures.

I thought of my little cousin Gemma, her thick strawberry blonde hair and bubbly personality. She was a sophomore in high school, captain of the hockey team. I agreed.

“Kara, hello.” The woman was wringing her hands. “I’m Heather, Brooke’s mom.” She pulled the door open wider. “Please, come in.”

Heather directed me through the kitchen, which led into the living room. A large brown couch lined the back wall, a row of windows behind it, a thin girl curled up on its left arm.

I made my way to the couch and sat down in the middle. Brooke turned slowly to face me and smiled sweetly. Her dark blonde hair was in a bun, greasy and matted, likely from EEG electrodes.

“Hi Brooke.” I smiled. “I’m—”

“Brooke, honey, this is Kara. She’s a speech therapist. She’s going to work with you, ok?” Heather scurried over to her daughter and started fussing with the couch in an attempt to put the recliner back down.

“Mommm, stopp.” Brooke’s speech was slow and effortful. She brought her hand up to swat at her mother, but it moved in slow motion. Heather wrung her hands. “Sorry, I’ll leave you two,” she said, and hurried into the kitchen. “I’ll just be right over here if you need anything!” She called.

“Hi Brooke,” I started again. “I’m going to be coming over after school to work with you.” Brooke nodded slowly, a lethargic smile curving her lips. I opened my mouth to go on, but stopped short. Brooke seemed focused, her lips pursed. After a few seconds, she breathed. “Soundds goood,” she said.

“Tell me about your life before the seizures,” I prompted. I needed a spontaneous speech sample. Brooke smiled and took a deep breath. “Before…thhhe—”

“Brooke was a straight-A student,” her mom jumped in. I hadn’t even noticed her creeping closer to the living room from her spot in the kitchen. “Played varsity basketball.” She smiled at Brooke. “Right, honey?” Brooke nodded, looking at me. Her mom continued. One day, Brooke had a seizure in the middle of class. She was rushed to the hospital where she stayed for nearly two months. She continued to have seizures, and the doctors couldn’t figure out why. They tried a host of medications, but nothing seemed to help. Finally, they found a drug cocktail that seemed to calm her brain.

“But the speech and word-finding deficits persist,” I murmured to myself.

“Brooke was in AP classes at the time. Now, she’s in special education. She can only handle a half a day of school because it’s too exhausting. She’s working on first grade math and reading.”

Brooke looked at me as her mom talked. Her eyes were soft but distant. I noticed the glisten of tears as they started to well up. I held my hand out. “You know what?”

Heather stopped.

“Let’s do something fun. You want to play a game?” I looked directly at Brooke, who nodded slowly. Then, she took a deep breath. She pursed her lips together and pushed down hard.

 “Mmommm, I haaaave…to go…” Brooke lifted her arm slowly and pointed toward the door.

“The bathroom? Sure,” Heather swooped in, gesturing one second.

“Take your time,” I said. I whipped open my laptop and started typing. Patient is a 15-year-old female presenting with seizure activity of unknown etiology. After a lengthy hospital stay, she was discharged home on Keppra and has been attending school part-time for the past three weeks. Speech production is characterized by

My typing comes to a halt as I hear screams from the bathroom.

“Kara, call 911!”

When Sam Found Language

I will never forget the day that I met Sam*. He was tall and shy, with dark tousled hair. He came into my room tentatively and sat still and quiet in his chair.

"Hi, buddy," I greeted him. He smiled shyly.

"How are you?"

He smiled again.

I pointed to myself and signed my sign name. Jen. Then, I pointed to him and gestured for him to introduce himself.

"Eoh," he said. 

How old are you? I signed. He stared at me. I signed, You. Age? Another blank stare. I signed, 7? 8? 9? Sam squinted, confused. I grabbed a blank piece of paper and wrote the numbers down, gesturing for him to point to one. He shrugged.

Under the numbers I scribbled out the alphabet. I pointed to the first letter.

"What letter is this?" I asked, enunciating clearly. Sam shook his head. I covered everything but the first row of letters. Where is B? I signed. Sam shrugged.

I had to figure out how to get in. When Sam looked away, I noticed that his cochlear implants had New York Yankees stickers on them.

Do you like baseball? I signed. Again, a blank stare. I grabbed my iPad and Google image searched pictures of the New York Yankees. When he saw them, his eyes lit up. He grinned and jumped out of his chair. He pointed furiously to the pictures and then perfectly imitated a pitcher's throw.

Yeah! Baseball! I signed.

He copied my sign. Baseball.

After that first session, I began to infuse Sam with language: American Sign Language. We started with the finger alphabet. We practiced forming the letters with our hands, matching them to the written letters, spelling our names and items in the room. 

What are you sisters' names? I asked. Sam shrugged. After an email to his mother and some practice, Sam could tell me: C-A-S-E-Y and H-A-N-N-A-H.

We learned colors and numbers. We learned shapes, animals, and food. We worked on answering questions.

Are the Yankees going to lose tonight? I signed.

No! He signed sharply, giggling.

In the early sessions, there was a lot of gesturing. A lot of manipulatives. A lot of real-life examples. We tasted honey to learn sticky. We left a teddy bear sleeping in the corner of my room to learn hibernate. We got in and out of boxes to learn prepositions. We stepped on leaves to learn crunchy. With this newfound language, Sam's previous use of tantrums came to a halt. A playful personality started to show through.

Sam proved to be a quick learner. We used sign language to build his literacy skills. Soon, he could read and write simple sentences. He began learning harder language concepts.

Why did the Titanic sink? I signed.

Because too many compartments filled with water, he responded.

Once we had a strong foundation for language, we began to target speech production in CV and CVC words. Sam had a diagnosis of apraxia of speech. This meant that his brain wasn't properly informing his mouth how to move for speech. When he would grope, his mouth unsure of how to produce the phonemes, I would show him the sign. With that visual, he was able to produce the word. We built up to CVCVC words with carrier phrases, so that Sam was able to make functional statements and requests in spoken English.

When I look at him now, four years later, sitting among his classmates in my push-in session, I am overwhelmed by how far he has come. His dark hair is still tousled. His cochlear implants still have Yankees stickers on them. But now, when I ask him a question, instead of a blank stare or shrug, his long arm shoots into the air, bouncing with impatience to respond.

I call on him.

White light is a division of seven colors, he signs.

That's right. That's how we see a rainbow. I smile.

Sam came to me like most of my other students do: severely language deprived. He was eight years old, with bilateral cochlear implants, unable to speak, sign, read, or write. A developmentally and cognitively typical child, he was using tantrums to communicate. 

When he was given a visual language that his brain so desperately craved, he was finally able to blossom into the curious, goofy, and capable child that he is today.

 

*name changed