A Nursing Home Mini-Series: The Final Chapter

Ebola Virus

I planned on writing more in the nursing home mini-series, but I've been sick with some virus. I gave the nurse a stool sample so the people in some laboratory nearby will play around with it to decide which virus. I don't care really because I'm getting out of here this weekend, as long as it isn't life threatening like Ebola. My luck. Ebola.

Anyway, I'll give you a microwave version of what went on. I was going to write a whole post about the time Beatrice answered the cell phone in the dining room in the middle of dinner. Beatrice is hard of hearing. The person to whom she was speaking was evidently hard of hearing, too.

"I have diarrhea," Beatrice said to the caller. The caller obviously didn't discern the word. "Diarrhea! DIARRHEA! DIARRHEA!" Beatrice screamed. 

A few people sitting nearby didn't blink because they were hard of hearing, too. The others went right on eating their dinner. I walked away from the table, and I was sorry about that, because we were up to dessert and the scrumptious pies usually served there are terrific. But I had no appetite. Diarrhea indeed.

 
And there was the time that two aides got in a verbal fight over whether they should serve chicken soup broth to a vegetarian. It was the height of the argument.

"You can't see the chicken because it's fuckin' broth!" screamed the one aide.

"Chicken is meat and vegetarians don't eat no meat!" screamed the other.

I didn't get involved, but I had my opinion, too. Chicken is meat. I'm just sayin'.

A few other posts were in construction, but I am calling this post the final chapter in the mini-series because it is. I'm feeling depleted of energy from the virus. I have rashes on my extremities, the "d" word (Beatrice would love this post), vomiting, stomach pains, fever, and nausea. If I were to take a guess, I'd say it was the norovirus. Same symptoms, same misery.
http://stroketales.blogspot.com/2013_03_05_archive.html

A Nursing Home Mini-Series: Praying Is Praying, aka Right Pew, Wrong Church

Beatrice drank water and wasn't dehydrated anymore, and improved to the point where she could participate in the nursing home activities.

Though Beatrice didn't know my ethnicity, she said, "Do you want to go to a worship service with me?" 

The nursing home had a hall where any event could be held. Last week, a Polka tribute. This week, a worship service.

The worship service was at 7pm and I knew it wasn't the Jewish kind. We, as Jews, don't say worship service. Every Saturday morning, we say "Shabbat" service, and on the many holidays throughout the year, we have a service to commemorate that holiday, or Holy Days, as with the case of Rosh Ha'Shanah and Yom Kippur. 

But we share a Bible--the Old Testament--and when it comes right down to the heart of it, we're all praying to the same God, so I said, "Sure. I'll go with you." 

I figured, with a stroke and following my drop-foot surgery, a bunch of prayers couldn't hurt. In other words, I needed all the prayers I could get.

Beatrice was in worse shape than I was, so I followed the aide who was pushing Beatrice's wheelchair in my wheelchair through the narrow curves in the hallway, negotiating and steering with one left hand and foot. I didn't take the cane because it was too darn far.

At last, we arrived at the massive hall, and I thought of the chairs as pews because it was a worship service. There were hushed and whispered sounds all around. Beatrice and I sat in our own wheelchairs outside the "pews." 

A few people handed out booklets from Baptist Homes Society Sunday Chapel Service which contained the notes and lyrics to the service, and minutes later, the tall pastor entered and a pretty pianist, who was already seated at the piano, started to play "Call to Worship and Lord's Prayer."

Glory be to the Father and to Son and to the Holy Ghost....

I could have hummed the melody because I could read the notes from my extensive music background. But that didn't sit right with me. I was on auto-pilot. My brain didn't want to do it, to sing those words I didn't believe in. 

I mouthed the words slowly so that I would reach of end of the "Shmah" when all the gentiles would reach the end of "Call to Worship and Lord's Prayer." Translation: "Hear, O Israel: the Lord our God, the LORD is one," found in Deuteronomy 6:4.

The next song  was "Jesus, Lover of My Soul." I didn't ever sing to Jesus. I automatically sang, under my breath, "Ein keloheinu." Translation:
There is none like our God, There is none like our Lord, There is none like our King, There is none like our Savior. Who is like our God?, Who is like our Lord?, Who is like our King?, Who is like our Savior?
Let us thank our God, Let us thank our Lord, Let us thank our King, Let us thank our Savior.
Blessed be our God, Blessed be our Lord, Blessed be our King, Blessed be our Savior.
You are our God, You are our Lord, You are our King, You are our Savior.

There were 3 songs left, and I sang silently the "Ma'Nishtana" for Passover and the blessing over the candles and the Dreidel song for Hanukah. It was a mish-mash of songs, in the wrong order and/or holiday, that I remembered from going to Hebrew school for 10 years and services for almost 60 years.

Then the pastor told a little tale that had to with, when I was listening, a man, some fish, and a river. I was distracted by the auto-nicity of my brain to sing the Hebrew songs rather than the gentile ones.

The service came to a close 45 minutes later and the pastor, with two hands, grabbed both Beatrice's and my wheelchairs and took us back to our rooms, Beatrice in front and me in back, confident in the knowledge that we both prayed. 

Deep in my heart, I knew that God would understand. 

A Nursing Home Mini-Series: Seeing Things That Aren't There, aka Hallucinations

Maggy was a fall risk, never knowing when she would pass out, and Beatrice, who fell in her kitchen, had an IV bag attached to her arm because she was dehydrated. They were relegated to their rooms for all activities, including therapy. And Cassey was, at last, home. So I had to find a new "eating" table, the most popular activity in the nursing home.

I chose to sit with Tillie because no one else wanted to. Tillie was always seeing things. She was 92 years old and she talked about the cats she saw so clearly on her feet, in the garden, through the plants. But there were no cats to be seen. She had a stroke 12 years ago, had macular degeneration, had a recent fall, and she was hallucinating. She was healthy otherwise, knowing that people rejected her but not knowing why.

During breakfast, she said, "Of course, the mother cat looked after her offspring. She was tawny in color and searching for food the kittens could eat." And she described the kittens, one being all white and one being striped. And she had a vision of dogs playing in the courtyard of our nursing home--one a blonde cocker spaniel, the other a tan and black beagle. 

So I decided to do some research on seeing things that weren't there. 

Oliver Sacks -- Hallucinations

The hallucination [that's what most neurologists call them] is convincingly apparent, produced by the same neural pathways as real-as-life perceptions. 

Oliver Sacks, a professor of neurology at the N.Y.U. School of Medicine and the author of a book called “Hallucinations," wrote this excerpt in The New York Times in 2012: "People with impaired sight, similarly, may start to have strange, visual hallucinations....Perhaps 20 percent of those losing their vision or hearing may have such hallucinations." Remember Tillie had macular degeneration?

Sacks added that Charles Bonnet Syndrome (CBS) is a condition where people with vision problems begin to experience visual hallucinations. This condition -- CBS -- usually belongs to the elderly. They may see active cats or flying birds, for example. Remember Tillie saw cats and dogs?

New medications or a faulty mix, or a quick change in environment, may cause hallucinations as well. I remember when my grandfather suddenly moved to a nursing home and he "saw," though nobody else did, a variety of animals soon after. Tillie went into the nursing home suddenly, too.

Given the imperfection of the human body, aka nobody is perfect, it is more than likely that something in the brain
is at fault. After all, the brain controls everything, as individuals, that make us who we are, like strokes, for instance. Any of those factors -- macular degeneration, Charles Bonnet Syndrome, sudden change in environment -- could have contributed to Tillie's hallucinations.

However, it didn't matter. Tillie, at 92, is who she is and lucky to be alive, and seeing things that aren't there is a part of her. I'd always sit with her because hearing odd shit is who I am.

A Nursing Home Mini-Series: Life with Old People

Some of you missed my last post -- http://stroketales.blogspot.com/2014/07/wake-up-stroke-survivors-before-its-too.html -- in which I told the outcome of my stroke-related surgery. The surgeon said the operation was successful. I say the surgeon did the best he could with what he had to work with. 

Anyway, I'm in a nursing home now, which is divided between residents (I say "lifers") or, as with me, people who go here to recuperate. I had surgery so I fall into the second batch.

The nursing home serves three complete meals a day -- breakfast at 8, lunch at 12, and dinner at 5, plus snacks, if anybody wants them, in between and after dinner. So you could spend around six hours just eating.

The nursing home is understaffed, so the aides start bringing  people down to the dining room thirty minutes before the meal started in order for all of the people to be there when the meal officially began.

The aides are responsible, too, for bringing the platters of all people who don't want to socialize. One aide said to me, "The people eat in their rooms, if they are sick or don't want to socialize with 'old' people." I took offense at that remark because I am one of them, the old people, I mean. I don't know when it happened and I don't feel old. But numbers never lie. I am 66.

I got to the nursing home just before dinner. In the wheelchair, I saw an open spot in the table for four. One of was the little, old lady named Gert. I don't know the reason for her going to the nursing home. She died three days later and Cassey took her spot. Cassey, who was a year younger than I was, was a geriatric/psychiatric nurse who had a hip replacement. She was quiet and liked observing the other two. 

Maggy was an 91-year-old, bust-ass, no-holds-barred, obese lady who actually was comfortable and secure being obese. Maggy was a diabetic who passed out until somebody in her family had the sense to gain her admittance to the hospital. Then the doctors figured out what it was, but I never knew. And I didn't ask. She came her to rest.

And the fourth was Beatrice, 89, who said platitudes all day like "Where there's a will, there's a way" or "If it's meant to be, it will happen." Beatrice had a fall and she exhibited black-and-blue marks on every inch or two of her body. She was also a sentence finisher, like if you paused and were trying to finish the sentence, she would finish the sentence for you. Most times, she was wrong in the word that she selected. And that got the hairs on Maggy's neck to stand up at full attention.

"I don't like when you fill in the blanks," Maggy screamed.

"Well, the right word fits the shoe," Beatrice said, mixing up platitudes. Sometimes, when Beatrice got tired, she said them that way.

So that was the table. I sat with them for three weeks until Cassey's hip allowed her to be discharged. Cassey sent me an email when she arrived home, happy to be with her boys (aka cats) and her comfy, overly high bed which, as her email said, she accessed with a step stool she borrowed from her sister.  

Maggy passed out again, and Beatrice was still hooked to an IV bag for dehydration. So tomorrow, I was on my own to find new people at a different table.

That's the thing about nursing homes. I didn't think I'd have time for making really good friends because there's a fast turnover rate, akin to a revolving door. But I had enough sense that I wouldn't die trying either.

Ho Hum: Life in the Hospital Is Mostly the Same, Except Sometimes....

The most famous definition of "crazy" comes down to doing the same things over and over again and expecting a different result. I think I am borderline crazy.

When I first go in the hospital, I think that I have a few days off, a vacation of sorts, but then I realize, no more than a half an hour in, that I want to be some place else other than the hospital. It's not the hospital's fault. I own this one.

Here is what happens every time: the nurses, due to liability issues (their liabilities, not mine), take vitals--that is, listen to my chest, take blood pressure with the cuff, and record my temperature--every 4 to 6 hours, especially when I first come out of surgery. Then comes the phlebotamist (some people say "vampire") to take the blood samples. The phlebotamists start at 4:30 am. 

Then I attempt to go back to sleep, but the nurse comes in again to check your vitals before she goes off shift at 7am. Then bathroom, dressing, brushing teeth, breakfast, therapy, lunch, more therapy, dinner which is served around 5pm, and I'm in bed by 7 pm. And I am exhausted.

Also, as a patient, I always look the same, no matter what mood I'm in, as shown in the photo on the left. If I'm sad, I put on a happy face. If I'm angry at the nurse, I won't show it, especially because maybe she'll leave out the pain meds and then say "whoops" when I call her on it. And nobody likes to be around a depressed person or one who is in pain or tired. So I hide those emotions more often than not. I don't like surprises so I don't acknowledge them. We already went over the mentally ill part.

So I was surprised, a day before I left the same old, same old hospital, that a break in the routine occurred. I had the lights out at 7 and was watching some television show about country singers when a gangly, middle-aged man opened the hallway door and wandered into my cluttered room. My gut said to me, "Danger, Will Robinson." My gut was the only body part who was talking to me. I didn't hear a peep out of my brain.

"Where's the bathroom?" the man said as he rifled through some clothes in my closet. The only thing I thought of is, I'd have to wash the clothes at some point--all of them. 

Then I spoke. "The bathroom is on the opposite wall," but he went straight ahead to the hospital bureau and opened a few drawers, touching personal items. I'd definitely wash that stuff, too.

The bed and bathroom were all that remained. Fortunately, he went into the bathroom, and I called the nursing station.

"A man just went into my bathroom. I don't think this is allowed because...." I didn't finish the sentence because the nurse already hung up.

Four nurses arrived in the blink of an eye and got the man out of there. I don't know if he was "finished" or not. Apparently, they didn't care.

The man turned around toward my bed. "Thank you, lady," he said.

"Did he hurt you?" one nurse remaining said. Once again, the nurse was worrying about her liability. I can't blame her. Jobs are hard to find in this economy. The nurse continued. "He just had a stroke and he didn't know what room was his."

"No, he didn't hurt me," I said, sorry that I called the nurses at all, considering that he was now a member of the infamous club.

Wake Up, Stroke Survivors, Before It's Too Late to Do Anything!

Nobody told me about tendon transfer surgery while I was in New Jersey. Or Philadelphia. Or what I read on the Internet. So what is it? 

Tendon transfer surgery may be needed on the hand and/or foot if muscle function has been lost due to a disorder of the nervous system, like stroke. 

You probably read my post called My Upcoming Surgery for Foot Drop, aka My 50/50 Gamble.(http://stroketales.blogspot.com/search?updated-min=2014-06-01T00:00:00-04:00&updated-max=2014-07-01T00:00:00-04:00&max-results=3)

Well, I had tendon transfer surgery, by Dr. Dane Wukich at the University of Pittsburgh Medical Center (UPMC), two  weeks ago. This is the first time I could write about it to all of you because of the ongoing pain that should slow down in another two or three weeks. The surgeon called it successful, but here's the detour he had to take because he encountered two problems:

The tendon, when he got to it, was atrophied, meaning that the tendon lost the power it once had. I was 5 years post-stroke. Here's a picture of what it looked like:

Also, the bone around the tendon was too thin to safely transfer it. I had osteopenia, a step before osteoporosis. 

So the surgeon cut the tendon rather than transfer it, allowing my foot to be flat. (The tendons shorten after a stroke from non-use). That's good enough for me. I still can't wiggle my toes, but it was worth it, not having drop foot any longer. It might take more than a year to discard the brace, but at least there is hope.

Again I ask, why didn't some doctor tell me about tendon transfer surgery before it was too late to do anything?

Folks, if you had a stroke or know people who had a stroke a year ago or less, investigate about tendon transfer surgery. You'll be doing yourself or them a great favor before it's too late, and before atrophy sets in.

The Day Before My Self-Elected, Drop Foot Surgery

My grandmother, on my father's side, was born in Russia, circa 1884. She escaped to Paris for 6 months to avoid the Russian pogroms, primarily aimed against the Jews, in the late 1800s. And then, when she found a ship going anywhere but Russia, she settled in Canada. If you asked my grandmother about her nationality, given that there were a few choices, she always said that she was French because she learned the language or, at least, enough to get by. 

Sarah Bernhardt

While in Paris, my grandmother saw Sarah Bernhardt, known as "The Divine Sarah" for her flamboyant roles, on the Parisian stage a few times when Grandmom was very young. That's where my father got the idea, from his mother, that as a teenager, I was the dramatic Sarah Bernhardt, as he addressed me, complete with exaggerated expressions, dramatic entrances and exits, and sullen moods. As nicknames went, it wasn't so bad.

Anyway, I outgrew the extreme behavior patterns at twenty, right on schedule, not being a teenager any longer, and my life went on. I had a stroke in 2009, and the Sarah Bernhardt-isms returned, less dramatic but still there, like this picture I posted in Facebook about my operation tomorrow:

Everybody said I was brave and/or out of my mind to have an operation that would correct my drop foot. And that got me thinking: I was brave, but was I out of my mind?

I used to be a runner, and like most runners everywhere, I dreamed of running the Marathon. The drop foot surgery, if successful, would allow me to rotate the foot and ankle, where now, my foot always hangs there, like it's lost the fight. It might take me a year or more and a tad of money for a trainer, but the Marathon is on my bucket list, and so are square and round dancing and taking lengthy strolls. So "out of my mind"? I don't think so.

I write this post the day before my surgery because, well, who knows, from one second to the next, how "it" will go? The risks of surgery are hideous; for example, reactions to the anesthesia including anaphylactic shock or rashes, infection, vomiting, dizziness, and yes, but not likely, even death. But how can I not go through with it. I may not have drop foot any longer,  and that means I could shed the brace forever within the year! 

A little more than 24 hours to go and I'll be on the operating room table, knocked out, surrounded by the surgeon, the residents, the  anesthesiologist, the nurses.  I am going into surgery calm, collected. I'll keep a diary to share with you as soon as I can.

But even now, once again, I ask myself about the surgery, "Are you out of your mind?" 

And the answer to myself doesn't surprise me because it's always the same: "I don't think so." 

The time is ticking down, seemingly fast.

How Two Legal Drugs Caused My Hemorrhagic Stroke

Pittsburgh, PA, is the magical land of good health where people embark on a journey just to be here, with Pittsburgh's reputation of new discoveries and treatments. Just today, I heard about a doctor who gave a man an artificial lung machine in a unit no bigger than a BLT sandwich.

Pittsburgh is where I found out stuff I didn't know, like my upcoming surgery on July 14 with the famed Dr. Dane Wukich, foot and ankle expert extraordinaire, to correct my drop foot, (or foot drop), where the tendons and muscles are not working enough to pull the ankle up. I want to run the Marathon--any Marathon--so I have to get my ankle working. (But that's another story for another day).

Today, I learned even more stuff. I took Coumadin, the blood thinner, from the start of my stroke over 5 years ago until now. I had loads of doctors then, and the communication between them was, at best, lousy. So I was on Coumadin until today when the well-known hematologist, Dr. Dhaval R. Mehta, who took lots of tests last month, figured out that I didn't need Coumadin anymore.

"No Coumadin?" I asked.

"No, you're done," the doc replied.

"Do I have to ween off of it?" 

"No, you're done," he said again. "Somewhere down the line, you should have been taken off Coumadin," Dr. Mehta said.

I was satisfied with Dr. Mehta's response but not with the last part. Somebody screwed up. But he had all the test results and I listened intently. But there was still a piece missing: why did I have the stroke? I was the picture of health: low cholesterol, low blood pressure, a non-smoker, no diabetes, a runner. So I put together some of my research as well.

This is my own theory. Avelox, an antibiotic, could result in clots as the side effect of that drug. I was in the hospital two weeks before I had my stroke in 2009 for an ear infection. So the ear doctor in Philadelphia put me on Avelox, and as a result, I got clots in both legs and I went to the ER because of the pain. 

The ER doctor admitted me and I was put on Lovenox, a low-molecular form of Heparin, to break up the clots. (Now here's where the story gets interesting). As a result of being on Heparin, I developed Heparin-induced thrombocytopenia (HIT), a serious side effect that may occur when one is being treated with heparin.

HIT can lead to low blood platelet counts, which I had. My platelet count went down to 18,000 and a normal platelet count is around 237,000 per mcL in men and 266,000 per mcL in women. 

HIT occurs in about 3% of people who are treated with heparin. HIT is more likely to occur with use of higher doses of heparin, but HIT can also be caused by very small heparin doses, including the amount used to flush intravenous catheters. So the very drug that was supposed to help me gave me HIT.

HIT is sometimes referred to as “heparin allergy." However, this is not correct terminology because it is not a true allergy. In most cases, the body makes antibodies to protect us from infections. The immune system in some people, for some reason the docs haven't figured out yet, makes antibodies in response to treatment with heparin. 

After the antibodies bind to the platelets, they are removed together with the platelets from the blood stream, resulting in a low platelet count.  Thus, HIT. And HIT can cause bleeding in the brain. Thus, a hemorrhagic stroke. 

Again, it's my own theory. So no more weekly blood tests, now that my taking Coumadin has ended. No more worrying about Vitamin K and cranberries, the substances that determined, in part, my Partial Thromboplastin Time (PTT) blood result. 

I celebrated by going home and having a turkey sandwich without the leafy greens (Vitamin K). Tomorrow, as the celebration continues, I will have cranberry juice. This weekend, I'm going to have some wine. Alcohol wasn't allowed with Coumadin. 

It took me over 5 years to discover that my taking Coumadin is finally over. I am satisfied with Dr. Mehta's decision. And the mystery of why I got a stroke has ended, to my way of thinking. Two legal drugs.... You never know.

My Upcoming Surgery for Foot Drop, aka My 50/50 Gamble

This may be my last post until my surgery on July 14th. Or maybe not. Anyway, I'll update you as soon as I can on the surgery. As usual, here's some background on the operation.

Ever since the stroke, I developed foot drop (or drop foot--I've heard it both ways), meaning the muscles and tendons that pull the foot and toes up are no longer working substantially. I walk on the side of my foot and the toes are not flat on the ground.

The American Orthopedic Foot and Ankle Society (AOFAS) says, "The surgical procedure for a foot drop is called a tendon transfer. In general, a tendon transfer is a procedure in which a tendon (and attached muscle) that is still working is taken from one part of the foot and moved to another part of the foot to try to replace the muscle function that is missing. The most common tendon transferred is the posterior tibial tendon." 

There's more. A second tendon, the peroneus longus, is severed above the ankle on the outside side of the leg. 

This tendon is then transported to the front of the ankle and the free end "is attached to the posterior tibial tendon and the anterior tibial tendon in a bridle configuration. With this construct, the posterior tibial muscle pulls on all three tendons to pull the foot up. The posterior tibial tendon is routed to the top of the foot as described above," says the AOFAS. Clever, huh!

Here's what it looks like when it's finished:  

Am I scared? Sort of. Anything could happen during surgery: anesthesia going south, infections. But do I have confidence in Dr. Dane K. Wukich? Absolutely!

As his website says, "Dr. Wukich is the chief of the foot and ankle division and associate professor of orthopaedic surgery at the University of Pittsburgh Medical Center. He is recognized nationally and internationally in this field and practices within the UPMC system and the Veterans Administration Medical Center is Pittsburgh. 

"His 80 publications include scientific articles, reviews and book chapters and he has presented over 150 medical lectures during his career. As a board certified orthopaedic surgeon with subspecialty training in foot and ankle surgery, Dr. Wukich is uniquely qualified to treat traumatic, degenerative, congenital and acquired disorders of the lower extremity. His orthopaedic training included comprehensive education in:

Amputations of the Lower Extremity  
Amputation Prevention 
Arthritis 
Biomechanics 
Degenerative Joint Disease 
Diabetes and its Impact on the Foot and Ankle 
Joint Arthroplasty 
Limb Salvage 
Metabolic Bone Disease and its Impact on the
Musculoskeletal System 
Neuromuscular Disorders and Spasticity 
Rehabilitation 
Sports Related Issues and Overuse Disorders 
Trauma"

Dr. Wukich examined my foot and said I am a candidate for this surgery because I have some minimally working muscles in my ankle and foot. If the operation is successful, I won't have to wear the cumbersome brace anymore. The doc said my chances are 50/50. 

How come no one in Philadelphia or South Jersey, where I am from, recommended this surgery? I haven't a clue. But I'm glad I came to Pittsburgh to find this information. 

By the way, Dr. Wukich doesn't know anything about this post. I won't tell him, either. He's a humble man, I think. But people who have drop foot will be educated on what they can do about it. "Options" is my middle name.

So I won't say "goodbye." That word is so final. Rather, I'll say, "See you later." 
------------------------------------------
3 months later:
Surgery is a success! No foot drop and my foot is flat on the floor! I'm wearing the brace for now, but who knows what the future will bring? But I'm staying positive and maybe....

Impulses and the Brain, aka Fuck! Where Did My Filters Go?

In 1848, in a report written by Dr. John Harlow, M.D., the doctor related the unfortunate, rock-blasting accident by a railway worker, Phineas Gage, who had a long metal rod blasted through his left cheek, through his eye, and out of the top of his head. Consequently, the accident caused damage to his frontal lobe. 

Gage survived the accident and had his memory, speech, and motor skills intact, but he had well-documented changes to his personality. (The photograph is of brain-injury survivor Gage, 1823–1860, shown holding the tamping iron which injured him).

Before his misfortune, Gage was described as organized, respectful to others, and well-tempered. According to Dr. Harlow, following the accident, he was "fitful, irreverent, indulging at times in the grossest profanity, and manifesting but little deference for his fellows." In other words, he was disorganized, had hissy fits, cursed, and disrespected others. The cause? He had damage to the frontal lobe of his brain.

 
The frontal lobe is so vulnerable to injury because of its location. Damage--any kind at all--to this lobe can lead to one or more of these problems: 

Change in speaking behavior

More or less problem-solving ability and creativity
Impairment of risk-taking activities
Reduction in sense of taste and/or smell
Damage to spontaneity and mental flexibility
Increased susceptibility to distractions 

Finally, after all this time, after more than 5 years, I discovered, through the story of Phineas Gage, why I had no filters after the stroke. But a little background first.

Of all the parts of the brain, the cerebrum or cortex is the largest part, which is further sub-divided into four lobes: the frontal lobe, parietal lobe, occipital lobe, and temporal lobe. (There are other "areas and sections," too, but the lobes are the subject of my focus).

Responsibilities of the frontal lobe: reasoning, planning, organizing thoughts, behavior, sexual urges, emotions, problem-solving, judging, organizing parts of speech, and motor skills

Responsibilities of the parietal lobe: information processing, movement, spatial orientation, speech, visual perception, recognition, perception of stimuli, pain and touch sensation, and cognition 

Responsibilities of the occipital lobe: visual reception, visual-spatial processing, movement, and color recognition

Responsibilities of the temporal lobe: visual memory and verbal memory involved with hearing and speech

My brain damage was in the first and the second—frontal and parietal, the former controlling behavior and emotions when it came to my filters, or lack of them.

I remember it well. After my stroke, as soon as I was mobile, I went out to lunch with my son. It was an Indian place that had a huge buffet. We ate our meal and as soon as the check arrived, we paid at the counter. All of the sudden, a hefty man, who couldn't wait for the food, cut to my right, almost knocking me over.

I began to chant. “Rude.” Then louder. “RUDE.” Then louder. “RUDE!” Then the ultimate. “FUCKING RUDE!” That chanting at the peak went on for about a minute. My son tried to usher me out, but I was transfixed on that spot, with people in the restaurant staring at their plates. The man continued grabbing food from the buffet. That, my friends, is when I knew: my personality, formerly consisting of peace, decorum, and patience, changed--completely. My filters were loose and couldn't be roped it.

Granted, I was aphasic more that first year, more than I am now, but I was off and gone that first year, screaming at receptionists if they didn't understand me, yelling at doctors (yes, doctors) if their opinion was contrary to mine, berating waitresses by repeating my order loudly if they were not in tune with me. I was a mess. I couldn't recognize me, as if there were two of me, one shrieking and the other assessing, all because of the frontal lobe not controlling my impulses.


I am better now, though still not perfect. The word "fuck," "shit," and/or "crap" are always present if I lose my filters for the moment, like "Fuck this" or "Don't be a shit" or "This is crap." Sometimes, I'll combine them as in "Fuck! This shit is crap." 

Sometimes, saying "fuck, shit and/or crap" feels so cathartic. But not all the time, as I did that first year. 

I'm going to have surgery July 14 to correct my dropped foot. I'll write a post about the surgery soon. So if I ever do anything athletic again, I'd wear a helmet. I wouldn't want to damage the frontal lobe again. Fuck no!