Jul 17
lwinslow
lwinslow , Posted on SUPPORT NETWORK Blog

One survivor's creative determination to live alone

Anna
            Glistening, near-naked bodies, impossibly perfect, strut along Ocean Drive, sneaking sidelong glances at those seated at very hip sidewalk cafes. At eight in the evening, still hours before the club scene swings into action, the beautiful people pick through stone crabs, piling shells into pyramids. Looking across this pile of shells, it’s difficult to imagine 1976 before the club scene, before the endless tanned parade of young models, before the 1980 Mariel boatlift, which, in one fell swoop moved the middle class Jews out and the poor Cubans into Miami Beach’s South Beach.
            I had just arrived in South Florida from New York City. I was still in my twenties and I was a shiny-new speech-language pathologist. I was lucky enough to snatch a job working as a contract therapist for a practice on Lincoln Road in Miami Beach. My patients were mostly confined to their homes, and had recently been discharged from the hospital. My home health agency information sheet said that my patient, Anna H. was seventy-six and was in good health, except for a stroke, which affected her ability to communicate.
            The address was a small building similar to others that lined the streets on that southern part of the island of Miami Beach, on the tip of South Beach. What was old is now new. And oh-so-hip. Her small apartment in a modest two story, pale-pink art deco building, opened right onto the beach. The building was no taller than two stories and was divided into four average-sized apartments. Each apartment had one bedroom, bath, a kitchen area with a back door and an entrance into the living area through a screened in front porch. What was outstanding about this nondescript building was that it had occupied the very last lot on Ocean Drive, south of Biscayne Street, or what is now South Pointe Park, overlooking not only the ocean but Government Cut—the sea lane ocean liners use to access the Atlantic.
Three acres of palm stretched between Anna’s building and the water, and Australian pinedotted sandy dunes where, I later learned, Anna liked to walk. Across       from this property was Fisher’s Island—then relatively deserted—but now home to millionaires the likes of Oprah. This was 1976 and Miami Beach was very white, very Jewish, and very old. Anna’s South Beach was a very poor area populated by the elderly on small, fixed incomes and by cocaine cowboy criminals immortalized on the popular 1980s TV series, Miami Vice. In those days the draw was the  local favorite (and now world-famous) Joe’s Stone Crabs, kitty corner across the four-lane street from Anna’s little home. Other than Joe’s, tourists had no reason to venture into that residential area. But I had other business in that particular neighborhood. Sharing an alley with Joe’s Stone Crabs was a nursing home called Four Freedoms, and not a half-block away another aptly named Hebrew Home for the Aged.
I worked at both of these facilities as a speech pathologist. I was young, fresh and optimistic. I couldn’t imagine a future in which I would be any different except more successful—whatever that meant. Years later, after that area was nicknamed South Beach, I returned to Four Freedoms as a supervisor of rehab services, and as South Miami Beach morphed into SoBe, Four Freedoms was renamed South Point Rehab. Staffed then with young, pierced, pink-haired trendy therapists, the nursing home still housed sick, white, old people although now the majority of the staff and the patients were Cuban. As Miami Beach changed, so did I. And I had yet to even imagine the road I would travel.
            I knocked on the door at Anna’s beachside four-plex. No one answered. I tried the door to find it unlocked. I walked around to the back and spotted her. My lasting image of Anna was of her silhouetted against the early-morning sun, standing barefoot on the sand, looking out over the turquoise Atlantic, shielding her eyes with one wrinkled hand against the sun exploding the sea with diamonds. The breeze was blowing her blue cardigan sweater gently and her gray hair skimmed across her face and behind her. I imagined her as a fisherman’s wife waiting for her husband or trying to spot the tall sailing ship that would bring back her pirate lover…
She saw me a moment later and walked over, smiling to greet me. She left her door unlocked, for there was nothing to protect inside: her belongings were modest, and there was nothing worth stealing. Subsequently, when I visited her, I just let myself in and waited for her. I don’t know what she thought about out there on the sand; she never told me. She couldn’t tell me because she had few words. The stroke took them away.
            Anna was lean, almost sinewy, and tall, or it seems so in my mind’s eye, and preferred shirtwaist dresses in the style of June Cleaver or Harriet Nelson. Her features were chiseled but soft like the smooth surfaces of rock sanded by time. I took her to be German, perhaps, European descended for sure. And she was South Beach tan.
            Her home was modestly furnished: a small dining table and two chairs, and a simply furnished living area that welcomed whomever entered through her front porch. I entered and took one of the aluminum chairs at the table. The little house was clean with few personal touches. The furnishings were so generic that I wondered if Anna had rented the place furnished. She sat in the only other chair. If I was impressed one way or another by her, so far, I can’t recall. I guess her greeting was appropriate. Certainly she was an unusual patient in that she walked without help and lived alone with no apparent care from another. When you’ve treated a number of catastrophically bitten people who were bed-bound and barely aware of you, a walking, talking person was a treat.
            I returned Anna’s steady gaze and introduced myself, told her why her doctor had sent me, and what I was there to do. Her gaze did not waver but she had yet to respond. I had nothing to do but  begin the testing. I always started my language testing with easy commands from a generic standardized test: open your mouth, hold up your hand—that kind of thing. I’d then move on to questions that can be answered with a “yes” or “no.” Following the questions, I had my patient point to something I would name, and then go on to short simple stories followed by questions about each story.
Anna had difficulty with everything I had asked her to do so far. She crinkled her forehead at the commands and only answered a few correctly. Her “yesses” and “nos” were not reliable. Although she listened with intensity, she could not recall facts from a paragraph she heard. I wanted to see if her inability to follow commands involved something physical, or a break in the signal from the intention center in her brain to her body, so I asked her to imitate what I did. She caught on well and followed my lead. Anna had some damage to the comprehension center of the brain due to her stroke.
 What else was amiss? I wondered.
Taking control of her possible responses, I posed completion tasks such as “boy and…” trailing off and gesturing that she should finish the phrase. She performed fairly well. Her speech gave no indication of muscle weakness of the mouth or throat.
When I eased back on my control and began sentences left undone that my patient had to complete (such as “Last Sunday…”) with the same inviting gesture to complete what was started, Anna strung together words which had recognizable structure but no meaning. Something on the order of, “Last Sunday…if you went out to the and bring back my my house.” Remembering my graduate school lessons from a mere three years ago, I knew that Anna presented me with a type of language disorder adversely affecting comprehension. I later came up with the label, “Wernicke’s Aphasia” to describe this condition.
Adult “aphasia” means a loss or impairment of language following brain damage.
 I also remembered that hallmarks of this disorder, also referred to as sensory aphasia, included: words spoken smoothly but not with any meaningful substance, problems retrieving words, poor comprehension, and difficulty repeating. Sensory aphasics don’t seem to know they are not communicating well. They have poor self-monitoring—they don’t understand their own speech.
            I used the rest of my test time to explore Anna’s writing, reading, gesturing, and verbal expression. Our conversations were not typical. I would talk, she would listen and respond with actions and “not-words”—and I somehow understood. Or maybe I filled in blanks. Maybe I got it all wrong, I’ll never know. Very basically, Anna did not understand much that was said to her. Although her speech had familiar rhythms, her verbal expression did not make sense. I set about to plan a course of action to improve Anna’s communication. I left her with a business card and told her I would be back the next day.
            As the screen door slapped shut behind me that first time, I thought about the prospect of living alone with an inability to adequately communicate.
We take so much for granted, I thought as I walked away.
            All the times I visited Anna, she was alone. When I got to know her better, I took liberties. As she stared out over her ocean, I came inside and ferreted for clues as to whom I could call about her to get information, some background, in case something happened to her. I felt I had the right since I was referred to her by her primary physician and had a responsibility for her well-being. I just assumed that everyone had someone.
She had no address book. No pictures decorated the apartment walls that gave up hints of antecedents or bouncing grandchildren. Some of the usual detritus of day-to-day was scattered around: bank statements, newspapers, junk mail that waited to be tossed. But no hint of people.
            In the beginning, I put my therapy books down on her kitchen table, waited for her to sit with me and started with our sessions. A certain personal protocol grew from visiting minimally verbal or nonverbal people in their homes. I had a routine. They knew why I was there. I told them my name, what they were to expect from me, and tenderly explored how much of what I said was understood, wholly or in part. I wrote down a lot of what I said aloud. It helped sometimes. If family members were present, it was easier. I could speak to the loved one with frequent glances at my patient knowing my message would be repeated to her once I left. With Anna, I was on my own.
She apparently had no family. Nor any friends. No one was ever there the same time as I was. How was I supposed to help her? I showed her pictures and asked her to repeat the names of the pictured items. I was somewhat successful in getting this tolerant woman to give back a recognizable word or two. I suppose I was quite proud of myself for being her crusader—the glamorous champion of communication who was going to restore life itself to this wordless woman. Not quite.
             I supposed a neighbor took pity and time and stocked her refrigerator because she had food and she did not appear hungry or malnourished. I just supposed. She caught me furtively glancing into the refrigerator one day and just smiled. My curiosity aroused, I asked her frankly with words and gestures who had bought the groceries for her. She stood up, picked up her sweater then her purse. She walked out the door. I guessed I was to follow.
            Anna lived in an area that would be desirable years later. In Anna’s time, the neighborhood was low-rise and poor. The apartments were filled with the elderly who overflowed their stoops onto the streets and beaches. Joe’s Stone Crab, nearby, served the wannabe famous who waited for hours to be seated after subtly palming the maitre d’ a large bill or two for the privilege of just being there.
            I walked briskly to keep up with Anna, who knew just where she was going. She turned to me before entering a tiny Cuban grocery store—the kind that sells the incidentals one forgot when they went to the supermarket. For an instant I felt stupid. I assumed Anna to be European but thought that she must be Hispanic and that was why she can’t understand my English. I usually explored a bit to see of my patients were more comfortable in another language but Anna seemed so… continental. Somehow, it didn’t occur to me she might be Latin.
             My poised erect-postured patient nodded her hello to the cashier and strolled down aisles, selecting items everyone needs: toilet paper, soup, coffee, cold cuts, the usual. She took longer to carefully select her fruits and a few vegetables. Wordlessly, she approached the cashier with me silently in tow. This was clearly her shopping trip—not ours. She handed the cashier a twenty-dollar bill, which apparently was sufficient, for she received change. Anna accepted her change silently, with a wry smile and a little shrug and threw it in her purse. The cashier displayed recognition of Anna, and Anna of the clerk, but neither spoke. Off we went back to her home.
I was dumbstruck. This was a woman who was neurologically impaired, who, because of her stroke, lost every vestige of verbal language. Yet, she maintained cognition, strategy, appreciation of options, humor, irony. She used a Cuban grocery not because she was Cuban but because she knew that the Cubans, still in a small minority on South Beach, would not presume to speak to her, an Anglo, in English. She did not have to speak to them. It was brilliant.
            After the Cuban grocery-shopping trip, I accompanied Anna to many places one needs in order to maintain independence. My car came in handy as well, although she never complained when she had to walk many blocks to get places. She had a solid, apparently long-standing relationship with her bank. Instead of the teller’s window, she chose a woman who sat at one of those desks in the lobby. I asked the bank woman if she was a personal banker.
She laughingly said, “No, but I help Mrs. H out when she comes in. I recognize her from before her stroke. Anything I can do to make it easier for her, poor thing.” It took me awhile to figure out that Anna had no concept left of the value of her money. Coins were confusing and so was the green money. To use a coin laundry, she took out all of her coins and just pushed them into the slot one by one until something fit. She used that coin as a model to choose others until she deposited enough to do her wash. She was clever.
            I recalled the cashier at the grocery. Anna gave her a twenty although she had some smaller bills in her wallet. It made it easier to get change rather than choose the right amount of change to give the cashier. Now, in the bank, Anna’s “personal banker,” cashed her social security checks and changed her small bills, giving her twenties and fifties so she could continue shopping and laundering independently.
            For many years since meeting Anna, I’ve often marveled at how resilient some people are, how thoughtful and clever they can be. Anna gave me a huge gift: the ability to interact with individuals on their own terms. I came to realize the wholeness of a person, and who they were before I came along. Treating Anna was exciting for the lessons she taught me. Much more excitement was yet in my future. Anna’s independence meant more to her than the security of a boarding house. She was determined to live and die in her own home.
 
 
1 Comment
  • Kerstin Wiggins
    Kerstin Wiggins,
    lwinslow, what a moving and beautifully written story? I have spent the last 1/2 hour completely enamored with Anna and her small apartment by the sea . Did you write this?
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