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rQ
28th June 1988
NUS Medicine


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Thursday, April 07, 2011, 10:38 PM
Thank You

He was lying on the bed, with his left hand flexed over his chest.

"Stroke," I thought to myself. As I approached his bed, I realized that there was a nasogastric tube sticking out of his nose. His hair was grey with age, and he was not moving any of his limbs. He appeared dazed.

"Would you like to examine him?" the medical officer asked. I nodded my head and made my way next to his bedside.

Just as I was about to speak to him, the medical officer said, "Oh, he can't speak." She then left the privacy of the area drawn up by the bedside curtains.

I hesitated for a minute, then asked, "Hello Mr K, how are you today?"

The gentleman turned his head to face me and to my surprise, lifted his left hand to his face and waved, albeit with some effort, as if to return the greeting. At that moment, I also noticed a pack of cards with words written on them on his bedside, along with a mini white writing board and a erasable marker.

"I am a medical student. Is it alright if I take a look at your arms and legs?" I continued.

He nodded firmly.

I proceeded to do a full neurological exam, and was very impressed with how well he could understand my instructions and how cooperative he was. Through the examination, I realized that he had right-sided hemiplegia (paralysis of the right arm and right leg). He was able to move only his left arm adequately, and his left leg slightly.

Just as I was about to finish my examination, the patient raised his left hand and placed it over the cards. I took the hint and carried the cards up to his eye level. He started flipping through the cards with his left hand, scanning them with his eyes one by one. However, he had to go through the pile of cards a few times before successfully finding the phrase he wanted to express. He pointed at it with his slightly clenched left hand and looked up at me, almost as if he was afraid that I would not understand.

I want to pass motion.

I did a quick check and realized that he was already on diapers.

"Mr K, you can go ahead and pass motion because the nurses already put you on diapers. They will clean you up later, don't worry ok?"

He nodded his head, then slowly rested his gaze on the foot of his bed.

"Mr K, how long have you been unable to talk?"

He motioned to his white board. I uncapped the marker, put it in his left hand, before holding the white board out in front of him. He started making messy strokes on the clean canvas.

23 天.

"23 days?"

He nodded.

I paused for a minute, wondering what it was like to be suddenly paralyzed and then be unable to speak for almost a month. The thought alone was already terribly depressing.

"Do you know why?"

He motioned to the left side of his head.

"Stroke on the left side?"

He nodded again. There was a distant look of sadness in his eyes. I later learnt that he had his first stroke a few years back which left him paralyzed on the left. He had been very active in rehabilitation, and actually managed to regain his mobility with the aid of a walking stick in a matter of a few months. Since then, he has been very compliant about his lifestyle and diet, putting in ample effort in reducing his risk for a subsequent stroke. Unfortunately, luck was not with him as he suffered another hit 23 days ago, robbing him of the ability to speak and paralyzing him on the right side as well.

I put the white board down and took the marker from his hand to recap it. Suddenly, he started motioning at his cards again. I picked them up and put it in front of him. He went through the laborious process of finding the phrase he wanted again, card by card, word by word. This went on for a few cycles, before he gave up, settled the cards down and put them away.

I felt helpless. Here I am, young and able, backed up with 4 years of medical knowledge, yet am unable to decipher what a poor old man wants to tell me. It was an extremely humbling moment.

A few seconds pass. He turned his head to look at me, then raised his left hand and started making gestures at the pillow.

"Do you want me to adjust your pillow?"

He nodded enthusiastically. I lifted his head and neck, placed the pillow in a more comfortable position, before resting his head back on it.

"Is this better?"

He nodded again. I thought I could see a smile in his eyes.

"Ok Uncle, I need to leave now." I said.

Upon hearing this, he looked up at me anxiously suddenly, and lifted his left arm to his head, repeatedly making gestures as if he was trying to get my attention frantically.

"What is it, Mr K? Is there something else you need?" I asked worriedly.

He repeated his gesture as he looked at me helplessly.

"Sorry Mr K, I don't understand what you are trying to say," I admitted, "Are you in pain anywhere?"

He shook his head, then put his hand over the white board. Once again I uncapped the marker and handed it to him before holding up the board in front of him. Stroke by stroke, he pieced his message to me. When he was done, he put the marker down heavily, as if the writing had zapped him of his energy. He looked up at me with earnest eyes as I bent over to read the message.

Thank You.

It was the messiest thank you I have ever seen in my life.

But it was also the most beautiful thank you I have ever received.

Communicating was already such a chore to him, and yet, despite his weakness, despite his poor left control, he ensured that his message of appreciation was brought across to me.

I was touched beyond words by his display of sincerity. I let my eyes linger on his masterpiece for a moment, before looking straight into his eyes.

"No Mr K, thank YOU."