Staying After The Stroke

Why do families fall apart after a CVA? Strokes devastate those around them, not just the person suffering from this trauma, but the entire family. Each person plays a role in the dynamics of a family, and when suddenly one member changes, without discussion, warning, or preparation, overwhelming effects occur. In 1994, the US Department of Health and Human Services, as part of the National Health Interview Survey, found a 7.6 increase in the rate of divorce in adults with acquired disabilities. I have seen quite a few marriages and relationships crumble after a stroke. It is hurtful for all involved, makes depression even more likely, and to be honest until faced with the situation we don’t know if our relationships could survive such a drastic change.

Back to my question: why does the breakdown of relationship happen? I have a few speculations. After a stroke the person recovering will be more dependent on caregivers. They will often need assistance with even the basic tasks of living, like getting dressed, feeding themselves, and even once they recover function for these tasks there may be some residual impact, leaving the spouse different in personality. Even when my husband has a cold or the flu, the change in our interactions can be frustrating. The caretaker of our home, the man who is active, full of life and love for his art becomes lethargic, instead of being out on the snow taking photographs, or in his studio painting, he is in his recliner with tissues around, covered in blankets. I can deal, his illness is limited, but if there were no end in sight I imagine it could be quite the scary prospect for a marriage’s future. On another note, emotional support may be altered. The unwavering wife, the rock of the family, now has episodes of uncontrolled crying, and where does that leave her husband who used to lean on her? One of the most crucial aspects of change that contributes to the breakdown of relationship following a stroke is altered communication. Aphasia is very common, and so even the simplest words, phrases can’t be spoken, not to mention the fact that understanding of questions or conversation becomes difficult. Think about trying to talk to your husband, he just keeps repeating the same word, it seems like nonsense, and you can see that he is clearly trying to get a point across. Frustrating, right?

Now the question moves to what do we do with this situation. The problems outlined all contribute to a collapse of the family unit after suffering a stroke. Part of the problem lies on our inability to step out of traditional roles with our loved ones. Recognizing that the essence of the relationship has shifted is essential. Lack of communication can also must be dealt with by reframing, watching for gestures, facial expressions, and body language. The nonverbals will often tell you more than the jumbled words could ever convey, and communication is crucial to allowing parties adjust to a new relationship. The person who had the stroke has changed. Personality, characteristics that often define a person, may no longer apply. If the goal is survival of partnership then the mindset of all parties has to change, and preconceived expectations must be released. The advice I like to give is that a path less traveled has appeared. Do you navigate your way through the changing terrain, the rocks and boulders, to find the beautiful sunset at the peak of the mountain? There is no right answer for dealing with these devastating situations, but I have seen the most amazing couples emerge, maybe a little shaken, but stronger nonetheless, and not regretful for extending their love to encompass a different concept of what marriage can be. Are you a person who has taken on a great challenge such as this? Or do you know someone who has? Let’s talk. How did you/they cope?

95 and Counting

We started the conversation talking about specific memories this elderly woman wanted to share. She prefaces our discussion with a statement that, in her mind, sums it up. With a high pitched voice, and rich Appalachian dialect Mary tells me, “Things just don’t come back to you like you’d think they would. Ain’t got much memory. I’ve about forgot it all.” Then she defies all she just said and remembers her story. Detailing life as a young woman, a wife, a mother, a farmer, she talks of days in her life before the nursing home, days before, as she says “my bones started to give out”. This petite elderly lady with long, wavy, barely gray hair holds the information of what life has been like for nearly a century. I am fortunate enough to get a slight glimpse into the mind of a woman who has experienced nearly a 100 years of change, and hear her talk about the transformation and the constant aspects of life over the years.

Mary tells me “I remember the milk cows, sheep, goats, hogs, a team of horses, and things like that. That is what took up my time. That is what I know. I knowed how to plant corn, potatoes, all kinds of little things in the garden. That is what took up your days.” She recalls more in-depth stories of tending her garden, helping her animals, herding them in to shelter when weather turned bad, and staying up into the midnight hours to make sure the baby animals, lambs in particular, were saved from the fate of freezing to death. She tells me of her childhood as an orphan, as her parents died and left 9 children, to “manage the best they could”, when Mary was not yet a teenager. She can’t recall her exact age, but tells me that she was pampered as she was not one of the oldest. Her face and words reveal shock when I tell her that average life expectancy in the United States is 77.7 years. Her family did not live this long and she feels like she is the exception.

Speaking easily of the days of past she recounts events in her life, but tells me that around the time her great-grandchildren came along there “must have been something happened to my mind”. She explains that currently, “It is hard to concentrate and sometimes I get scared because I am confused about where I am.” This happens most often when she wakes up at night, and she is able to “get straightened out” once she fully wakes. She regretfully tells me “If you’ll notice, I can’t tell you anything of benefit.” But what Mary fails to realize is that her presence, her story, the wisdom gained in her years are of benefit to us all.

What I see when talking to Mary is a person whose brain is in very good shape after 95 years of hard work, living, and thinking. She has normal age related memory change. Precise details are decreased, and the particulars of events happening in present day tend to fade more quickly. When I ask her to let me in on the secret to living such a long and fruitful life she explains how she took care of her body, working hard and walking a lot. I learn that they never called it exercise, as activity was just a way of life. I posed a question to Mary that required a bit of thought on her part, as it would for anyone. I wanted to know the best and worst thing about being a woman 95 years of age. The best, she tells me, is being able to “eat all you want because nobody pays attention if you need to trim up”. This statement, coming from the smallest woman I’ve ever met, reveals a great deal about how some components of our belief system and self image, deeply ingrained, carry throughout the span of our lives. The worst thing is a concept she can’t quite put her finger on. She simply states “I’ve lived through it all and there’s not much use to try and sort it all out, I am just here and that matters.”

Mary is very kind, beautiful, and grounded. When speaking of tomorrow she tells me in a quiet voice “The future will take care of itself. I like to be where I am and not waste the day with worrying about tomorrow.” This is how she has lived her 95 years. Her story is intact, the important parts, her ties to the past remain, but today is where she stays.

Cheers to Mary.