Twilight Children: Three Voices No One Heard – Until Someone Listened

Intrigued, I asked for more information.

Joy had a patient named Gerhardine Sharple, who was currently in the stroke rehabilitation unit, housed in a nearby medical complex. Gerhardine, known as Gerda, was eighty-two. She had been in good health and living independently up until five weeks earlier, when she had had a massive stroke. After the initial stay in the hospital, she was then released to the rehabilitation unit and seemed to be making a reasonable recovery. However, there was an ongoing problem with her speech. Strokes often interfere with the language center in the brain, causing loss of communicative speech, which is known as stroke-induced aphasia. In Gerda’s case, she had recovered certain elements of speech almost immediately. In particular, she was capable of responding appropriately if she was asked simple, concrete questions. However, in spite of intensive speech therapy work, two problems remained. One, while she had demonstrated the ability to respond appropriately to questions, this did not mean she always complied with the request. And two, she produced no spontaneous speech whatsoever.

Joy said Gerda had been widowed many, many years before. She had been living alone in a small isolated farm. The house, a two-story clapboard of the sort commonly built at the turn of the twentieth century, stood amid ancient, half-dead cottonwoods and was surrounded by miles of sagebrush and little else. Although the emergency services had found things clean and tidy, the property was dilapidated in the way of the rural poor, and a haven for small animals. More than a dozen chickens ran happily in the yard, a goat was in the half-collapsed barn, and sixteen cats shared the house. Indeed, Joy said, Gerda seemed a stereotypically reclusive “cat lady” and, as a consequence, she had had little contact with neighboring farms.

She did have a family, but they were widely dispersed. Her daughter, married to a Spaniard, had been living in Spain for decades, and her son lived half a continent away in Detroit. Joy had contacted the son, whose name was Edward, and said he seemed distant and largely unconcerned. He had taken the news of his mother’s stroke with a disgruntled moan and characterized Gerda as “difficult.” He said he’d tried on two or three occasions to get her to see that the only real way he could take care of her in her old age was if she moved to Detroit where he and his family lived. Gerda had flatly refused. She was even unwilling to consider selling the house, he said, even though she could get a good price for that property, because it was a desirable location for rural development. He’d pointed that fact out to her several times. Why did she want to keep it? It was far more space than one person needed and starting to get very run-down because she couldn’t afford the upkeep and was simply past being able to do any of it herself. But his mother was difficult. She would never compromise to make it easier for anyone to help her. He was a self-made man, he explained. He’d pulled himself up from nothing. Got a good education, married into a good family, started a successful business, and really had made something of himself, but it hadn’t been easy. It was still hard work. He couldn’t just drop things to be at his mother’s beck and call.

The daughter was even less involved. When social workers had entered Gerda’s house after the stroke, they found photographs of the daughter, her Spanish husband, and their two children, but there was no way to tell when the photos had been taken. They couldn’t even find reference to the daughter’s name in the house. This was possibly not due to any purposeful removal but simply because Gerda did not seem to be a “keeper.” Her house was immaculately clean, in spite of all the cats, but also spartan. Joy had obtained the daughter’s name – Anna – from Edward, but this was clearly not a close family. He and his sister, who had returned to the States only twice since her marriage twenty-three years earlier, had no more contact than Christmas cards.

So that was the situation, Joy said. Social Services were now dealing with Gerda’s immediate future. She could only remain in the rehabilitation unit as long as it was apparent she was actually in the active stages of rehabilitation. For most stroke patients this lasted three to six weeks. In the doctors’ opinion, Gerda seemed to have made this initial recovery. Now decisions on her future placement had to be made, such as how much longer would she need full nursing care and would she be able to resume an independent life eventually? Could she care for herself in an isolated location such as her own home? At the moment, assisted care seemed more appropriate, or, indeed, full-time nursing home placement. Of course, all of this required money. A decision needed to be made, which would most likely entail selling her house to finance assisted-living arrangements.

Joy sighed. As the social worker, she had spent time trying to explore these various scenarios with Gerda, and Joy’s overall impression of the old woman was not one of a stroke victim so much as a very depressed individual. Depression, Joy said, is common among elderly patients who lose their independence and suddenly find themselves sleeping in strange beds, eating strange food, and having to live according to strangers’ rules. Joy was accustomed to dealing with that, but in this instance, it was grossly complicated by Gerda’s lack of speech. Joy had consulted the gerontologist supervising Gerda’s case and told him that she felt Gerda’s mutism might be largely psychological, due most likely to depression. The gerontologist put Gerda on Zoloft, which, if anything, had made Gerda even more subdued.