“Mom will be ninety years old this year,” Debbie, her daughter, told me, “and as long as I can remember she has always been a pistol — outgoing, vibrant and full of life.” She tap danced with a senior’s troop at Roy Thompson Hall in the Seniors Jubilee well into her late eighties.
Two years ago, prior to moving into a retirement home, Corky lived alone in her own condominium. She drove her own car, helped out her friends who needed a lift, went out and shopped for herself, and made her own meals. Occasionally she would take the gals, as she liked to call them, and go to lunch.
When she moved into the retirement home, she was made the floor representative, because she was very social, healthy and active.
Unfortunately, in July 2014 Corky experienced an embolic stroke, leaving her with both aphasia (loss of speech) and weakness on the right side of her body. She was admitted to North York General Hospital (NYGH), but despite the care offered her there, her health seemed to be in a steady decline. She stopped eating and her vital signs were dropping. The health care team at NYGH cautioned the family that because of her lack of nourishment her health would continue to deteriorate. Perhaps, the hospital staff said, the family should consider placing Corky in palliative care. This was terrible news,” said Debbie. “They were preparing us for her end-of-life.”
Corky’s children — Debbie, Robert and David — could not accept the idea of placing their mother in palliative care. Fortunately, Corky’s appetite returned and she was able to eat and drink enough to maintain hydration and increase her strength. Her children believed she should be rehabilitated. When a bed became available at The Salvation Army Toronto Grace Health Centre (TGHC) in August 2014, she was admitted for ongoing assessment and possible rehabilitation.
As a result of her stroke, Corky has global aphasia — a type of non-fluent aphasia, which is characterized by severe impairment of both expressive and receptive skills (difficulty speaking and understanding words as well as the inability to read or write). Lisa Chong, the speech-language pathologist at the TGHC, conducted aphasia therapy sessions with Corky. They met five times a week and worked on Corky’s comprehension and expressions. Part of the therapy involved using functional communication. Lisa practiced social phrases — “Hi, how are you?” — with Corky, and then worked with her on producing the appropriate responses. They also worked on identifying the content of pictures as well as identifying and naming family members. Corky’s verbal expressions and responses did not improve significantly, though, and her sessions in aphasia therapy have since stopped.
The stroke has also left Corky with a weakness on her right side. When she first arrived at the TGHC, Sarah, her physiotherapist (PT), and Emily, her occupational therapist (OT), worked on Corky’s legs. For a short period of time they encouraged her to stand and to take steps. However, because of her aphasia, Corky had difficulty understanding their commands, which made it hard for her to accomplish these exercises. Also, when Sarah and Emily attempted to help her stand, Corky resisted and began to push them away. They decided a change in strategy was needed. Sarah continued to work with Corky on improving her strength and range of motion; she implemented exercises that Corky found enjoyable and not distressing.
At the moment Corky is in a program with Ella, physiotherapy assistant, to help stretch out her legs so she doesn’t stiffen up. Sarah tells me that even after being non-ambulatory (not able to walk) for months, Corky has retained quite a bit of strength and a good range of motion in her legs. “I was amazed. I thought, all that tap-dancing.”
Following her stroke, aware that her right hand was weak, Corky favoured her left hand. Emily began to work on helping Corky regain functional use of her right hand. Some progress has been made. Corky was able to pick up small objects on Emily’s commands, but she had trouble releasing them.
Corky, as you can imagine, still likes dance and music. She occasionally participates in the Sit N Dance program, as well as taking a Music Session with Learn to Heal in recreational therapy. Susana the therapeutic recreation therapist believes the programs in recreational therapy help patients like Corky to interact and connect emotionally by giving them the opportunity of participating with others in a social gathering.
I asked Susana why Corky only participates occasionally? She responded by telling me that the staff always invite patients to the activities but use their judgment to see if the patient is active and eager to join. “Sometimes,” Susana says, “Corky’s facial expressions have communicated her unwillingness to participate in an activity.”
Both David and Debbie believe their mother is receiving excellent care at the TGHC. “The nurses and the health care team are unbelievable,” said David.
“The nurses,” Debbie told me, “show such care and compassion in all the things they do for my mother. Some nurses help my mother put on make-up, which my mother loves to have done.”
With some guidance from the nurses, Corky is able to feed herself with her left hand and wash her face. However, the nurses help her with other activities of daily living. They get her up into her wheelchair to start the day and help her get dressed, manage her oral care and comb her hair.
“I believe despite having aphasia,” David said, “Mom is able to communicate with winks, a smile and facial expressions. Regardless of her stroke, I think her big personality is still intact.”
I asked David what the family goal is for Corky? He told me that his family agrees that they want to continue to provide Corky with an environment much like the Grace — one that offers stability, happiness, warmth and dignity. Corky is on a waiting list for a long-term care facility, but her family is thankful that for now she is receiving wonderful care at the TGHC.
The day I went to see Corky, Leo, the fourth floor patient care coordinator, agreed to help with the introductions. We entered her room and approached her. We asked how she was doing, but before Corky could smile we got three different responses from all three of her roommates. “Doesn’t she look great?” asked one roommate. “She’s doing fine!” offered another. “I like her purple top,” said the third roommate.
I recalled David telling me that her roommates would participate in answering for Corky. In a way these are now her gals and they are providing each other with friendship, care and compassion.
I smiled at Corky and introduced myself. I told Corky that I was writing a story about her. She smiled back and I placed my hand over hers and wished her a good day. As Leo and I were leaving, unsure, I asked him if she winked at me? He said, “I believe she did.”