Patient Stories

A 35-year-old patient with underlying comorbidities experienced a large medullary brainstem stroke while caring for a partner who was positive for COVID-19 and symptomatic. Upon admission to the hospital, the patient was under investigation for COVID-19, was intubated, and required breathing assistance from a ventilator. The speech-language pathologist (SLP) was asked to assist with finding alternative means for the patient to communicate. 

Upon entering the intensive care unit (ICU) room, the patient's eyes were open. I introduced myself and described my role. The patient blinked with intent and moved his head slightly, but had difficulty moving his arms and legs. From there, I asked him to wiggle his toes/fingers and give a thumbs-up. Although many of these tasks were too challenging, the patient was able to lift his index finger clearly and easily. 

I asked the patient, "Show me how you say NO" and the patient made slight movements with the head side-to-side. I asked the patient, "Show me how you say YES" and the patient began blinking quickly as nodding was too hard. I asked the patient a series of basic yes/no questions to establish reliability of these responses. For example, "Is your name Mathew?", "Is your name Sally?", "Do you live in Texas?"

Once the patient was able to successfully and accurately respond to a series of those questions, we worked together to establish a way for the patient to say "I don't know" or "Not Sure" (i.e., closing his eyes tightly). We also worked on finding a way for him to ask for suctioning (i.e., raising his index finger) as the patient frequently required oral suctioning to manage his secretions. 

The patient was clearly becoming fatigued at this point and the session was coming to an end. For now the patient was able to participate in decision making like whether to FaceTime family or for medical decisions like if a tracheostomy tube was within the patient's wishes. 

Before I left the floor, care communication was completed with staff and signage was placed in the room to notify providers of the current guidelines for communication.

In the coming days, while the patient was intubated, I then focused on establishing a partner-assisted selection system with pictures, words, or letters.