My new nursing home admit greeted me with his fist raised as I made my way down the corridor to the nurses’ station. His eyes locked onto mine and he waved his fist in the air while hollering:
“Twenty-two! Twenty-two!”
I had no idea what he was trying to tell me. I stopped and laid my hand on his other, half-flaccid, arm.
“I’ll be back to talk with you in a little while, I promise.”
He lowered his fist, seemed to relax, and nodded at me.
Greg Booker, the charge nurse told me, was very quick-tempered and had already punched another resident earlier in the day. He had suffered a stroke as a result of a cardiac arrest at the factory where he worked as a foreman. While at the acute care hospital, he had regained much of the strength in his right arm and leg, but he was unable to speak in sentences and struggled to utter even single words.
“And, by the way, he hates to take medicines”, nurse Alice added. “Good luck talking with him. He’s got a really short fuse.”
Mr. Booker’s medical history was well documented in the hospital discharge summary. So was his social history. He was single with no family nearby. Without being able to speak, his life was changed forever, as profoundly as if he had remained paralyzed. I wondered if his short temper was related to injury to his frontal lobe resulting in difficulty controlling his impulses, or if it was just a reflection of his frustration at not being able to say what he wanted to get across, or possibly both.
I entered his room. He stood up and offered his right hand. His face grimaced as he worked to raise his arm and form the words:
“Doctor…uhm…I…I have…eh…twenty-two…uhm…I mean…why…twenty-two meh…aaah…”
He ran his left hand through his unruly salt-and-pepper colored hair and his face contorted as he made a high-pitched grunt.
“Twenty-two”, he said, exasperated.
“You’re taking twenty-two pills a day?”
“Yesss!” he nodded emphatically.
“That sounds like a lot. Let me listen to your heart and lungs and check your circulation and things, and we’ll see if we can’t get rid of some of those pills.”
“Okay. Okay!”
He cooperated for the exam, which, other than his expressive aphasia and mild residual right-sided weakness, was normal.
“All right, let’s go over these medications together. Did you take any medications before you got sick?”
His mouth moved, he squinted and his cheeks contracted asymmetrically.
“Not any” he said after a while.
We both leaned over his chart as I started at the top of his medication list.
“This is just an aspirin. It cuts middle-aged guys’ heart attack risk by 25%. Even I take one of these every day.”
“Oh-kay” he blurted with the emphasis on the second syllable.
“This one is for cholesterol. It also cuts heart attack and stroke risk, by up to 50%. I think we should keep it, but these next two are basically vitamins. I don’t think you have to take them at all.”
“Oh-kay.”
“This one is a stool softener. Are you constipated?”
He shook his head. I crossed out the third pill and we continued down the list. His blood pressure pills stayed, but it didn’t seem like he needed to take his fluid pill three times a day. He showed no signs of heart failure or fluid overload.
“I think we can stop two of the three doses of this fluid pill. If we weigh you every day we’ll see if you start to hold on to fluid without them.”
“Oh-kay” he smiled. We were on a roll.
“Now, this one is for prostate trouble. Did you have slow urination before your heart attack or did you have to get up to go to the bathroom a lot at night?”
“Na-ah!” He shook his head vigorously.
“I bet you had a Foley catheter for your urine for a while when you were really sick. You’ll probably be able to stop it.”
He beamed.
After we had finished, he still had plenty of pills left to take, but it was obvious from his expression that he was pleased.
He started to work on saying something again. After several false starts he was able to say:
“After…I mean…uhm…after this…uh…after I’m…uh…after I’m here…will…will…will you, will you…will you…”
He slapped himself in frustration but no more words would come out.
His eyes met mine and he shrugged.
“Are you asking if I will be your doctor after you get done here?”
He grinned. “Yesss!”
“I’d be honored to.”
He grabbed and shook my hand and suddenly his right hand seemed strong and purposeful.
A Country Doctor Writes: 
Great story…you’re a good doc who obviously can read lips or minds..either way…a great talent.
Is aspirin still a good idea after a stroke?
Excellent post! I can’t think of many things more devastating than a stroke resulting in expressive aphasia, and I’m sure that just stopping to really listen to them helps their recovery more than we realize.