I had been working as a nurse practitioner in stroke/neurology for three years when I encountered Mr. B, a 67-year-old patient who came to our hospital with acute onset of right-sided weakness and aphasia following a moderately-sized left-middle cerebral artery stroke.
Mr. B’s course was typical of an acute stroke patient, and we proceeded through our work up and evaluation as usual. Since Mr. B’s language center was in the left side of his brain, he was suffering from language deficiencies that included profound expressive aphasia. During his stay in our hospital, he worked with our skilled therapy team. It was evident to all of his healthcare providers that he was extremely frustrated with his inability to communicate.
The day before we had scheduled to send him to acute rehab, I entered the room for daily rounds with another nurse practitioner on our team. Mr. B again seemed agitated and frustrated as he tried to communicate his wishes to us. I grabbed my notebook and a dry erase marker, which he was able to grip in his right hand.
To our surprise Mr. B was able to write, but the letters were jumbled, and we set the notebook page aside feeling unsuccessful in our attempt to communicate.
An hour later we were called back to Mr. B’s room by his daughter. It turns out that when she was a child, her father had used mirror image writing to communicate with her as a special code. She saw the notebook page from earlier that morning lying on his bedside table and recognized the pattern immediately. We grabbed a mirror and were able to decode the message.