The book Damn Shoes and Other Talking Tales is divided into 5 sections:A distinctive feature of the human being is the use of language, particularly the ability to talk and understand the definitive speech of others. Together with our human spoken language skill is written language, the ability to read and to write. Aphasia is characterized as the partial or complete loss of spoken and written language skills, usually the result of an injury to the brain from either head trauma or a vascular stroke. A great portion of my fifty-eight year clinical career has been spent as a speech-language pathologist working with adult patients with aphasia.
The type of aphasia the patient has is related to the site and extent of insult to the brain. In general, aphasia develops from lesions to the left cerebral hemisphere (left brain.) The more forwardly positioned brain lesions produce what is known as a non-fluent aphasia, characterized by extreme complications in saying words, while retaining fairly good understanding of what others are saying. More posterior brain lesions often produce fluent aphasia, in which the patient may speak with a jumbled or jargon speech, often completely unaware of his or her own jargon and also showing some difficulty in understanding the speech of others. Most people with aphasia actually end up performing somewhere in between the extremes of non-fluent and fluent aphasia.
While the type of aphasia is determined by the site of the brain lesion, how well the patient communicates is usually determined by his or her personality and by the reactions of the people surrounding the patient.
All normal speakers speak to express their ideas, their needs, their feelings; patients with aphasia, even with their compromised speech, speak for the same reasons. Our attempt in this chapter is to lead the reader to appreciate the differences and communication struggles of the adult person with aphasia. As we recount some speaking situations and conditions, they may appear humorous and produce laughter. We are not laughing at the patient, but rather at the reactions of the listener who takes literally the patients verbal responses in particular situations. In a different light, the reader may experience an emotional tear while reading about someone recovering from aphasia. Although most of the aphasia tales occurred dating back to the 1950s, some recent names and locales have been changed when possible to protect patient identity.
We begin with the aphasia tale The Thank You, a story that had great impact on me as a clinician over a life-time career as a speech-language pathologist. We then tell the story Damn Shoes, a fun example of a non-fluent aphasic woman cheering at a football game. Like many people with non-fluent aphasia, her perseverative responses of the same few words were taken literally by those surrounding her in the stadium. Two other talking tales, Away and Water, Water, Water, provide an amusing perspective on how the typical listener responds to these repetitions of non-fluent aphasia patients. A retired airline pilot with fluent aphasia describes in his own jargon speech problems he once had landing a DC-10 in Circling Over Dallas. In Your Penchant for Apples?, the reader will experience some of the frustrations shared by the patient and clinician when attempting to evaluate a patient's newly acquired aphasia. Of the many speech therapy group sessions that I have experienced, we have selected one narrative in particular, Honolulu Annie, which illustrates some fun interaction in aphasia group therapy.
Here we have the title story of this book, 'Damn Shoes.' The star of this narrative was a 44-year old woman, a WAC veteran of World War II, who was a non-fluent aphasia patient in the Long Beach VA aphasia clinic. She was diagnosed as having "Broca's aphasia" (her predominant problem was the inability to speak.) She became well known in the neurology section of the hospital for her inability to say anything but the perseverative simple phrase "damn shoes." She would repeat the nonsensical phrase with differential inflections. For example, if I asked her if she wanted a home-pass for the coming weekend, she would reply with an enthusiastic "damn shoes," complete with all the happy-voice inflection that would confirm her desire to go home for a few days. If I asked "do you like the coffee on the ward?" her negative voice inflection would say "no" as she repeated "damn shoes." We will call her Mary Lou. She was normal in appearance with no arm or leg weakness, with her only apparent deficit being the severe aphasia that permitted her to say only "damn shoes" with perfectly sounding speech.
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One of the more pleasant tasks I had as a young speech-language pathologist at the Long Beach VA in the early 1950s was to accompany our aphasic patients to various recreational programs. The internal programs included visiting with a visiting move star every other week (Loretta Young, Doris Day, and Kathryn Grayson among others.) Recreational programs outside of the hospital grounds included deep sea fishing, picnics, and various professional athletic events. Another speech clinician and I would accompany about twenty-five patients, most of whom had some form of aphasia, on the bus to an arena, stadium, or other event destination.
Mary Lou frequented these field trips. One Sunday afternoon, we visited the Los Angeles Coliseum with tickets for row 35 near the forty-yard line to see the Los Angeles Rams against the Chicago Bears. The game was billed "A battle between Bob Waterfield of the Rams and Sid Luckman of the Bears." Mary Lou was a real Rams fan and thus, stood up and hollered loudly for every Ram advance and opportunity. The problem was that all she hollered was "damn shoes" on nearly every play. Finally, the man seated directly in front of us could stand it no longer. He stood up, turned around, and exclaimed "Listen, lady, so Sid Luckman's a Jew!", then adding "Can he help it if he's the best player out there?"
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The aphasic patient who perseverates on the same few words will often, though misunderstood, encounter a realistic response from their listeners, who react literally to what is continually said. In this case, the "damn shoes" had no literal meaning, so the listener took it upon himself to assume Mary Lou was berating the ethnicity of a rival team's star player.
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