His wife was petite. She gave every impression of having been dependent on a physically and behaviorally imposing husband, although their roles were now reversed. Bill had had a stroke a month earlier and Sally was distraught. She was sure that he could recover and concerned that the medical team had not referred him for active rehabilitation. He had shown no signs of recovery of function after his stroke, though. In their opinion there was nothing to build on, but they had asked me to assess if there might be psychological factors or a depression holding him back. When I saw Bill he had no language. He appeared to be trying desperately to communicate, however, almost like Jean-Dominique Bauby in his diving bell. He had something between a cough and an effort to clear his throat that apparently had persisted for weeks. He hacked every few minutes, then fixed me with what appeared to be a pleading look in his eyes. Some patients after a stroke cannot clear saliva pooled in their esophagus, but Bill’s hacking was different in its quality and persistence.
