Monday Morning, Case 1

Mondays start the same, I travel to a patient's house to provide cognitive rehabilitation and psychotherapy. This individual was involved in a head-on automobile collision with a drunk driver some 20 years ago. He sustained a significant brain injury that involved the frontal precortex, or the so-called 'dashboard' of the brain. He was in a coma for several months following this unfortunate accident, and he was left permanently disabled as a result of his injuries. If seated and involved in casual conversation, he may appear a bit guff, but most of his cognitive deficits would go unnoticed. When he attempts to walk, or tries to manipulate objects with his hands; however, limitations in his ability to coordinate purposeful movement become painfully apparent. Today we are planning to build a game board for the game "Othello." The board that he currently has uses small glass beads for the game pieces, objects that are very difficulty for the patient to place accurately on the game board. A trip to several stores and we have some pegboard for the game board and golf tees for the game pieces. We then discuss the dimensions for the board and discuss how to elevate the board so that the golf tees will stand perpendicular to the board. We consider the pros and cons of raising the board versus shortening the golf tees. After drawing the dimensions on the pegboard we play a game of chess. The patient beats me once again--he played chess for ten years prior to his accident, I, on the other hand, am a novice player. After the game I tell him that I noticed how he staggers his pawns in order to defend aggressive attacks, and he beams with pride that he has taught me something. Most people (family included) familiar with this patient treat him like a child and only put up with him for a minimum amount of time. He is discredited by others, viewed as 'damaged,' and considered a burden. He is frequently socially inappropriate, occasionally responds to others with sexually explicit comments, and becomes temperamental when his needs are not immediately met. He reminds me of fraternity brothers in my past.