{Karlton Bontrager}

Two in a row. And then he was back to zero again. These PTA scores are becoming an obsession for all of us. Throughout the day Karlton rehearses the names of the three pictures he is supposed to remember from one day to the next. We’ve even tried to help him by coming up with simple mnemonic devices. So on Saturday morning when he was asked to recall the three pictures, he rattled them off with confidence and without hesitation. But he recited the three from the previous day, not the ones he was to have learned overnight. Again he was back to beginning the sequence of three days with perfect scores.

My training in error analysis tells me that there is important information here. Why did he make the mistake? In this case, it was probably his inability to inhibit the first response that came to mind. Or perhaps it was unwillingness to take the time to examine the response for correctness. In either case, we have encouraged Karlton to take his time in answering.

It is puzzling, too, why he needs so many prompts for knowing what day of the week it is. Could it be that his ability to read a month calendar will emerge gradually in somewhat the same way that reading the wall clock did? At the moment, he needs to have someone cross off the previous day’s date or at least tell him that it is a new day. Seeing daylight follow darkness and eating breakfast are not yet sufficient cues for understanding that the calendar day and date have changed.

On his last day at Dunedin Public Hospital, Karlton gave us a peek into his thought processes. He was uncertain of the time of day, but he reasoned aloud that he had eaten breakfast and that he had taken a shower. Moreover, the clock hands pointed to 11:30. He guessed that it was morning. (Note that he started with mealtimes but did not continue in that direction to focus on the time between breakfast and lunch. Instead, he took diversions to time-of-day activities and then to clock time.)

In conclusion, perhaps we are placing too much emphasis on the PTA questions. We are indeed eager for Karlton to move on, and he is clearly in need of much less sleep, remaining awake and alert for ever longer periods of time. He is conversational, clever, and witty (though many of his jokes are what I call second grade humor). Yet his mind is not functioning fully as before. He continues to need many supports.

Last Friday was Karlton’s second consecutive day to earn PTA scores of 12 out of 12. He mentioned to the occupational therapist who has questioning him that he’d like to get onto the Internet to check his e-mail. Lo and behold, she gave him permission to do so!

On the way back from the physiotherapy gym that day, the PTs wheeled Karlton into the computer room. It was afternoon, and he was tired from the exertions of having to walk. Soon afterwards, the nurses came to flush the PICC line and take a blood sample. Moreover, he was frustrated by the slowness of the computer link. Thus, that milestone was not the breakthrough that it might have been.

He returned on Sunday and had greater success. Choy-Lang and I showed him his website. He was interested in his photos on display, particularly the panorama of Queenstown and the sheep-in-the-fog shot. He does not like being able to use only his right hand for typing, and the mouse is still difficult to control, so he dictated a message to a Queenstown friend while I typed it for him. When I left him last night, he was writing on paper another message that he wants to send out via email.

Gradually, the world is opening up to Karlton again. This is such an exciting time. It’s Monday morning, and the PTs will give him a good workout today, no doubt. He’ll be tired this evening, but what a good feeling of tiredness it will be!