LIVE EVENTS

Click here for live event dates.

FEATURED WORK

“The Shaking Man, Part 1”

(In honour of Terri Beamer Shelor and Karen Gaines--incredible instructors, mentors, and speech-language pathologists)

I met the shaking man in London Town. In a red Tube cab, my eyes were glued to the movements of his hands, ticking, repetitive. I made nothing of it and three days later serendipity united us in the grey, wide building of my Shoreditch workplace. He was marching in place in the rehabilitation gym, seeming to tremble from the exertion of lifting the feathery weights wrapped around his ankles. As I slowly recalled where we'd first met, I looked closely at the shaking man and saw that his buzzing had become more pronounced. Quivering...rehabilitation centre...exercising. I immediately understood, and he confirmed it himself two weeks later...tremors. They had started a year-and-yesterday ago, he told me, and upon medical counsel, he had come here for physiotherapy. Upon yet more medical counsel, he came to me for swallowing therapy, for it seemed whatever was shaking this man had also invaded the very anatomy that ensured his sustenance.

As all diligent inquisitors of my profession do, he wondered aloud why he was referred to a speech-language pathologist for a swallowing problem. I acknowledged by way of: "Next door neighbours are the vocal cords (starters of speech) and the esophagus (transporter of food and drink parcels). Sometimes the delivery worker accidentally delivers the esophagus's parcel to the vocal cords (which also happen to be near the lungs' chambers). The vocal cords do not like visitors, you see. Any stranger who comes potentially brings chaos, discord, and ill-health to the sterile and solitary chambers the cords maintain; to them, the parcels only harbour the germs of the outside world. One too many 'gifts' and their chambers may breed infection, inflammation, or pneumonia--yes, abnormal airs. Because we speechies have wonderful knowledge of this neighbourhood, we have the honour of ensuring that gifts are routed to the stomach through the esophagus and not to her neighbours the vocal cords (or the lungs their chambers). Thus it is my goal for you not to have food in your airway; in a word, I aspire for you to get well, and I aspire for you to aspire to do the same. Yet, I do not aspire for you to aspirate. Certainly, aspiration is not our aspiration.”

After I spent a few days working with him, the shaking man told me about his unsettling dreams: Immediately before the first of his tremors, he had dreamed of a man and his four adult children. They had come as strangers from the breeze and set up a debt collecting firm next to the shaking man's house. They called their business simply 'Park & Sons'. “Every night, at the darkest minute, come dressed ironically in white garbs, they invade my house to demand debt be repaid. The quivering man, incredulous, stated to them that he did not owe money to anyone, that he had paid the last of his debts six years earlier and still had the receipt to prove it. Still, Park & Sons invaded night after night, taking a few coins and bills and property. Dark after dark they made the promise-like threat that they would take all from the man eventually and leave him to waste away. "I have the dream nearly every night," said the shaking man. "And each time, the man and his sons take more from me than they had before.” Although I am not one for superstition, the steely fear and conviction the man displayed as he related his nightmares compelled me to believe that somehow the sleeptime events were manifesting in this man's reality. First there was the case of his weakened muscles warranting physiotherapy, and now the dysphagia--the swallowing difficulty. What next? I wondered.

As the weeks went on and the man told me of his latest encounters with the evil debt collectors, his demeanour changed. Wherever the colour of London sky goes in winter, there the colour of his face had gone also. He soon had difficulty centering his body when he walked and shortly thereafter was resigned to a wheelchair (how cruel for an infant to wrestle himself from the pram only to be forced back in as a man). A spry athlete once, his muscles were now sore and stiff from the beatings he received from Park & Sons. A dourness overtook him, the butterflies of his jovial days now months of moths at dusk. Many sessions did we have. Many times did I watch him eat, the shaking man. Many times did the food and drink slip into his airway instead of his stomach. The coughing, the runny nose, the clear-crisp voice turned into eddies of gasping drowns. Many times I asked myself: why must we breathe and eat so closely together, with only a thin wall separating these life sustaining channels, and with only a fleshy flap protecting life's breath when food comes to play? How cruel that the holy design of homo sapiens sapiens must endure such a flaw. I wish Frost's words would have applied here, for you see, two roads diverge in our red bodies but not quickly enough, not swiftly enough. Alas, intelligently designed are we and evolutionarily cunning is our form. Thus this is deliberate and no flaw at all. But I dare say the shaking, coughing man facing me has overwhelming reason to believe otherwise.

Park & Sons continued pillaging. The man continued to owe no debt, but this reprieve was of no use, "and so my body I steel as they still steal," said the shaking one. The swallow sessions ticked on. For all his darkness now, the shaking man worked harder in our treatment sessions than any patient before him. We used detailed and technical exercises to protect his airway and improve swallow; "tuck your chin-hold your breath-bear down-swallow hard-swallow again-cough gently-swallow fast-say 'ahhhh'”, repeat. Mouth and tongue-strengthening exercises, repeat. Sometimes we needed the aid of technology, of tingling electricity applied to the neck and chin to resurrect the Lazarus muscles. Other times we simply used the collective wisdom of mothers past, present, and future: "Smaller bites," "slow down," "et cetera" (it never ceases to amaze me that mums know best). With the debt collectors still ransacking, we kept working, the long-term plan: being to enable my patient to store as many enjoyable eating sessions as possible and to delay the rate with which Mr. Park & Sons cause his swallowing to deteriorate.

By our last session we had arrived at a modified diet; food became softer and meats especially now were chopped up and he disciplined his fluid intake with small sips and slurps. As we both agreed, all of this would allow him to maintain his dignity and the joy of feasting but also ensure that his throat could safely accommodate the primeval urge to be nature's alpha omnivore. Not long after the end of our therapist-patient relationship, I came across the man while on a weekend stroll by River Thames. Of all the bends far from me where the man could have been, on this magnificent serpentine water, serendipity yet united us, at the Ferris wheel's leaden-eyed reflection in the South Bank. We exchanged hellos and asked how each was doing. The shaking man had a slight smile on his face, easy to notice and be taken aback by as I had grown accustomed to seeing a flat and numb countenance on his best days. Then he told me about the latest of the debt collector and his sons: "Mr. Park & Sons," he said, "strangely enough, haven't attacked me in a long while. They wait in the shadows of my doorstep, make no mistake, pacing menacingly back and forth...but that's only it, nothing more. No prophesying attacks, no prescient beatings, no pillaging." As I saw the smile broaden on his face and let the breadth of his words sink into my mind's rivers, I freed a breath from my chest's cage. No attacks, only restless pacing, no debts to collect. This, it seemed, was good enough for my once-patient, and on blue London day, this was good enough for me.

------

short story/prose poetry, health humanities

© Reinfred Dziedzorm Addo; Originally published by National Foundation of Swallowing Disorders; 2018

“The Shaking Man, Part 2”

(In honour of Rebecca Blackert Epperly and Kristin King, wonderful instructors and speech-language pathologists)

‘Park & Sons’ intermission is over,’ the shaking man told me when our therapist–patient relationship resumed at my Shoreditch clinic. ‘I had another of thosedreamslastnighanatheycamiere…’

His quivering had increased, joints even stiffer, breathing more labored, movement less fluid. There were dark circles under his eyes and tufts of his hair were gone, his color almost wiped away.

This time he was here because the debt collectors were trying to silence him. They schemed to steal his speech, the very thing he used to recount their assaults or to protest against them or to ask for help. This trick up their sleeve is known as dysarthria: the Greeks and Romans defined it as speech that is disjointed as a result of weak muscles.

Park & Sons wanted to make him incoherent, for no one listens to an incoherent man’s words. No one listens to the man whose lips curve in a downward droop even when he isn’t sad. No one listens to the man whose exhausted speech muscles will not let him properly utter a dignified ‘r’ or a distinguished ‘s’ or a delicate ‘m’. Who will listen when he speaks but his voice is too quiet? Who will honor his time when his mouth moves but sound does not come? It seems nobody wants to stay around for a re-enactment of Babel where many of the words are difficult to understand.

When the shaking man’s words started strong but trailed off—like the metro growing quieter as it leaves me for fair Camden Town—it was much easier for us to talk over him, to cut him off or to finish his sentences.

Minutes after the session ended, I went into the restroom and beheld him in a most vulnerable state. He was leaning in the doorway to a stall, stumbling from the toilet to his wheelchair. His fingers were pale from the grip he had on the stall door.

I asked him, ‘Are you all right?’ But it was only a courtesy, as the answer was obvious.

He piped up. ‘Yes, fine.’

I had always admired the shaking man’s tenacity, his determination when all logic deemed his chances unfavorable, when his morning alarm taunted a defeatist, No, today you cannot achieve anything. You dare not hope against all hope. Throughout my knowing him, I had often seen him in the corridors taking painful-looking steps as was his ritual after our sessions, determined not to be confined to the wheelchair.

Yet now as his grip loosened and his body lurched towards the ground, he revised his answer to ‘no’, tears in his eyes. ‘I need help, about to fall,’ he added, as though admitting defeat.

I placed myself between him and the cold linoleum, but by protocol did not try to catch him, so as to avoid losing my balance and injuring us both. Instead, I gave him a loose embrace from behind, slowly cushioning his descent. As he slid down, I planted one leg and gradually sank into a kneeling posture with one knee touching the ground. There seemed to be a beauty in this gesture; by kneeling and lowering myself, I was symbolically showing solidarity to the man, signifying that he wasn’t alone and that people would fall with him if that’s what it took to face Park & Sons. It seems in life we paradoxically often take to one knee and lower ourselves in order to be made higher in a firm stance against adversity.

And so the shaking man and I again did battle with Park & Sons. They hatched their plans and made their attacks in the dead of night; we strategized and defended ourselves in broad daylight. It seemed we knew something they didn’t: darkness always dies when it touches light.

The shaking man donned his battle gear. At boot camp we disciplined the sober slurring. I led him in drills of tongue twisters: ‘pa-ta’ turned into ‘butter’, ‘ka’ turned into ‘cup’—‘pa-ta-ka, buh-ta-ka, butter-ka, buttercup’, over and over and over and over. In reading and in speaking, precision was our obsession, and so I prescribed a slow rhythm. No need for a polka, just a waltz to synchronize every soldier to achieve clear and crisp annunciation. Lip, jaw, teeth, tongue, throat, uvula, nose: in time, these sergeants came to understand their directive, their war waltz. To make precision excellent, we added the element of overexaggerating the articulators. It was best for him to overemphasize every movement with deliberation and conviction.

But of course there were two sides to this war. Having lost the battle of articulation, Park & Sons found new areas to attack. Each day the shaking man presented himself to camp with his latest battle wounds: the dry mouth, the tremors, the slow movements, the stiffness and the unsteady gait. What unnerved me most was the voice crackles. Park & Sons had learned something we had hoped to keep a secret from them: cut off your enemy’s lines of communication and you have the upper hand, as this causes frustration and panic and desperation. And so we fought this angle of attack. Every day the man battled as his voice wavered and at times went silent while his lips and tongue continued their movements for the sounds of his beloved language, his beloved alphabet.

To combat this he learned to have a near-yogic calm. ‘Breathe deep into your belly,’ I would tell him, ‘hold, let it out slowly through parted lips. Roll your head clockwise, slowly, gently. Tense your shoulders upward, and gently relax them downward.’ And he learned to be a river: by drinking water often, finishing his cup at least three times a day, he kept his vocal cords hydrated.

Park & Sons took a new approach to slow the battle and the man down to their speed. He was now unsure of many things—of planning actions and using information, and even of his bearings on time and date and place. He now seemed like a train bound on one journey, unable to change course, inflexible. A stupor came over him, and he felt nothing for celebration or alarm, even if he was headed for disaster. At times his train lights would pierce through the fog to reveal a scene in the distance, but it would prove to be a mirage once the train reached that place.

All of a sudden the shaking man would fall asleep, even with sun in the sky. Upon waking, he would apologize. The sweat of his body had developed a habit of leaking, his skin slick with the sheen of oil.

Park & Sons ensured the man’s speaking apparatus matched the dulled train lights of his personality. His speech became quiet, a near whisper. Even worse, he could no longer carry a full chorus save for the low flat drone of his one tone, a hymn written for a single note. For this we unleashed officers previously at our base: we summoned the physician and the psychiatrist. To restore the train lights to their former brightness required a whole team. Tirelessly we worked, buffing and shining and tinkering with the bulbs until the lights flooded the world once again with a golden beam. Yet, we didn’t stop.

The shaking man strolled with me through the corridors of my clinic, stopping to practice crystalline speech with anyone who would give us half a moment. A dutiful student, he agreed to do homework, to speak to his spouse and friends and acquaintances, not minding so much the what of conversations but more so the how. He must have wanted high marks, as he even went on town outings, speaking to strangers and using their unfamiliarity as a gauge of his progress.

Like that of a master of the theater, his voice filled space, his mouth opened wide and long, and his breath was a gale, the air of which moved through his mouth and nose chambers to amplify his speech. He placed emphasis on all the right words, and his notes moved up at the end of each question. He could make sudden exclamations, while for solemn expressions his sombre notes fluttered downwards.

All this our machine confirmed. Months earlier, our visuals of recordings of his speech-air particles had looked like flat plains, at best mounds of earth; now we saw fully formed valleys and mountain tops.

One day after a session, he told me he was a poet and had loved doing readings, but after his diagnosis of dysarthria he had confined himself to writing. ‘Now I’ve survived this round of attacks from Park & Sons, I’m going to do readings again. I’ve actually signed up for an open mic tomorrow.’

***

Tomorrow came, and I went to the open mic as a listener.

He began: ‘I met the shaking man in London Town. In a red Tube cab, my eyes were glued to the movements of his hands, ticking, repetitive…’ Through every turn of phrase and every pause, I heard his words. I heard them crisply, fully, with each rise and fall of intonation. I heard them loudly—not that he needed much volume, for we the listeners had hushed enough to hear the ghost of a breeze. When he said the last word of his poem, he received one of the loudest rounds of applause and finger snaps of the open-mic hour.

I knew then that Park & Sons would have another hiatus. None the fool, I anticipated there would be more attacks to come—perhaps for the man’s brain, the control center itself. However, this win was enough to banish misery for a while. The look on the face of my twice-patient told me he knew what I was thinking, and the smile that followed told me he was content for now and that I needn’t worry. This victory was splendid enough for him, and on a green London day it was splendid enough for me too.

------

short story/prose poetry, health humanities

© Reinfred Dziedzorm Addo; Originally published in Signs of Life anthology, ed. Sarah Sasson; 2021