98 Chapter 5
On Roy’s chart, the diagnosis read “closed head traumatic brain injury.” Radiological
reports showed that the blunt blow or blows had damaged the temporal- parietal lobes of his
brain. Although his head had bled, no foreign object had penetrated the brain. The computed
tomography scan showed several ruptured blood vessels and damage to Wernicke’s and adjacent
areas of the brain. There was also bleeding (hemorrhaging) within the brain but not enough to
require suctioning (evacuation). Also listed on the medical report was “jargon aphasia.”
“Do you remember the assault?” asked the se nior detective. Roy looked at him, smiled, and
calmly replied, “It all depends on the acrylic.” The detectives looked at each other quizzically.
“Roy, do you know the names of the assailants?” Again Roy smiled and replied f luently: “Thus
far.” Then he gestured to the table next to his bed, apparently offering the detectives a glass of
water. They politely declined. “On the night of the assault, you were playing pool with friends
and two strangers,” stated the se nior detective. “Do you know the names of the strangers?” Roy
again smiled and f luently said: “It all depends on the acrylic, don’t you know, and thus far tula
beyond the reef.” Perplexed, the detective deci ded to have him describe the assailants: “How
tall were the strangers?” Roy took a sip of water from the blue cup on the hospital table and,
laughing, replied: “I’d say, thus far, that, you know, tula is the thus far.” Then Roy chuckled.
Undaunted, the first detective again asked in a much louder voice: “How tall were the strang-
ers?” and Roy, becoming irritated, said: “Thus far, you know!” The other detective, writing in
a notebook, said: “Sir, you are not making sense.” Roy looked at the se nior detective and rolled
his eyes, suggesting that the ju nior investigator was the one not making sense and needed to
pay better attention.
Eventually, Roy was admitted to the hospital’s rehabilitation unit. The battery of speech,
language, and neuropsychological tests profiled his aphasia and related cognitive deficits, pro-
viding the basis for therapy. Often Roy refused to participate in the evaluation procedures and
indicated that he was confined to the hospital for routine tests. With coaxing by his wife, Roy
did participate in a token test. This test is used to assess the patient’s auditory comprehension
and involves the patient matching differently colored, shaped, and sized chips based on the
examiner’s verbal requests. For example, the examiner might say, “Point to the red circle” and
“Put the yellow square below the blue triangle.” When Roy did cooperate rather than dismiss
the request, he could only do the easiest task. The results of the test showed severe auditory
comprehension deficits.
After several weeks of poor rehabilitation gains, especially in aphasia therapy, a special
examination was conducted. Roy’s failure to participate in therapy was addressed and a psychi-
atric consultation reviewed. The psychiatrist confirmed that Roy denied his disabilities, a com-
mon reaction in patients with parietal lobe damage, and engaged in projection. According to
the psychiatrist, denial is a defense mechanism used to avoid confronting negative life changes.
Projection serves the same purpose and allows the patient to assign responsibility to others.
Denial and projection often go hand in hand. The psychiatrist noted that these reactions often
subside naturally, but Roy’s radical psychological reactions appeared chronic. The rehabilita-
tion team agreed that unless they could be reduced or eliminated, Roy would be discharged.
According to the psychiatrist, there are no medi cations to eliminate denial and projection, but
sometimes confrontation is helpful.