I recently underwent my annual physical examination with Dr. John S. Carr, my primary care physician. Approaching age 50, I recognize the value of paying a man wearing a white lab coat to grope me and give me his opinion of the experience.

Aside from the humiliation of having someone poke and prod parts of my body that don’t normally receive a great deal of poking and prodding (at least not from other people), the assessment was encouraging: I am in great shape for a man my age. That sounds terrific, although I cannot help but notice that such statements must now be qualified with the words “for a man my age.” In my youth, I was in great shape. Now, the statement must be qualified.

As I left Dr. Carr’s office, I remembered that he was also my mother Laura’s primary care physician during the last years of her life. The recollection stirred old memories of a marvelous lady struggling through her twilight days.

I first took mom to see Dr. Carr in 2004 while she was slowly recuperating from a debilitating stroke she had suffered on December 29, 2003 — the day after my 41st birthday.

Owing to the stroke, mom was suffering from aphasia, a language impairment that affects a person’s ability to speak, read, and write. Because the use of language and writing is considered a central communications function distinguishing human beings from lower animals, a large part of someone’s personality is due to his or her ability to use language. Aphasia robs a person of this communicative function, which changes part of the person’s personality. The extent and duration of aphasia depend on the extent and duration of the injury. Spontaneous recovery from aphasia occurs during the first three months after a head trauma, although a limited recovery is possible later.

Aphasia is common in stroke patients. Notice I used the word “patients,” not “victims.” The National Stroke Association suggests that people avoid negative words that emphasize a sufferer’s helplessness. People who see themselves as victims cede control of their lives to others — family members, friends, doctors, caregivers, God, or fate — when they need to take charge of their own recovery. A “patient” has rights and responsibilities for recovery that a “victim” lacks.

National Stroke Association

Research indicates that about a third of all stroke patients develop aphasia. A dizzying array of types exists — global aphasia, Broca’s aphasia, anomic aphasia, Wernicke’s aphasia, isolation and transcortical motor aphasia as well as fluent and nonfluent forms of aphasia. Each type is related to the others, but each type also has its own distinct symptoms and recovery patterns.

“Apraxia” is another new term I learned during my mother’s illness. It is related to aphasia, but a patient suffering from apraxia will confuse the meaning of gestures and pantomime. He or she may wave goodbye to someone who asks for a sandwich or open a purse to look for a plate or a pair of shoes.

Combined with aphasia, apraxia can be especially frustrating for a stroke patient. In many cases, if someone cannot speak, he or she can pantomime the act and still communicate. Thus, if I have laryngitis but I need to find my toothbrush, I can mime brushing my teeth, point to the bathroom, and thereby communicate to a friend that I need help locating the desired item. A person suffering from aphasia cannot speak clearly, but presumably the person can still gesture for a toothbrush. A person suffering from both aphasia and apraxia cannot communicate effectively through speech or gestures, which leads to anger and a feeling of helplessness.

To improve on mom’s speaking skills, her speech therapist assigned a workbook filled with exercises to practice and rehearse aloud. Most of the pages included parts of a sentence with the expectation that the stroke patient would fill in the blanks. About 20 pages in the book included simple math problems and questions such as, “If it is now six o’clock and you are going to the movies at eight o’clock, how many hours must pass before you go to the movies?”

Mom was never a whiz at math before her stroke, and much less so afterward. She could never get the answers to the math problems, so we focused on supplying missing words in sentences. Sometimes she answered with amusing results.

I remember opening the workbook on one occasion. “Name three things you would find in the forest.” Unfortunately, mom could only think of two things she would find in the typical pine forests of Georgia: Teddy bears and barracuda.

“Name two hobbies that you enjoy.” The only things she could call to mind were “screaming” and “killing time.” In a later session when I asked the question again, the only hobby she could name was “kill the Commie.”

The workbook contained this partial sentence: “When I leave the house, I put on my socks and __________.” Instead of the expected answer — “shoes” — mom responded with “galoshes.”

Here was another entry: “When I am sick and require medical attention, I go to see the _________.” Instead of “doctor,” she replied: “chiropractor.” Her brother Bobby was a chiropractor, so presumably this is why she responded as she did. Ironically, mom was no fan of chiropractors during her pre-stroke life. She never would have allowed Bobby or any other chiropractor to lay hands on her. The stroke altered her perceptions in many ways.

“I was born in the state of” was another question that never ceased to provoke a humorous response. Sometimes she said “Maine” or “Arizona,” although my favorite utterance was the polysyllabic “Massachusetts,” pronounced correctly, unlike her usual pre-stroke pronunciation of “Massa-two-sus.” I don’t think mom ever visited Maine or Arizona and, as far as I know, she had visited Massachusetts only once in her life.

“South Carolina. Mom, you were born in Orangeburg, South Carolina, on August 6, 1939.”

“Scootch for 1939?”

“Yes.”

She let out a half-whistle. “Scootch!” Translation: How did I get so old?

“You are not old in the span of geologic time, mom.” That rejoinder always merited a laugh or, at the very least, a phony guffaw.

Mike and Laura celebrate her 65th birthday, August 2004

The speech therapist recommended that mom and I sing songs. Music is wonderful therapy for stroke patients. Something about the lyrical, rhythmic quality of music triggers memories and improves recall. I saw this firsthand when my mother could not remember my name but she flawlessly recalled the lyrics to “Dixie.”

Whenever I drove her somewhere in the car, we would sing together. Sometimes we indulged in a spirited version of “Dixie,” but we also enjoyed “She’ll be Coming ‘Round the Mountain, “Michael, Row Your Boat Ashore,” “Swing Low, Sweet Chariot,” and “Tutti Frutti, Oh Rudy, A Whop Bop-a-lu A Whop Bam Boo.”

When we grew tired of the old classics, we invented our own songs. I recall a ditty we thought up the day before we visited Dr. Carr’s office for the first time.

I had patiently explained that we were going to see a new doctor and his name was Dr. Carr. I then described what would happen during the visit. To help her keep the discussion in mind, I started singing part of a nonsense song I made up on the spot. I pointed to mom to finish each verse.

MIKE: Dr. Carr; Dr. Carr. You may be near; you may be —

LAURA: Far.

MIKE: You be my king; I’ll be your —

LAURA: Queen.

MIKE: And you can be my —

LAURA: Mr. Clean.

“Okay, mom, that’s very good. Very good.”

“I is very good?”

“You is marvelous, mom. Marvelous.”

“I is marvelous, mom. Marvelous!”

The next morning, as I drove her to see the doctor, I suggested that we sing our new song. This second rendition took an unexpected turn.

MIKE: Dr. Carr; Dr. Carr. You may be near; you may be —

LAURA: Far.

MIKE: You be my king; I’ll be your —

LAURA: Queen.

MIKE: And you can be my —

LAURA: Sex machine!

I laughed. “Sex machine? Sex machine, mom? Really? Have you been watching Cinemax again?”

Pleased at my reaction, she cackled. “Sex machine. Lord, yes!”

“Lord, no, mom, No. I met the man. He’s nice enough, but he doesn’t appear to be a sex machine.”

“Sex machine. Lord, yes!”

We shared a laugh and I thought no more about it.

Dr. Carr’s nurses, two black ladies named Jessie and Paula Renee, cooed over mom during that first visit. They greeted us as I pushed mom’s wheelchair into the waiting room. Flanking us on both sides, they told her how wonderful her hair looked and how well she was doing, providing exactly the right level of attention to placate her inner demon. Paula Renee took over the wheelchair duties from me and escorted us into a small windowless room to perform a preliminary examination.

Paula Renee reached behind the door, removed a fold-up metal chair, and handed it to me. “You can sit in this if you would like to, sir.”

“Yes. Thank you.” I unfolded the chair and tucked myself into a corner near the exam table.

Paula Renee disappeared while Jessie, the more senior nurse, took the lead. “Now, Miss Laura, we’re gonna take your blood pressure. You’ve had that done before, haven’t you?”

She nodded. “Yes. Innumerable times.”

Jessie laughed. “Listen at you. A big talker!”

“Ever since her stroke, her vocabulary has expanded.”

Mom squinted at me. “Has expanded? Me?”

“Well, not you. Your vocabulary. Your vocabulary has expanded.”

“My vocab’lary?”

“Yes, mom. You now use big words like ‘innumerable’ and ‘immensely’ and ‘merciless bullshit’ more often than you did before the stroke.”

Jessie laughed. “You said that, Miss Laura?”

Nodding, mom confirmed the accuracy of my statement. “Life is merciless bullshit.”

“Like I said: Her vocabulary, some parts of it, anyway, has expanded. It has become earthy, too.”

“She talks pretty big, all right.”

“I do?”

“You do.”

“I is marvelous, mom. Marvelous!”

Jessie slipped the blood pressure cuff on mom’s left arm. “Yes, you are marvelous.”

Mom’s eyes grew wide. “Wait a minute. Wait a minute.”

“What’s wrong?”

Mom pointed at me.

“What?”

She wagged her finger. “You can scootch her.”

I frowned. “What?”

“Scootch her ‘bout my.” She paused, waving her good arm in ever larger circles. “You know. You know.”

“No, mom. I don’t know.”

“You know. Scootch ‘bout my — my — my. I is marvelous, mom. Marvelous!”

She flailed her left arm frantically.

“Oh. Tell her about your breast cancer?”

“Yes. Yes. Breast cancer.”

I looked at Jessie. “She wants you to know that she had breast cancer several years ago, and they had to remove some lymph nodes from her left arm. So she wants you to use her other arm to take the blood pressure. Is that right, mom?”

She nodded. “That right.”

Jessie frowned. “But your right arm was injured by the stroke.”

I nodded. “Is that a problem?”

Jessie leaned down and attached the cuff. “I just don’t want to hurt her arm any more than it already is hurt.”

Mom pulled away with a look of horror plastered on her face.

“It’s okay, mom. She won’t hurt you.”

“Now, Miss Laura, you don’t know me very well, but I can promise you I ain’t gonna hurt you on purpose. I won’t do that.”

Mom wagged her finger. “No hurt me! I won’t do that!”

“Is there another way to take the blood pressure besides using her arm?”

Jessie sighed. “I can try to take it through her leg. That doesn’t always work, though.”

Mom nodded. “Yes. Yes.”

Jessie pulled the cuff off mom’s arm. The Velcro made a tearing sound. “I gotta get a different cuff — a bigger one. Let me see if I can find it. I’ll be right back, Miss Laura.” She rushed from the room.

Mom smiled. “Yes, Miss Laura. I’ll be right back. Be right back.”

“You know, mom, when we checked you into Emory Eastside the day you had the stroke, they took your blood pressure in your left arm and you didn’t have a problem.”

“No problem?”

“No problem.”

Mom looked down at her right arm. “Problem?”

I nodded. “Yes, it’s a problem. That’s why you’re taking physical therapy.”

She rolled her eyes.

“At least it’s not as bad as speech therapy.”

She grinned. “At least it’s not as bad as speech therapy. Yes. Yes.”

“You don’t remember anything about that day, do you? You don’t remember Ken or Nurse Kelly or Dr. Rollins?”

She nodded. “No. No.”

How about Dr. Naji — Naji — Nasty pastry. I don’t remember his name exactly. He was your neurologist.”

“Nazi — pajama?”

“Yeah, Dr. Nazi Pajama. Something like that. You don’t remember him?”

“Dr. Nazi Pajama?”

“Yes, Dr. Nazi Pajama. That’s a great name for him. You don’t remember Dr. Nazi Pajama?”

“No. No.”

Jessie breezed back into the examination room with a huge blood pressure cuff. “Well, now, Miss Laura, let’s see if we can get this puppy to work.”

Mom found this remark indescribably funny. “Puppy to work! Puppy to work! Let’s see if we can get this puppy to work!”

“You’re a big hit, Jessie.”

Jessie laughed as she wrapped the blood pressure cuff around mom’s left thigh. “I reckon so.” She stood and grabbed a pump. “I don’t know if we can get a reading through her pants, but all we can do is try.”

Still laughing, mom looked at me. “All we can do is try. Let’s see if we can get this puppy to work. All we can do is try.”

Mom and I watched Jessie as she pumped up the blood pressure cuff. She also placed a stethoscope on mom’s thigh and listened intently. Eventually, she shook her head.

“You couldn’t get a reading?”

“Afraid not.”

Mom’s jocular mood instantly evaporated. “Let’s see if we can get this puppy to work.” Her voice was devoid of inflection.

Jessie leaned down so she was eye-to-eye with mom. “We couldn’t get that puppy to work, Miss Laura, so we’re gonna have to take your blood pressure in your arm. I asked Dr. Carr when I was in the hall if I could use your left arm, and he said it was fine.”

Mom frowned. “He said it was fine?”

“Yes, he did. And I trust him. Dr. Carr is a good doctor. He’ll do you right, Miss Laura.”

Mom pointed. “Let’s see if we can get this puppy to work?”

“I told you, Miss Laura. We can’t get this puppy to work.”

“I is marvelous, mom. Marvelous!”

“Yes. You are marvelous.”

Mom sighed and offered up her arm.

I tried to reassure her that it would be all right, but she refused to look at me or Jessie. She gazed down at the floor.

Jessie slid the cuff onto mom’s left arm and squeezed a hand-held device that pumped it up. “Now, Miss Laura, I’m sure you’ve had your blood pressure taken before. You know how this works. You’re gonna feel some pressure on your arm. I promise you, though, everything will be fine.”

Mom shrugged.

The Great Blood Pressure Imbroglio ended in five minutes. Jessie smiled as she unwrapped the cuff and slipped it from mom’s arm. “Now, that wasn’t so bad, was it, Miss Laura?”

Still pouting, mom again shrugged. Whatever.

“It was a little high, but nothing too bad. I’ll tell Dr. Carr.”

I smiled. “That’s good to hear. She takes all kinds of blood pressure medicine.”

Jessie stood. “I’ll be back in a minute.”

We watched her go, and I turned to mom. “You know, she’s just doing her job. If it didn’t work on your leg, she had to take it in your arm.”

She stared at me with the beginnings of white hot anger. “If that’s the scootch, I can take the thing!”

Although I did not quite understand, I nodded. No need to risk her anger.

A moment later, Jessie and Paula Renee marched into the room. Each lady stood on one side of mom’s wheelchair.

Paula Renee tapped mom on the arm. “Jessie tells me she took your blood pressure with no problem. You said you were very brave.”

Mom held up her left arm. “This puppy was brave.”

“Yes, ma’am,” Paula Renee agreed.

“I is marvelous, mom. Marvelous!”

“Yes,” Jessie agreed. “You are marvelous.”

Paula Renee and Jessie laughed. After a moment of perplexed introspection, mom joined them. Our brief bump in the road was forgiven, or at least forgotten.

The nurses performed the rest of the preliminary examination with the speed and precision of a NASCAR pit crew. They drew blood and attached and detached the EKG electrodes so quickly mom did not have time to protest. I had brought her urine and fecal specimens from home, so we skipped the most difficult portions of the examination.

As we neared the end of the exchange, Jessie cleared her throat. “One more thing before Dr. Carr comes in to see you, Miss Laura. We need a weight.”

Mom’s eyes grew wide. “A weight?”

Paula Renee pointed at the scales next to the wall. “We’re gonna help you up outta the chair, Miss Laura. You take three steps, then step up on the platform, and we can get your weight.”

Mom looked at me plaintively.

“Don’t look at me. They need to check your weight, mom.”

She opened her mouth to complain, but they did not give her time. The women were considerably stronger than they appeared because they hoisted mom to her feet before she knew what had happened. Her surprise registered on her face.

She tried to speak, but the ladies erupted into enthusiastic chatter. They spit out the words quickly, in short bursts of rapid-fire colloquialisms. Sometimes they addressed each other. At other times, they spoke directly to mom. They laughed and joked as they inched her ever closer to the scales. I did not know if this was a well-worn routine or a spur-of-the-moment strategy, but it was inspired. The nurses knew their patient well.

Jessie looked mom directly in the eyes. “Now, all you have to do is lift your right leg, Miss Laura. We’ll take your weight and ease you onto the scale.”

Mom looked to Paula Renee.

“Just lift up your right leg and we’ll help you.”

She looked at me.

“Go on. It’s okay.”

Still looking hesitant and fearful, mom did as she has been instructed. As soon as she lifted her leg, the women ushered her forward and she stood on the scale. Her frame appeared to wobble, but they had her wedged between them.

Focusing on the top of the scale, Jessie leaned forward and adjusted a metal bar. “It looks to be 208.”

Paula Renee confirmed the reading. “Yep. It’s 208.”

Mom looked back and forth between the two nurses. “It’s 208? Dat good?”

Jessie smiled. “Dr. Carr will prob’ly tell you to drop a few pounds, Miss Laura.” She patted her own stomach. “But he tells almost everybody that.”

Jessie and Paula Renee cackled. Mom did not seem to understand, but she joined in their cackling, nonetheless. She always enjoyed a good laugh even if the reasons for mirth were not altogether clear.

Jessie looked at mom. “Now, then, on a count of three we’re gonna step off, okay? Use your right leg again. All right, Miss Laura?”

Mom nodded. “All right, Miss Laura.”

“One. Two. Three.”

She stumbled, but the two women were beside her, and she did not fall. They half carried, half shuffled her to the wheelchair where they gently turned her around so she could collapse into the seat.

Jessie was all smiles. “Good job, Miss Laura.”

“Yeah, good job.” Paula Renee beamed at her.

Wiping sweat from her brow, mom was proud. “Good job, Miss Laura?”

They spoke in unison. “Yes.”

Mom looked at me. “Good job, Miss Laura!”

“So I see.”

“I is marvelous, mom. Marvelous!”

“Yes,” I said. “You are marvelous.”

Mom laughed.

Jessie smiled at me as she and Paula Renee headed toward the door. “Normally, I would make her put on a gown and crawl up on the exam table, but this time we can make an exception. Anyhow, Dr. Carr will be here in a few minutes.”

“Thank you.”

As soon as Jessie and Paula Renee had left us alone, mom turned to me. “They are good ladies and fine spiritual advisers.”

I laughed heartily. “I agree with the first part, but I don’t know about the second.”

We were still talking about the fine spiritual advisers when, sure enough, Dr. Carr entered the room.

He appeared to be in his early fifties. He wore oval-shaped glasses and kept his hair cropped short as though he were a former military man. He had removed his white lab coat and wore Khakis, a striped tie, and a plain white shirt as well as Hush Puppy shoes. Standing close to six feet tall, he was ramrod straight. He exuded a quiet confidence that suggested he was not an idle, frivolous man.

Opening the door to the examination room, he looked down at us as we sat in our chairs. “Hi, folks. I’m Dr. Carr.”

I reached up and shook his hand. “I’m Mike, Ms. Martinez’ son. And this is your patient, Laura Martinez. I’m here because she is a stroke survivor and I need to make sure I understand what’s going on with her treatment. I also left a copy of my power of attorney with the front desk.”

He nodded.

Mom smiled. “Hello. How are you doin’?” She grasped his outstretched hand with her left hand.

For all of his military bearing, he was not a cold man. He met her smile. “I am fine but, more importantly, how are you?”

“Fine.” She looked at me. “I fine?”

I shrugged. “All things considered, I suppose that’s true.”

She cackled. “I is marvelous, mom. Marvelous!”

“Well, let’s see.” Still standing, he carefully read the paperwork affixed to his clipboard. It took him several minutes to leaf through mom’s extensive medical history. After he had finished, he plopped down onto a chair with rolling wheels and looked at us.

Mom blinked. “Whatever is the matter?”

He smiled again. “Nothing is the matter. I just need to perform my examination.”

I leaned forward in my chair. “He has to perform your physical exam, mom.”

She looked uncertain, but fell silent.

Dr. Carr removed a stethoscope from around his neck and began his examination. I turned away and read a magazine I had borrowed from the waiting room. Mom occasionally uttered extraneous remarks — “boy, that scootch is cold” was her comment when the stethoscope touched her bare skin, and she initially objected to his plan to check her reflexes with a small hammer — but mostly all was quiet.

“Stick out your tongue and say ‘ahh.’”

“Stick out your tongue and say ‘ahh,’” she repeated.

“No, ma’am. I need for you to stick out your tongue and say ‘ahh.’”

“Ahh?” She looked confused. “Say ahh?”

I looked at her and, sticking out my tongue, mimicked the desired maneuver. “Ahh.”

“Oh.” Mom turned and, in an overly dramatic moment, extended her tongue. “Ohh.”

I laughed. “Close enough.”

Dr. Carr rolled the stool closer to her and stuck a small wooden stick into her mouth with one hand while he shone a small pen light into her throat with his other hand.

The examination proceeded as expected. When he unbuttoned her shirt and slipped it off her shoulders to listen to her breathing from behind, she gazed at me. “Don’t look, junior.”

“Not to worry.”

She laughed. “Not to worry. Not to worry.”

When he had completed his examination, Dr. Carr leaned forward over his desk and furiously scribbled on his clipboard. From time-to-time, he consulted a sheet of billing codes.

Eventually, he looked up from his clipboard. “Well, for the shape you’re in, you’re in good shape.”

Mom was wide-eyed. “Oh, yeah?”

“Oh, yeah. You should drop a few pounds, and we will need to keep an eye on your blood pressure, but otherwise you are doing well.”

“I is marvelous, mom. Marvelous!”

Glancing up, he smiled. “Yes, marvelous.” He looked at me. “I’ll mail you the results of the blood work when it returns from the lab. I’ll send a copy to her neurologist, too.”

“Thank you, sir.”

He stood, as did I. We shook hands.

"That’s it then. Unless there’s anything else we need to discuss.”

Before I could respond, mom pointed at his feet. “Those shoes are sharp!”

Dr. Carr and I gazed at his unremarkable Hush Puppies.

Laughing, he looked startled. “Well, thank you. My wife bought them.”

Mom laughed, too. “Wife bought them. Wife bought sharp shoes.”

“I’ll tell her you approve.” Tucking his clipboard under his arm, he reached for the door. “Anything else?”

Still laughing, mom blurted out, “Sex machine. Lord, yes!”

He squinted through his owl glasses. “What?”

I tried to interrupt, but mom overrode my voice with her top-of-the-lungs rendition of our new song in its entirety. The good doctor had been opening the door as she launched into the musical number, so I suspect Jessie, Paula Renee, the receptionist, and anyone else in the building heard the spirited ditty as well.

LAURA: Dr. Carr; Dr. Carr.

You may be near; you may be far.

You be my king; I’ll be your queen.

And you can be my sex machine!

Silence enveloped us as we considered our respective responses to this latest outburst.

To break the awkward silence, I pointed. “You know, those shoes really are sharp.”

“Thank you.”

“It’s the aphasia, you know.”

“I is marvelous, mom. Marvelous!”

“Right.” Frowning, he pulled the door open and scurried from the room.

“You know something,” I told mom as the door swung closed. “You really are a piece of work.”

“A piece of work. Lord, yes. A piece of work!”

Fast forward eight-and-half-years into the future. As I left Dr. Carr’s office following my 2012 physical exam, I recalled that long-ago episode. Choking back tears, I chuckled at memories of my mom, a woman who was never at a loss for words even if words were at a loss for her.

I miss you more than I can say, old lady. You is marvelous, mom. Marvelous!