Stroke and Recovery - Case Study

This case study involves a lawyer who has suffered a serious stroke. John Smith is 62 years of age and is a partner in a mid-sized city firm. He has a general practice which focuses on business and commercial law based upon his excellent work habits and a large group of loyal business clients. He has produced substantial billings from his own efforts as well as work for other partners and associates in the firm. Two months ago he suffered a serious stroke. He was discharged from the hospital after five days and spent another three weeks in a rehab centre. His physiotherapy has been successful in reducing his left side paralysis but he continues to have problems.

John has been home for four weeks but he shows no signs of returning to work. Several of his partners have visited him but they find him remote, guarded and uncommunicative. John is an important source of business and revenue for the firm and his partners are concerned that there will be obvious business losses if John does not return to work. They want to support John and do everything they can to help. On the other hand, John's large office sits vacant and clients are becoming restless.

John's wife, Betty, has tried to talk to him about returning to work but he refuses to discuss it other than to say "You don't understand." John's daughter, Susan, has spoken to him as well and he is less gruff with her. Susan is also a lawyer.

Unknown to anybody, John is falling into a deep depression. He is scared stiff. He feels trapped in a disabled body, yet he does not want to admit to his family, friends and partners the full extent to which he feels disabled. He does not think he can return to work for several reasons. Firstly, John cannot control his bladder at all times and he has had some embarrassing accidents which he has tried to hide from his family. While the accidents have grown fewer, he still has some leakage and there is no way he can return to work if he is afraid that he will wet his pants. He feels deeply humiliated and embarrassed. Secondly, John always holds a telephone in his left hand to leave his right hand free to take notes. His left side paralysis has left some residual disability and he feels awkward and inadequate when he tries to lift the phone and hold it to his ear for any length of time. Thirdly, John's speech is still somewhat slurred although there has been dramatic improvement from just a month ago. Lastly and most important, John's spirit is sagging and fading. He feels useless, worthless and hopeless. He remembers well a former Provincial Premier (also a lawyer) who committed suicide after a serious stroke. John is beginning to see suicide as the only way out.

John's wife Betty and his daughter Susan have discussed John's situation but they do not know where to turn. Susan has a vague notion that the Canadian Bar Association has a Wellness Program and her Provincial Bar Association has a Lawyer Assistance Program. A law journal ad catches her eye and she finds herself dialling the telephone number for the Legal Profession Assistance Conference (1-800-667-5722). Susan learns that LPAC has a series of Health, Wellness and Recovery courses including a course called Heart Attacks and Strokes: Return to Work. She orders -the course material and when it arrives, she devours it quickly. Susan comes to realize that professional help is available for someone like her father in the form of rehabilitation consultants and counsellors. Susan calls LPAC once again and obtains the telephone numbers of several consultants and counsellors in her city. LPAC encourages her and reassures her that she is on the right track and that she should find a counsellor as soon as possible and then help her father and mother to buy into the process.

Susan meets with a counsellor, Ruth, and then introduces her to her parents. A meeting is arranged for all four of them. Ruth introduces herself and her services but then asks Betty and Susan to excuse themselves and she meets directly with John.

Ruth is very experienced with stroke survivors and she is well aware that John will probably have bladder problems, physical paralysis disability, depression and a plummeting self confidence. In a two-hour session with John she uses her own expertise and experience to break the ice and raise the subjects that John could never mention to another person, let alone to a member of the opposite sex! Ruth charts out a game plan that includes a possible solution to John's four problems. Ruth writes out a detailed "Return to Work Contract" which will be shared with Betty and Susan as well as John's managing partner. In addition, Ruth writes out a checklist of things John will need but this is a private document that will only be shared with Betty.

Ruth has shown John a catalogue of absorbent underpants and disposable senior diapers and she has recommended that John try two lines of products that have been successful for other businessmen. Needless to say, John is surprised to learn that other men his age use such products and he is encouraged when Ruth tells him that a senior bank official (no name given) has been using these two actual products for several years with excellent results. Ruth can arrange for home delivery of these products, directly from a medical supply store so John will be spared the embarrassment of asking at the local pharmacy.

Ruth has recommended a mini head set telephone device that will allow John to speak on the telephone without the use of his left hand. This will be helpful in two ways. Firstly, it overcomes the left-hand paralysis disability. Secondly, the high quality mouth piece will help to compensate for John's inability to speak as clearly as he would like. John is offered the choice of a plug in or a wireless head set. He chooses the wireless.

Ruth recommends to John to hire a student ($8.00/hr) to drive him in John's car to work on a trial basis for four hours per day. The student will stay at John's firm to be available to drive him home if the need arises. Further, the student will be aware of John's bladder problem and will be available to help with a change of clothes if the need arises.

Ruth agrees to speak with John on the telephone every day. John agrees to tell Ruth how he really feels and how well he is doing in coping with his fear and anxiety. John agrees to see a psychologist if his depression continues.

We can fast forward our story to three months later. John is now working at the office for five hours per day, Monday through Thursday. He works at home on Friday for three hours and he focuses on more complicated problems arising from his practice for which he needs total concentration and no distractions. John refers more work to his associates but he has been extremely successful in holding on to all of his clients and his billings have now achieved 70% of his former productivity. John's partners are delighted and relieved. Betty feels that she has got her husband back and she is overjoyed.

In actual fact, John found the first two weeks back at work very difficult as he tired easily. On some days, he had to return home earlier than he had planned. Over time, however, John's strength and endurance improved. The daily routine of going to the office has improved the paralysis disability and it is only slightly noticeable. John's bladder problems improved but he still has the occasional accident and he often has minor leakage. He feels confident that his lined underpants will prevent disaster but he does keep a full change of clothes in the office in case of an emergency.

The biggest change in John has been in his spirit and attitude. He feels good about himself and life has become worth living once again. As a result of his stroke, he finds himself taking a little more time to enjoy life, especially his family and personal relationships. John has found it useful to see a psychologist three times a month to help him with his feelings and moods. He continues to talk to Ruth three or four times a week by telephone and he plans to keep this up until the end of the year.

In terms of costs, John's return to work has been remarkably inexpensive. The special clothing and diapers as well the student/driver have cost less than $200.00 per week. His head set cost less than $500.00. Ruth's fees and disbursements are just over $1,900.00, based upon an hourly rate of $65.00. The psychologist has charged $125.00 an hour for a total expense of $1,750.00. At Ruth's suggestions, these expenses have been submitted to John's disability insurer. To John's surprise, the insurer has picked up all of these costs, happy to avoid lengthy or permanent disability claim. John's firm had agreed to pick up these expenses (except for the underwear and diapers which were strictly confidential) and the managing partner budgeted for these expenses. When the expenses were paid by the insurance company, the managing partner received unanimous approval from the firm to donate an equal sum to LPAC.

John realizes that he would still be at home living a life of despair and deterioration if his daughter, a lawyer, had not sought out assistance from LPAC. John has read a number of articles and papers from LPAC and has come to realize that it is based upon the simple principle of lawyers helping lawyers to overcome personal and professional difficulties. As John said to Betty, these people saved my life and salvaged my career. If I am not willing to help another lawyer in trouble, who will?