The man who can only say yes and no

By Ed Ram BBC News 4 January 2016 From the section Magazine

It's common to have communication problems after a

severe stroke. But Graham Pawley is an unusual case - he
can understand everything but say very little back. He has
to get by with "yes" and "no".
Communicating with Graham is a bit like playing a yes/no
game - you have to keep asking yes and no questions
until someone gets the right answer.
I'm sitting on the sofa in Graham's flat. I am looking at
his medical report. He is trying to tell me to read it out to
him.
It's not strictly true that Graham can only say "yes" and
"no". He can say "and", "no" and "mmm" mmm means
yes. He also makes an "urr" sound. When he says "and
urr" he has something else to say and wants you guess
what it is.
"And urr" he says while I read the report.
"Yeah, it's really interesting for me to see this," I say.

"No.''
"Sorry, are you sure it's okay for me to look at it?"
"Mmm, mmm. And urr"
"You want to have a look at it?"
"No," he waves his left hand.
"I can keep it?"
"No," more gesturing.
Paul Webley, Graham's "befriender", starts guessing too.
"It's good? He's the first person you've let read it?" says
Webley.
"No, no, no," says Graham.
This carries on for a minute or two. He can't really use his
hands to express himself either.
"It's helpful? I'm helping?" I ask.
"Mmm. And urr"
"Oh, you want him to read it to you?" says Paul.
"Mmm, mmm," says Graham.
"You see, we always get there in the end," says Paul and
smiles.
In July 2013, Graham had a severe stroke and he is
almost unable to express himself. He can't read properly
or write. He is able to understand everything said to him.
He can't move his right arm and has limited movement in
his right leg.
A stroke happens when the blood supply to part of the
brain is cut off - often by a clot blocking a blood vessel. "A
stroke can impact your brain in a huge number of ways.
Almost all are life altering," says Cate Burke, from the
Stroke Association.

"Graham's condition is called aphasia," says Prof Tony

Rudd (NHS clinical director for stroke). "It's quite unusual
to have severe problems in communicating and have got
good understanding."
But it can happen. "The part of your brain that controls
communication is separate to the bit of your brain for
understanding, Rudd explains.
"Aphasia can mean that you just have trouble finding the
right words. But it can also be worse - the person may
have no understanding of what's been said and not be
able to express anything."
Aphasia and Stroke statistics
About 33% of people who have a stroke are affected
by aphasia
Stroke occurs about 152,000 times a year in the UK that's one every 3 minutes 27 seconds
First-time incidence of stroke occurs almost 17
million times a year worldwide - one every two
seconds
There are around 1.2 million stroke survivors in the
UK
Stroke is the largest cause of complex disability - half
of all stroke survivors have a disability
Over a third of stroke survivors in the UK are
dependent on others.
Source: Stroke Association
Graham can't write, or read more than the odd word or
two, but he can follow television and films. He can use a
phone but he can't text any more than a letter or two.
Always well turned out in a tailored shirt and thin tie,
Graham, who is 56, lives in extra-care sheltered housing
in London - a brand new tower block that has 24-hour
care. Almost all of the wall space in the flat is covered
with large bright oil paintings.

"He painted all of those, he loves Caravaggio," says Paul.

"That's him in that one." The profile of a man with short
hair and a beard can be seen looking over and past the
other figures in the painting.
The agony of the change to Graham is clear as you get to
know him. The stroke has put an end to doing the things
important to him. "He used to paint, draw, busk and make
his own clothes. He can't do any of that now," says Paul.
Neat collections of felt-tips, crayons and tubes of paint lie
unused on a dining table. He is able to use his left hand
to tap and swipe at his iPad but he cant make complex
movements.
It's clear from his appearance, his cleanliness and the
order in his flat, that Graham is interested in detail. In a
black plastic file is a series of employee reference letters.
One by one Graham holds them out. He was a mechanical
engineer. The letters tell a story of his career moving from
sewing machine construction to developing components
for aircraft.
There are videos on YouTube of Graham playing the
harmonica he used to busk in Camden in his spare time.
His harmonica is kept in the cardboard box that it came
in. Framed family photographs line the surfaces in the
living room and bedroom. Many of the photos are of his
son, Alex, who died aged nine from a condition that he
was born with.
Bright waistcoats that Graham made himself hang in
colour order on a rail in the bedroom. He holds one up by
the hanger. "Alex", reads the label on the inside. "Oh,
because that was the name of your son?" says Paul.
Paul works at Opening Doors, a support charity that helps
LGBT people who are over 50. "Graham was referred to
me by Age UK Camden. They have contact with the

people who work in the extra care accommodation," says

Paul.
Paul sees Graham every other Saturday. "It was an
unusual case and he needed a gay mate," Paul says. "I
walked in here and thought, 'How the hell are we going to
do this?' Two hours later it felt like we'd been properly
chatting for hours."
The pair knock along together, smoke the odd cigarette
and laugh at each other. For someone who can't ask a
question or crack a joke, Graham is surprisingly good
company.
Graham doesn't have many friends who come to visit him.
He broke up with his wife 12 years ago and came out as
gay.
He doesn't often see one of his grown-up daughters, as
she has been ill in hospital. His other daughter visits
every couple of weeks. Graham rarely sees his ex-wife but
they are on good terms. His sister comes to see him every
so often.
Graham wears a black hat with a series of small feathers
tucked in the side. It covers a large circular scar left by
surgery after the stroke. Burke from the Stroke
Association says "I don't like to say that people will never
recover but it's unlikely that he will make a full recovery".
Professor Rudd says. "Speech therapy and talking to
people will help and improve Graham's level of
communication."
Graham breaks down in tears when asked about how he
feels about what has happened to him. To see this very
positive man speechlessly cry gives a brief glimpse into
the impact of stroke on his life. Graham's tears dry and he
takes his time to recomposes himself. Perhaps incredibly,
he looks happy.

Later in a vintage clothes market Graham tries on a jacket

that is part of a suit. He is standing up and looking in a
mirror that Paul's holding up for him. The stall owner is
laughing - a couple of customers tell him that the jacket
suits him. He manages to buy the jacket for 35.
Graham's stroke has shown his character, the passion he
has for life. He draws pleasure from his ability to charm
and makes his acquaintances forget his limitations.
"Do you see what I mean?" says Paul as we walk away.
"It's like that with everyone he comes into contact with - I
think it's what keeps him going."
Graham doesn't receive a lot of care - there's help at hand
in case he falls. He goes out in his chair on his own, shops
and cooks meals for himself.
He and Paul go to galleries or out for a drink when they
see each other. "Once he took me to a church that he
goes to in Soho," says Paul. "The vicar was really pleased
to meet me - he didn't even know Graham's name or
anything about his story."
For many it is hard to start to understand the changes for
Graham. "Extreme aphasia is worse than suddenly being
dropped into another country that has a completely
different language and mode of communication," explains
Rudd.
In Graham's case, he is very close to the normality he
knew. He can understand everything - but his ability to
only say "yes" and "no" isolates him. People can only
ever guess at what it is that he actually wants to say.
"Imagine coming out of the cinema with your mates and
not being able to say anything when they ask 'What did
you think?'" says Paul. Giving views and opinions are how
people define who they are and what they stand for - part
of how people present themselves to others. Like the most

things in Graham's life, this expression of individuality has

become very difficult.
In the future, what does Graham want? To paint again, to
read, to make more waistcoats?
"Mmm, mmm, and urr" Yes, but there is something else.
"Love, a boyfriend, to go on dates," says Paul.
"Mmm, mmm," says Graham.
"There are loads of dating apps but for Graham I think it's
going to be something that will happen with someone he
meets face-to-face.
"That's the next step, I think," says Paul. "He'd love to
have a relationship again, just the same as everybody
else."
Pictures by Ed Ram