Time to get a candidate for SD-Sen
by scottso, Sat Dec 30, 2006 at 09:31:41 AM EST
(Cross-posted at dailykos with a different title)
I've been waiting to hear something about how Tim Johnson was doing, and finally this story (http://www.nytimes.com/2006/12/29/us/29j ohnson.html?_r=1&ref=politics&or ef=slogin) came out in the NY Times yesterday. As a neurologist, I am able to do some reading between the lines that others might be unable to do. Here's what it says medically for him -- and, since this is an analytical group blog, politically for us.
First, they are weaning down his sedation, which obviously means he is getting better rather than worse. The tone of the doctor's comments supports that too. While one can obviously never be too certain about anything when it comes to serious illness, at this point I would have no reason to believe that Senator Johnson is going to die. As many on this site (and others) have discussed, Senate precedent appears to indicate that he will continue to hold his seat as long as he is alive, so barring an unforseen catastrophe I think we will hold the Senate 50-49.
More on the flip.
Second, however, is that fact that he's been in the ICU for over 2 weeks. That's quite a long time. Anybody who gets any neurosurgical procedure spends a day or two in the ICU, and one might commonly be in the hospital for a week or so -- but in a regular floor bed, not the ICU. That tells me that his condition remained quite serious for quite some time. Another thing that tells me that is simply the fact that he has remained on sedation so long. I don't think they would do that unless there was significant cerebral swelling -- otherwise sedation would have been weaned far sooner.
Third is an offhand detail from the article that is pretty ominous -- if you know something about neurology:
"They have said that he is expected to undergo physical therapy to address weakness in his right side."
I can deduce 2 things from that statement, in combination with the rest of the clinical history as it has been reported:
3a. Because the right side of the body is controlled by the left side of the brain, Sen Johnson's arteriovenous malformation (AVM) was in his left cerebral hemisphere.
3b. In virtually all right-handed people, and even in the substantial majority of left-handers, the left hemisphere is responsible for language. And some of the areas important for language are in the back part of the frontal lobe -- close to the areas that would be responsible for the movement of his right side. So there is a good chance that Sen. Johnson has suffered damage to his language functions. This is referred to as aphasia.
Aphasia relates not only to your ability to produce language, but also to your ability to comprehend language. It can be hard for laypeople to even come to grips with what this means. In its most severe form one is basically left in the state of a pre-verbal (or nearly pre-verbal) child. Imagine the closest 18 month-old in your life to grasp this. That child can look around, see plenty about what's going on, who is there, she knows who her mommy & daddy are and that they love her, etc. But she can't understand the vast majority of what you say -- maybe a word or a phrase or two here and there. In its milder forms a person with aphasia might be able to communicate pretty well, but have trouble finding words sometimes -- and also trouble grasping the exact meaning of things that are said from time to time. Some people have limited forms of aphasia -- where just expressive language is affected, and comprehension is intact, or vice versa. But this is actually very uncommon; the vast majority of people with aphasia have some degree of difficulty with both expression and comprehension.
Now I cannot say for sure that Johnson is going to be aphasic, nor do I want to appear to be engaging in Fristian diagnosis from a distance (from my perspective as a neurologist, his actions vis-a-vis Terry Schiavo make him an utter disgrace to the medical profession). But there is another important historical clue in this regard: the fact that he had some impairment of speech abilities -- i.e. aphasia -- during the initial conference call with reporters. That tells me that the bleeding -- and therefore the AVM itself -- was right near his language areas.
For someone like a sitting U.S. Senator, even mild aphasia is not a good thing to have -- especially if you're up for re-election next cycle. If he has trouble finding words, then it will be very tough for him to make a good impression on the campaign trail -- doubly so, since voters in SD will be looking for evidence that he is healthy -- or damaged -- in making their voting decisions. And if has trouble with comprehension, there is simply no way he is going to be able to deal with complex legislation, negotiations, committeework, etc. One may conceive of language as the most fundamental of our cognitive abilities; it serves as the foundation for almost all our other cognitions, and it is truly what makes us human.
As mentioned, it possible that I am in error (I haven't examined the man, after all), and it is also possible that Johnson recovers with some mild aphasia, but that his language improves to 100%, or very close, over the course of months or a year. But given the details we have been privy to thus far, suggesting a fairly serious neurologic injury, I think there is a good chance that he will be left with a permanent and significant language deficit. With such a deficit he may still be able to enjoy his life, and appreciate the attention of his family and friends. And if he's lucky, and it's mild, he might even be able to function halfway decently -- but not at the level of a U.S. Senator.
So while we wish Sen. Johnson a full recovery, and send our prayers to him and his family, from the strategic standpoint I think it is highly likely that Johnson will not be running for re-election in '08 -- and that SD is thererfore going to be a major Republican takeover target. Any Dakotans care to comment on the Democratic bench?