Matt was beginning to acknowledge those who greeted him and was more expressive, raising his eyebrows, opening his eyes wide, and occasionally smiling spontaneously. He was increasingly aware of his surroundings and attentive, and with it, his rate of learning and comprehension improved, that is, until he tired. Rest periods of an hour or more were an essential part of the recovery process. For several weeks, Matt had tried to make his wishes known and even to talk, but although his mouth moved, no sounds came out, forcing him to mouth a few words, nod his head, or use a familiar hand motion to signify so-so or maybe. Still, it was something, and this small input and seeing him smile more readily delighted us.

Little by little, Matt began to string a few words together. He spoke so quietly that we only understood 25-30% of his words. Occasionally, he surprised us by saying phrases and words clearly and loudly. Sometimes, he perseverated, meaning he got hung up repeating the same word. And often, he couldn’t think of or say a specific word. For fun, we tried to repeat one of his Pop Pop’s favorite sayings, “Shave and a haircut, two bits,” with some success.

In addition, speech therapy worked on recognizing written words and practicing writing. His printing was big and squiggly. By early August, he had added the days of the week, months, and numbers (1-10) to his repertoire—but struggled with letters, the latter of which would prove difficult for years to come. Matt’s vocabulary expanded as common phrases were added, such as thank you, you’re welcome, I love you, and my name is Matt.

We had much to learn about the nuances of language and effective communication, things we had taken for granted until now. A conversation involves listening, understanding, formulating a response, finding the right words, and, in Matt’s case, hoping his vocal cords would resound strongly—loud and clear. Listeners were obliged to lean in close to hear and read his lips, to make sense of his jumbled words, low volume, and hoarse voice. It was reminiscent of the patience required to listen to a child learning to speak and how tiring it was for those on the receiving end.

Matt’s cognition, speech, and language skills were very much in their infancy, and his prognosis—uncertain. This was perhaps the most significant unknown aspect of his recovery in the future.