How many is not supposed to be a trick question

Do you have brothers and sisters?

At a dinner party, a wedding, the first day of camp, this could be an icebreaker. In grade school, it could be a prelude to drawing a family portrait. At an initial speech pathology evaluation following a serious brain injury, it’s supposed to be something else, a yes/no question, to elicit a yes/no response. An entry to analysis not only of the ability to speak, but of cognitive function as well.

Do you have any brothers or sisters?

My son doesn’t always answer. He is reserved in his willingness to communicate with people he doesn’t know. The damage to his short-term memory means it takes time and repetition for him to know someone. I categorize people for him: That is someone we don’t know. A constant refrain in hallways and elevators headed to therapy or on an outing to the grocery store, a basketball game, or a movie theater. Not someone we know. Not someone we know. When it’s someone new to his care team or his medical team it goes like this: This is [insert name]. [Name] is [insert relationship]. Repeat and repeat.

My son has been asked the screening question about brothers and sisters many times.

By the first speech pathologist, at the University of Iowa Hospitals and Clinics (UIHC), during his first hospitalization. A lovely white-haired woman with dangling earrings and the aura of an interesting past, who connected well with him. She was evaluating how much he could understand, how well he could express himself. He used his eyebrows, as he still does, but that was when he wasn’t speaking at all.

By the speech pathologist at On With Life, the first of several rehab facilities, who fed him pancakes to evaluate his ability to swallow. Still not speaking.

By the speech pathologist at the Center for Disabilities and Development at UIHC, where no, he did not want to shoot the little mermaid and her cartoon cronies, using lasers by moving his eyes while staring into a computer monitor. Evaluating him for a speech assistive device as he struggled to speak. He was, however, alert and aware enough to roll those eyes with an edge of snark, not wanting to be treated as a child.

I sat there thinking, Die, little mermaid, die already! I wonder, had I said that, if he would have been more willing to use his eyes as lasers, to blast her doe-eyed little icon off the computer grid. Maybe. Maybe not.

He was asked by the speech pathology students at the speech clinic at UIHC: Do you have any brothers? Or sisters? What they lacked in experience, they made up for in enthusiasm, in being closer to his age (22 or so to his then 32⸻young adults who hadn’t forgotten how to play), and in their ability to learn from what doesn’t work, like the inevitable question that comes after he says yes:

How many brothers do you have? or How many sisters do you have?

How many is not supposed to be a trick question.

The answer is supposed to be a number. The question is supposed to be about memory, word finding, aphasia screening, and other things speech pathologists assess. Sometimes my son closes his eyes. Sometimes he averts them. Sometimes he rolls them. But it’s a question he never answers.

In speech therapy, it’s not useful for the family to answer for the patient. We make an exception for this line of questions.

He has three sisters. Ask them. If you’re taking a medical history, he has two. If you’re asking about early childhood, he had two. Now he has three. He has brothers. If you’re asking about early childhood, he had one. He lost him for a while, but now mostly remembers that he got him back; if you’re taking a medical history, it’s his half-brother.