John Croke was a on a work call when, suddenly, he couldn't talk. He went to the bathroom to look in the mirror, and saw a drooping right cheek and eye.
Croke, who works at his family's business at home in Philadelphia, tried to go downstairs for help, but realized his right leg wasn't cooperating either. "So I got on my belly and army-crawled," Croke, then 28, told Insider. Downstairs, the office manager called 911.
Croke had suffered a stroke due to a clot in his brain, and received a clot-busting injection to break it up. But part of the clot got caught in a narrow artery of Croke's brain, which a surgeon attempted to remove with only partial success. Over the next 48 hours, Croke had two more strokes and a heart attack, possibly caused by other clots and brain swelling.
Croke — who, up until then, played and coached soccer — was left paralyzed on his right side. He also had aphasia, or impaired language comprehension and speech.
While the condition manifests differently in different patients, for Croke, it saddled him a sailor's tongue. In addition to "yes" and "no," "anything I was trying to talk, it was 'fuck,'" he said. "My grandmom was talking, and I was like, 'Oh, well, fuck fuck fuck fuck.'" Croke said his grandma started crying and had to walk away.
Croke, who still has aphasia but also a broader vocabulary, talked to Insider to raise awareness of the relatively common, but misunderstood, condition.
Croke underwent a year of outpatient treatment
Years before his strokes at age 24, Croke developed a streptococcus infection that a doctor misdiagnosed and treated with the wrong antibiotic, Croke said. As a result, the infection spread to his kidneys and heart, eventually damaging a heart valve so severely Croke needed a mechanical aortic valve replacement.
Four years later, a clot developed on the AVR, traveled to his brain, and caused the initial stroke.
For two weeks after his strokes and heart attack, Croke couldn't swallow. He underwent one month of inpatient treatment and a year of outpatient treatment, including physical, occupational, music, and speech therapy. It took him six months to relearn how to drive a car.
Now, at age 35, Croke remains in speech therapy for aphasia. Sometimes his sentences tumble out flawlessly, other times he takes long pauses and stutters before landing on the right word. He knows German and Korean, and sometimes those words pop into his head before the English term. He uses hand gestures to fill in the gaps.
People with aphasia "are inconsistent every day," Brooke Lang, Croke's speech pathologist, told Insider. "One day they can be talking fairly fluently in sentences, and the next day it seems like they can't get a word out."
Once, a year after his strokes, Croke said he was "L-boned" by another car. When the police arrived and started asking questions, he tried to explain he had aphasia.
"It was like 10 minutes of trying to explain it and he didn't know what I was talking about and didn't really understand," Croke wrote to Insider. "The cop was dismissive, but that's with a lot of people in general when you have aphasia."
Swear words can come more easily to some aphasia patients
Aphasia, which typically occurs after a stroke or other brain injury, affects over 2 million Americans of all ages, according to Aphasia.org. The language deficits don't reflect any changes in intelligence but rather difficulty translating thoughts to words.
In some cases, aphasia can cause a foul mouth. This may be because curse words are "automatic" like "hi," "yes," "no," and "thank you," aphasia researcher Lori Bartels-Tobin wrote for the Aphasia Center.
"The other thought is that emotionally driven words, which can sometimes be swear words, are often easier for a person with aphasia to say," Lang said. "So if they are excited, upset, angry, it is not uncommon for these swear words to be a part of the conversation."
Less commonly, swearing can reflect a personality change, depending on where the initial brain damage occurred. One grandmother in the UK name Pat Preston made headlines when a stroke transformed her from polite and reserved to outspoken and easily irritable.
"Before I had a stroke I would still get annoyed at things but I could control my upset, however now I just can't help it," Preston told the Daily Mail. "I can swear during conversations and a couple of weeks ago my grandchildren were playing up and I called them 'little bitches.'"
For families who are embarrassed by their loved ones harsher speech, Bartels-Tobin suggests pushing substitute words like "rats" and bringing awareness to the curser when it happens. You could say, "You just yelled 'shit' in front of a bunch of children and it was embarrassing, can you try to keep that a lot quieter?" she writes.
But ultimately, Bartels-Tobin says, "the best way to cope is to just laugh about it and apologize to offended parties if needed."
