The Hand That Doesn't Answer Back

My grandfather had a stroke in June, on the right side of his brain. He survived it, and I am more grateful for that than I can fit into a sentence that doesn’t sound like something printed on a card. The left side of his body did not survive it with him, not fully: his left arm and leg have barely moved since, through a hospital stay and then a string of rehabilitation centers he is still living in as I write this. I visit most weeks. Most of what I do there is small and almost nothing: adjust the bed position, help him to lean up, help him to drink, help him to clean his lips. A lot of times, I simply hold his left hand in mine and feel. I hold it and nothing comes back at all, not a flicker, and I have started to dread walking into that room a little, because I keep hoping this is the visit where something does.

The easy assumption is that nothing came back because nothing is there to come back, that the silence on his left side is a silence in him. That assumption is carrying more than it has earned, because at least three different things could be producing the same stillness, and I have no way, sitting in that chair, of telling which one I am looking at.

The first is the plainest. A stroke on the right side of the brain damages the pathways that carry outgoing motor commands to the body’s left side, since those pathways cross to the opposite side before they ever leave the brainstem. A signal to move can be blocked there without anything being wrong with what comes in. On this account, he may feel my hand completely, register the warmth and the pressure just as he always has, and simply have no working channel left to close his fingers around mine or turn his head toward it. The hand would be silent. Nothing else would be.

The second is stranger, and it belongs mostly to the right side of the brain. It is called hemispatial neglect, and it is not a loss of feeling so much as a loss of the machinery that would notice the feeling was there to be attended to. Vallar and Perani, in a 1986 study mapping lesions in patients with this kind of damage, tied the most severe and lasting cases to right-hemisphere damage around the parietal lobe, the region that ordinarily handles attention to both sides of the body and the world, while the left hemisphere only really covers the right. Take out the right hemisphere’s share of that job and nothing steps in to cover the left side anymore. In its mildest form this looks like not turning toward someone standing on your left. Its most severe documented form is a condition called somatoparaphrenia, made famous outside neurology by V. S. Ramachandran and Sandra Blakeslee’s 1998 book Phantoms in the Brain, in which a patient stops recognizing a limb as their own at all and insists it belongs to someone else entirely, a stranger, a relative, a body left behind in the bed beside them. If this is closer to what is happening in my grandfather’s case, then the problem was never in his hand, or even, exactly, in his awareness of touch. It is in whatever process would normally reach out and claim that side of his body as his in the first place, a process that itself went dark, taking the claiming with it rather than the feeling.

The third explanation is the least dramatic, and probably the most common: he is exhausted. Post-stroke depression is extremely common well past the acute stage, affecting roughly one in three stroke survivors, according to a 2014 meta-analysis of more than sixty studies and twenty-five thousand patients, and so is the kind of plain fatigue that has nothing to do with which hemisphere was hit. A quiet hand on a given afternoon might have nothing to do with the left side of his brain specifically. It might just be a tired, sad man in a bed that isn’t his, who has been in one institution or another since June, and who has told me more than once, quietly, that he’d like to go home.

There’s a name for the specific weight of not being able to tell these apart, and it turns out I’m not the first person to need it. The psychologist Pauline Boss coined the term ambiguous loss and laid it out fully in a 1999 book of the same name. She splits it into two kinds. In one, someone is missing and might still be alive somewhere. In the other, someone is right in front of you, breathing, warm, entirely physically present, and still not fully reachable, the way families describe losing someone to dementia long before any death certificate gets signed. Boss’s work names something I felt before I had a word for it: the worst part usually isn’t the loss itself but the back and forth, hoping he’s still fully in there on the way over and getting the flat disappointment of a hand that doesn’t close around mine, over and over, for months, with no visit ever settling the question for good.

What unsettles me most isn’t any one of these three explanations. It’s that from where I sit, holding his hand, they are indistinguishable. A fully present mind behind a broken outgoing wire, a mind that has lost the very capacity to notice and own one side of itself, and a mind that is simply tired, all three would look, from my side of the bed, like nothing happening. This site keeps circling a version of this question in safer settings: whether a dog’s eyes can be read, whether a chatbot’s fluency means anything behind it. In those, I always had the comfort of distance, an animal whose inner life was never really at stake for me personally, a program I already suspected was empty. There is no distance here. The problem of other minds is real, and it is sitting in a rehabilitation center this afternoon, and I do not get to resolve it before the visit is over.

I don’t have a tidy way to close this, and I don’t trust anyone who’d offer me one. I don’t know, on any given afternoon, which of the three things I just watched happen, and I don’t get to find out before I have to stand up, say something too small for the moment, and go home. What I do know is that the not-knowing has never once been a reason to stop reaching for his hand. If anything it works the other way. Because I can’t verify what’s on the other end of that silence, reaching for it again, on the next visit and the one after that and however many come after those, is the only honest thing left for me to do. I am not holding his hand because I know he’s in there. I am holding it because I don’t, and it is still, somehow, his hand.