Fighting Their Way Back

Several summers ago, Clay Christensen, the Harvard University business theorist behind The Innovator’s Dilemma, was giving an early morning talk at his church. Christensen’s son was in the audience and knew something was wrong when his father, a respected and practiced lecturer, began speaking what Christensen describes as “gibberish.”

Because Christensen is a diabetic, his son thought he might be going into insulin shock. He fed gave his father candy and checked his blood sugar, but it wasn’t low. At the hospital, Christensen was diagnosed with his third major health crisis in about as many years: a stroke.

Although it came on the heels of a massive heart attack and cancer, the stroke was in many ways the most devastating to Christensen. All three health events could have killed him, but the stroke took away something central to the professor’s work and identity: his ability to speak for extended periods of time with authority and confidence. For him, it wasn't just the class sessions for his business students, but the lectures he gives far and wide.

"A clot apparently lodged itself on the left-hand side of my brain, just behind the ear, which the doctors said was right in the center of where you formulate speech and writing,” he said. “It killed that portion of my heart – my brain. You see me saying the wrong words even as we speak.”

In an early morning interview, the slip was hardly obvious. But Christensen is acutely aware of each misstep, and is frustrated with the long recovery that’s seemed to plateau of late. He’s back to speaking to business audiences all over the world, as well as students, and most probably wouldn’t notice a problem if he didn’t mention it. Slight irregularities in language retrieval and cadence still bother him, though.

“It continues to be a vexing challenge for me,” he said. “I am not as articulate as I want to be.”

That sentiment is shared by Eric Barr, a professor emeritus of theater at the University of California at Riverside, who last year suffered successive strokes that left him temporarily without speech or the full use of his left side, and impaired his memory.

“You’re accustomed to doing everything, and one day the stroke comes and you can’t do anything on your own,” he said. “I have trouble with email and getting computers to work now, and trouble with the phone a lot of times. The stroke wiped out a lot of the pieces that were important for work, not just for theater.”

Barr continued: “It’s very frustrating.”

Each year, hundreds of thousands of Americans suffer from strokes, which are caused by either blockages or hemorrhages in the brain. Symptoms run from mild to severe, and from physical to cognitive. Aphasia, or loss of language, is the most common cognitive effect of strokes that occur on the left side of the brain. Recovery times vary from hours to years to never, based on the severity of the event.

For those people without major lingering effects, returning to a relatively normal professional life depends on “how you regard yourself in the milieu, and the regard or comfort you have with who you are,” said Ronald M. Lazar, a professor of clinical neuropsychology in neurology and neurological surgery at Columbia University who studies strokes and language.

As a rule, Lazar said, “the smarter and more talented you are before the stroke, the more sensitive you’re going to be after the stroke to the perception that you’re different.” Lazar recalled a brain injury patient who was a top businesswoman. She told him with certainty that she was showing just 60 percent of her former cognitive ability. But tests revealed she had lost just 5 percent of her ability.

Academics are “susceptible” to the same kind of trap because they’re generally high achievers, said Lazar. But, he said, “how you adapt to this is a determinant of how you will function.” Professors who aren’t afraid to ask students to repeat their questions or slow down or fill in a missing word will likely be more successful back in the classroom, he said.

Using those adaptations, Christensen was able to return to the classroom after one semester away. But for Barr, due to the severity of his physical and cognitive symptoms -- including the continued limited use of the left side of his body and his memory lapses -- returning to the classroom was out of the question, he said. It wasn’t something he was prepared for.

“I’d been teaching for 37 years and was chair of the department for over 30 years and I didn’t have a thought about retirement,” Barr said. “This wiped me out. I couldn’t walk without a walker and it was clear I wasn’t going back to teaching. The decision was made for me.”

Even though he’s stopped teaching, Barr hasn’t stopped working, formally or informally. During his stay in the hospital after his stroke, he couldn’t help but coach a timid medical student on public speaking. He's continued to record acting podcasts for his website, too. And in April he performed a one-man play he wrote about his stroke experience, called “A Piece of My Mind.” The show offer a frank discussion of the emotional after-effects of his stroke – having to learn to depend on others and accept help – to the uncomfortable physical ones, such as incontinence.

Barr hopes to be able to travel with the show, sharing it with other stroke patients. That wish – along with writing the play in the first place – became a therapeutic goal, he said.

Christensen also used work as motivation to recover. He canceled speaking engagements in the immediate aftermath of his stroke, in July 2010, but purposely left a talk on his calendar for late September of that year. He worked intensively with a speech therapist , and one of his grandchildren helped him work through the foreign language training program Rosetta Stone – in English.

By September, he was nervous but ready -- thanks to some 40 hours of practicing the speech with his wife. During that talk and others later that fall, Christensen told audiences what had happened and encouraged those in the front rows to throw out words he seemed to be struggling to find.

At the end, he said, “They gave me a standing ovation.”

Christensen’s students were no less welcoming when he returned to classes at Harvard’s Business School in January 2011. Christensen also credited the school’s case study method – based on discussions rather than lectures – with the ease of the transition.

Four years later, Christensen’s research productivity -- if not his speech -- is back to normal. But he says he only sees his speech therapist every six months or so, to say “thank you.” The rest of the work is his.

Barr continues intensive speech and physical therapy. He’s starting to regain control of his left hand, and recently started riding his horses again.

The therapy is physically and emotionally demanding, and it’s somewhat strange for the professor – who used to teach speech classes – to be the student.

“When you start in rehab, the therapy is more cognitive work than I was accustomed to,” he said. “I said, ‘Can we do some articulation?’ ” Barr also said he prompted the hospital chaplain to recite Shakespeare with him, instead of biblical verses.

Robert Goldfarb, a professor of communication sciences and disorders at Adelphi University, had a similar experience after his stroke a year ago. Unlike Christensen and Barr, Goldfarb didn’t lose language, but he did temporarily lose his ability to speak clearly.

“It sounded like I was drunk without the benefit of alcohol,” he said.

Goldfarb, who has studied strokes and their impact on language, knew what was happening to him as it occurred. He was driving his wife to their summer home and told her to get him two aspirin while he could still swallow. He thinks it might have prevented more severe long-term damage to his brain – although, as he was active and in good health, he never envisioned himself having a stroke. (Jill Bolte Taylor, a neuroanatomist at Harvard, has also described the experience of studying her stroke as it happened, in her book My Stroke of Insight. She declined an interview request.)

Also somewhat surreal was when Goldfarb discovered that his speech language pathologist had read one of his textbooks and was applying the professor’s techniques to his therapy sessions. It earned him an ego-boosting “minor celebrity” status at the hospital, he said.

Stranger still was when, upon Goldfarb's return to work in the fall, a student told encouragingly that he was becoming “less clumsy” as the semester went on.

“ 'That’s a good diagnostician,' I told her,” he said, noting he was too “stubborn” to take a semester off to recover more fully.

“Either they’re going to have to listen harder, or I’m going to have to listen harder,” he recalled saying about his students.

Strides aside, strokes were physically and emotionally disruptive to all three professors’ lives. But they’ve also inspired new professional interests for each. Barr has several scheduled upcoming performances of “A Piece of My Mind,” while Christensen has written a book about the importance of work-life balance called, How Will You Measure Your Life? (Helping him write it was part of what inspired his co-author, Karen Dillon, former editor of the Harvard Business Review, to move to London to spend more time with her husband and children.)

Goldfarb, who still suffers from the lingering physical effects of his stroke, said he’s newly interested in disability studies, after what he described as less-than-helpful treatment from his university during his recovery. He says that he was a barred from campus until he got a doctor’s note and can no longer take the faculty shuttle from the train station to campus. Instead, he said, he pays for a town car out of pocket. (A university spokeswoman declined to comment on these claims, saying that it was a private personnel matter, but said that Adelphi has a “robust disabilities support structure.”)

All three professors said they continue to rely on friends, family, students and colleagues for support – including for encouragement to be patient with their progress, after decades at the top of their respective fields.

“You have to deal with what life throws at you – sometimes it’s good and sometimes it’s not,” Barr said. “It’s like an old acting exercise – you deal with what you’re given.”