ABSTRACT

Following a significant stroke, Denzel Smith, a 72-year-old African American man, obtained extensive physical and cognitive rehabilitation, relearning basic skills including coordinated movement and speech. Seven months later he appeared to have made significant gains in his cognitive and verbal functioning, reestablishing his ability to eloquently discuss and argue intellectual points. As a younger man, Mr. Smith had earned degrees in both economics and law and worked in the financial arena throughout his life as a hedge fund manager and financial consultant. For 30 years, Mr. Smith had focused on an entrepreneurial enterprise, building a lucrative financial business. He overcame racism and oppression to succeed in areas of business in a society where strangers, other professionals, and even family members consistently questioned him; his friends often described him as fearless, tenacious, headstrong, authoritarian, and demanding. Mr. Smith’s career and providing for his family defined him, as he had achieved much success in these domains. He and his wife had two sons, and over the years Mr. Smith had encouraged them to join the family business, holding them to high but supportive standards. Both sons eventually followed in their father’s footsteps and worked side by side at Mr. Smith’s company. However, Mr. Smith’s sons began to notice slight changes in his behavior following rehabilitation from his stroke. Mr. Smith, a widower for the past two years, now lived alone, and his sons became aware that he wore the same shirt and pants throughout the week, even if they became soiled. They noted that he appeared to be losing weight, although his refrigerator was stocked with now-expired food. Although Mr. Smith could still verbally spar with his sons and speak eloquently in casual conversation, they discovered that he devised business plans that were not logical or linear in thought or as thorough or detailed as they once

were. At one business meeting, Mr. Smith appeared mildly confused and left the room unexpectedly. Given the changes, his sons became concerned about his ability to act as CEO of his company. However, when Mr. Smith’s sons addressed these issues with him, he responded with anger, denial, and argumentation. He claimed his sons were attempting to take over leadership of the company without his consent. He refused in-home services such as cooking, cleaning, and yard work, asserting he had single-handedly cared for himself and his entire family for years.