Okay. Before I begin, please rest assured that I am not engaged in, nor do I intend to engage in, any kind of inappropriate behavior with this person whatsoever. This is going to take a LOT of explanation, but there is literally nowhere else I can think of to ask something like this, so please bear with me!

I work in a nursing home. The patient population is largely composed of older folks, with the occasional mentally handicapped adult mixed in. Among the latter, there is a 50-something gentleman who suffered a traumatic brain injury a few years ago and apparently functions at approximately the level of your average two or three-year-old. He is able to communicate verbally up to a point but his language skills are comparable to those of a toddler, he can feed himself, use the toilet, comprehend and engage in simple games, etc. Whenever you have to care for other people, there are some who are more or less difficult to deal with, and some with whom you develop a closer bond than others — this guy is definitely of the second distinction. I adore him, but only as one would adore a very charming, but totally innocent little kid. He is by far the sweetest, most endearingly earnest and unassuming patient I have ever had. He never shows aggression (except occasionally towards himself out of frustration, but never anyone else), and he’s always trying to get a smile out of me, even if it’s just by casting a dubious sideways glance at me when I say something silly. He is strangely adept at just this sort of thing, and actions like this are indicative of a level of understanding beyond what he is outwardly capable of expressing in any other way, which brings me to my main question: Could it be possible that he ISN’T as brain damaged as he appears to be? In light of his very reserved and civilized behavior, I cannot completely discount the small possibility that he is somehow less incapacitated than anyone believes, and is capable of far more advanced, adult-like thinking than we are giving him credit for. Sometimes I SWEAR, his cognitive ability is close to that of a normal adult, but his physical awkwardness and his inability to verbally express himself belies that, and the thought of it is enough to bring me to tears. All of the doctors on the staff here insist that although he’s exceptionally personable and empathetic, he is incapable of more advanced cognition and his status will likely never improve. I wish I could agree, but I am becoming more and more doubtful.

Nobody ever comes to visit this poor man, and he was basically left alone in his room and ignored until I started working here about a year ago and came to notice how different he was from the other patients. Supposedly, he was beaten nearly to death by some creeps who wanted to rob him, but before that incident he was like a sports columnist for a newspaper or something completely decent and normal like that. I can’t imagine why he never gets any visitors — he must have had family or friends out there somewhere. He is so sweet and easy to deal with that I find myself making excuses to interact with him. All of the other staff members at the facility now joke that he is "my boyfriend" because it’s obvious he is enamored of me — supposedly the first thing he does now when he awakens is to inform the nurse on duty that "Mary be here soon" or "Mary on her way" repeatedly, likely as a way of seeking reassurance that I am indeed on my way. If I am off, he tells everyone he can that I am "to the beach", because I guess that’s where I usually tell him I’ve been. I would give ANYTHING to be able to take him places or spend more time with him, because he doesn’t deserve to sit in this dreary, depressing place day after day, where everyone is basically waiting to die. But I’m scared to say anything to anyone anymore because I’m afraid they’ll think I have some sort of inappropriate attraction to him, even though I am only interested in giving him the opportunity to have a chance at a worthwhile life. In spite of his injuries, it remains apparent that he was a very good looking guy, he still is, he has very sad blue eyes and a big smile and he’s just a total charmer, which adds to the suspicion that we have some sort of secret romance going on. I think it’s mostly just an inside joke here, but stuff like that is usually rooted in reality in some way, so I don’t want to push it.

So if you want to cut to the chase, I am curious to know if anyone out there has encountered someone who was thought to be very brain-damaged but wound up being much less so than was formerly believed. If so, how did you figure this out? Were you able to prove it to the doctors in charge of their care?
(cont.) Do you think I should ask to take him out or to at least spend more time working with him, or will it look bad to the rest of the staff? I’d hate to think my baseless paranoia is depriving him of having a better life.

(I have no idea what section to ask this in, BTW)

The one thing I know from doing biological psychology is that the brain is a strange and mysterious thing and no one actually really know exactly how it works, or how much it can recover after a traumatic incident. It functions a lot on what is called redundant systems, which means there can be incidences where the main system is compromised, but eventually a redundant system can bring back more functionality over time – maybe not as slickly, but enough to get the job done. What is also possible is that 1) this can improve over time as more functions are rerouted but it can be very slow 2) very different functions of the brain can be effected by an injury leaving a mish-mash of higher cognitive skills and basic skill left.

It would not surprise me that he either has some areas of cognitive skills that are preserved – it depends where the damage took place. He evidently has some of the abstract concepts such as time preserved as well as recognition. It’s very difficult to say with brain trauma if things will improve or not – often it is the worst case scenario, but it can’t be said for certain.

In terms of helping him, perhaps if you can show you want to explore something that would also be counted as something like professional development for you – like a skills set. If he can’t read any more he might be able to access one of the communication forms such as Makaton (Writing with symbols) that they use in SEN schools. If you perhaps suggested you could try and learn that or other "techniques" as you have a rapport with him as well, that should be an acceptable professional rationale.
Otherwise, you could potentially organise something which is not limited to just him, or suggest other people take him out too. I would ask! Nothing to lose!

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