Shopping For Others

"I always say shopping is cheaper than a psychiatrist." Tammy Faye Bakker

Shopping is scary. Supermarkets are now warehouses of panic for me. It's all just too much. Too much noise, too many people, too many options, music and announcements on the PA system, conversations of other shoppers, and brightly colored packaging all competing for my attention - it's complete sensory overload.

This first time I went shopping post accident I spent about five minutes inside the store and left near tears without my groceries.

I can no longer shop without a list; there is just too much distraction. Without a list I wander around in the store for hours buy bags full of stuff and then discover, when I'm unpacking my haul at home, that I've forgotten the very thing I went shopping for in the first place.

Before I instituted the "No Shopping Without List" policy I would engage in something that I've come to call "Shopping For Others". Technically, that's a misnomer. Shopping for Others was something my friends and I used to do when we were in high school. It's sort of a social experiment and works best in places like Walmart, preferably late at night. The idea is that you unobtrusively add items to a stranger's shopping cart when they are not looking. The more inappropriate the item is for the cart "owner" the better. Sometimes we'd hang around to watch our victims when they were checking out, relishing their baffled expressions.

My new version of shopping for others is really just an expression of how overwhelming stores can be for someone with attention and executive function issues. Now instead of shopping for other people, it's like I'm shopping for my old self. I start out fine and then get distracted and add things that maybe I don't really need. Eventually, I end up with a cart brimming with stuff. Then I get freaked out because I know I probably don't really need all this, or it's more than I budgeted for, or..well... it's just overwhelming. There really isn't an effective or eloquent way to explain it.

So there I am with a cart full of stuff that I want but don't need and I start to feel guilty and bad and silly. Coming home with with cocoa and hot sauce and diced tomatoes only to find out that I already have cocoa and hot sauce and diced tomatoes just makes me feel worse. In an effort to avoid excessive pantry redundancy and ridiculous amounts of impulse buying I just leave.

Yes, I shop, fill my cart with groceries and then I leave, abandoning my overflowing cart in the middle of an aisle.

Sometimes, feeling guilty about what I'm about to do, I fake an emergency phone call. I pull out my phone, look at it with a concerned expression, punch a couple of numbers and pretend to be listening to a distressing voicemail. Then, trying my best to look upset, I walk purposefully from the store leaving my full cart right where it was.

The first time I did it, I felt awful. It's wasteful, I know. I'm sure there were some frozen items in the cart that time. I try to avoid frozen foods now. Who knows how long it takes for store employees to determine that a cart has, indeed, been abandoned. I'm actually waiting to see my picture hanging behind the cash register: WARNING - This Woman is a Chronic Cart Abandoner. If you see her leaving a full cart, call the Manager on Duty IMMEDIATELY.

It also creates more work for the store's employees, and I do regret that. It's just that sometimes, it's all I can do.

Lists do help. Shopping when not stressed is also helpful. There are days when nothing works; when, standing in front of the towering shelves of breakfast cereal, I'm certain that choosing the correct one is an absolute impossibility. I know, on some level, that there is no correct breakfast cereal, but in that moment, standing before the seemingly endless selections, I just lose focus and then all the options appear at once and there's no sorting them.

I shop myself into a corner and the only way out is to cut and run because the prospect of unpacking the cart and working my way back through the store re-shelving all those items makes me feel like crying. On some level there's a cultural parallel here. We Americans have been shopping ourselves into a corner for years now. I do believe that societal stressors manifest as psychological distress and illness. If no one has written a book on this yet, it's about time someone does. Disorders du jour always correspond with new cultural developments. During the late nineteenth and early twentieth century when great, almost inconceivable, leaps were being made in travel and communication and photography there was a rash of hysterical paralysis and blindness and "elective mutism". Today those ailments are rare. Now, in the "Information Age" when we are bombarded by data from every possible angle, the popular diagnosis is Attention Deficit Disorder. Maybe my injuries just made me more sensitive to what is inherently out of balance in the world.

Perhaps we don't need to commute for hours a day, driving 64 miles an hour on crowded highways to get to our jobs. It is possible that we do not need 85 varieties of breakfast cereal in order to lead a productive and fulfilling life. Maybe it's not necessary to have TVs in restaurants and waiting rooms and gas stations. Learning to live without all this distraction might actually mean learning to live.

Back to Life, Back to Reality

"Oh, life is a glorious cycle of song,/ A medley of extemporanea;/ And love is a thing that can never go wrong;/ And I am Marie of Romania." Dorothy Parker (1893 - 1967), Not So Deep as a Well (1937), "Comment"

I know my plan was to not keep attempting to do the things I used to do, but it's difficult. For example, I'm doing a three day art show at the beach next weekend and need at least 100 small paintings to fill the tent. That means I have about 7 days to finish them.

100 paintings in one week.

Oh yeah, I'm insane.

Before this would not have been an issue. I just would have done it - stayed up all night if need be, but it would have gotten done. Now it's a challenge. In fact, the whole weekend will be a challenge. It will be long days manning the booth, interacting with people, setting up and tearing down. There's no way I could do it by myself. We'll see how well I can handle it with help.

So far, I've finished 7 of the 100 paintings. Only 93 to go!

(This is a picture of Marie of Romania. I'm thinking about dressing like her for the art show.)

Fear and Loathing

"The truth that many people never understand, until it is too late, is that the more you try to avoid suffering the more you suffer because smaller and more insignificant things begin to torture you in proportion to your fear of being hurt." Thomas Merton (1915 - 1968)

Driving scares the shit out of me. Actually, it's not just driving, it's riding in cars, being in cars, thinking about being in cars... Driving is often actually the lesser evil because it gives me, perhaps falsely, a sense of control. At least it's me behind the wheel. When I'm riding in a car I cringe when trucks pass too closely for my comfort and routinely slam my right foot to the floor hoping my "breaking for others" triggers some sort of sympathetic magic that slows down the car.

I had a panic attack today in the car. I wasn't driving, and we were passing a huge truck in the rain. It wasn't fun for me. Of course it's not fun for anyone around me either. There I was freaking out about a situation that was, for all intents and purposes, perfectly safe. Of course, that's the beauty of panic attacks. They are rarely about anything truly dangerous or scary.

Although I do have a Post Traumatic Stress diagnosis which manifests in my world as panic attacks in cars and nightmares although the dreams have, mercifully, become less frequent, I don't really want to devote much space here to talking about that. Unfortunately, everything is connected. In this case a lowered tolerance to stress, which is a fairly typical MTBI symptom, probably accounts for much of my car panic.

On the whole today was a very lovely day. I was doing quite well. Now, I feel like an idiot and, thanks to the physical effects of panic (adrenaline, tensed muscles, etc.) I'm stuck with a headache and knots in my shoulder and neck muscles.

I feel like a fool because I know that we really weren't in any danger. Then again, I didn't think I was in much danger when I was crossing that intersection on a green light. And that is the problem. That's where the fear sneaks in. "You thought you were safe then, didn't you?" it says, "Well, you weren't. Go ahead, relax. It's ok to think you're safe now, too. Just know that you're really not because horrible, unexpected things happen when you're least prepared for them."

And that's the part I really hate, because, you know, on that point it's absolutely right.

Sleep, Perchance?

"Life is something that happens when you can't get to sleep." Fran Lebowitz

We take sleep for granted. It only becomes precious when you can't get it. For some reason it is impossible for me to get a decent amount of sleep when my husband is home. No, it's not that we're up until the wee hours humping like rabbits, it's just that he's still a night owl and I'm not. I'm not an early bird either. My sleep habits defy classification.

Last night I got a whopping 6 hours of sleep. A couple of years ago that would have been plenty but today it just doesn't cut it. His alarm went off today at 8 a.m. I did not get to sleep until around 2 last night. Needless to say I was not amused.

Usually, I'm pretty good with wake up times. I can sort of pre-program myself to wake up just before the alarm. It's one of the brain functions that still works well. This, however, only works if I know when the alarm is going off. There was no mention of an 8 am wake up call during the movie we were watching until 1 o'clock the night before.

My husband has been off for the last two weeks and for me it's a bit like vacationing at Gitmo; loud irritating music (he LOVES techno but it now makes my head hurt and after about five minutes causes twitching), sleep deprivation, dog collars and leashes, ... the water-boarding should start any day now. So while he's enjoying his time off, I'm walking around on the verge of hallucinating because I haven't had a decent night's sleep for the past week and a half. He, on the other hand, could fall asleep in the middle of a Pogues concert.

So tonight I'm drawing a line in the sand. It is now about twenty after 11 and I am going to bed. There is no pressing need for me to get up early tomorrow so I'm asking him not to set his alarm. If he doesn't let me get a solid 8-9 hours of quality sleep he's the one who'll be wearing the black hood and spending the next three days in "the hole".

Shit Storm Monday

"The idea that I can't share my problems with other people makes me not give a shit about their problems." Chuck Palahnuik (1962 - ), Invisible Monsters, 1999.

One of my favorite sayings, which I used to say in a kinda of ironic manner, is "Who am I? Job?" Today the universe decided to see if I was. Everything, and I mean everything that could have gone wrong, went wrong.

Repeatedly.

Brilliantly.

WRONG.

I'll list them quickly: one of my tenants called the electric company because she thought her bill was too high, they came, they saw, they decided I need to install another electric service and are making my life a living hell although we thought we had this ALL FIGURED OUT previously. Whilst figuring out the wiring rat's nest I discovered that downstairs tenant is living in SQUALLOR and FILTH and has moved her indigent grandson into the studio apartment she already shares with her daughter. (2 people..well...ok, three people, no way). Indigent grandson is SMOKING even though it was made clear that there was to be NO SMOKING in the building. This is especially irksome because I rented the apartment to her partially furnished and now the bed and couch are STINKING. Indigent grandson is also flicking his ash EVERYWHERE. It is covering every flat surface in the place. When I say every flat surface I mean that. It's not just like, oh, here is an overflowing ashtray, it is, quite literally, a table that is covered with ash, almost as though he were just flicking it on the table directly or had emptied an ashtray on the surface. This is disturbing enough but there are cardboard boxes and bags COVERING the floor. One of the exits is blocked. NOTHING is hanging in the closest which are large and one of the best features of the apartment, instead there are piles of boxes and bags. One stray cigarette butt and it's a pyre.
When I came home I tripped in the upstairs and stepped on my hubby's laptop essentially destroying it and wrenching my back and shoulder. Enraged and upset I walked downstairs to get the mail whereupon I learned that my unemployment had indeed been denied although I might appeal if I chose to BY JULY 13th. Coming inside to check my email I learned that my credit card had been denied twice when the art association hosting an upcoming show tried to bill me for my entry fee, oh, and, by the way, when they tried to call me about it my phone was DISCONNECTED. (Yes, folks, I forgot to pay that one. Thanks, Amnestic Disorder.) Credit card still has an available balance so I'm not sure what the hell is going on with that. THAT, is tomorrow's problem.

As for tonight, I'm waiting for the boils and the locusts to show up.

Energy Conservation

"Nobody realizes that some people expend tremendous energy merely to be normal." Albert Camus (1913-1960)

Lack of energy and fatigue became an issue almost immediately. At first, of course, I was tired and sore and on a cocktail of painkillers and muscle relaxants. That makes me sound like I should have done a stint at the Betty Ford clinic but I never even got the "good stuff". The closest I came was a script for oxycodone which after my first and only "before bedtime" dose, caused me to wake every forty-five minutes hallucinating the smell of toast.

I soon found that even after I had rested up post accident, I just didn't have the get up and go I once did. Everyone said it would just take time. "You were in a really bad accident," they said, "Just give it some time." Even my neurologist who eventually admitted I had "Post Concussion Syndrome" told me that I would return to normal in a few weeks.

Some things did get better after a few weeks, but the fatigue never quite went away. I learned that I needed to plan ahead and ration my energy. My first semester back at work in the classroom was more of an education for me than for my students. On days when I taught, I soon realized that I wouldn't have energy left for anything else. I went from being a night owl who routinely stayed up till the wee hours reading or painting to someone who had to be in bed by 10:30 in order to function the next day. Often, I'd go to bed even earlier so I could be asleep by ten.

I found that not only did I need a bare minimum of 8 hours of sleep per night, that eight hours was a challenge. Ten hours was really the ideal amount but that was usually impossible.

In addition, I really did have to monitor my energy expenditures during the day. If something was mentally taxing or emotionally draining or physically challenging I was pretty much done. On days when I had physical therapy I was useless for anything else.

After even a relatively normal day I just wanted to sit and do nothing - no talking, no activity, no socializing. I kept scheduling activities, dinners with friends, art events, even date nights with my husband, only to find myself regretting making those plans when I was too tired to follow through with them. I was convinced that all of my friends would write me off after multiple calls to cancel plans.

Eventually I got better at knowing how much energy various tasks would require, and I stopped thinking I could do everything I did before. Honestly, it's still a struggle. I still want to be able to stay up late and not feel like I have the world's worst hangover the next day. I want to be able to spend an evening or a weekend with friends without running out of steam half-way through. I want to have the energy to do the things I want to do after I'm finished doing the things I have to do.

I still miscalculate and wear myself out. Sleep is still something I guard jealously and something that is often elusive, and I still cancel plans with friends far too frequently for my taste. I keep waiting for the magical solution - if I get organized enough, when the semester ends, if I didn't spend so much time going to doctors and therapy appointments then I would have more time and, consequently more energy. The reality is that this is my life now, complete with disorganization and seemingly endless semesters and appointments every week. I need to balance the time I have now without waiting for more time in the future or lamenting all the time I've lost.

And Sometimes, the Unexpected Normal

"A good relationship is like fireworks: loud, explosive, and liable to maim you if you hold on too long." Jeph Jacques, Questionable Content, 11-14-08

Today started at 5am. I don't know why I was up at five, but I was. The whole day felt off after that and I didn't get much done. The lack of sleep was starting to catch up with me by about 3:30 and my husband, who was in New Jersey helping his grandfather pack for a move, wasn't home yet. We were supposed to go to a party at 5, but I was dragging and, I'll admit, a nap was looking very tempting.

My friend Susan called to see if we were coming and convinced me to venture out, and I'm happy she did.

When we got there, Sue was grilling up burger and veggies and had a host of yummy salads spread out on the counter, and Z. had made some pulled pork bar-b-que with Pigman's Bar-B-Que sauce. Pigman's is a great little place on the Outer Banks and my favorite bar-b-que. You can find it at http://www.pigman.com/ . The picture is of my half-eaten bar-b-que sandwich, decorated with a candle in celebration of my birthday last weekend. And yes, there was coleslaw on the sandwich.

There were fireworks after dinner complete with a "Bouncing Betty" misfire that inspired my husband to run AT the sparking ordinance, grab it and turn it around so it wasn't shooting toward the rest of us. Heroic, but perhaps not the wisest decision. Thankfully, no one was hurt but it did add to the evening's excitement.

It was a couple hours of normalcy - a good meal, hanging out with good company, and I almost missed it. But I'm not going to dwell on that, suffice it to say that there have been many times when I was too tired to go out, and had to cancel plans in favor of an early bedtime. Thanks to everyone for a lovely evening. I'm glad I got to spend it with friends.

Adapt and Evolve

"Remember that in every single case in history the process of adaptation has been one of exceeding slowness. Do not look for the impossible, but do not let your path deviate from the quiet and steadfast insistence on full opportunities for your powers." Franz Boas



Already I am making changes to this site. While previewing the blog I found myself having difficulty reading the text. Having a blog about brain injury that brain injured people can't read seemed counterproductive, so I adjusted the font size and some colors. I think it's better now, but welcome comments and suggestions.



Slow adaptation and evolution is one of the things I need to work on. I am not a "let's give it some time and see how it goes" person. I prefer to reveal the finished product, gleaming, new and perfect and let my trials and false starts remain safely tucked behind the scenes. Yes, I am one of those artists who doesn't like people to see their "works in progress".



This blog, heck, this whole year, is a work in progress.



This is one of the double edged swords of my MTBI. While on one hand is it, largely, an invisible injury, on the other hand I find it very difficult to have what I often feel are obvious symptoms. Perhaps I should phrase that differently. What I have are not obvious symptoms, except to me. What I have are difficulties; difficulties that I never had before.



I used to teach English and Speech at a local community college. When I went back to work after the accident, it was mortifying to stand up in front of the class and "lose" a word, or forget what I had said during the last class, or completely lose my train of thought. It's hard enough teaching an uninterested bunch of 13th graders, struggling while you're doing it is simply inelegant. Besides, any show of weakness tends to arouse the predatory instincts in groups of older teenagers. At times I felt like a wounded wildebeest facing a room full of hyenas.



In reality, most people probably never even knew I had a problem. Sure, I was suddenly the absent-minded professor and I'd like to think that students who'd taken my classes "before" would have noticed a difference, but, honestly, I knew I wasn't that much worse than most of the community college professorial pool. My student evaluations were consistently positive but I knew that I had changed. I didn't get into the zone anymore. The connections that came easily before suddenly weren't there.



I've since changed the classes that I teach. No more English, now I teach Speech and the occasional Drama class. While it would seem like teaching Speech would be more difficult than teaching English, it's not so. Speech classes mean lots of students speaking. English classes are more like that scene from "Ferris Beuller's Day Off" where Ben Stein stands in front of the catatonic class droning on and on, "Beuller? Beuller? Beuller?" English classes call for the full-on floor show. Teaching a Speech class means I get to sit in the back and listen to dozens of students try to persuade me to legalize marijuana. Believe me, it's easier than reading 24 research papers about why we should all smoke pot.



So I'm trying to be more comfortable with the process. This entire project is about letting people see me sweat through some of these challenges. You all get ring-side seats from my screw-ups and failings. Hopefully I will also adapt and evolve.



"You have to go through the falling down in order to learn to walk. It helps to know that you can survive it. That's an education in itself." Carol Burnett

List-Serve

"I don't like the sound of all those lists he's making - it's like taking too many notes at school; you feel you've achieved something when you haven't." Dodie Smith, I Capture the Castle, 1948

I make lists, lots of lists. Theoretically, this is to help me remember things. In reality, about half the time, I lose the list.

Like the old AA adage, "It works if you work it," making lists is only helpful if A) you acutally write things down, and B) you can find the list when you need to remember what you wrote down. In fact, lists work in much the same way that memory does. In order for memory to function, you have to A) store the information and B) be able to retrieve it when you want or need it.

Writing endless lists that magically disappear when you need them most is not helpful. Ok, let's be honest, when I say the lists disappear, I really mean that I lose them, or misplace them or simply put them in a Very Important Place, and then forget where that is.

My house and car and purse are littered with Post-its and scraps of paper with numbers and messages and To-Do lists and phone numbers and passwords. There is an excellent book called "Man in the Holocene" that details the descent of an elderly paleontologist into dementia. As he begins to realize he is losing his memory, he starts making notes and posting them around his home. The notes contain various types of meaningful information - personal memories, archeological facts. It was one of those books that I read years ago that stayed with me. As I was reading it, I remember thinking it would make a brilliant film, and I found myself talking about it the other day when discussing memory with a friend. I sometimes wonder if, as I age, I will end up listing my important facts on bits and pieces and papering my walls with them. People will head injuries are more likely to develop memory problems as they age.

What would I choose to list? What will be important to me twenty, thirty years from now? How much will I have forgotten by then?

Eight months after the accident, I got married. We didn't have months of planning. My husband works in the film industry and I have a background in both theatre and catering. The idea that it takes a year to plan a wedding is complete hogwash. We booked, planned and tied the knot in a month, but I digress. The point I was trying to make was that while I was writing out invitations I forgot the name of my Aunt. Forgot it. Gone, baby, gone.

It was the first time that my memory loss really scared me.

I recall looking at my mom who was helping with lists and addresses and almost being ashamed and afraid to admit that I could not remember her name. I groped. "Um, you know, ... jeez." There was probably a curse or two thrown in. I curse like a sailor when frustrated. Somehow THOSE words stayed in my active and accessible memory. Finally, I said something like, "Oh my god...the woman...she's married to Uncle Ed."

"Aunt Violet?" My mom said it like a question although I have only two married uncles. As if there were another possible woman married to Ed. The question in her voice was really an expression of amazement and disbelief. She'd never seen me lose that kind of fact before either.

All of this discussion stems from my forgetting my calendar and notebook this morning. As I rushed out of the house on my way to a doctor's appointment (what else?), I was rifling through my purse looking for my checkbook. It was there yesterday, I swear. I took several items out of the purse. I put them back in. I took them out again. I got distracted. I did not put the calendar back in the purse.

Unfortunately, this fact did not become apparent until I was already on the road. The reason for my distress: I had several appointments scheduled for today, all at different times. There were not recurring, same time/same place appointments.

I can't even follow my own rules.

And this made me think about the futility of lists, or at least of lists you can't find.

As I walked from the doctor's office to the hospital garage, I noticed something on the ground, three small pieces of paper folded in half. They were three pages torn from a small desk top calendar: June 18, June 19th, and June 20th. Unfolding the sheets revealed on the back of June 20th a list...

Call 2 remaining people
Conserve energy - have extra
Dictate in room
Malpractice ins -> what is the time frame?

Bed early call Una
Email Barran - last items - MBSR first floor
CV Jeff/Teacher portfolio
Sign up 4 [illegible] red

I will remember these things from this lost list here. Just in case the person who wrote them forgets.

I Can See Clearly Now - Sort Of

Today I picked up my new prism glasses. One of the effects of my MTBI was double vision. It occurs primarily on my right side and is generally from about one foot away from my face to about 10-15ft away. This is supposed to be one of those "easy" fixes, which, in the world of brain injuries is like winning the lottery.

Easy is a matter of opinion.

I was appallingly myopic prior to the accident; legally blind without glasses. Now I'm nearsighted and have double vision. I also found reading and writing very difficult as I had problems focusing and would get headaches and tire easily. Some text was just unreadable. Certain sizes and types of fonts just didn't seem to agree with me at all. There were texts assigned for some of my classes that I just couldn't read, no matter how hard I tried.

At first I thought the reading issue was an attention problem. I didn't even know that vision could be affected in so many different ways.

So now I have three new pairs of glasses. I have the "Reading" glasses that are the prisms which correct for the double vision. Essentially, they bend my vision to re-align what I'm seeing. That doesn't even really explain it correctly but it's close. What I see without them is much like looking though one of those old dual lens cameras, the kind you where you had to align the images in order to focus, except my images aren't quite aligned. These reading glasses are meant to be worn OVER my contact lenses.

The second, is a pair of distance glasses. These are my normal prescription without the prisms. These are find for daily wear if I'm not doing much reading or close work - painting, etc.

The third pair is a combo. These are progressive lenses (bi-focals without the line) with the distance prescription on top and the prisms on the bottom. The idea with these is that I can wear them if I know I'll be reading during the day. These correct for the doubling but I can use them without wearing my contacts.

So, while it may be an easy fix, I now have three different pairs of glasses that I need to manage. Since organization is one of the MTBI challenges, this will be as well. I'm hoping that establishing homes for these glasses will make that easier, and getting into a routine with putting them back when I'm wearing my contacts will help.

My only organizational/storage issues will be with the reading glasses. Since I'll be wearing these with my contacts and won't always be reading or studying in the same place I will have to keep track of where these glasses are at all times. This will probably necessitate designating several places, one in the office, one in the bedroom, one in the den, where the readers "live" when they're not on my nose. That way, I know where to look, and if they're not in any of those three places THEN I will know they are legitimately lost and can go into panic and search mode.

Since this is my first day with the glasses, I'll have to wear the progressive pair for several days to see if they will really work for me. I'll admit that at first they took some getting used to. There is a bit of a fish-eye effect with the prisms, and my mid range was still doubling a bit when I first put them on. At the moment I've been wearing them for several hours and no head-aches so far which is an encouraging sign. I will just have to give it some time and see how I do driving and adjusting from focusing on near and far objects.

Hot or Mild? or, Everything I Didn't Know

"Aristotle was famous for knowing everything. He taught that the brain exists merely to cool the blood and is not involved in the process of thinking. This is true only of certain persons." Will Cuppy


Before the accident, I never even knew there was such a thing as Mild Traumatic Brain Injury. Like most people I thought you were either brain damaged or not. The words "brain damaged" always spoken in a whisper, the way cancer used to be.

Brain damage was, in my mind, right up there with "the big 'C'". It was something that happened to other people. It was something from which you did not recover, at least not completely. And it was something that usually left those unlucky enough to suffer it, either paralyzed or drooling or hooked up to ventilators waiting to die.

I had no idea there existed an almost infinite continuum of brain damage, ranging from imperceptible to substantial, and that's just in the "Mild" brain injury category. There are thousands if not millions of people out there right now walking around with mild traumatic brain injuries who don't know it. There are thousands of people walking around out there with MTBIs who know there's something wrong, maybe really wrong, but who won't ever get a diagnosis or the help and support they need because they and their doctors aren't aware of, or aren't considering, MTBI.

MTBI can occur with a seemingly innocent bump on the head. It can occur without loss of consciousness. Adolescent and child athletes are especially susceptible to head injuries, with girls even more susceptible than boys. Mild concussions occurring within a short period of time can have exponentially worse outcomes. Two sound knocks on the head during one sports season can have profoundly detrimental effects on a growing brain, but that's a topic for greater exploration in another post.



Most people don't realize that a seemingly innocent bump on the head can cause:





Memory Problems This can be forming new memories, retrieving old memories, and, or short term memory lapses and everything in between.


Emotional Changes Mood swings can be an issues, and can come just as easily from dealing with the injury as from the injury itself. Difficulty controlling emotions can also be a symptom. Emotional outbursts are common. Some people experience fairly profound personality changes which can be as distressing for the injured, as it is for their friends and family.


Hearing Loss or Change This can range from out and out hearing loss to difficulty discriminating voices to changes in the way sound is perceived.



Speech Problems Difficulty forming words, processing sounds, retrieving words, remembering names, are all common. This can also extend to the written word and cause problems with reading (perceiving) words or actually writing words.


Eye Problems Persistent double vision is not uncommon, as is difficulty focusing, trouble reading, and increased eye fatigue.


Dizziness Vertigo or dizziness can be caused by neurological damage or by problems in the ear canal (more on that later). It can also be caused by vision problems and needs to be assessed by professional both to understand the cause and address the symptoms. Dizziness is one of the problems that can be an "easy" fix so it is definitely worth exploring with a trusted doctor.


Loss of Executive Function This is basically the part of your brain that controls everything else. It's the part of you that makes decisions and organizes both your belongings and information, as well as the function that allows you to multi-task and divide your attention. It is a complex and interesting set of skills that also deserves a more in depth discussion.



Changes in Taste and Smell Loss of taste or smell can happen but it is also possible to have changes in the way taste and smell are perceived. This can lead to other issues like not wanting to eat, and a loss of enjoyment in eating.



Fatigue Post injury fatigue can be overwhelming at times. The effects and symptoms of brain injury can be very subtle but pervasive. Sometimes it can seem like almost everything, all "activities of daily living" are more difficult, and, consequently take much more energy. The result is fatigue. It IS harder to think, to see, to hear, to make decisions, to move, etc. and all the extra energy it takes to process the information your brain takes in every day leaves little remaining at the end of the day.



Loss of Enjoyment This can range from enjoyment of hobbies and interests, to your sense of humor, to loss of enjoyment of sex. Causes are just as varied and can be depression, or distractability, or loss of energy, or simply a change in the way your brain processes.



Depression/Anxiety Brain injuries can cause a number of distressing "mental health" symptoms which can often lead sufferers to seek treatment. These are not symptoms to be ashamed of, they are merely manifestations of the injury and the resulting frustration.



Lack of Tolerance This could easily be lumped under Emotional Changes or possibly even Executive Functioning, but I think it deserves special consideration. A "shortened fuse" is an extremely common result of brain injury and, when you think about all the other symptoms that can and often do go along with it, it is much easier to understand. Frustration is a constant when dealing with this type of injury. Fatigue goes hand in hand with that. Consider how you, yourself respond to difficulties when extremely frustrated and fatigued and you will understand how it's like for MTBI folks, except with a brain injury you exist in that place most of the time.





These are just some of the possible symptoms resulting from a MILD Traumatic Brain Injury. We're not even talking about severe brain injuries. But this list gives a brief overview of all the things we normally take for granted that can be affected by a head injury.



MTBI is subtle. It is, as I like to call it, an invisible injury. It's possible to look normal and seem normal and face difficulty completing what most people would consider a basic task like calling to order take-out. Although they look the same on the outside, many brain injury patients feel like completely different people on the inside. But don't beat yourself up if you had no idea MTBI existed, I had no idea either.



I used to wonder about disease outreach. You always see people working on fundraising campaigns for cancer and diabetes and MS and a host of other diseases, and often the spokespeople, when not asking for money, are talking about awareness. I always find myself thinking, "Who doesn't know about cancer? Who hasn't heard of diabetes?" But I suppose the reason these diseases are so entrenched in the public consciousness is because of these awareness programs. Perhaps it is time for a Mild Traumatic Brain Injury awareness campaign.



Maybe I need to design some "Got Mild?" t-shirts and sell them on this site. I could include a list of possible symptoms on the back. At least it would get the information out there. I think I'll work my way up to the telethon.

Time, Time, Time, See What's Become of Me

"The only reason for time is so that everything doesn't happen at once." - Albert Einstein

Trauma disrupts time. This applies to psychological and physical traumas alike. An outdated definition of trauma refers to it as being "outside normal experience," and, in a very real sense, that is correct. Trauma disrupts the normal linear framework of life. In the traumatic moment, the personal narrative changes, dilating, drifting, sometimes leaving amnestic gaps, and then time stops.

After the accident it was almost as though my brain became a malfunctioning VCR, with the tape of my life playing in either slow motion or fast forward. I had no normal perception of time. Repeatedly, I would miscalculate the time it would take to complete tasks. Hours would lose themselves as I read email or cooked dinner. Knowing the problem existed, I would watch the clock if I had an appointment, being sure to monitor myself as the pre-ordained hour approached. I would consistently misread the clock, or, having told myself that I had "an hour until I need to get ready to go" I would look up to find that, unbelievably, not only had the hour passed, but an additional twenty-five minutes as well. The sense of futility and lack of control that ensued became very familiar in the months following the accident and with each additional "slip" I became more and more frustrated. Episodes like this would often leave me crying in frustration as I quickly gathered my things and dashed out of the house hoping my Doctor was running as late as I was. Lucky for me most of my appointments were with Doctors and my twenty minute delay usually meant I was right on time to meet the Doc. Sadly, this did not diminish the stress and anger in the moment I discovered my "lost time" or during the subsequent rush. In addition, my "new improved" brain had a knack for forgetting important things; things like wallets, and keys, and checkbooks, and phones, always at the most inopportune moments.

Stress, forgetfulness, and lateness exist in a particularly evil positive feedback loop. I am late. I get stressed. I forget things. I get more stressed. I get later. I get even more stressed. I forget something else. You can see how this just keeps on going. Now, imagine going through this routine every day.

Imagine going through this routine every day for the last two years.

There are things that help. Usually it's the simplest things that make the most sense. Keeping important items in one specific place is a huge help. Using timers, as insulting as it sounds, has worked more than once. It's also not a bad idea to build redundancy into your scheduling and reminders. By that I mean, telling your family, telling your friends, and asking them to gently remind you of appointments. (The gently part is key. Constantly having friends and family telling you about appointments, especially when already running at an 8 out of 10 stress level can easily be interpreted as nagging, especially when coupled with frustration and other brain issues.) In addition, keeping things as routine as possible also helps immeasurably. Sometimes this is difficult to work out, especially with Doctors. Physical therapy appointments may be easier to schedule. Recalling an appointment that is always on a Tuesday and always at 2:30, even if it happens every two or three weeks, is much easier on the injured brain than remembering different days and times.

I find that writing down appointments and times helps me. I've always been a visual person and that is one of the ways I learn best. If I can visualize my calendar, it's more likely that I can recall the information I need.

True to form I have overestimated my new abilities again. In this entry, I had hoped to address various ways that the perception of time can be changed by a brain injury but I find myself running out of steam and I think a discussion on "lost time" following an injury deserves a more in depth treatment. ("Lost time" in this sense refers to a more expanded sense of both time and loss, as in, "I feel like I've lost a whole year recovering from this injury".

So, in closing, time management problems may be minimized by employing any of the following:

Perfect Placement. Keep essential items (keys, wallet, purse, phone, etc.) in a convenient location. ALWAYS put them back in the designated space. Make sure family members know where these items belong and ask them to put the items there if you accidentally leave them elsewhere. In addition, keep extra sets of keys available for emergencies.

Redundant Reminders. Write yourself notes - multiple notes if necessary. Tell family and friends about your appointments and ask them to remind you, multiple times if necessary.

Create Routine. If possible, try to schedule appointments on the same day and at the same time. For example, if you know that your Neurologist appointments are always on Tuesdays and always at 2:30, you will be more likely to remember them. Another way to approach this would be to designate certain days as "Doctor Days". This method limits appointments to certain days. For example, you might only schedule appointments on Tuesdays and Thursdays. This way, you would know to check your calendar each Tuesday and Thursday morning to see if you had any appointments. (I'll write more about Creating Routine in future posts because it can be helpful with many other brain injury issues.)

Write it Down! This one should be obvious but it isn't, especially with regard to medical appointments. Most doctor's offices had out those handy little reminder cards with your next appointment date and time already filled in. While these are wonderfully convenient for most non-injured brains, for brain injured people they can provide a false sense of security. Little cards get lost with alarming ease. Not only that, ALL those appointment cards look the exactly the same, so if you're collecting multiple cards from multiple doctors it can get confusing. I'm not saying don't take the card; not at all. Take the card. Just WRITE the appointment in your calendar at the same time, that way, ALL your appointments are listed in one place and you're not searching around for one tiny little card. Which leads me to the final suggestion...

Keep a Calendar. Keep all your appointments and pertinent information in one place. Carry a calendar with you. This could be a traditional paper calendar booklet, a PDA or a smart phone. Experiment if you have to in order to determine which format works best for you. If you are a visual, sensory learner, you might prefer to physically write out your appointments on a paper calendar like I do. I know other people who love gadgets and find using digital calendars work better for them.

Dealing with a brain injury, even if it is classified as "mild" is an ongoing process. This is not "recovery", instead it is a process of adaptation and the challenge is to learn who you are now and how to best support yourself as you navigate this uncharted interior territory.

Every Day A New Begining

This is the first day of my 39th year, a year I have determined will change the rest of my life. Naturally, you can say that about any year, any day, for that matter. But these changes will be, as much as possible, by choice. This is the year I will learn, or relearn, how my brain and body work.

In March of 2007 I was working in New Jersey and having completely my work for the day, decided to drive home to Pennsylvania a day early to meet my boyfriend for dinner. On the way home, less than five miles from my house, my car was struck by a truck driven by a drunk driver. He ran a red light and tried to beat me across the intersection. My Element was pushed up over the highway divider where it sheared off a sign, then skidded across two lanes of opposing traffic and into a parking lot where it came to rest in a planter against a sign for a printing company.

I suffered what I later learned was a Mild Traumatic Brain Injury, back, neck and shoulder injuries and a knee injury.

Up until that point I knew nothing about brain injuries. I thought you either scrambled your brains and became "retarded" or you healed. What I learned was that there is an enormous continuum of "Mild" brain injuries - alterations in thought, emotion, perception, feeling, motion and control that, although pervasive and disabling, are not considered "Severe".

For the past two years I have been fighting this condition, trying to "get over it" and "get well" and return to what my life was like before March 27, 2007.

This is the day that I stop trying.

This year will be my great experiment. This year I will begin a journey of, for lack of a better term, "Radical Acceptance." The task I propose for myself is one of exploration. Although I desperately wish it were otherwise, I cannot become what I was before this accident, this injury. My task during this year will be to explore the person I am NOW - to determine her strengths and weaknesses, and to try to embrace this person without wasting any more of my precious energy mourning what I used to be.

There will be changes. In order to truly become effective in this new incarnation, I need to find new ways of doing almost everything - cooking, cleaning, paying bills, working, making art, having relationships, etc.

Throughout my life I've always loved beginnings. Each new year, new semester, new project, offered the chance to begin again. This time I'm being forced to change. My own brain and body are demanding a completely new way of being. If I am to succeed and re-establish a workable and satisfying life, I need to restructure almost everything "from the ground up" so to speak.

In the coming year I will be changing my surroundings, adapting my home and workspace to my new requirements. I will be changing my relationships, and learning new ways to exist with my family, my friends, and myself. I will be changing the way I eat and exercise and care for myself. Hopefully, while making these more concrete changes I will also change the way I think and feel. That, I think is inevitable. I may even learn something before I'm done, and that, perhaps will make all the rest worthwhile.