I know I am in bed. My eyes close. There is no attempt to do anything. I no longer need to monitor myself. There is no more need to double check everything that I do. Mental and physical checklists may be dispensed with. My self-monitor functions may now be suspended. They are replaced by a review function.

During the day I am constantly involved with behavioural monitoring. I need to use checklists to get out of the house. I create quick mini checklists for any task being undertaken. Checklists are created before shopping, before going to the copy centre, the post office or any other location. If it is a new location then Google maps will be consulted. The destination is identified, the best route is searched out and, if it is difficult, or complex, or foreign, Google street view will be employed to pre-drive the entire trip. Landmarks are identified, along with turning points, and places of potential hazard. All this activity represents an incredible amount of work, work that has become so internalized, and habitual, that I do not remark on it any more. It is how things are now done.

All of this mindfulness, and attention to detail, comes to an end as I climb into bed. I am suddenly free. Liberated from the need to self-monitor. Free of checklists. Free of forced attention to detail and behaviour. It is finally possible to relax. What do I do when I relax? As I drift off to sleep, my mind begins to call up imagery from the past day. I begin to review my actions and assess the success or failure of my behaviour, and my program of self-monitoring. When I remember people staring at me, dumbstruck and uncertain – is that because of something I have said, or done? Without thinking of what I am doing, I contemplate each detail that may have been missed, catalogue all the errors that may have been made, the discrepancies in the matrix of reality that suggest an otherwise unsuspected problem, or a missed social faux pas.

This late night review results in increased critical thought, and leads me to a heightened state of wakefulness. At the moment on which I seek rest, my behaviour rouses me to an alert search for error. I was unaware I performed this action until I began investigating my sleep habits.

This review does not occur at every sleep attempt. There are times when I am so exhausted that I immediately fall into deep sleep. The great pleasure of “cognitive naps” is that I am aware they are naps, necessary short interludes in the course of the day. I know that in 45 minutes I will awake feeling renewed and refreshed. There is no attempt at any form of self evaluation. Then there are those nights on which I lie down to sleep but become diverted into self-referential wakefulness.

It is now 05:53:24. I have been awake since 1000 yesterday. I am wide awake and unable to sleep. I blame myself for this state of affairs. I stayed up late to watch the election results. I think of all the Canadians with whom I spoke and I am proud to have played a role, however minuscule.

Tonight, I have also been thinking of this passage in a book by Dr. Muriel Lezak:

I no longer use the term “recovery” when discussing brain damage. Brain damage that is severe enough to alter the level of consciousness even momentarily, or to result in even transient impairment of sensory, motor, or cognitive functions, is likely to leave some residual deficits. In cases where the damage is more than mild, the use of the word “recovery,” which implies restoration or return to premorbid status, when discussing the patient’s prognosis can give the patient and family false hope, delay practical planning, and cause unnecessary anxiety and disappointment.

P 175 Oxford University Press; Third Edition edition (March 1 1995)

Link to the Amazon.ca product page for   Neuropsychological Assessment

I have an injury from which I am unlikely to recover. Yet the insurer who has an obligation to assist me in rehabilitation refuses to acknowledge the medical diagnosis, or the evidence of injury. I lie awake and attempt to puzzle out what to do.

My wish is to just go to sleep and never again wake up.