Having created the prior post, and having added to it, I have identified the following three issues as major triggers contributing to my tailspin:

• Negative Environmental Feedback
• Future Prognosis
• Doctor X Issue

Negative Environmental Feedback

When I am preparing documents, or doing other work on the computer, I have available to me a huge range of resources. If I am unable to remember a word, I have immediate access to online dictionaries and thesauri. If I forget a street name I can look it up in Google maps. If I am trying to read an incomprehensible scientific study on TBI or neurobiochemistry, I can resort to Wikipedia to find explanations of terms, or locate other articles that present the same topic in lay terms. On the computer it is difficult to loose a file (but I have done it). I have several items of software that will perform local searches and help retrieve the missing item. Unless I am very unlucky, any lost digital item will be quickly found.

None of this technology is available out in the physical world. There is no way I can push a button and find all of the different versions of a printed document and their current physical locations within my household. Nor can I push a button and find all my missing socks. This is just not possible (yet!).

One outcome of this is that my engagement with the physical world is very different from my engagement with the virtual world. The real world does not permit Do-Overs. In the virtual world there are unlimited Do-Overs. In the real world I cannot alter the flow of time. In the virtual world I can endlessly manipulate it; this post carries a publication date but some of the text was created weeks ago (and some of the edits are being made days or weeks after the publication date). When I search in the virtual world I have the benefit of extremely powerful search and indexing technology, tools created by some of the best coders on the planet. When I search for a lost document in the physical world the only resources available to me are my own mental faculties.

As a result, the “real world” is much harder to navigate than the virtual one. In the real world I constantly encounter evidence of my deficits. These deficits are more pronounced and more likely to generate frustration as I do not have computer based assistive technology available to me. I keep making the same error over and over regardless of (forgotten word. Normally I would do a search at this point, locate the desired word, or a synonym, enter it in the text stream, and you, the reader, would have no knowledge of my difficulty [ Found it! It should read “regardless of the amount of hyper-vigilance” ] This example illustrates the degree to which I can make a virtual world presentation which serves to cloak, or to minimize, my real world deficits ).

In early August I ceased document preparation and abandoned my virtual environment to focus on deferred household chores.  When I made this change in routine I encountered a whole host of real world problems and, as these encounters revealed my deficits, this level of self awareness brought me down. In the virtual world my deficits are masked; in the physical world I cannot avoid confronting them.

Future Prognosis

One of the exhibits I submitted to the insurance company was a page of text found on the web site of Dr. Glen Johnson, Clinical Neuropsychologist, at the following URL:

TBI Guide – When Will I Get Better?

Dr. Johnson speaks of his experience of having patients with serious MRI evidence of injury making a quick recovery while those with no such MRI evidence continue to experience long term debilitation: “This highlights the problem that medical tests are not always the best predictors of long-range outcome.” He also states that progress, and further improvement, tends to be quite limited after the two year mark.

I found this information very hard to accept. I had a negative MRI (no injury was evident) and it has been more than two years since the date of the accident. Activity that once gave evidence of improvement (such as walking), no longer has the same effect. No matter what action the insurance company takes, their decision will not alter my health dynamic in any significant way. I need to accept that my present level of deficits are unlikely to significantly improve. Now aged 61, it is highly likely that I am condemned to live out the rest of my life dealing with these issues. This fact is extremely hard to accept.

Doctor X Issue

I do not wish to provide all the details of this matter. Suffice to say that I wrote and submitted a quasi-legal document and I worked very hard to ensure that it was complete and accurate in all respects.

After the date of submission, I obtained access to other documents which showed that my memory of events was clearly incorrect. This knowledge contributed greatly to my tailspin. I had to accept that my memory of comparatively recent events was not to be trusted. I do not know how to square this fact with my ease of recall of long forgotten events that occurred in my childhood.

One outcome has been a growing mistrust of my own perceptions; I have few independent means of verifying my view of the world. The fact of my piles of “lost” papers, my tottering To Do pile, and my inability to engage in accurate recall, despite seeking to do exactly that, constituted significant blows to my self image and accelerated the tailspin.

In writing this, I realize I am making an acknowledgement of my deficits. This acknowledgement, like the blog, is “public” (But this is not a highly trafficked blog so I doubt anyone will review this post other than perhaps Colin and I). Regardless of who reads this text, making this acknowledgement appears to lead me to some greater degree of acceptance. I am what I am. I have a limited capacity to return to being the person I once was. And these truths deliver the experience of life as it is lived.
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Note:
With regard to the Dr. X issue I should provide a clarification. The errant memory issue concerned my reporting of a 30 minute period of clinical interaction in his offices. The bulk of the document dealing with the Dr. X issue does not depend on my memory as it consists of referrals to the scientific literature on TBI and a series of arguments based on those facts.