Recovery Narrative

TBI Recovery Narrative

Table Adapted from Nochi, 2000

Weeks of Post-Injury Main Neurological and
Sex Age Cause Coma In Years Neuropsychological Deficits
1 Male 32 Fall unknown 12 STM, speech, ambulation
2 Male 50 MVA unknown 10 STM, attention, emotion
3 Male 49 MVA 8 3 STM, attention, emotion
4 Male 30 MVA 4 11 STM, LTM, emotion
5 Male 27 MVA 4 7 STM, speech, coordination
6 Female 24 MVA 2 4 STM, learning
7 Female 54 MVA 0 28 STM, attention
8 Male 28 MVA 16 6 STM, seizure disorder
9 Male 45 Sports 0 9 STM, emotion
10 Male 40 MVA 0 5 STM, emotion
Average 37.9 9.5
Median 36 8
High 54 28
Low 24 3
100% have changes in STM
50% changes in emotion
30% experienced no coma
40% unemployed

 

This is the table that gave me so much trouble. It formed the primary trigger for the last depressive episode.

The table is based on one contained in an article describing the application of newly constructed self narrative as a means of adapting to TBI injury. These recovery narratives take different forms but each variation assists the victim in undertaking a positive response to his / her injured state.

My negative response to the recovery narrative article was not due to the narratives but was a reaction to the data contained in the table excerpted above. This table created a number of cognitive shocks. These shocks are described in the following sections.

Recovery Narrative – Shock of Injury Duration

The first shock was due to the fact the sample population has spent an average of 9.5 years in recovery. The longest recovery duration is 28 years. Given my present age, and this extended recovery period, I am forced to acknowledge I will likely deal with this injury for the rest of my life. This has been extremely difficult to accept.

Recovery Narrative – Shock of Similarity

The second shock came with the recognition of the similarity between my injuries and those of the sample population. The first lawyer to handle my file spoke with the insurer, and then relayed the insurer’s opinion that my injury was “unique,” that it was unlike anything they had previously encountered. Based on this opinion, the lawyer advised it was unlikely the insurer would accept my claim.

Yet, when I examine this table, I find that 100% of the sample experience short term memory (STM) issues. This is one of my major deficits.

Fully 50% of the sample experience problems with emotion. Again, this is one of my major deficits. Since the date of injury I have experienced a very flat emotional range  — so flat that an incidence of spontaneous laughter provoked a blog post. I encounter none of the emotional responses previously experienced either in relation to individuals, or objects, or processes. When I undertake a test for Autism Spectrum Disorder (ASD) the test indicates that I now exhibit the clinical signs of this illness. If I answer the same test battery based on how I would have responded prior to the injury then there is no evidence of ASD.

My period of unconsciousness is not known. My best estimate is a duration of between 30 seconds and one minute. The problem is that the duration of coma is not a reliable indicator of the injury impact. In the sample population described by the table, the male who experienced 8 weeks of coma has returned to work while the other individuals, with much shorter periods of coma, or no reported coma, remain engaged in recovery.

Recovery Narrative – Shock of Severity

Another key data point was the age of the individuals at the time of injury. If you subtract the recovery period in years from the current age of each of the victims, you find that the average age at time of injury was 28.4 years with a median age of 24 years. Age is a recognized factor in the severity of brain injury. I was 5 months shy of my 60th birthday at the time of the accident. This is more than twice the median age of the sample population. Given this fact, I am thankful my injuries were not more severe.

Recovery Narrative – Shock of Loss of Self

The key insight derived from this article, and the associated table, is the realization that my prior life strategy  (a compensation strategy, or learned behaviour )  does not address, and cannot resolve, the TBI deficits. The strategy may have worked to avoid bullies, and in helping to fit in with a group, but it does not facilitate recovery from TBI.  Insight into my injury, or my psyche, is of little practical benefit in dealing with the deficits.

I need to develop a new strategy, and adopt a new self image. Together these function as a coping mechanism helping me adapt to the injury. This calls for a “new” me. It also demands I place less emphasis on the strategies deployed by the “old” me. This realization has been very difficult to accept. I have no idea how to go about doing this and the thought of abandoning 60 years of accumulated life experience is extremely daunting.

Update 21/06/14 17:12:59

I revisited this table prior to seeing Dr D and realized that it contains another critical data point. Subtracting the post injury recovery period from the age in years gives the age at time of injury. The median age at date of accident for the table sample is 24 years. My age at date of accident was 59 years.

Age is a known factor in the severity of brain injury. I was over twice the age of the other individuals in this study.

 

 

 

 

Struggle

My experience of life has become a daily struggle. There is little sense of “winning,” of accomplishment, of fruition. Every day becomes another confrontation with the same issues. No matter how I exert myself, I make no headway.

This is a bleak, but realistic statement of the facts. Yes, there have been some minor improvements. But these positive changes are the same as a year spent learning to bake chocolate chip cookies. After a year’s dedicated effort, you stand proudly in the kitchen and announce only 97% of the latest batch were burned black. An improvement? Certainly! It is better than burning 100% of the batch. But given the amount of time spent (years) and the focus (daily, hour by hour) it seems a little rich to announce any improvement at all. It is similar to making the claim  “This year I am drowning, but I’m drowning 2% slower than I was last year.”  And I am nowhere near being able to get out of the water. The true message is  Never get out of the boat!  But I was pushed.

There are other aspects of struggle. These include the following:

  • Fear of slipping back into vacancy
  • Problems with learning
  • Problems with effective functioning
  • Learned behaviour issues
  • Looming financial disaster

I intend to examine each of these in future posts. The one topic I wish to address here is the fear of slipping back into vacancy.

I do not know exactly how to describe the vacancy. In my reading on TBI (which is not extensive and which suffers all the faults associated with poor comprehension), I have not come across any mention of anything similar. Perhaps this item should be subsumed under a general fear of the unknown, of being knocked out of regular life patterns, and habits, and being unable to easily resume them. When we talk about “knowing” we are really speaking to the fact that major elements of our life constantly repeat. We know where we work – we go there almost every day. We know what we do – our work typically does not change very much. We know our friends – by definition friends are a constant presence in our lives. We know where we live – unless we are young adults we tend to remain in one location for extended periods since moving causes such disruption in our normal patterns. We know our daily routine – our diet tends toward the habitual, as does our choice of garment, hairstyle, and all the rest.

We think of ourselves as being engaged in constant change. When it comes to cellphones and service plans this may be true. But, for the most part, we are deeply embedded in a series of long term, unvarying routines. It is not until you are injured, and unable to continue with the routine, that you realize the degree to which you have come to depend on constant repetition to ease your way through life. We speak of brain injury rehabilitation but we might more accurately speak of a process involving involuntary loss of old routines and being forced into the acquisition of new ones.

Exactly how the vacant state fits in with this pattern I do not know. I do know that becoming aware of myself sitting, staring blankly into space, was key in forcing me into a daily struggle to recover.

 

 

 

 

WIDWID

In IT there is a well understood acronym: WYSIWYG. Pronounced wiz-ee-wig it refers to an approximate match between what is seen on the screen display and what will be available in the final printed output. WIDWID is something different. It stands for Why I Do What I Do. This neologism is part of my attempt at self explication.

I can already hear a reader cackling “This guy is too much. Enough already with the pointless self-exposition. Have you not heard? It is time to move on. Are you unaware of life beyond narcissism?” And I would agree with that sentiment exactly.

The chief reason to continue with this WIDWID effort is that the old me had a user manual that had been revised, and perfected, and updated, for over 60 years. The new me lacks any kind of user manual at all. With the old me, I could sit down and eat dinner without any problems. It was easy. It was natural. It required no thought. Somehow, I understood the manual, and everything operated exactly as it should.

Today, I sit down to dinner and raise a fork of food to my mouth and discover I am trying to put it in my ear. Whoa Nellie! How did we manage to do that? What a dumb mistake! What was I thinking? Was that ever embarrassing! How do I get the broccoli out of my inner ear? I have pushed the boundaries on this illustration, but not by much.

You only have to put your food in your ear so many times before you are really, truly, deeply, completely, and utterly, motivated to get back to the way things were before. That is precisely the situation I am in at the moment. That is exactly the problem I face. You, dear reader, may label my WIDWID effort as narcissism. And, at first, I will agree with you. I would like nothing better than to get beyond these deficits, and problems, and return to being the person that I once was. That prior person had his warts and defects, but at least he was fully functional in a way that I am not. And he kept the broccoli out of his ears.

There is another wrinkle which adds to the complexity of the problem. I have spent hours in exhaustive web searches for information on TBI, and the means to recover from it. I have spent days diligently attempting to digest complex medical literature that would be incomprehensible to me even if I did not experience any of my current deficits.

What have I learned from my hours of research and study? That I am on my own. That contemporary medical science has an imperfect understanding of brain function. There are different models of how the brain works, different theories of how the parts interconnect. There is no complete understanding of the type that exists with regard to setting a green stick fracture. There is no repair book for the brain. Further to this, brain injury appears to express itself differently in different individuals. It is not clear if this is due to the mechanics of injury, the unique area of the brain that was injured, the age of the victim, interaction with other personal factors, or a thousand and one little gotchas and complex nagging details. In short, nobody really knows. The most widely adopted approach is to simply allow nature to take its course and give the brain time to heal itself. Everyone appears to agree that this is an extremely slow process.

So I am stuck with an injury that I do not understand, and do not know how to repair. The same injury stumps medical science. Be aware that if you suffer a brain injury, you will be on your own. And, while you are diligently trying to fix a problem that no one understands, you will likely be labelled a narcissist.

The foregoing is the primary case for WIDWID. I will attempt a more detailed examination of this topic in the following posts.