Wednesday, March 14, 2012

Ask Me About My Brain Injury

Could brain injury have sparked soldier's rampage in Afghanistan?

"The U.S. Army staff sergeant who allegedly murdered 16 Afghan civilians in a dead-of-night spasm of shooting, reported to have suffered a traumatic brain injury during a deployment to Iraq in 2010.

Research on traumatic brain injury has established a clear link between brain trauma and irritable, aggressive behavior that can be explosive, often without apparent warning or provocation. Sometimes, brain injury magnifies a victim's longstanding tendency toward irritability, depression or hostility. Some brain traumas bring personality changes in their wake, causing even laid-back types to become irascible and impatient." (LA Times 3/13/12)

It is worth noting that brain injury, especially in the front of the head/prefrontal cortex does cause a person to lose their sense of inhibition. Modern medicine now has the ability to save lives when people sustain a traumatic brain injury, but we need to put as much time and money and assistance into the other side of the recovery, and not expect TBI folks to go about their lives like they did before. 

Paul Williams, in his office in Encinitas. Two months after his brain injury and still in outpatient rehab

My experience with my husbands injury was such that they sent him home after two months of care, one month of ICU, then another month of In-Hospital-Rehab. Then one day the doctor announced to me, "good news, we will be sending your husband home with you tomorrow". 

I didn't know what to say. I was stunned.  Just the day before, Paul had screamed at a nurse and stayed up all night wandering the halls and then he failed his "making brownies and cooking strategies" test. A week before he had jumped out of bed, had a blood pressure drop, keeled over backwards and was wheeled out to the emergency room again. His face was still black and blue from his head slamming on the linoleum floor.

I didn't know the first thing about taking care of a person recovering from a brain injury. The thought of the responsiblity was too much. Looking at the doctor my turned pale. I could barely take care of myself, what were the doctors I knew what they were thinking "we can't justify to his health insurance company why he has to be here longer".  

I asked the doctor for more time. He gave me 2 days and then we brought him home. I'd also asked for Paul to see a neurologist to see what he was capable of on his own,... at this time no one had asked to take his drivers liscense away or even suspend it. And Paul thought he was ready to get right back into his routine. For a while, I had to be clever about hiding car keys. 

The car thing stunned me. How could the government not require a driving test from someone who'd had 5 centimeters of their brain removed. Everyone assumed he was good to go

A friend of a friend was an eye doctor for our health provider. At a party I shared with him I was really concerned about what kind of blind spots Paul might have and whether we could find a way to suspend his liscense at least until we knew if he was a cogent thinker again. This doctor friend checked Paul's eyes and said, "he's got a big blind spot on his right side but that just means he'll have to turn his head around to see what's over there. Otherwise, he's good to go!" 

That was it. Everyone agreed, he was good to go. Other than a brain surgery buzz cut hair-do he looked like himself. He looked okay. Except, I could see the difference. Like: he wouldn't quite look you in the eye when he talked to you/he was sort of in another hazy-world. After the sun went down he would talk incoherently-this is called sundowning. And, he was a terrible driver-sometimes thinking an off ramp was just an extension of the right lane.

Some of these symptoms changed or went away in the six months post injury. I was told the first six months was when most of the recovery would occur, and that was mostly true. Because Paul had such a high IQ before the injury he faired better than most. His brain surgeon had even joked that with luck and with Paul's 180 IQ he could 'afford to lose a few brain cells and still be a genius'. And that 'folks with high IQ's often fair better after a brain injury'.

The nurses told me "whatever personality traits he had before, he will still have, but they may be played out more dramatically, more emphasized". This advice turned out to be mostly true. 

So in Paul's case he was quick to anger, was very impatient and liked to lecture. That looked like this: yelling at the security check person at the airport (pre 911) and getting his luggage examined, pushing a hefty security guard at a Los Lobos concert and getting collared and thrown out, talking non-stop with breathless run-on sentences during sharing time at a Buddhist meditation retreat, yelling at a meditation "expert" and calling the guy an asshole (the guy was full of himself and i rather liked this one), or wearing his bicycle helmet to the national booksellers convention with the words Ask Me About My B.I. written on it (this was a good one, B.I. meaning Brain Injury), yelling at the top of his lungs at a Belgian train station "I hate fucking Belgian Trains!" because it didn't follow the schedule precisely. 

On the note of the Belgian train...we sat near an Austrian couple who noticed Paul was snappy and impatient with the conductor. I noticed their discomfort. Embarrassed and thinking we'd just entered Ugly American territory, I explained to them he'd recently had a major brain injury and this is what a miracle-recovery case looked like. The man's reply was, "he should still behave himself." 

I had no idea how to handle Paul in these situations. (I wasn't from a family with rage issues). And I wasn't an occupational therapist, but I was thrown into the role of being just that. Where was the book, How To Handle Your Brain Injured Beloved Spouse in 5 Easy Steps.

I think of all the advancements made in battle-zone medicine. It's a heart breaking job for families with brain injured soldiers (and it's all gonna fall on the families) coming home from war zones. Spouses and sons and daughters rejoining families and then hospitals and then rehab and then looking normal but really, not being the same. Not being the same at all.


  1. Interesting point about the G.I.. As for you, Cindy Lee; you were given such a task to handle... I just really can't imagine... I feel for you, your family and of course, Paul.


  2. Thank you for your kind thoughts Ray. It's a day to day thing, distraction can be necessary to say the least, in moderation...

    Thanks to Denise Sullivan for a heads up on this weeks upcoming hearing on Brain injury in Washington...

    On March 19, 2012, the House Committee on Energy and Commerce’s Subcommittee on Health will hold a hearing entitled “A Review of Efforts to Prevent and Treat Traumatic Brain Injury.”

  3. Re: to bad driving by friends or loved ones with TBI's, I just came across this bit of info while taking an online traffic school test (speeding ticket, believe it or not stopped right in front of Paul's nursing home taking my son to school one morning)....Wish I'd had this info post brain injury time...

    "If you are concerned for the safety of a family member, friend, or other person who can no longer drive safely, you may write to your local Driver Safety Office or the address given below. You should provide the person's name as shown on the license, birth date, driver license number and current address, and explain what you observed that led you to believe the person is an unsafe driver. The letter should be signed; however, you may request that your name be kept confidential."

    Mail your letter to:

    Department of Motor Vehicles

    Driver Safety Review Unit MJS J234

    P.O. Box 942890

    Sacramento, CA


    "DMV will contact the person for a reexamination and, if necessary, administer a driving test to determine whether or not the person is safe to drive. The person may be issued a restricted license. It is possible that the person's driving privilege may be revoked as a safety measure, not only for the safety of that individual but also for the safety of the rest of the driving public."

  4. I love the music these guys make. The one and only time I have seen them live was in a little club in LA .. Great show, tickets were cheap and you should have seen how people crowd reacted. They cross boundaries for those who love good music.

  5. Traumatic brain injury is very different than other injuries, as the brain is not able to recover like other parts of the body. Also referred to as TBI, traumatic brain injury changes the injured person's life permanently, as their mental acuity, body functions, physical control, and personality each may be affected.

  6. Those are, indeed, tough shoes to fill, Cindy. It's truly sad to hear about what happened to your husband and hearing you talk about the changes that occurred to him after the accident. But I hope you'd continue to be brave and tough for him. He needs you now more than ever. The vital role family members and loved onces play in a patient's recovery shouldn't be underestimated. Knowing that there are people around them will make them feel that they didn't lose everything, and that there are still a lot more in life to look forward to. Keep strong!
    Louisa @ US Health Works