A good night – about to get better

Had a very pleasant evening with a bunch of friends tonight. Ate good food, talked about old memories and shared stories that we had somehow never told each other before.

Good times.

Now I’m home – my spouse stayed behind to catch up some more, while I came home to rest. We’ve been driving separate cars to common events for some time now, because there are times when I . Just . Run . Out . Of . Steam.

Tonight is one of those nights. While everyone was still going strong, I said my good-byes and ducked out. Got a few miles down the road before I realized that I’d forgotten something, turned around and went back, chatted a bit more, then finally made it home.

I had a really nice ride home. The night was clear and cold, and for some reason tonight just looked so beautiful. Maybe it’s all the Christmas lights. Maybe it’s because I don’t have to go to work for another week and a half. Maybe it’s because I gave myself time to get going, so I don’t have to bump up against the rough edge of my limits later on. For whatever reason, it was a beautiful drive, and I took my time coming home.

Now I’m having some hot lemon water to help with my cough, and I’m winding down … getting ready to hit the hay. This is good – much better than being crazy rushed and forcing myself to hang around and be the life of the party. I really like my friends. I also like getting a good night’s sleep.

The wind is up tonight. It sounds like a wild animal prowling around the house.That’s fine. It can prowl. I’m taking a shower and going to bed.

The hurt of the hidden wound

Got a tip about this article today. Good reading – check it out.

It was July 4, 2009 when Lieutenant Colonel Stewart Hill had his independence taken away from him. But he doesn’t remember much of what happened on that hot, dusty Saturday, and has no recollection at all of the moment the lights went out on his former life for ever.

His last memory was of a Chinook helicopter rising from a ploughed Afghan field. It carried the lifeless body of 18-year-old Private Robert Laws and other injured men of the Light Dragoons and 2 Mercian, victims of an attack with rocket-propelled grenades by the Taliban. After that, the gaps have to be filled in by others.

Read the rest here >>

concussion now i’m stupid

Someone visited this blog yesterday with the search “concussion now i’m stupid” and it seems like it’s in the air.

I had a great day Saturday — I had a very social day, and I was out and about in town, which rarely happens with me. I either don’t have the time, or I don’t make the time, or I find a hundred other things to do that are more interesting than interacting with other people in a city.

But Saturday, I took a bunch of chances, and I had a ton of interactions that were really positive and encouraging.

Sunday, on the other hand, was a huge challenge. I wasn’t able to rest as much as I had wanted/planned, and I was really feeling the effects of all the exertion on Saturday. Even if the exertion was good and positive, it was still exertion, and I didn’t remember to rest.

One of my big problems is, when I get over-tired, I often forget to self-monitor. That happened to my yesterday. So, I ran into trouble.

With a Capital T. Had a huge meltdown yesterday. As in — rage and tears and being stuck in a loop of anger and shame and frustration and resentment. I hate when that happens. I could feel it coming on, and I thought I could stop it, but I couldn’t. It was like a repeat tsunami of unwanted overwrought emotion. Waters pulling out, then washing in and wrecking everything in its path. Emotion pulling out, then rushing back in and leveling everything in its way.  It came and went for about three hours, and it totally screwed me up — and my spouse. Not pretty at all. And I’m still “hungover” from it this morning.

Ugh.

Looking back on things with a less emotional eye, one of the things that complicated my situation yesterday was that insidious little voice in the back of my head that managed to find everything I’d done “wrong” on Saturday, amplified it about a thousand times, and then commenced to tell me You’re So Brain-Damaged and Stupid. Who would ever love or care about you? You’re such an idiot – you had a concussion — no, wait, you had a bunch of concussions – and now you’re stupid. You’re so stupid you don’t even know how stupid you are.

Stupid.

Well, you get the idea. And sure enough, as always happens when that voice gets going, before long, I was at war with the world, at war with myself, at war with my spouse, at war with my job, at war with everything and everyone who came anywhere near me.

concussion now i’m stupid…

My thinking is too slow, I’m not sharp and quick like I used to be, I’m not even funny anymore (and I used to be a laugh and a half all the time), and who would want to bother with me?

Geez.

It’s bad enough that I have to contend with the physical and logistical issues, but when that voice gets going… well, the only thing to do is go to bed.

I managed to do that eventually, but not on my own steam. I had to be guided to bed and put away like a cholicky baby. I friggin’ hate when I’m reduced to that. But when I’m in the midst of that storm/tsunami, I cannot for the life of me pull myself out.

For future reference, I need to keep the image of the tsunami in my mind, when I feel it coming up. So I can get to higher ground. Tell my spouse I need to take a break, and remove myself to my bedroom or study, to simmer down. Just get myself out of the way of the wave. Maybe go out for a walk in the woods. I did that yesterday at the end of the day,  and it helped tremendously. Yes, the walk in the woods — climbing up to the top of the nearest big hill — helps me a whole lot.

I also have to have a talk with my spouse about this TBI business – it’s not okay for them to talk to me like I’m an idiot, which is what they’ve been doing more and more over the past year. Apparently, they seem to think that because my memory is a bit spotty at times, and my processing speed has slowed, I’ve lost my innate intelligence. Either that, or they have always acted this way, and I’ve just recently stopped allowing myself to be intimidated into hiding my issues from them. That’s always a possibility.

So, there are three main issues I am contending with — the wave of emotion that cannot and will not be stopped and can only be avoided until it calms down… the voice in my head that tells me I’m stupid… and the voice I live with that tells me I’m impaired. The first one, I just have to be mindful of and learn to avoid being swept away. The second one, I have to either ignore or actively argue with. The third I have to have a serious talk with — and possibly involve my neuropsych to explain to my spouse that my relative weaknesses are manageable and don’t mean I’m reduced to a simpleminded shadow of my old self. Some days it feels like that — like yesterday — but it’s not the truth of the matter.

But ultimately, the bottom line is, here’s the #1 Lesson I (re)learned over the weekend:

I have to pace myself. If I have a big day, even if it is a really good big day, I need to take the next day OFF and SLEEP. Rest. For real. Nothing else matters. No distracting entertainment is worth the price I’ll pay for exhaustion.

Achieving more by doing less

I am really resisting writing this post, but I have to put it out there for the sake of honesty — and also to get it into my head that this is the way things are now.

It’s not that what I’m thinking about is a bad thing, or even an unpleasant thing. It’s a new thing — a true thing — that I’ve been resisting for as long as I can remember, much to the dismay of my family, my coworkers, and my neuropsych.

I hate having to admit that I have been wrong, and they have been right… but in this case at least, I have to admit it:

I get more accomplished, when I do less.

Now, it might not seem like that big of a deal, to admit it. What’s the big deal?

Well, people have been “on” me for years, that I do too much. I take on too much. I have too much on my plate. I’m spread too thin. My spouse has been lecturing me for years, that I don’t relax enough and I have too many projects going on. We’ve actually had some pretty bad fights about it. I defended my hyper-busy-ness with every fiber of my being, till the bitter end, and it’s not helped our marriage at all. But I was convinced that I was right, in having twelve balls in the air. I felt so energized. Like I could do anything. And it never seemed like there was a problem. If I didn’t finish things, so what? They were boring, I told myself. And I needed a fresh start.

Well, that outlook has modified somewhat over the past couple of years that I’ve been working with my neuropsych.  Taking a long, hard look at my patterns on a regular basis, I’ve realized that being super-busy is often a direct result of anxiety. It’s not about positive exuberance. It’s not about having a vision of a future I can eagerly step into fully and with all confidence. It’s about existential angst that is welling up and driving me ahead of it, like a wild stagecoach driver whipping the team of horses into a mad gallop… in the meantime not holding the reins or guiding them in any particular direction.

This mad gallop is plain to everyone else’s discernment. It’s obviously a ploy on my part to avoid life, rather than engage with it. But it is disguised from my view by something in my perception that interprets a mad dash towards whatever comes to mind as a positive and life-affirming thing ;}

Over the years, countless people have tried to get me to stop and look at what I was doing, but I resisted — and resented — their “interference” with my grand plans. I wasn’t planning, of course. I was just flying willy-nilly in every and all directions, for the sake of flying willy-nilly. Nothing more. And when I got to a point where I couldn’t continue with what I was doing, I’d drop it… and then wonder, sometimes years later, why I ever quit what I was doing, if I was so devoted to it.

Crazy.

Well, as I mentioned, that’s been changing over the past year or so. Once I started logging all my activities and tracking them — for real, not in some quasi-reflective journal entry that rambled on about this and that for pages on end — I started seeing what was really going on in my life, and I wasn’t pleased. I looked back on all the projects I’d started — each one seeming like the thing that was going to catapult me to greatness and/or solve all my personal problems through professional success. What I saw was not greatness, but whatever-ness. Oh, man… what a wakeup call.

And I started to admit that maybe I was spending an awful lot of time on things for the wrong reasons. Maybe I was spreading myself too thin. No… obviously I was spreading myself  too thin. Judging by what little I was getting done versus what lots I was putting into my efforts, my approach was not effective. It was downright disastrous.

So, I decided to change things up. I swept a whole bunch of projects off my plate. I trimmed the fat off my docket considerably, tabling projects I thought would be cool, but obviously demanded a lot more time and energy and manpower than I could muster. I decided to do without a lot of the lists I made for myself. I also quit imagining I was going to have these multiple career paths, and be able to pick and choose between the cream of the crop, on down the line, whenever I chose to switch my path.

And it was working out pretty well. Suddenly, I had a lot more time to devote to my pet projects — the really pet ones, that is. I could focus more on the details that had slipped by me before. And I had a lot more bandwidth to do the things I enjoyed during my free time. Sleep hasn’t appealed to me much over the past months, because I was still totally into the idea that I could continue to keep up a blistering pace on a select few things — for the fun of it. Literally. I felt really “on” at work — I felt like I was really making headway and was taking the tiger by the tail.  Woo hoo – right?

Um… not so much. Now, months on down the line, I find myself worn out, all turned around by myriad details that once seemed so clear to me, and not delivering at the rate my boss wants me to. My thinking is not clear, my relationships at work are suffering, I feel like I’m slipping into a hole of my own digging, and I’m battling to get myself out. I find myself taxed and tapped, angry and raging and resentful and antagonistic and defensive and increasingly volatile… saying things I wish I hadn’t… and my marriage and work situation are both suffering as a result.

Here, I’d thought I was supporting my family and my coworkers better by driving myself like a crazyperson, taking on all sorts of tasks, when all I was doing was driving myself — and my spouse and my coworkers — crazy.

Which brings me to what I’ve been learning — the hard way — over the past couple of weeks.

I actually perform better, and I accomplish more, when I do less.

… As in, when I work in intervals — planning and thinking things through ahead of time, then mustering my energy and tackling tasks with full attention and focus.

… As in, when I spend less time on busy-work, and I devote the bulk of my attention to strategic and tactical planning and implementation, saving my logistical energy for select tasks — no more than two or three a day.

Indeed, I do better, when I tackle less of the little niggling details work that’s just filler for my time and is more about my brain thinking such-and-such is important, when it’s not really.

And I accomplish more when I don’t insist on taking on this mountain of everything by myself, as I’ve always been prone to do.

Truly, the practice of only doing 2-3 significant things a day, when I used to tackle at least five-to-ten times that amount, is a huge change for me. It’s a difficult change… An unsettling turn of events. It makes me nervous — incredibly anxious. I feel like I should be doing something. But during those stretches when I’m “doing something” to the tune of 20 deliverables a day, and I look back on my notes about what I actually accomplished, well, the results are a lot less impressive, than my fantastical plans.

But if I break it all down and pick and choose from the things I need to get done and don’t worry about the other things, till I get the most immediate couple of things done, it’s friggin’ magic, man.  I get waaaaaay more accomplished if I take things 2 and 3 tasks at a time and do them in an extremely focused and intense fashion, than if I “pace myself” and take on 20-3o items (no joke) at a “reasonable pace”.

They say timing is everything. It’s true. It’s even more true that the right timing in the right way for the person in question is more-than-everything. Some people can go slow and steady through a mountain of small details. I, on the other hand, drown in those details. Just like there are slow-twitch muscles that long-distance runners use, and fast-twitch muscles that sprinters use, I’m more of a fast-twitch kind of person. And if I slow down to go at a “reasonable” pace, I’m toast.

So, there we have it. I’ve had my helping of crow for the day. I have to admit, it feels good to say/write it out loud, but it’s been a long time coming. And I have a lot of work to do, to reverse the damage that’s come from ignoring and denying the truth about how I work best — and worst. But reverse this, I will. I’m the comeback kid. I’m not going to quit till I get where I need to be.

Even though I know it’s good for me and it’s the only way I can really work effectively, the idea of only doing a few things  a day still makes me intensely anxious. I don’t expect to get used to it overnight.

But you know what? Doing a little bit at a time in a very focused, intentional way gets me there. And since actually getting there is what matters to me (and my spouse and my coworkers and my boss) — even more than the “journey” on the way — that’s what I’ve got to focus on. Results. For real. Not plans and methodologies. Results. What works. What works for me.

Onward.

How Can I Recognize a Possible Concussion?

One of the nice things about being a blogger is that I can add my information to the general wealth of data about subjects of interest to me – in this case, mild traumatic brain injury. This blog is about more than telling my side of the story — it’s about fleshing out info that other trusted sources provide, in ways that are personal and individual… and hopefully contributing to the general understanding about traumatic brain injury, and sports-related concussion in particular.

The CDC has a wealth of information on concussion in youth sports over at their Heads-Up site.

What’s missing is a bit of in-depth explanation about the different points they make.

Since this month is Brain Injury Awareness Month, I hope to contribute to the awareness piece with further info and examples from my own concussion experiences.

From the CDC site about recognizing concussions:

To help recognize a concussion, you should watch for the following two things among your athletes:

  • A forceful bump, blow, or jolt to the head or body that results in rapid movement of the head.

AND

  • Any change in the athlete’s behavior, thinking, or physical functioning.

Athletes who experience any of the signs and symptoms listed below after a bump, blow, or jolt to the head or body should be kept out of play the day of the injury and until a health care professional, experienced in evaluating for concussion, says they are symptom-free and it’s OK to return to play.

Signs Observed by Coaching Staff

  • Appears dazed or stunned
  • Is confused about assignment or position
  • Forgets an instruction
  • Is unsure of game, score, or opponent
  • Moves clumsily
  • Answers questions slowly
  • Loses consciousness (even briefly)
  • Shows mood, behavior, or personality changes
  • Can’t recall events prior to hit or fall
  • Can’t recall events after hit or fall

Symptoms Reported by Athlete

  • Headache or “pressure” in head
  • Nausea or vomiting
  • Balance problems or dizziness
  • Double or blurry vision
  • Sensitivity to light
  • Sensitivity to noise
  • Feeling sluggish, hazy, foggy, or groggy
  • Concentration or memory problems
  • Confusion
  • Does not “feel right” or is “feeling down”

Remember, you can’t see a concussion and some athletes may not experience and/or report symptoms until hours or days after the injury. Most people with a concussion will recover quickly and fully. But for some people, signs and symptoms of concussion can last for days, weeks, or longer.

Now, for some explanation to fill in the blanks…

To help recognize a concussion, you should watch for the following two things among your athletes:

  • A forceful bump, blow, or jolt to the head or body that results in rapid movement of the head.

The head, atop the neck, holds our precious brain — which has the consistency of pudding, and is surrounded by fluid which protects it from the bony inside of our skulls. Unfortunately, the bony insides of our skulls can have rough/sharp edges which can rake across the surface of the brain and cause damage that way, should the head/bodybe knocked so hard that the brain pushes past the protective fluid and scrapes against the inside of the skull.

You can see a video of different types of brain injury at YouTube. It’s very informative, and I recommend it.

When the body or head is hit hard enough, the brain can hit against the front inside part of the skull, be injured there — and then fly back against the rear of the skull (called coup-contracoup — which means head-back0fhead — injury), causing damage to the rear part of the brain as well. Under ideal conditions, the protective fluid provides an ample buffer to shelter the brain, and the inside of the skull is not really sharp and uneven. Unfortunately, there are no guarantees that that’s the case.

Forceful bumps or blows or jolts to the head can be things like:

  • being hit on the head by a ball, such as in soccer or baseball
  • colliding with another player and bumping heads
  • being elbowed or kicked in the head
  • colliding with the catcher and slamming your head against his/hers when you’re trying to steal homebase
  • falling and hitting your head on the basketball court floor

Another way the brain can be injured by a hard hit to the body, is a whiplash effect — where the connections that are located at the base of the skull and neck are twisted and torn by the head snapping forward and backwards really hard. You don’t need to be knocked out, and you don’t even need to have your head hit, to sustain a concussion in sports.

Forceful bumps or blows or jolts to the body can be things like:

  • being tackled hard in football
  • being fouled hard and knocked to the floor in basketball
  • falling during a soccer game
  • colliding with another player when going after the same ball
  • landing hard after any kind of fall, even if your head doesn’t hit the ground
  • running into the wall when you’re eplaying squash/raquetball

It’s important to remember that these very common collision/impact occurrences (which are part and parcel of just about any sport) will NOT necessarily lead to concussion. If everyone who was tackled hard, or fell, or was fouled hard and ended up on the floor/ground sustained a concussion, there would be a whole lot of impaired people walking around.

Being hit or tackled or falling during a game or practice is NOT a guarantee of a concussion. This is where the next criteria comes in… the “and” part.

AND

This AND is important. The first set of criteria — the bump, blow, or jolt to the head or body are no guarantee that a brain injury has occurred, but they can serve as a trigger to watch out for the following. The next point is what acts as an alert that a concussive event has occurred.

  • Any change in the athlete’s behavior, thinking, or physical functioning.

Signs Observed by Coaching Staff

  • Appears dazed or stunned
  • Is confused about assignment or position
  • Forgets an instruction
  • Is unsure of game, score, or opponent
  • Moves clumsily
  • Answers questions slowly
  • Loses consciousness (even briefly)
  • Shows mood, behavior, or personality changes
  • Can’t recall events prior to hit or fall
  • Can’t recall events after hit or fall

Symptoms Reported by Athlete

  • Headache or “pressure” in head
  • Nausea or vomiting
  • Balance problems or dizziness
  • Double or blurry vision
  • Sensitivity to light
  • Sensitivity to noise
  • Feeling sluggish, hazy, foggy, or groggy
  • Concentration or memory problems
  • Confusion
  • Does not “feel right” or is “feeling down”

Here are some examples from my own experience:

When I sustained a concussion from a hard tackle during a football game in high school, there was an immediate change in my thinking and physical functioning.

  • First of all, I was not thinking as quickly as I was before the hit. Even I could tell I was slower — I wasn’t following the calls by the quarterback very well, and I was clearly a little dimmer than I had been before the hit. I had trouble understanding what was said in the huddles before the following plays, and I had trouble following the instructions I was given. For example (I can’t remember the exact details, but this is how it was), when I was told to go long and then cut left at a certain point, I went long, but I didn’t cut left.
  • Secondly, I was not as coordinated as I had been before the hit. I ran clumsily — like I was drunk — and I couldn’t catch the ball when it was thrown right to me. I also stumbled a lot, and I fell a few more times. For all I know, I did more damage to myself, but I was so totally focused on continuing the game and not letting my teammates down, I refused to take myself out of the game. They had to stop the whole game, completely, to get me to quit playing. I was that stubborn.

When I sustained another concussion from a fall during a soccer game a year or two later  in high school, there was yet another immediate change in my physical functioning and behavior.

  • First of all, I was a lot less coordinated than I had been before I fell. I couldn’t control the ball as well as I had before, and it felt like I was moving in slow motion. I stumbled and fumbled, and there was obviously something different about how I was playing.
  • Second, I was not the same player I’d been before my fall. Before, I had been aggressive and confident on the field. Afterwards, I was hesitant, confused, and I hesitated before shooting on the goal (or just plain failed to shoot). I had a number of opportunities to score, but I didn’t, because I was uncertain and confused. I was also less able to be a team player. I didn’t pass the ball to my open teammates as frequently as I should have. I also became more withdrawn and was not communicating with the coaching staff on the sidelines. It was like I was in my own little concussed world, suspended in a foggy soup that slowed down all the input and output.

Athletes who experience any of the signs and symptoms listed below after a bump, blow, or jolt to the head or body should be kept out of play the day of the injury and until a health care professional, experienced in evaluating for concussion, says they are symptom-free and it’s OK to return to play.

Absolutely, positively. This must be done. Unfortunately, I myself never received any medical evaluation or treatment for my injuries. But on the bright side, I was removed from play in both instances. Nobody watched me afterwards to make sure I was symptom-free and it was OK for me to return to play. Then again, by the time I got to those games, I’d had a number of TBIs already, so I already showed symptoms of impairment. Still, the changes I did experience, on those two separate instances, were clear indicators that I’d undergone a concussive event. I only wish someone had known what to look for, and helped me out.

Another important piece of the CDC info is:

Remember, you can’t see a concussion and some athletes may not experience and/or report symptoms until hours or days after the injury. Most people with a concussion will recover quickly and fully. But for some people, signs and symptoms of concussion can last for days, weeks, or longer.

This cannot be overstated. Concussion, hidden as it is inside the skull, can also be hidden by time. It can take hours or days for symptoms to show up, which is why it is so important that not only coaches, but also teachers and parents and teammates are all familiar with the danger signs and informed about how to respond appropriately.

One of the things that can show up later, are behavioral issues. Indeed, behavioral issues are the bugaboo of mild traumatic brain injury, because on the surface everything looks fine, and the brain may have recovered from its initial trauma, but there are microscopic changes under the surface that can have long-lasting effects. If you know someone who plays sports, whose behavior has suddenly started to change for the worst – suddenly they have a lot of anger, rage, irritability, distractability, sensory issues, fatigue, insomnia —  it could be they had a concussion during a game or some other event — and nobody realized it, including them.

Concussion doesn’t just affect the student athletes — it affects everyone who interacts with them, everyone who loves and cares about them. It’s in all our best interests to learn about it, learn what to watch for. And to report it to someone who can help.

As the CDC says, most people recover quickly and fully, and it doesn’t need to wreck their lives. But if you don’t pay attention to the first warning signs, it is all too easy to re-injure yourself (having a concussion increases your chances of experiencing another one from 2-6 times). So, paying attention, right from the get-go can help prevent other problems from happening.

In retrospect, I wonder what might have happened, if I’d stuck with track and field and cross country exclusively, and not played any team sports that involved tackling or the danger of falling/collisions. I wonder if I would have been so susceptible to drugs and alcohol, if my behavior would have been so problematic. Thinking back, I had a ton of problems when I was a kid that actually resolved as a result of organized sports. Unfortunately, the thing that helped me most, also introduced more problems to my mix.

Well, I can’t worry about it. What’s done is done, in my case. I’m just happy I’m as functional and well-off as I am, today.

I also hope that coaches and trainers and teachers and teammates are learning enough, today, to help avoid the kinds of situations I got myself into… and help address the after-effects of the kinds of injuries that I — and hundreds of thousands of others young athletes — experienced. The CDC material is really helpful, and they have lots of free information and additional materials available.

Check ‘em out. It’s worth the trip.

Once we’re aware of brain injury… what then?

One of the things I hope happens during this month — March is Brain Injury Awareness Month — is that TBI awareness doesn’t “dead end”.

What I mean by that is, I hope that in learning about brain injury, tbi, head injury, concussion… whatever you choose to call it… people don’t reach the conclusion that a brain injury is The End of the Line for people who sustain one.

Proof that this can’t possibly be true, all across the board, is the fact that Every 21 Seconds, someone in the U.S. suffers a traumatic brain injury.

1.5 Million Americans suffer a traumatic brain injury each year.

And those are just the ones we know about.

There are very likely many, many more individuals who sustain head injuries (or concussions) and either never fully realize it, or who say nothing about it, don’t report it, don’t seek medical assistance, etc.

Now, I don’t know about you, but that sounds like an awful lot of people. Which means, there are a whole lot of folks walking around with a history of head injury. And it means that this “silent epidemic” as some folks are calling it, has a substantial presence in our lives, whether we like it or not.

And although this silent epidemic is a serious one, from where I’m sitting, it’s not catastrophic. It doesn’t need to signal The End of Productive Life for survivors. And it certainly doesn’t necessarily mean that we TBI survivors are all disabled or incapable of getting on with our lives.

Now, I’m playing devil’s advocate here — and it may seem out of character, because I’ve devoted a fair amount of time and energy to raising awareness about the difficulties that come with TBI (especially “mild” traumatic brain injury, or mTBI). I’ve spent a lot of time talking about my difficulties and challenges and things that hold me back and get in my way. I’ve really wanted folks to get a sense for what it’s like to deal with TBI on a daily basis, not sugar-coating it, and not hiding the warts and bumps and foibles and screw-ups that beset me along the way.

I’ve taken the liberty of saying things here and voicing opinions that are clearly the results of my issues — temper tantrums and tirades and poor-me bitching and moaning. I’ve been as honest as I can be — on purpose — because that’s a side of this condition that needs to be acknowledged and reckoned with.

At the same time, though, I also want this blog to show how, despite these challenges and problems, it is possible to overcome them. With the right strategies and the right outlook and the right tools — and the right self-awareness — you can overcome mild TBI’s challenges and get on with your life. You can even overcome a more severe TBI — I may have had a more severe one that I originally thought, when I was knocked out by that rock when I was 8 years old (but I don’t remember how long I was knocked out, and I didn’t get medical assistance that could identify what the real story was with me, back then, so I’ll never know for sure just how severe that injury was — for all I know, my brain might have swelled or I had a bleed, or something like that, but 35 years after the fact, any evidence of that didn’t show up on the MRI or EEG).

TBI doesn’t have to be the end of the line. Concussion, either (and let’s use those terms interchangeably this month). A head injury may sideline you for a time, but it does NOT need to become a permanent, life-threatening condition that plunges you into chaos and desperation. For some people it may be that, but there is no rule written in stone that says that TBI is the end of the road. While the organizations and research facilities which are seeking funding and want to get the public’s attention around TBI may resort to dramatic accounts to get people’s attention and get them to take this national health issue (note, I am not saying “crisis”) seriously, as an individual I am saying that TBI can be survivable. And it does NOT need to permanently derail your life.

Now, I know the dangers of giving people false hope. Sometimes an injury is a permanently disabling one. Sometimes there’s just no chance of getting back certain functions and abilities. Sometimes the brain is just “done”  in places, and the things it used to do, are things of the past. For people in that situation, I feel a great deal of compassion. Not pity. Compassion. They are in serious need of help — especially when their injuries have come as a result of serving their country, and their TBIs have left their spouses and kids and other family members with a huge gaping hole where their personality and presence used to be.

That’s a terrible, awful situation, and those folks need all the help our nation can offer.

But when it comes to Brain Injury, there is no set-in-stone rule that says a certain outcome is 100% predictable. There is no 100% certainty that a certain type of injury will result in a certain type of effect. Everyone is different. Every brain is different. We’ve got our genetics, our physical fitness, our personal expectations, even our individual character, to factor in. We’ve got past training and conditioning — physical, mental, spiritual — to consider, as well as the amount of support we receive. And then there’s plain old grit and mettle…

What happens to one person and results in certain after effects, can happen to another person and result in something completely different. It’s not an exact science, and there are as many unpleasant surprises along the way, as there are pleasant ones. There are no guarantees, and there are no unassailable absolute rules about TBI that say if such-and-such happens, you can expect such-and-such to occur.

Each head trauma survivor, and their family and friends, have to find out for themselves what is truly possible for them.

But while we’re learning about the issues and problems and difficulties and challenges, let’s also keep in mind the possibility that there is much, much more we have to learn about how much recovery is truly possible. For all we know about brain injury, right now, there’s a ton we don’t know. That goes for the brain, itself. And in this day of medical and scientific expertise, where trained professionals with “qualified” backgrounds are doing their utmost to help us feel more secure by being their expert selves, it would do us all some good to keep in mind that their demeanor and their outlooks are parts of roles they play — as experts, they must necessarily appear strong and confident and authoritative. Which opens the door to following them blindly down roads where the surface is not paved nearly as well as they would have us think.

And it can also close the door to other possibilities — the possibility that they might be wrong about how the brain works and how it heals. The possibility that they may be wrong about what the human spirit is capable of doing. The possibility that they may be looking in the wrong places for some of their answers, and that they might be discounting valuable information and experience that others can use, because it’s not part of a double-blind peer-reviewed controlled experiment conducted under tightly monitored conditions.

March is Brain Injury Awareness Month, and my own personal contribution to the collective awareness is this: Just because you sustain a brain injury doesn’t mean your goose is cooked for all time. There may be some things you have to let go of — like that go-go-go lifestyle that kept you from paying attention to your whole life. There may be some changes you need to make — like exercising regularly, or taking some meds to keep yourself cognitively engaged. There may be some challenges you cannot shake — like constant headaches and all-over general aches. But everybody has something they have to overcome. It comes with the human territory. And for every one thing that we have to let go of or adjust away from, there are about a million other things we can do or pursue, to take its place. Just because you can’t do ___________, doesn’t mean you can’t do _____________.

The world is bigger than that. And so are we.

Awareness of Brain Injury is just the first step. And it doesn’t have to be the last. There are millions of people who are dealing with the after-effects of TBI, years after the fact, and not all of them have been rendered incapable of living their lives. How well they recover and move on with their lives depends on myriad factors, not least of which is character and the strength of the human spirit. It’s not all about the brain. It’s about the mind. The body. The heart. The soul. The brain is one piece of the equation — it’s an important piece that cannot be disregarded. But it’s not the only piece.

This is important information. It’s critical. And it’s vital that we not lose sight of the whole person, when we look at TBI survivors. Each person has their own personal “constellation” of abilities and limitations. And each person has a choice in how they approach them. We TBI survivors may not have the same faculties as we had before our injuries, and we may not have the same faculties as others, but we are still very human and we are still very much alive, and that in itself should count for something.

That being said, during Brain Injury Awareness Month, I am really hoping that more of a conversation can emerge about the nature of brain injury, and we can hear more stories of recovery. There’s always the danger, I suppose, of successful recovery stories convincing people that brain injury is not that big of a deal, and that all you need is time and rest, for things to get back to normal. That’s not how it works. I’m not sure it works that way for anyone, brain-injured or not. Likewise, there’s the danger that showing the lives of people who were brain-injured who never fully recovered will tell people that once your brain is damaged, it’s the end of the line for you. That’s not how things have to work, either.

It’s more complicated that that. More complex. Perhaps more than can be handled and addressed and discussed in March.

Well, at least this is a start. The month is just beginning, and there are 30 more days in which to talk about all this.

Onward…

Anger, anger, and more anger

temper strikeOne of the things that can make TBI particularly difficult, in the ensuing weeks, months, even years, is anger issues. Rage issues. Flying off the handle and attacking others for no good reason that they can see.

There are a lot of reasons this happens. Some of them are:

  • Fatigue – your system is compromised by too little sleep and/or too much activity (with me, the two go hand-in-hand), and you don’t have the energy/wherewithall to stop yourself from going off
  • Fear – there’s nothing like a sharp spike of adrenaline, combined with anxiety and fear to set you off. Fear has a way of clouding your judgment, so you not only under-think situations (from fatigue) but you also overreact to the circumstances (which may or may not be true).
  • Frustration – when you’re trying to get something done/said/understood, and it’s just not happening, no matter how hard you try, patience wears thin — especially with yourself. My frustration tends to be directed inwards, though it also gets directed outwards. But the inward-turning kind is actually a lot worse for me. It makes me mean and aggressive. The worse I feel about myself, the angrier I get with life in general, and the more I tend to blow up.

It certainly doesn’t help that my brain gets into an uproar and starts getting into a biochemical soup drama, so that even if I wanted to think straight, I can’t.  The constant restlessness of my brain, coupled with the toll that agitation and fatigue take, can combine for a pretty potent mix of explosives.

So, what can I do about it?

  • At a very minimum, be aware that I’m angry. It often feels like something completely different — it feels like I’m just revved, and I don’t recognize the emotional piece of it. It may sound simple, but realizing that I am actually angry is a big challenge for me.
  • Realize that my anger does not necessarily make sense to others. What I’m thinking and feeling may be entirely unique to me.
  • Realize that my brain may be sending me wrong signals, and the surge of emotion that’s coming up may be simply a biochemical response by a physical system that is WAY overloaded and highly sensitive.
  • Remember that the long-term effects of a blow-up are probably not worth the satisfaction I get from venting. No matter how justified I feel about my anger, it can do much more harm than good. I have to think about whether I want to spend the next days/weeks/months patching up the damage I do to myself and my relationships with others, thanks to uncontrolled anger.
  • Keep myself in check. No matter how justified I feel, the more revved I get, the more I need to step away. I need to do whatever I can to remove myself from that situation, before it escalates and turns really nasty.

It’s not a perfect process, but it’s something. It’s an ongoing thing, and I’m far from perfect. But ultimately, life has a way of teaching me the lessons I need to learn, so if I just keep at it, eventually I do make some progress.

Doing it differently this holiday season

I did something quite unusual last night — I went Christmas shopping by myself at a much slower pace than usual. I didn’t manage to buy everything I set out to, but I got everything I could, and I got through the experience in one coherent piece — and I was able to get my nap after I got back.

Normally, this time of year is marked by team-shopping with my spouse. They contact everyone in the family and find out what people want… or we talk about what we think people want, and then they make up the list. We take the list, hop in the car, and head out to stores that look like good candidates, then we slog through the process of elimination, muddling our way through… with me getting so fried I either completely shut down and become non-communicative, or I melt down and fly off the handle over every little thing.

We usually spend several evenings like this, ’round about this time of year, and we’ve both come to dread it a little. My meltdowns had become more extreme over the past few years, and this year we were both really dreading the whole Christmas shopping business — to the point where we are going to be late(!) with presents for family members in other states. That’s never happened before. We were always good about it. But my meltdowns screwed everything up.

We both recognize that doing a lot of social things, this time of year (when work is actually getting more crazy, what with year-end and all), takes a huge toll on me. Even if it’s with friends (especially with friends), all the activity, all the interaction, all the excitement, really cuts into my available energy reserves. And then I get turned around and anxious… and I either regress to a cranky 9-year-old state, whining and bitching and slamming things around… or I melt down, start yelling, freak out over every little thing, and start picking at my spouse over things they say and do, to the point where neither of us can move without me losing it.

What a pain in the ass it is. Of all things, the uncontrollable weeping bothers me the most. The yelling bothers my spouse. It’s embarrassing for me and frightening for them, and neither of us has a very Merry Christmas, when all is said and done.

So, this year we did things differently.

We split up for the day and took care of our respective activities.

My spouse went to a holiday party that was thrown by a colleague of theirs who’s married to an attorney who deals with financial matters. I was invited, too, but we both realized that it would be pretty dumb for me to try to wade into the midst of 50+ actuaries and tax attorneys and their spouses who were invited to the shindig… and try to hold my own. Certainly, I can keep up with the best of them, but marinating in such a heady soup, especially with everyone hopped up on holiday cheer (eggnog, red wine, punch, etc.) and all animated and such, would have been a recipe for disaster.

So, I didn’t go. Instead, I took our shopping list and headed to the mall to stock up on what our families had requested. We had written down in advance all the names and the specific gifts we were going to get, and we had also written down where we were going to get them. That list was my lifeline. Especially in the rush and press of the mall, which sprawls out in all directions, with satellite stores on either end.

I’m happy to report that I actually did really well. I made a few tactical errors — like not parking in the first lot I came to and walking in. But that turned out okay, because if I had parked in the first lot, it would have been all but impossible to get down to the other end of the mall. I studied the list carefully ahead of time and used a highlighter to mark the stores where I’d be going. I also kept my focus trained on the task at hand — even if it was just sitting in traffic. I also walked a lot more this year than other years. I found one parking space and used it for two different stores. And I didn’t hassle with finding a space that was as close as I could get to the building. I took the first decent spot I could find, and then I walked to the store.

Imagine that — in past years, I was possessed with finding parking as close as possible, and I would move the car between stores, even if they were only 500 yards apart.  This year, I just walked the distance. Even though it was cold, for some reason the cold didn’t bother me, and it actually felt good to be out and moving.

I think that my 5 months  of daily exercise has paid off, in this respect. I think part of the reason I was always consumed with driving everywhere was that I just wasn’t physically hardy. I was kind of a wimpy weakling, in fact — though more in thought than in body, but a wimply weakling, all the same. But having a good physical foundation — even just from doing an hour (total) of cycling, stretching, and light lifting each morning — has made a significant difference in my willingness and ability to walk between stores.

It might not seem like much, but the walking (instead of driving) between stores part of the trip actually made a huge difference in my overall experience. Walking between stores — stopping at the car on the way to stash my presents — helped me break up the activity and clear my head. It got me out of that in-store madness, the crush and the rush, and it got me moving, so I felt less backed-up and agitated. And that let me start fresh at the next store.

That was good, because the first store was a friggin’ nightmare. It was one of those big-box electronics places, that supposedly has “everything” but really didn’t. It was exhausting, combing through the stacks of movies and music, only to find everything except what I needed. The lighting was awful — extremely bright and fluorescent and glaring. People kept bumping into me, or walking so close I thought they would run me down. But the worst thing was the acoustics. Everything surface was hard and echo-y and the place was overwhelmingly loud, and every single sound was at least partially distinguishable, which drove me nuts. I’ve noticed that acoustics have a lot more impact on me than light, when I’m out shopping. The store was one big cauldron of loud, indiscriminate noise, and my brain kept trying to follow every sound to see if it mattered. I couldn’t function there. Not with the place full of people — and very agitated, anxious, aggressive people, at that.

I eventually went with a gift card and got the hell out of there. I doubt I’ll ever go back when it’s that full. When the place is low-key and all but empty, I can handle it much better. But at this time of year? Not so much.

Walking back to my car chilled me out. Sweet relief.

At the second store — a bookstore — I started to feel pretty overwhelmed. They had long lines, and the place was packed — which is good for the retailer, but not so great for me. I spent the longest amount of time there, in part because I could feel I was getting overloaded, and I stopped a number of times to catch up with myself and remind myself what I was there to buy. My list was getting a little ragged, at that point, what with me writing notes in the margins and taking it out/putting it back in my pocket. So, eventually I just pulled it out and held onto it for dear life. I must have looked a little simple-minded, but I don’t care. Everyone else was so caught up in their own stuff, anyway. My main challenge there, was not getting trampled by Women On A Mission — many of them carrying large bags and shopping baskets that doubled as ramrods to get through the crowds.

One cool thing happened, though, when I was taking a break — I had a little exchange I had with two teenage boys who were talking about some book they’d heard about. I was just standing there, pretending to look at a shelf of books, just trying to get my bearings, when I hear this one young guy tell his buddy, “I heard about this book I should get — I think it’s called the ‘Kama Sutra’ and it’s, like, about sex, and it’s got these pictures… and it’s really old… like, from India or something.”

Well, I perked up at that, and suddenly very alert, I looked over at them and said, “Oh, yeah — the Kama Sutra, man… You should definitely check it out.”

They kind of looked at me like deer in headlights, and they got flushed and flustered and stammered something about not knowing how to find it. It was about sex, and they didn’t know how to ask someone to help them. I so felt their pain…

I confidently (and confidentially) pointed them to the book-finder computer kiosk, where they could type in the title and it would tell them where to find it in the store.

“Dude, you should totally look into it. It’s got lots of information — and pictures — and it’s been highly recommended… for hundreds of years.”

They got really excited and headed for the book-finder kiosk. Here’s hoping they — and their girlfriends — have a very Merry Christmas.

That little exchange got me back in the game, so I took another look at my list and managed to find the handful of books and music and calendars I wanted to get. I headed for the line and just chilled/zoned out. I didn’t get all tweaked about how long it was taking; I listened in on a conversation for a while, till I realized it was mostly about death and health problems people were having.

Oh – and another thing that helped me keep my act together, was the 4:15 p.m. alarm that I have set on my mobile phone. 4:15 is usually when I need to start wrapping up my day at work. I need to do a checkpoint on the work I’m doing, start to wind down, and begin keeping an eye on the clock, so I don’t get stuck in town past 6:00, which is what happens to me when I don’t watch my time after 3:30 or so. I have this alarm set to go off each day, and it went off while I was in the store, which was a blessing. I had completely lost track of time and I was starting to drift, the way I do, when I’m fatigued and overloaded and disoriented.

It startled me out of my fog, and I knew I still had a bunch of things on my list to get, so I refocused and started thinking about what I would get at the next store, so I could just march in and do my shopping without too much confusion and disorientation. After I paid for my books and music and calendar, I debated whether to have my presents wrapped for free, which might have saved me time in the long run. But I couldn’t bear the thought of having to interact with the folks who were doing the wrapping. They looked really friendly and gregarious — Danger Will Robinson! Warning! Warning! Even a friendly conversation was beyond me at that point.

I realized I just wasn’t up to that, and I must have looked like an idiot, standing there in the middle of the foyer, staring at the gift-wrappers for about 10 minutes, but who cares? Everyone was so caught up in their own stuff, they probably didn’t notice me. And if the gift-wrappers were uncomfortable with my staring, they didn’t show it… too much ;)

Anyway, after I managed to extricate myself from that store, I headed for my last destination. Again, I didn’t sweat the traffic getting out of the lot, and when I got to the final store, I parked at a distance from the front doors and walked in through the icy cold, which was good — it cleared my head.

Inside, I consulted my list again and headed directly for the section that had what I needed. Halfway there, I remembered that I’d meant to buy a very important present at the first store, but I’d totally blanked on it. I started to freak out and got caught up in trying to figure out how to get back to that first store and not lose my mind in the process.  Then, I slowed down and stopped catastrophizing, and in my calming mind, it occurred to me that — Oh, yeah – they probably carried that item at this store, so I went and checked, and sure enough, there it was – score! I didn’t have to back to big-box hell. At least, not that day.

I found some more of the presents on my list, and although I didn’t get everything I needed, I made a decent dent. My partner can come with me and help me sort out the other items either today or tomorrow. Or possibly when we get to our family — they usually have some last-minute shopping to do, and they can cart us around with them. And I won’t have to drive.

By the time I got home, I was bushed. My spouse wasn’t home yet, so I called them — they were on their way home and were stopping to pickup some supper. I said I was lying down for a nap, and they didn’t have to wake me when they got home. Then I took a hot shower to get the public germs off me, laid down, and listened to Belleruth Naparstek’s Stress Hardiness Optimization CD. I had a bit of trouble relaxing and getting down, but I did manage to get half an hour’s sleep in, before I woke up in time for dinner.

My partner had a pretty good time at the party, but they said it probably would have been a disaster for me — so many people, so much energy, so many strangers, and unfamiliar surroundings. I concurred, and I showed them what I’d bought that afternoon.

We’d both done well. We both missed each other terribly, but we did get through the afternoon without one of those terrible holiday incidents that has dogged us for many, many years. Like Thanksgiving, which went so well, this Christmas shopping trip actually felt normal. It didn’t have that old edginess that I always associate with holiday shopping. It didn’t have the constant adrenaline rush. In some respects, it feels strange and unfamiliar, but you know what? If strange and unfamiliar means level-headed and low-key and plain old sane, and it means I can keep my energy up and pace myself with proper planning… well, I can get used to that.

Yes, I’ve done things differently this year. And it’s good.

In search of consistency

One of the things about TBI that makes it so maddening is that it strips you of regular functionality without ever bringing the fact to your attention. In fact, if anything, a brain injury is expressly “interested” in keeping you from knowing that you are impaired.

The brain doesn’t want to believe that it is having problems. The brain doesn’t want you to believe that you’re having problems. It’s like there’s this inherent mechanism that STOPS THINKING as soon as it encounters something threatening. It’s like the very experience of hesitation or trepidation short-circuits the rational faculties of the brain with a cascade of fear-chemistry, and it automatically shifts gear away from the parts that scare it. And you end up never realizing the degree to which you are actually impaired.

Until everyone else around you gets tired of your issues and lets you know. But even then, it can be all but impossible to get your head around what they are telling you. Because despite all evidence to the contrary, your brain is telling you YOU’RE FINE! EVERYTHING IS HUNKY DORY! WHAT- ME WORRY?! NO WAY!

And everything goes to hell (or almost does) before you ever notice.

That’s what happened to me. And in my case, the situation was even more dire, because everyone around me totally bought the cover I’d been using for as long as they’d known me — that I was fine, just a little eccentric, just a maverick/rebel — and they didn’t pick up on the problem spots. Perhaps also in part due to the fact that a lot of my friends have also sustained head trauma in the past (?)

Anyway, now I know I’ve got issues, and I’ve got professional help both identifying the problems and coming up with solutions.

One of the areas where I’m trying to get my house in order, is with regard to consistency. I’m really good at coming up with a plan of action and sticking with it for a few weeks, then I fall off my own wagon, so to speak, and I end up wandering aimlessly, not tending to the things I need to be tending to. I make people crazy, including people I work with. And I’m tired of doing this.

I’ve been keeping a daily planner/log for quite some time, but only lately have I really focused on making sure that I both identify things I’m going to do AND identify the amount of time I’m going to spend on them AND track the results. I have spent the last month or so logging the things on my plate, and then looking back at what I’ve accomplished, and marking off the things that worked out, and the things that didn’t.

And it’s helping. In the past, I would just write down a bunch of stuff I knew I needed to get done, and then just take them piecemeal, or in sudden rushes of activity, or just whenever I felt like it. I didn’t have a lot of discipline around it all, because (I told myself) I was an “artist” and I was too creative to be stuck in some time-management grind, day in and day out.

Well, being creative and an artist is all well and good, but it’s a pretty crappy way to get anything done. Especially if I’m going to be working at a truly professional level and keep my career moving in the right direction.  If I’m going to be able to do jobs that entail a certain amount of responsibility, and if I’m going to get out of a line of work that depends heavily on being project managed by others (allowing me to manage myself), I must develop the habit of consistency, and doing the things I promise I’m going to do, when I promise I’m going to do them.

So, that’s my thing, now. That’s my intention. I am spending time each day scoping out my day, and I spend time after the fact, recapping what I’ve done. It’s a lot more planning and assessment than I am accustomed to doing, and it’s been a real challenge at times. But this is non-negotiable. If I am going to live the life of an adult, rather than as a dependent child (and relying on constant supervision at work is a form of childish dependency), I’m going to have to bite the  bullet and just buckle down and do the work of managing myself. Actively, intentionally, deliberately. Consistently.

Either I swim with this, or I will sink. It’s that simple, really.

Duty to Warn: The Fort Hood Murders/Suicide and the Taboo Question

The Baltimore Chronicle has an interesting article by Gary G. Kohls, MD about the role of psychiatric medications in the Fort Hood incident. From the article:

Most of us have been listening to the massive, round-the-clock press coverage of the latest mass shooting incident at Fort Hood, Texas. Seemingly all the possible root causes of such a horrific act of violence have been raised and discussed. However, there is an elephant in the room, and it’s something that should be obvious in this age of the school shooter pandemic.

We should be outraged at the failure of the investigative journalists, the psychiatric professionals, the medical community and the military spokespersons who seem to be studiously avoiding the major factor that helps to explain these senseless acts. Why would someone unexpectedly, irrationally and randomly shoot up a school, a workplace or, in this case, an army post? Why would someone who used to be known as a seemingly rational person suddenly perpetrate a gruesome, irrational act of violence?

The answer to the question, as demonstrated again and again in so many of such recent acts of “senseless” violence, is brain- and behavior-altering drugs.

You can read the rest of it here.

I can see his point, and I think it is a good idea to factor in the potentially dangerous effects of psychoactive drugs. But I also believe there are many layers to this, the effect of drugs being only one of them. Something(s) else contributed to pushing the shooter to that point. And I’m not sure we can fairly lay all the blame at the feet of the pharmaceuticals industry.

Whatever the cause of the rampage, this issue of pharma-gone-bad is of particular interest to me, because as a multiple-TBI survivor with a bunch of cognitive-behavioral issues, it could be all too easy for a “qualified” doctor or neurologist or psychiatrist to load me up with a bunch of pills and send me on my way. I consider myself unbelievably fortunate and blessed to be working with a neuropsychologist who is very wary of pharmaceuticals and approaches them as a last resort, when all else fails. They are also very happy when I come up with alternative solutions to my issues that work well and do not involve drugs —  like exercising regularly as an antidote for fatigue and drowsiness and a way to wake up fully in the morning.

Interestingly, my psychotherapist tends to come down on the side of drug therapies for individuals with attentional difficulties. I may have to cut them loose, if they turn out to start pressuring me to resort to drugs. If they so much as start hinting at me using them, simply because other approaches “don’t appear to work as effectively” I may have to have to reconsider working with them and seek help elsewhere. Who knows? I may even cut out the psychotherapy completely.

Hard to say, at this point. I think it’s been helping me in some ways… no, I’m pretty sure it has.

But I have been growing a little more leery of my shrink, over the past month or so. They seem more distant than they did at the start. They also have said some things to me over the past couple of sessions that don’t sit right with me, but I haven’t actually followed up on. I should probably do that, to clear the air. It’s hard for me to spend the time and money with someone who I think doesn’t believe me, or seems to be insinuating that I’m misrepresenting my difficulties to the rest of the world. I’m not sure if they think I’m worse off than I appear to be, or if they are just having a hard time, themself.

To be fair, they did suffer a devastating personal loss, last year about this time, so I think it may be messing with their head a little bit. They have definitely not been at their best, of late. So, I’ll cut them some slack, give it some more time, slow things down, and not let them pull any punches with me. We’ll see how it goes.

Bottom line (if there is one) is… mental health care providers can have problems, too. And those problems can get to them in some pretty serious ways.  I’m just glad my shrink isn’t trained in small arms — I’m assuming they aren’t — and that they don’t work in an environment where the use of firearms is part of the job.