Brain injury comes in a number of different “flavors”, but it affects us in very similar ways

Brain injury is a brain injury, and as much as we may say “each brain is different, each injury is different,” we still need to look at the ways that each kind of injury is similar to others. And the experiences we have can be quite similar.

Loneliness, isolation, confusion, not feeling like yourself, getting angry quickly, mood swings, and let’s not forget the bone-crushing fatigue and the embarrassment that comes from not being the person you used to be… They are all things brain injury survivors have in common, and it’s helpful to actually treat people accordingly.

I honestly don’t understand why more emphasis isn’t placed on the experience of brain injury. That’s what trips us up, quite frankly. That’s the thing that makes our recoveries so much harder — the experiences we have and the effects those experiences have on our selves, our Sense-of-Self.

Well, that’s why I’m here. To speak up for those of us who tend to get stuck in our post-BI experiences, and need to see there’s actually a way out… Because there is. There is always hope — even in the most dire cases. Nobody can tell me different. That’s just how we’re built — to amaze… to heal… to grow… to learn. And learn some more.

Here’s a quick summary of the different types of brain injury:

Acquired Brain Injury (ABI)

includes things like stroke and anoxic (being without oxygen) brain injury. Some consider traumatic brain injury to be an acquired brain injury, because it “is damage to the brain that was not present at birth and is non-progressive” (See The ABI Manual for more). Personally, I wouldn’t call it “non-progressive”, but everyone’s experience is different.

ABI Resources:

Stroke

happens either when a clot blocks blood flow in the brain (called “Ischemic” stroke) or a blood vessel pops and there’s a brain bleed (called “Hemorrhagic” stroke)

Stroke Resources

Traumatic Brain Injury (TBI)

is related to trauma to the brain that comes from a fall, an attack, a sports injury, or an accident.

TBI Resources:

Concussion

is what people often call a “mild” TBI. Concussions are sometimes considered less serious than traumatic brain injuries, and a lot of people consider a TBI that clears up after a while, to be a Concussion.

Concussion Resources:

 

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My last decent vacation in a good long time…

open book with a landscape scene in the pages
The way life goes, you never know how things will shape up. I’ve had so many hopes and dreams over the years, and so many times, I’ve been on the verge of really breaking through… then something happened. And that “something” was often a TBI.

I was just getting my act together in elementary school, finding my footing with my peers and getting involved in a special program for “gifted” kids and discovering what worked for me, when I got hit on the head and things changed. I became combative. Difficult. A behavior problem. So much for the gifted program. They showed me to the door on that one.

My family relocated, and I was finally figuring out how to interact with the people around me (who all talked with thick accents I could barely understand). Then I fell out of a tree and wrenched my neck. And I kept hitting my head while playing sports. Football. Soccer. Just playing outside. Hitting my head was routine. I can remember a number of really significant blows to my skull that disrupted my consciousness, but they happened against a backdrop of regular clunks on the head. It seemed like every time I got on my feet and started feeling like I had a grip on my life, I’d get hurt (again), and I’d be back at square one.

I eventually got out of my parents’ house and got on with my life. When I drank a lot, I fell down — a lot. I may have (probably) hit my head a bunch of times, but I don’t remember much from the 4-5 years after I left my parents’ home.  Those years that could have been some of my best (and in some ways, they were). They could have been years of exploration and learning and experience like no other, but instead they were mired in the muck of hangovers and all the confusion that comes from not knowing what happened the night before. A few scrapes with the law… being ostracized by my peers… some violent confrontations… making money by borderline means, just to get by… it was definitely an experience — that’s for sure. But it took me years to recover from the damage I did to myself.

After I was in the working world, driving to work each day, I got in a bunch of car accidents. They weren’t huge deals, mostly just fender-benders, but whiplash and getting clunked on the head didn’t help matters any. During years when most of my peers were getting on their feet, finding their way in the world, I was scrambling. Trying to catch up, after being set back. I got a job, then got hit by a speeding door-to-door salesman. I left that job without saying why. Just left one day and never went back. I relocated to a really great city, but just before moving, I got rear-ended and spent the next several months in a manic haze.

Years later, I had a pretty decent job with a lot of responsibility, then got tangled up in a 7-car pileup, and everything fell to pieces there, too. That worked out okay in the end, because I found a much better job and a completely different career track, but it did a number on my self-confidence, and it caused me to pass up a golden opportunity that my new manager laid at my feet (and begged me to take). I can only imagine how much more stable my life would be now, had I actually taken them up on it.

The last and most debilitating TBI was when I fell down a flight of stairs at the end of 2004. I was just 18 months away from having some investments mature, and if I’d been able to hang in there and keep up with my life, I could have repaired and paid off my house, gotten rid of my debt, and really solved a lot of logistical problems that are the kinds of things that only money will solve. None of that got solved. It all fell apart. And it’s taken me 12+ years go piece it all back together to just a semblance of how things once were.

So, what does this have to do with my current vacation (which is now drawing to a close)?

In the course of my life, I’ve never known just when everything would fall to sh*t. It’s partly me being oblivious, partly me not having a reliable crystal ball that lets me peer into the future. So, all those times when I just assumed I’d have time to do this, that, or the other thing… all those times when I thought I was set… all those times when I didn’t pay attention to what was Right In Front Of Me… in so many cases, they were the last hurrah for that part of my life. The last shred of self-confidence. The last vestiges of feeling competent. The last months of feeling like I could actually plan my future with certainty. The last weeks of being able to take certain things (like how my brain worked or how I’d react to experiences) for granted.

I didn’t savor those things when they happened, because I was too damn’ optimistic. Too oblivious to just how sh*tty life could get for me. Not experienced enough to realize that things could get That Much Harder for me in a moment’s time. I took them for granted. I didn’t wring every last bit of goodness out of them, while the goodness lasted. And now I just look back on a lot of wasted opportunities and chances I totally missed enjoying… all because I thought there would be another time that would be somehow better.

I don’t believe that anymore.

Especially not this morning.

From here on out, my vacations will probably be a lot more work than relaxation, a lot more frustrating than renewing, and a lot less worth it to me. But they’ll continue. Life goes on. Sh*t gets complicated. So it goes.

For today, I’m just going to enjoy myself. Because this might just be as good as it ever gets.

I have the next week OFF

beach with ocean and "relax" drawn in the sand
Soon…

I’m leaving for a week’s vacation today. I have a handful of errands to run before we can get on the road, and then we are heading out to a waterfront town that’s full of art galleries and novelties shops and all sorts of great restaurants. We have a few restaurants that we really like, but mostly we avoid the crowds and excitement, buy Mexican or Chinese takeout and head for the beach for our own waterfront dining. It’s the best way — sitting in the car right at the edge of the water, having a nice filling meal that doesn’t cost a million bucks.

It’s going to be nice to get away. It’ll give me time to think, time to relax. I realize that I’ve been stuck in limbo with my life for some time. There’s been all kinds of drama in my immediate and extended family for the past 15 years — actually, longer than that. More like 40 years. And it’s really dragged me down, watching everyone go through their problems — me included.

But now, here I am, at a place in my life where I just don’t feel like I have the time to fritter away on feeling terrible about things that I can just take care of. I’ve learned a whole lot about how to deal with my TBI issues, and I’ve made an amazing recovery. So why not enjoy it?

Why not, indeed? I feel like I’m at a point in my life where I’ve learned more than enough hard lessons, I’ve been through my make-or-break circumstances, and I’ve made it through. I’ve paid my dues. Now it’s time to just enjoy my membership.

It’s funny… I don’t tend to think of myself as that old. I’m really not. But I have been knockin’ around on this planet for over half a century, and I’m kind of over the whole newbie experience. I’m not a newbie. I’ve been around the block plenty of times. And it’s about time I just settled into living my life and enjoying it, instead of constantly pushing myself to “take it to the next level”.

Please. What next level? No matter how hard I work, no matter how hard I push, there will always be another level ahead of me. So, why not just settle in and get the most out of the levels I reach? I haven’t done nearly enough of that over the years. And while it does keep me sharp and invested in my life, it’s also depleting and drags me down.

Eh, whatever. I’m going on vacation. I’ll probably blog a bit while I’m there. Just relax into it, do some writing, have a good time, while I’m at it.

And now… it’s time for more errands, as I prep for my 7-day escape.

Onward.!

Seeing my skills for what they are – and aren’t

moon shining on tree in fieldI’ve been “back and forth” about my job, for the past few months. One week, I love it. The next, I hate it and can’t wait to get away. I supposedly got a sort of “promotion” a few weeks ago — more responsibility and more influence, but no more money. Doesn’t seem to be much of a promotion, right? My boss is making bad decisions and is pushing me to put their ideas into action. It’s pretty much of a train wreck, with all the people at the top fighting over their territory, making their minions represent them.

Ridiculous. I don’t agree with any of it. But somehow I’m supposed to make it happen?

The only benefit: it makes the situation crystal clear — I really need to get the heck out of that situation, brush up my technical skills, put my resume out there, and get ready to move after the new year. I actually have some old projects I’ve been wanting to revive, and now seems like a great time to do it.

I tend to have a pretty low opinion of myself, mainly because I know what else is possible, and I’m very clear about how far I fall short. Plus, always being tired, my self-esteem really suffers. Like today. I’m just not feeling that capable or worthwhile…

Except for something that happened last night.

I was on my way home from a meetup in a nearby city, and as I was rolling through the dark countryside, I saw a bunch of cars stopped ahead of me. I was coming up to a tricky intersection, where a hidden road crosses at the bottom of a long, gradual hill. The tail lights of the cars ahead of me weren’t moving, there seemed to be smoke in the air, and I could see people standing in the road farther up the hill, so I slowed down and pulled over, just to figure out what was going on.

When I took a closer look (I was pretty tired), I saw there was a car sitting in the middle of the road with its wheels splayed and its front-end crushed in. The interior was full of smoke, and the whole thing was shrouded in a gray cloud. I was worried at first about there being a fire and the vehicle blowing up — I’ve seen too many movies, I guess. But I couldn’t just sit there. It didn’t look like anyone was helping, yet.

I walked closer to the wreck – carefully. There was glass everywhere. Pieces of car. Rear view mirrors. Chrome and plastic. Halfway up the hill, I could see another car lying on its roof in the darkness. It wasn’t smoking. It was just sitting there, eerily motionless, as people gathered quietly around it.

The vehicle nearest me at the bottom of the hill was a tangled wreck. Once upon a time, it looked like it had been a pretty sweet Mustang. No more. The airbags were shredded. Drawing closer, I could hear voices. I could hear a woman’s voice and a man’s, so I knew someone was alive. I lifted up the “curtain” of limp airbag that was hanging over the driver side window, and behind it there was a driver with is face smashed in and blood all over him, talking to a woman on the remote assistance intercom — like those Northstar systems that come with cars to help you unlock your doors or call for help. The woman was talking to him like he was coherent, but he was really messed up. He clearly had a head injury, his movements were jerky and automatic — like I’ve been a number of times after getting clocked on the head. She kept asking him questions, and he was responding like he knew what he was talking about. He didn’t. He was in bad shape.

Beside him, there was a passenger whose left leg was bent weirdly. No wonder. The car’s engine had been pushed back practically into his lap. I didn’t get a close look at the other guy — who was talking a bit, too — because I was focused on just talking to the lady. And others had come over to help and were checking him out. I talked to the lady on the intercom, told her what I was seeing, and reported what others were seeing about the other guy.

I also “talked down” the guys in the car, who were trying to get out. The driver kept reaching down beside his seat for something, but I told him to stay putDon’t move. Help was on the way. The interior of the car reeked of alcohol, and one of the other bystanders who was helping said she’d seen drugs beside the seat.

The local first responders were there within minutes. The accident was just a few miles from the local fire station, and when the fire truck pulled up, I told the firemen what I knew. They were on it, and I got out of their way. Then I got back in my car and moved on.

When everyone else stood at a distance, I stepped up.

When everyone else couldn’t communicate and keep things in order, I could.

When a couple of seriously injured people were on the verge of potentially hurting themselves more, I kept them safe and kept things steady.

I’ve been in these kinds of situations a number of times. A co-worked who collapsed and was unresponsive… someone who’d fallen and hit their head… an elderly person who had a bad reaction to a medical trial they were participating in… a person pinned between their car and a fence, when they didn’t put it properly in park… I’ve come across those people who were badly injured or hurt enough that they couldn’t help themselves, and I’ve been there for them, till help came. Several times I’ve run for help, myself.

It’s what I do. It’s one of the things I do best.

And for all the foolishness that’s taking place at work, at least I know this is something I do. Handling reality. Dealing with a true emergencies.

And I need to remember that, as I navigate this scene at work… finding a path out… figuring out what’s next. There are some things I do better than just about anybody else. They’re just not part of my job description, right now.

After #TBI – Don’t depend on your brain’s weak systems

hand holding pen, checking off lists on a checklist
Getting stuff done… one thing at a time.

From the Give Back summary of how to fix your brain… This is something I have to constantly remind myself. It’s a hard one, because I hate to think of my system as being weak — or weakened. But that’s exactly what’s happened. And the thinking systems that have been weakened have been permanently altered. So, I need to always keep this in mind. When I forget it, I suffer. And so does my work and my relationships. My whole life starts to go downhill.

3. Don’t depend on your brain’s weak systems for organizing and memory to manage your time and your activities.

  • Get your brain to use your full intelligence to plan your day thoughtfully, a day ahead of time, when you can think everything through well.

It’s practically impossible for me to do this a day ahead of time, because things can change so rapidly with me. From day to day, I don’t always know what’s “coming down the pike”. Stuff changes rapidly — plans change, weather changes, people change their minds about what they’re going to do.

But that doesn’t mean I can’t plan in other ways. The best way for me to do this is break it up — look at my next day plan on the afternoon / evening before… and then check in with myself first thing in the morning. And keep track of things throughout the course of each day. Track it.

  • Write that plan down on a schedule form so that you take no chances of forgetting what you need to do.

Scheduling things has become a lost cause, in general, because things are so unpredictable at work and at home. So, I have a standard list format that I use.

[ ] Thing I need to do

[ ] Really important thing I need to do (I use a yellow highligher)

[/] Thing I am in the process of doing or have started

[x] Thing I have done (I have a green marker to track the things I’ve completed)

–> [ ] Thing I needed to do today, but didn’t get to, so I need to do it tomorrow. (I use an orange marker to make it stand out)

I try to keep a running list of things that I “carry over” from one day to the next. I’ll copy my –>[ ] items onto lists for later days. That way, I can keep track of everything I need to complete.

  • Develop the habit of writing plans and following them, and soon you will be in total control of your time and your productivity.

I agree. The habit of writing out plans and following them (as best I can) has done wonders for my ability to get things done, as well as my self-confidence. I have a support system that works for me. And when I use it (which I admit is not consistent enough), it really helps offload a lot of the mental grunt work, to save my brain for more interesting and important (and challenging) things.

If there had to be one thing I’ve done that’s helped me get back to the level of functioning I’m at now, it’s developing lists and systems around lists, that let me do what needs to be done without having to think too much about how to do it all. Coming up with a ‘standard operating procedure’ for just about everything — from getting up in the morning and going to work, to taking down the Christmas decorations — has made me a whole lot more functional than I ever was, when I was just going with the flow or winging it.

Lists are my friend. They can be yours, too.

Onward.

1. Know that you have a new brain, one that can work well once it is reprogrammed.

hand holding magnifying glass over brain, which is made up of gearsOne of the things I really appreciate about the  Give Back Orlando materials is that they don’t sugar-coat TBI recovery, but they also don’t make it into a “accept your new normal” approach, where you have to resign yourself to everything being so much worse than before. The core message is that you can improve… provided you make some specific changes in how you live your life.

The first change is:

  1. Know that you have a new brain, one that can work well once it is reprogrammed.
    • It needs to be reprogrammed because your old programs don’t run quite right on your new brain.
    • Help yourself to keep this fact in mind as you go through your day.

When we’re very young, we come into the world with the capacity to create a whole lot of synapses — connections in the brain that carry information. Over time, our synapses are “pruned”, as our brain refines its ways of doing and understanding things. By the time we get past adolescence, a lot more connections have been pruned than we had, just 10 years earlier.

It’s been said that one of the things that “gets you” after TBI, is that you may have lost a bunch of the connections you really depended on… and that’s a loss.

But here’s the thing, see? If we have “neuroplasticity”, we can create new connections to take the place of the ones we’ve lost. That, to me, is the essence of TBI recovery.

Granted, there may be parts of the brain that are so damaged that there’s no repairing them by present means. Maybe sometime on down the line, but not right now. But the brain is an amazing thing, and we can create a lot more connections than people used to think we could. In fact, the old ways of understanding the brain — that you can’t repair it, if it’s injured… that only certain parts are used for specific activities… that damage is permanent — those old ways have been disproved.

It’s not true.

What IS true, is that with regular practice and the right approach, the brain can be “reconditioned” to perform at, near, or even better than levels you had before.

But you have to realize that change has to happen. You have to deliberately create those new synapses, those new connections, those new ways of your brain functioning. You can’t keep doing things the same way as before, over and over.

You have to realize you have a new brain.

And you have to keep reminding yourself of that, through the course of each day.

It’s like trying to run a Windows 10 program on Windows 3.1 (remember that? I do). It’s just not going to work. Not because Windows 3.1 was so much worse. It was good for what it did. It’s just that the “gears” work differently now.

And you have to accept that fact.

I’m not talking about accepting it because it’s a sad fact that life is going to be so much worse.

I AM talking about accepting it, so that your life can get so much better.

Big difference.

So, that first step is the best kind of acceptance of all.

Again:

  1. Know that you have a new brain, one that can work well once it is reprogrammed.
    • It needs to be reprogrammed because your old programs don’t run quite right on your new brain.
    • Help yourself to keep this fact in mind as you go through your day.

From Give Back (Orlando): Summary of How You Fix Your Brain (after #TBI)

merry go round with city in backgroundI’m dusting off my old Give Back Orlando materials and taking another closer look at them. Since I’m back to being on my own — but this time with a whole lot more context, as well as a whole lot more experience and a history of actual support. I’ve made amazing progress over the past 10 years, and now the page turns in the chapter of my book.

I’m not sure a book is the right comparison, though. It’s more like a merry-go-round that slowly turns in cycles, while I ride the highs and lows. Yep, it’s exactly like that — a merry-go-round. Except, it’s not always a lot of fun. Then again, with my vertigo and nausea, merry-go-rounds stopped being fun for me, a while back. So, maybe that’s about right, after all.

Back to basics… I repeatedly come back to basics in this work. And it is work. It’s continuous, regular process that really has to be a way of life for it to actually take hold. I’m incredibly fortunate that I’ve found the supports I’ve had along the way. And Give Back Orlando was one of the first resources I found that helped me so much. My old neuropsych used to tell me how impressed they were at my progress, and I have to credit Give Back for much of that.

Heck, just knowing that it’s possible to recover, that there are others who have been through it and are just getting on with their lives — or doing better than ever… that’s huge. It was a major turnaround for me, when I first read their Models of Exceptional Adaptation in Recovery After Traumatic Brain Injury: A Case Series. To say that was life-changing is an understatement. It gave me incredible hope and a positive outlook that has stood me in good stead for the past 10 years.

Here are the basic tenets of the Give Back approach. If you’re struggling with TBI, I strongly encourage you to consider these – as well as the resources here.

  1. Know that you have a new brain, one that can work well once it is reprogrammed.
    • It needs to be reprogrammed because your old programs don’t run quite right on your new brain.
    • Help yourself to keep this fact in mind as you go through your day.

     

  2. Since your old habits don’t quite work well enough, you need to TAKE CONTROL of your brain and get it to think through the things you are going to do.
    • Your BRAIN no longer does its job well enough on automatic pilot.
    • Now, your MIND has to make sure it does its job properly, whenever you do anything in which the results are important.
    • Any time you need your actions or your words to have quality, your mind has to make sure that your brain produces quality at every step.
    • It’s as if your mind now has to be the boss.
    • You need to be MINDFUL so that you can be an effective boss.

     

  3. Don’t depend on your brain’s weak systems for organizing and memory to manage your time and your activities.
    • Get your brain to use your full intelligence to plan your day thoughtfully, a day ahead of time, when you can think everything through well.
    • Write that plan down on a schedule form so that you take no chances of forgetting what you need to do.
    • Develop the habit of writing plans and following them, and soon you will be in total control of your time and your productivity.

     

  4. Learn how your new brain works by studying your head-injured moments.
    • If you study them carefully, they will teach you a great deal about your new brain.
    • The more you become an expert on your new brain, the better you will be able to make it do what you want it to do.

     

  5. By analyzing your head injured moments, you will realize that you make most of your mistakes when you are not mentally prepared.
    • By writing a good daily plan, and by warning yourself whenever you are about to get into a situation in which you tend to make mistakes, you will help yourself to become well prepared for almost everything.
    • As you do this, you will have fewer head-injured moments.

     

  6. Your analysis will teach you how often you get overloaded, what overloads you, and how overload affects your thinking and your ability to do things.
    • Once you know what overloads you, you will be in a position to plan to prevent it from happening.
    • This will make a big difference in reducing head-injured moments.

     

  7. Every time you discover another head-injured moment, that is another step toward recovery.
    • Celebrate the discovery, just like finding a twenty-dollar bill in the street.
    • Develop a great attitude about recognizing when your brain malfunctions, because that is what makes a great self-therapist.

     

  8. On the other hand, if you analyze a head-injured moment, it shouldn’t happen again.
    • If it does happen again, you should be ticked off at yourself.
    • What did I miss?
    • How could I let this happen to me?
    • I’m supposed to be in charge of these head-injured moments, and this one snuck right past me!
    • Figure out exactly what went wrong with your plan, and be determined to never let it happen again.

     

  9. Be sure to understand that fixing your brain is not like fixing your car.
    • This is an ongoing fix-it process.
    • Whenever something important in your life changes, the change creates a flurry of head-injured moments that need to be fixed.
    • Whenever something stresses you out or makes you ill, you have more head-injured moments.
    • As you do self-therapy, you will also discover new, unexpected and quirky head-injured moments, even after years of self-therapy.
    • So self-therapy is not a task. It’s a way of living.

     

If you live this way, you control your head injury and keep head-injured moments from interfering with your life, but if you slack off, the head-injured moments will be back.

So help yourself to welcome self-therapy as something good you do for yourself, and avoid thinking of it as a chore.

That will help you to make it a part of your life.

I probably would have been better off taking naps

I probably would have been better off taking naps

I’ve been thinking about all the time (and money) I’ve spent over the past year, working with the 2nd neuropsychologist… They responded back to my cancellation email saying “understood”. Actually, don’t think they do understand, but that’s neither here nor there. If they really understood, they’d offer me a refund for services-not-rendered, because to be honest, I’m not appreciably better off now, than I was a year ago April, when I started working with them.

If anything, I might actually be worse off, since they were pretty keen on telling me all the things I needed to look out for, and where my first NP was intent on getting me to not think of myself as disabled, the 2nd one was all about that.

Plus, they were all keen on telling me how badly off my spouse is, how I can expect them to go downhill sooner, rather than later, and getting them in for some testing, they could get help for their decreasing capacity.

Yeah, I’ve been through that before… again, with another “provider of services” for folks who can’t take care of themselves. I’ll be the first to admit that I can be gullible and overly trusting, especially when it comes to people in the “helping” business. I tend to take them at their word, which is how I want people to take me. But alas, it’s not always warranted.

Nor was my trust of this latest NP. Sure, they came highly recommended by the first NP, but I don’t think that old NP was a very astute judge of character. Plus, I think they have a tendency to be as trusting as I am. They spoke highly of a number of other clinicians over the years — but the ones they recommended were incredibly disrespectful of them behind their back. That does not fly with me. No way. No how. Not gonna work. And it never ceases to amaze me just what jerks people can be.

Well, anyway, I’ve gotten away from that bunch of jerks.

And again, I think back to all the hours and dollars I spent trying to stick with a program that wasn’t supported by others whose job it was to support me. I literally spent an extra 4-5 hours nearly every Monday night, along with untold hundreds of dollars, trying to make it work. Because I believed. Because I trusted. Because I was locked on a target that was incredibly important to me.

I would have been better off, just going home at a decent hour, getting some extra sleep, and spending the money on books and a new computer. I could have bought a lot of books — and a couple of really decent computers — with the money I spent on those sessions.

Well, live and learn, right? On the bright side, I did have some good times, here and there, and I did learn a few things along the way. So, it wasn’t a total waste of time and money. Just mostly.

And it has occurred to me that one of the big reasons I’ve flamed out at a number of jobs over the years is because of fatigue. Come to think of it, I believe that fatigue is the #1 Reason Things Have Gone South For Me At Work. Seriously. When I think back on all the jobs I’ve held that ended sooner than people expected me to leave, I always had a long commute, to and from the office. Over an hour each way – five days a week. The practice of working from home hadn’t shown up on the radar, yet, and I was still drawn to work in the city. I had to be on-site each and every day, surrounded by loud people, frantic situations, and all kinds of chaos. Even though I enjoyed a lot of it — fast-paced environments, and all that — it took a toll. It wore me out. And it took a huge chunk out of my resilience and ability to cope.

So, I had to leave.

Over and over again.

Sooner than I should have.

Some jobs, I left after only a few months. Others, I stayed nearly a year. Others, I hung in there for a few years, but got worse and worse off as time went on. Fatigued. Worn out. Confused. Turned around. Blown up and blown apart and wiped out, each and every weekend.

Fortunately, it’s not like that anymore. At least, with my current job, I can work from home 2-3 days a week. Sometimes I can even get a nap. And on the days when I do go into the office, I can go in at my own pace. Do a few conference calls from home, then drive in after 10:00, when the roads aren’t so clogged, and I can get where I’m going more easily. Evenings, I can go work out at the fitness center, then roll home after 6:00, when traffic is less. I should have done that last night, instead of trying to get home directly. I sat in horrible traffic for over an hour, total. Not a good use of time. I really should have worked out.

But again, lessons learned.

Next week I have another chance. Heck, I can even go work out this weekend, if I like. I really should. I need the strength work.

So, that’s my revelation for the day / week / month… I need my sleep and I have to take steps to make that happen for myself. Instead of forcing myself to make things work, taking up extra hours and energy (and fuel for the car) to wedge myself into a situation that’s not really working, I should do something truly constructive with my time and resources.

Sleep. Rest. Recoup. Regroup.

And just enjoy my life for what it is.

Where privilege, power, money, and influence fall off

1923 broken down car with wheel off
Sometimes, a wheel just comes off – I just wish I hadn’t “driven the car” longer than I had to

So, my life is morphing, and that’s okay. It’s good, actually. It’s a long time coming — a wake-up call, reminding me where I really fit in the grand scheme of things, and prompting me to “buck up” and take matters into my own hands.

Not be dependent on a system that’s inherently hostile to me, by design.

Take responsibility for my own situation, and do everything I can to advance my own cause, as well as support others who need similar help. That’s what this blog is all about — putting my own personal quest / journey out there, in hopes that others might just benefit from it as well.

Brain injury is woefully misunderstood. Brain injury rehab resources are irregular and over-hyped and work differently for many different kinds of people. Plus, they can be expensive and/or inaccessible to folks who aren’t rolling in money. So, this blog is intended to fill certain gaps that exist in the world — by design.

It’s been said several times by people on this blog (who have a history of involvement in the brain injury rehab field), that brain injury can be a “cash cow industry” that’s seen its share of fraud and exploitation. I can totally see how that can be — you’ve got patients who are impaired to various degrees (some of them severely), who can’t advocate for themselves. You’ve got friends and family and loved ones who know precious little about brain injury, what to expect, how to handle it, etc. And you’ve got an insurance infrastructure that will pay for some things, but not for others. Considering how vulnerable brain injury survivors are, it’s the perfect industry to get into, if you have no morals or ethics… or fear of burning in eternal hellfire and brimstone.

Even if you’re a good person with the best of intentions, keeping to the straight and narrow must be awfully difficult in that industry. My first neuropsych (NP) bucked the system for years, providing services to me at a discounted rate and submitting insurance claims with the billing codes that worked. The later NP apparently never mastered that skill. Either that, or they didn’t actually want to. They said they spent a lot of time fighting with the insurance companies, but it seems to me they didn’t explore every conceivable loophole available.

I just can’t get free of the belief that, if they’d wanted to find a way to help me at a sustainable level, they could have found it. Find a way or make a way. The fact that they didn’t, and then they charged me more to make up the difference… maybe that’s standard practice in the NP field, but that won’t fly with me.

So, the long and short of it is that here I am, on the business end of the rehab cattle prod — like so many others, removed from regular support because it’s overpriced, and I’m not paying market prices. Assigning market prices to services to vulnerable people seems… odd to me, anyway. Hell, having healthcare be market-driven strikes me as a complete departure from the way healthcare should be handled, anyway. Hospitals were often started by religious groups, and the concept of healthcare was expanded in the Roman Empire after Christianity became the official religion. So, there’s historically been a religious/spiritual element to healthcare.

Historically, that is. Over the past 50 years, perhaps because of the decline in religious fervor, it’s become more of a commodity. And healthcare, in my opinion, can be about the most predatory kind of market I can think of.

I mean, who makes their money off vulnerable people who have nowhere else to turn? Seriously… who does that?

Well, anyway, that’s pretty much how the world works, these days. Of course, there are healthcare providers who will step outside the standard-issue money-making paradigm and act as true healers. But those people can be few and far between. And I think it must be easy for young clinicians to fall into the dominant mindset of charging as much as possible for services rendered. Treating healthcare like a provider-consumer arrangement, where everybody is expected to be a “good consumer”.

That logic makes no sense to me at all. A few years ago, I wrote a post I am a shitty healthcare consumer, and it still holds true. I will never, ever be comfortable with the paradigm that reduces everyone in the healthcare equation to providers and consumers, as though sick and vulnerable people are actually in decent enough shape to “fulfill their role” and the power dynamics, privilege, and influence were equal.

That’s what that dynamic seems to expect — that doctors and patients are on equal footing. But we’re not. Not even close. They have the power, the knowledge, the influence, the ability to commit us against our will or prescribe treatments that no one else can. They hold the power over our lives and deaths, at times. They hold the proverbial keys to access to information and resources (diagnosis, meds and rehab, for example), which only they can wield in the public arena.

So, expecting patients to be “good consumers” is a stretch. It’s a stretch invented by people who don’t seem anywhere near aware of the inequities of power, influence, control, and knowledge. With great power comes great responsibility. Somewhere, things are falling down.

In my case, it fell down big-time.

My most recent NP knows:

  • I am the sole provider for my household
  • I have a dependent spouse who is unable to work regularly and is becoming increasingly disabled
  • I am being paid 20% less than originally promised, because my employer got acquired, and the new overlords don’t feel like paying out the bonuses I earned (which were included as part of my overall compensation)
  • I have specific challenges which make my day-to-day more difficult than they “should” be for someone with my base level of intelligence
  • I have no other reliable source of day-to-day support
  • Other people who try to help me, don’t have the level of expertise to understand the nature of my difficulties, so they mistake my neurological problems for psychological ones and try to treat me for that
  • I have to leave work early and drive a couple of extra hours each Monday to get to my sessions (which is a real hardship for me at times)
  • I have almost no retirement savings, thanks to the organizational problems after my mTBI in 2004
  • I have many house repairs to make, which will drain what savings I’ve managed to put aside, over the past 3 years. By the time the essential repairs are made, I will have no “safety net” left.

None of these issues are a problem for the NP. They are married to a fully employed spouse, they are on staff at one of the top hospitals in the nation. They teach at a big-ass university that’s one of the top schools on the planet. They have two offices in the same medical building. They live within a few miles of their office. They have the time and the money to take two weeks off to take their family to Paris and other points around the world. They have a PhD, and they present at professional conferences, as well as offer public education sessions. They’re in “thick” with some of the leaders in their field, being trained by some of the top docs. They’ve got a full roster of patients — a waiting list, in fact. And they’ve gotten rid of all their former clients who were on the type of insurance I have, because the insurance company won’t pay them their rate.

So, basically, they’re set.

And I would think, comparing their situation to mine, that they’d at least be able to cut me some slack. If I were in their shoes, I’d make an exception, because it can be done. One client out of tens doesn’t pay full price… big whoop. The difference is easily made up. I know, because I myself have been in many situations where I ran events where some people could pay full price, while others had to get a break. That’s just how things work in the world where I live — some have more money to contribute, while others have less money but other talents to add. You work a deal with people. You make the most of what they have, and if money isn’t one of those things, you find another way for them to contribute.

In this world, inequity abounds. What we do with our privilege and power says a lot about us as human beings. And if you apply the same measures indiscriminately across the board, expecting everyone to operate on your level and chip in the exact same amount of money as the next person, that’s not just unrealistic and unfair, to my mind, it’s unethical. It’s kind of shitty, actually.

So, yeah, I’m not bothering with that NP anymore. I’ve already deleted their contact details from my phone.

Maybe they meant to be shitty, maybe they didn’t. Maybe they’re just overwhelmed by their responsibilities.  Whatever. I don’t know what goes on the hearts and minds of others. But I do know that in the patient-doc dynamic, they were the one with the power, and they chose to use their power to disenfranchise me.

Screw that.

Screw them.

I’m just sorry I didn’t see this sooner.

I could have saved myself a lot of money, if I’d just moved on without giving them the benefit of the doubt.

Whatever.

Onward.

 

Taking a closer look – again

picture of person with a light swich on the side of their head and a hand reaching down to turn on the switchSo, I’ve been on this TBI recovery quest for about 10 years, and I’ve had some amazing results. The last neuropsych I worked with marveled at my progress. In 40 years, they had not seen anything like my recovery.

Well, of course not. They’d never worked with me.

The thing is, in all those years, I rarely had a very clear view of exactly what I was doing with that individual each week. Or why. I had my own ideas, of course, but I wasn’t fully aware, I wasn’t fully “online”, and I didn’t have the full capacity to really wrap my head around what all was happening, and why it mattered.

I just showed up each week (sometimes twice a week) and did what seemed appropriate.

Now things are much more stable with me, I’ve got a much better understanding of myself and “how I work”. I also have a good hindsight into what worked for me, and what didn’t.

So, it’s time to start digging in again… see what’s there.

My current neuropsych (NP) has decided to not drop me because of insurance. They actually seem to understand that there’s value in it for me, and I think there’s value in it for them. I suspect that my old NP had a talk with them (they keep in touch), and talked them out of dropping me. Either that, or they just didn’t give it a whole lot of thought before they made that decision.

Either way, we’re going to be working together for the foreseeable future – at least till the end of the year, anyway. And a big part of what we’re going to do, is study my past NP evaluations, to more fully understand what it is/was that I’ve been dealing with. It’s all been a little hazy to me, over the years, despite being so intent on learning more about my situation and working through it. I suppose there’s always opportunity to learn and grow – and I often don’t fully grasp what’s going on with me until years after the fact.

Well, it’s years after the fact. And I’ve got a much better understanding of what the deal is with me, how things are put together, how it affects me, and what I can do with that knowledge to make my life even better.

One of the big areas of focus with me is on my strengths. What do I have going for me, that I can use to offset the difficulties? What are the unique talents I bring to the table, that I can put to good use for myself and others?

This isn’t just about figuring out what’s wrong with me, so I can sit around and feel badly about myself. It’s about finding my relative weaknesses and then matching them up with my strengths, to do something useful with myself.

And take things to the next level.

This isn’t going to be easy, by any stretch, but it’s important work.

And it’s time to do it.

Onward.