Triage on the battlefield of life

From Wikipedia:

Triage (pronounced /ˈtriɑʒ/) is a process of prioritizing patients based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately. The term comes from the French verb trier, meaning to separate, sort, sift or select.[1] There are two types of triage: simple and advanced.[2] The outcome may result in determining the order and priority of emergency treatment, the order and priority of emergency transport, or the transport destination for the patient, based upon the special needs of the patient or the balancing of patient distribution in a mass-casualty setting.

Some days, it seems like everyone is dying. Lying wounded on the battlefield of life and gasping for breath.

Along come the doctors to decide — who lives, who dies. Who gets to wait and see.

They sift through the sheer volume of us… separating, sorting, selecting who will receive a portion of their insufficient resources.

What is our order?

What is our priority of emergency treatment?

How and when and to where shall we be transported?

Where are we going, anyway?

Truly, it seems as though all of this country is in a mass-casualty setting.

Triage continues.

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.

The downward spiral of fatigue

It’s wild – it starts with the best of intentions. It’s exciting… very exciting to life my life, to go-go-go, to do lots of things and get tons of stuff done.

But if I don’t watch myself, I can get into trouble pretty quickly. If/when I get over-tired (and at the rate I tend to to, it’s usually a question of when I’ll get over-tired, versus if that will happen), a downward spiral starts in, that just won’t quit, till I start to rattle and shake like the USS Enterprise being pushed through an asteroid field at full speed. (And I hear Scotty yelling, “Cap’n, she’s breakin’ up! I can’t give ‘er anymore!“) I question my sanity, my ability to cope, my ability to live, and I’m exhibiting symptoms that someone who doesn’t know better would interpret as mental illness.

It’s not mental illness, per se. It’s my brain acting strangely under abnormally taxing conditions.

Here’s how things steadily go downhill…

The Downward Spiral of Agitation and Fatigue

And before I know it, I’m in trouble. I’m angry, I’m emotionally volatile, I’m raging, I’m blowing up at people, I’m melting down into a pile of quivering agitation, I’m irrational, I’m over-reactive, I’m hyper-active, I’m everything I know I should not be, but I am powerless to prevent it.

Also, I am in pain. Not just the muscular/skeletal pain that comes from over-exertion, but the surface pain that comes from fatigue, that makes everything hurt, from my clothing to human touch. It’s awful, and there’s nothing to do to stop it, when it’s full-on.  Advil doesn’t help. Only sleep does — days and days of extra sleep.

The thing is (the pain aside), a lot of the behavioral problems that come up are a result of how I perceive myself in relation to the rest of the world. Yes, I’m emotionally volatile. Yes, I’m losing it when I should be keeing cool, but it’s not so much that I am in trouble over things I’m doing — the real trouble happens and I get bent out of shape, when I misinterpret what I’m doing. I assume that because I’m having problems keeping things straight in my head and I’ve gotten turned around, that I’m screwing up (yet again) and I’m a mess, I’m broken, I’m damaged, I’ll never amount to anything, yada-yada-yada-yada-yada-yada-yada-yada-yada… an unbelievable amount of agitation results, which feeds back into the insomnia/fatigue loop. And that just makes my behavioral issues worse.

I’ve been seeing this more and more, lately, as my sleeping habits have deteriorated. They truly have. It’s been very fun and exciting to do things late into the night (as in, after 10 p.m.), but it’s cost me dearly, in terms of peace of mind, not to mention being able to deal effectively with increasing demands and challenges.

Stop the madness!

Seriously.

So, I have re-prioritized rest. I’ve bumped it up to the top of the heap. And I’ve made some small but important adjustments in how I do my work, so I have a better handle on things.

Objectively speaking, I’ve actually been dealing with some of the challenges and demands quite well — but because I’m so tired, I can’t really accurately assess how well I’m doing. So, when I feel like I’m having trouble, I assume I’m not doing well at all… and my successes are nearly lost on me. Unless someone can talk me through them. Like my spouse or my neuropsych.

Speaking of my neuropsych, I had a really great meeting with them  last night (thank heavens), on the spur of the moment. I was in town, they were in town, they had an opening in their schedule, and I had a sudden cancellation on mine. So, we managed to meet for a few hours. And after checking in with them about some recent experiences that had thrown me for a loop, I realized that I had actually done extremely well under very demanding and challenging circumstances. The biggest hurdle in all of it, was me being so tired that I couldn’t think clearly about what had really happened that was good.

I was so tired, nothing seemed good. But it actually was. So, my neuropsych talked me back from the brink of despair. And then I went home and  got to bed at a decent hour — 9:30 p.m., thank you very much! — and I woke on my own after 8 solid hours.

Wonder of wonders.

And suddenly, the world looked a lot better. The “mental illness” subsided, my mood disorder cleared up, my crappy attitude and biting self-criticism subsided, and I was able to get on with my life. Like a normal person.

And I’m back on track with watching myself more closely than I had been, taking my issues one at a time through the course of each day, and addressing the real underlying problems when they come up, so I can get on with my life, despite them. I’ve refined my daily log for what I have planned and what I really do. I’ve become quite diligent about keeping notes on my daily activities, and now I’m furthering that even more with a better kind of journal that helps me a lot.  Tracking my activities and the results is one sure way to see how I’m doing, from day to day. My brain will tell me any number of things about how I’m doing — many of which may in fact be untrue. But if I’ve got my notes, I can see for myself how I’m doing.

Onward…

Keeping up with keeping up

As time goes on, it never ceases to amaze me, how easy it is for me to be pulled off track in all sorts of directions. Distraction is a huge trap with me, and the cumulative effects can be pretty brutal.

I start out knowing I want to get from Point A to Point B. But all around me, there are tons of distractions… Little things I think are important, but really aren’t… Big things that may be important, but are keeping me from focusing on reaching my ultimate goal, one step at a time.

I start out wanting to go from Point A to Point B… but those other things look so interesting… and I end up getting pulled in all sorts of different directions.

And sometimes I never get to Point B. It’s just not good.

So, what I have to do, is just block out everything outside my main goal, and focus exclusively on that. I can’t afford to be distracted, I can’t afford to be pulled off in different directions.

I have to keep myself involved and invested in what I’m doing with myself, so I don’t get pulled all over creation, chasing after this and that and the other thing.

But how? How do I build a proverbial wall around the things I’m working on, to keep focused and involved?

I’m still working on that, but one of the things that works for me, is resisting the urge to go off and do something else, when I feel as though I have just completed a task, and I want to change up the pace.

I say “feel as though I have just completed a task” because a lot of times, I’ll get the sense that I’m done with something, when I’m really not. There are extra details that are left hanging. Loose ends that need to be tied up. But in my constantly restless brain, I get antsy, and I get pulled off into other things. I tell myself I’ll come back to what I was working on later, when I’m more rested and relaxed.

The thing is, when I’m antsy, I tend to get pushed into high gear, which has me frantically doing the distraction-thing (like picking up some other piece of work that’s pretty involved), and in the process of distracting myself from my prior agitation, I fatigue myself even more, and I become even more prone to distraction and poor attention.

Which sets me waaaaay back. It’s not good.

This impulse control business is just nuts… And the attentional issues… oh, please. It’s just too much, sometimes. If I’m not careful, I’ll end up ranging far and wide, thinking I’m being productive… and I’ll get nothing done in the process. It’s a downward spiral of worsening distractions and increasing workload. Crazy. Crazy-making.

So, what I’ve been doing lately, which has been working out really well for me, is when I’m done with a very demanding task which has either upset me or tired me out, I’ll just step away and take a break for a few minutes. Gather myself back in, catch my breath… and then I’ll go back to following up on what I was just working on before. I’ll write up my notes from the experience, highlight the lessons I can find, and I’ll mark any follow-up items that need to be done.

I have to do this right away — or I will forget the things that are important, which need following up. If I wait, I am lost. And it’s no good trying to reconstruct the experience, days — even weeks — later. My brain thinks I can do it, but it’s wrong. I can’t.

I also have to keep a calendar pretty carefully, showing what I’ve worked on in the past. I have to not only keep a calendar of what I need to do in the future, but also keep one for what I’ve done, so I can keep track of the balls I have in the air. I tend to literally forget what I’m working on, and then I get distracted and wander off in all directions.

A retrospective calendar is key for me. Without it, I get into real trouble. And it needs to be in monthly format — with 4-5 rows of 7 squares, one for each day of the week — so it’s more visually meaningful for me.

Keeping up with keeping up is not always easy. And it requires specific tools and techniques:

  • Sticking with tasks until they have been completely followed up on.
  • Taking breaks when I am tired, and always coming back to what I was doing before.
  • Planning my time carefully, with an eye to what I need to accomplish.
  • Keeping a calendar for my past and my future, so I don’t forget what I’m supposed to be working on.

The most important technique of all? Keeping in mind the possibility that I might be forgetting something, and I might be letting something slide… and doing a reality-check to make sure I’m correct. I can check my notes, I can talk to people, I can consult my project list. Whatever I do, I dare not forget that I’ve got things going on.

The main thing is, not to give up. Not to quit. Not to abandon the job before it’s done. And to remember, my brain might be telling me I’m good to go, long before that’s the case.

Working TBI issues one at a time

Traumatic Brain Injury issues do not have to sideline you and disqualify you from a productive and satisfying life. There is a way to address your own particular issues, even if your issues are unlike those you hear others talking about. Despite multiple TBIs, starting in early childhood, I have been dealing with recurring concussion/head injury issues regularly and very successfully for years. I have not received any formal rehabilitation, until about a year ago. It’s helping immensely, but I wasn’t “dead in the water” before I connected with my neuropsych. Through trial and error and a whole lot of hard work and practice, I’ve figured out how to make it in the world, TBIs and all.

For me, successful recovery is more about your method and techniques, than it is about treating a specific symptom. Everybody’s symptoms are different. What we have in common is the nature of our injuries — our brains have been hurt, and they don’t behave the way they used to, anymore. It’s confusing and frustrating and overwhelming, and it is really tempting to give up.

A lot of time, I hear people who have been affected by TBI (both survivors and friends/family members) say that when it comes to dealing with TBI, they just don’t know where to start. So, they settle for less of a life than they should/could have.

It’s true – it is hard to know where to start. The brain affects every single aspect of our experience, cognitively, behaviorally, physically… you name it, the brain is involved. And when the brain is injured, then you’ve got problems.

Without a doubt.

What I have found particularly helpful is a daily practice that is sort of along the lines of Give Back Orlando’s approach. It’s not always easy, and it can be time-consuming, but without it, I’d be sunk. Here’s how I handle my issues and manage my life:

  1. Each day, I write down the things I want to accomplish. The things I want to do. The things that will make my life worth living. I write it all down in a list format on the blank side of a piece of 8-1/2×11 scrap paper (I’ve got tons of that), and I put checkboxes beside each item. I also write down the times I want to get them done, if time is important (like an appointment or a deadline). I mark the most important ones with yellow highlighter, so I don’t miss them.
  2. I take this list with me as I go through my day. I use it to keep myself on track and remember what I am supposed to be doing.
  3. If/when I accomplish something, I put a check-mark in the checkbox I drew beside the item and I make a note about why it worked out (like “I was focused” or “I HAD to get this done”).
  4. If I did not accomplish something on my list, or it got totally screwed up, I put an X in the checkbox and I make a note about why it got screwed up (like “I was too tired,” or “I ran out of time because I was impulsively doing other things”).
  5. Either during the day or later on, I take different colored highlighters and mark the checkboxes of the things I got done with green. I mark the checkboxes of the things that got messed up with pink (I hate pink). And I mark the checkboxes of the things that didn’t happen through no fault or doing of my own with orange.
  6. At the end of the day — or on the morning of the following day, if I am too tired the night before — I sit down with the list and look at how I did. I make notes on the paper about what caused me to mess up. I think about what my day was like and I think about how I could have done things differently.
  7. I also make a point of learning about the parts of the brain that manage those things I have trouble with, and throughout the course of my days, I exercise those parts by doing those things in enjoyable ways, so the affected parts work better when I’m doing necessary things I’m not that keen about. For example, I have had a lot of trouble reading and comprehending what I read, since my last accident in 2004. To get myself back on track, I practice reading things I really enjoy and get my blood pumping — like action adventure thrillers and magazine articles about things that fascinate me, and books about current subjects that others are talking about. Malcom Gladwell is a great one to read, because he’s a great storyteller, and so many people have read his best-selling books. I can discuss what I’ve read from him with just about anyone, and they (unknowingly) help me remember and process what I’ve read. The trick with this, is to make sure I don’t wear myself out. I can tire myself out quickly by being too consumed by activities that fascinate me, and when I’m tired, it introduces a whole other set of complications.
  8. When I am putting together my list of activities for the next day, I make a point of referring to my lists from the past days, seeing what was derailing me, and figuring out coping strategies for how to handle my new set of activities. Failure is not an option for me, and some things MUST be done well, or they should not be done at all.

It’s an ongoing process, and it’s become part of my everyday routine. It is extra work, but oh, how it pays off!

It has taken me some time to get this system together in a way that works for me. Give Back Orlando’s approach is excellent, but I needed to tweak some things for my own purposes. I need to be a bit less rigid with how I manage my time, than they appear to be — I understand the need for holding to a schedule, but I have to be more flexible, because that is how my daily professional life goes — it’s a stream of constant interruptions that keep me on my toes. Having my list nearby all the time helps. I also put it into my computer at work, so I am tracking my progress throughout the day.

I am also more expansive than Give Back Orlando with my explanations for why things messed up. Fatigue and exhaustion factor in very strongly for me, as does anxiety, so I focus on them pretty intently.

But no matter what the differences between me and GBO, the approach is more or less the same — decide how you want to live your life, and then figure out what issues are keeping you from accomplishing what you want to accomplish. Address those issues on a case-by-case basis, watch for emerging patterns. Learn about the things that are holding you back. And never, ever, every give up working at achieving what you want to achieve.

(Speaking of Malcom Gladwell, in his book “Outliers” he talks about how you need to do something for 10,000 hours in order to get really good. Regardless of innate talent, people who do what they do for 10,000 hours are consistently better than people who practice/do less. So, it looks like true success is really a matter of time. I’ve got time — it’s one thing I do have!)

If you do your daily planning and analysis and remediation regularly and with intention, and you believe that you are capable of change in your life, I truly believe that (no matter what anybody else has to say) you can overcome the cognitive-behavioral and physical pitfalls of traumatic brain injury. You do not have to abandon your hopes and dreams and settle for less in your life.

You just have to figure out what you want to do, be determined to do it, and work your ass off to get there.

The MTBI Downward Spiral

I’ve written before about how ignorance and narrow-mindedness produce greater disability than injuries alone.

TBI related issues like increased distractability, lower thresholds for anger, and sleep disruptions, the cascade of behavioral and logistical effects can create subtle cracks in the foundation of your everyday life, which ultimately compromise your ability to get on with your life in a mature and responsible fashion, even your physical and mental health.

Here’s how you can get into trouble, thanks to a TBI:

  • TBIs have a nasty way of slowing down your thought processing speed.
  • Sleep disruptions have a nasty way of resulting in increased agitation and distractabilty.
  • Increased distractability can lead to “careless mistakes”.
  • These can lead to arguments with others.
  • Arguments can escalate if your flashpoint threshold is low.
  • A low anger flashpoint threshold can become even more explosive if you’re tired and not thinking well.

For example — say a guy with a wife and two kids and a good job is in a car accident and smacks his head against the car window. I’ll call him (Car Accident Guy.) He’s knocked out for a few minutes, and when he comes to, the EMTs take him to hospital, check him out, determine there’s no serious damage, and turn him loose. He goes  home and lies down for a while, then the next day he’s up and at ’em again, ready to get on with his life and just relieved he wasn’t hurt worse in the accident.

He seems fine to everyone at home and at work — the only problem is, all of a sudden, he can’t seem to do the simplest things — like going to the store. Or completing a job his boss assigned to him. He keeps getting distracted by the simplest things, and when his wife sends him to the store to pick up milk and bread and his prescription refill, he ends up coming home with milk and eggs and shampoo, instead. In the process, he runs out of his daily dose of blood pressure medication, and his wife is upset, impatient and pissed off at him.

His wife tries to overlook his forgetfulness at first, but after a while, she starts to get pretty fed up with this guy. They quarrel and bicker, and he becomes nastier and nastier when they fight. He takes it out on his kids, too, yelling at them when they do things like turn the t.v. up too loud or come home late for dinner.  His wife’s patience gets shorter and shorter, and she feels like she has to double-check everything he does. He used to be so reliable, but now he’s just not trying… What’s wrong with him?

At work, things are getting tougher, too. Car Accident Guy’s boss has been noticing how he’s not delivering results when he promises he will. The reports are late. The analysis is incomplete. And he’s started making stupid mistakes he doesn’t even catch till someone brings them to his attention. Even when folks do show him how he screwed up, he’s contentious and argues about it, and his relationships with his co-workers seems caught in a downward spiral. His boss tries to talk to him, but he can’t seem to sit still in their meetings, and he keeps changing the subject or talking about other stuff that has nothing to do with what they’re there to discuss.

All the while,  Car Accident Guy has been missing his daily blood pressure dose, and his BP has been climbing — especially when he’s angry. He seems even more angry than usual, in fact, and his wife finally prevails on him to see his doctor. When he goes to the doctor, his blood pressure is way out of control, and his doc becomes very upset with him for not taking his daily dose. The doc considers him non-compliant and lectures him, and Car Accident Guy takes issue with his tone and snaps back at him. The doc, who has had a long day and isn’t in the mood for this crap, puts him on notice that he’d better clean up his act, or else. Car Accident Guy is immediately sorry for the tone he took with the doctor, and he apologizes and promises to do better. Feeling self-conscious, he tries to listen to the doctor and get what the doc is saying, but he can’t seem to focus, and he loses the piece about needing to schedule a stress test in six weeks. He takes the new BP med prescription from his doctor and puts it in his shirt pocket — but he’s distracted by what the doc is saying to him, so he isn’t actually aware of which pocket he put the script in.

Done with the appointment, he sails out of the office, forgetting to make the appointment for the stress test, trying like crazy to recall — from memory — the exact content of the his visit, so he can be sure to get himself back on track.

When he gets home, his wife asks him how the appointment was, and he has trouble remembering. He tells her it was okay, but when she asks him what the doctor said, he can’t remember exactly, so he avoids her question. She senses he’s covering something, and she’s concerned that there’s something seriously wrong with him that he’s not telling her. She becomes anxious and starts to press him for details, which he cannot recall exactly. He snaps back at her, and the conversation escalates to yet another argument.

Exhausted and frustrated, he stomps off to bed, tosses his clothes in the hamper, and sleeps the rest of the day. While he’s sleeping, his wife does a load of laundry — including the shirt with the prescription in the front pocket.

When he wakes up, Car Accident Guy remembers he needs to take his BP meds, and he also remembers he needs to get his new prescription. He can’t remember where he put the script, exactly, but it must be in the clothes he was wearing at the doc’s office. Unfortunately, his shirt and pants have gone through the laundry, and the prescription is in soggy tatters in the washer. Furious with himself and furious with his wife, Car Accident Guy flies into a rage and verbally attacks his wife, his kids, anyone who is nearby. He drives off in the car, calling his doctor on his cell phone for a new script.

The doctor is noticeably irritated, and he thinks Car Accident Guy is not committed to taking care of himself. He writes another script and faxes it to the pharmacy, so his patient can pick it up. Car Accident Guy thanks the doctor and heads to the pharmacy, but on the way there, he’s distracted by a yard sale along the road. He pulls over and spends an hour and a bunch of money buying some pieces of furniture he doesn’t really need, but that look nice and are available for a good price.

He loads the furniture in his car and heads home. When he gets there, his wife is still angry with him, and she’s packing to go to her mother’s house with the kids. In the meantime, his anger has completely dissipated, and he doesn’t understand what she’s still angry about. He also can’t understand why she isn’t pleased with the bargains he found. She asks him where his prescription is.

“Prescription?” he asks…

That’s more or less a cause-and-effect narrative of what can happen, just from a couple “simple” problems like sleep disruption, distractability, and lower anger thresholds — all of which are common in TBI. Even MTBI (supposedly “mild”) can produce life-wrecking after-effects. Believe me. I’ve lived it. I know. Car Accident Guy’s story is not terribly different from my own, though my own circumstances are different — still, the types of problems mulitiple MTBIs have brought me are not that different from these.

It’s eerily easy to end up in a downward slide — in no small part due to sleep issues, which contribute to distractability, which contributes to frustration, which contributes to lowered anger flashpoints.

But in the same vein, being aware of the issues up front, makes it eerily easy to avoid situations like this.

Getting enough sleep is a start. Being mindful of your energy level is another. Keeping notes about what you need to do is yet another. And stopping to check in with yourself and double-check your work is yet another.

TBI, even mild traumatic brain injury, can totally screw up your life. The good news is, it doesn’t have to.

Anger Notes: From mountain to molehill

I had a little difficulty this morning, getting into the day. I go through the same routine every day — wake up slowly… give myself time to wake up enough to get out of the bed without tripping or falling… get up and brush my teeth… go downstairs to put water on for coffee… do my morning workout while I am waiting for my coffee water to boil… think about what I need to accomplish today while I am working out… finish my workout and make my coffee and cereal… and then get into my morning.

Most days, if I have had enough rest, the routine goes like clockwork. But I recently started lifting heavier weights, and I also had a chiro adjustment yesterday, so I’m a little sore and stiff, and I need to get more sleep. Under normal conditions, getting the 7 hours that I had last night would make me very, very happy. I actually slept through till the sun was coming up! And I would feel like enough. But I am still recovering from staying out all night on New Year’s Eve last week, and I need to get even more rest than usual, so I can get back to my regular sleep schedule and get over being stiff and sore from the increased weight and also the adjustment I got yesterday.

Now, for most people, being behind on their sleep and having a little stiffness and soreness in the morning is no big deal. For a lot of people, it’s actually a way of life. They don’t get totally thrown off by lack of sleep. They just muddle through the day somehow. They don’t get all tweaked and freaked out over every little thing, with hair-trigger temper outbursts over every little thing. They just go through their day, like it’s no big deal. And they live their lives like everything is relatively normal, popping Advil or Aleve or having a few drinks at the end of the day to chill out and sleeping in, in the morning.

The people who don’t have issues with sleep deprivation and pain clearly are neurologically intact. They probably have not sustained traumatic brain injuries. They probably don’t have post-concussive syndrome, and they probably haven’t sustained brain trauma/head injury.

I, on the other hand, am not in that “space.” When I am behind on my sleep, it introduces a whole host of issues that make the most basic activities into challenges. When I am in physical discomfort, I tend to push myself even more, perhaps because doing that relieves the discomfort for me. But pushing myself tires me out even more. And when I get over-tired, I have a hard time relaxing and going to sleep… which makes me even more tired in the morning. And then I have all sorts of cognitive-behavioral problems. It’s a vicious cycle that’s very difficult to break.

That’s that cycle that started with me last night. I should have gone to bed around 9:30, but then I had some stuff to do, and I needed to talk to my spouse, who was out at a late meeting till 9:30. By the time they got home, I was ready to go to bed, but the sleepy part of me didn’t want to go to bed, so I stayed up and talked with them about this-and-that.

Finally, they packed me off to bed, seeing that I was pretty much wedged into the couch, and I was making myself comfortable for a long stay-up. It was 10:30, by then, and it took a focused, concentrated, concerted effort on both our parts to get me up off the couch and upstairs to bed. Then — being as tired and as contrary as I was — I stood in front of the bathroom mirror and inspected myself, studying my double chin and looking for gray hairs and trying to make my hair stand up straight by tousseling it and trying to spike it straight out from my scalp. I know, it’s strange. But this is the kind of stuff I do when I’m really, really tired and I don’t want to go to bed.

After about 15-20 minutes of this… and deciding that yes, I am still a handsome individual with good bone structure and not to much saggy skin in the wrong places… I finally got my ass in bed. Then I remembered I needed to stretch and take Advil (my bedtime routine), so I can better relax. I did that, and I then did my progressive relaxation exercises to get myself to sleep, which went really well — even better than I expected. I got to sleep around 11 p.m.

Happily, I slept through till 6 a.m., which is a wonder, because I’ve been waking up around 4-4:30 or so — which sucks — and that felt pretty good. I gave myself some time to wake up, before I got out of the bed. If I roll out of bed right away, I tend to stagger around a lot, which is loud and also a little dangerous. There are plenty of hard surfaces and sharp corners I can hit my head on. Plus, my spouse doesn’t like to be woken up by my clunking around, bumping into stuff — which happens, when I get up too quickly.

I got myself up and started getting into the day. But man, I was clumsy this morning, right from the start. I had trouble holding my toothbrush, had trouble holding onto the water spigot, and it was really really getting to me. I am definitely foggier and more out of it this morning than I’ve been in a while. It’s probably due to the adjustment I had yesterday — the chiro went pretty deep.  And when I’m foggy and clumsy and out of it, I get really, really agitated. Every little thing gets to me, and I have a harder time with those spikes of anger that come up when things go wrong for me. They seem to come out of nowhere, and when they show up, they can be intense — and the intensity makes them even more confusing and frustrating (and damaging) because my mind knows that my reaction to what is happening is wildly out of proportion to what is going on, and I feel like something is terribly wrong with me, that I feel this way. And I start in with calling myself all sorts of names, telling myself I’m a damaged idiot loser who can’t keep their shit together, etc. etc. ad nauseum.

I’ve written about this temper flare stuff before in my posts Flash in the (brain) pan and A constant restlessness (and elsewhere), and it still holds as true as ever.  And this morning, when I was just trying to brush my friggin’ teeth, already,  I could not seem to keep my act together. I had trouble holding the toothbrush, and when I put it down on its rest, something about how it was positioned bothered me intensely. Then I tried to turn off the water, and my hand slipped, and I hit the side of my hand on the edge of the spigot, which hurt.

And that old temper flare jumped out again, like Old Faithful… that geyser that comes up regularly at Yellowstone. Or maybe a better analogy would be, like one of the geysers that erupts periodically without warning. Tori Amos has an album I love called “Little Earthquakes”. Maybe I’ll do an album called “Little Geysers.”

Anyway, for a few minutes, as I stood there nursing my aching hand, I was

absolutely furious!!!!

It was all I could do to keep myself from hitting something or slamming something down. I was angry with the spigot for having hard edges. I was angry with my hand for being so weak that a little bump would hurt so much. I was angry with myself for being so uncoordinated and not being able to simply turn off the water like a normal person would. But most of all, I was angry with myself for getting so bent out of shape over something so simple. “I know better,” I told myself. “Why can’t I act better?

I was really getting whacked-out over this, and it literally threatened to derail my morning. When I get going like this, I descend down into a pit of ugliness, and the whole day can be tainted by my temper outbursts, whether they are internal or external. In fact, sometimes the worst ones are internal, that no one but me sees or hears or knows about, which makes my crabby, short-tempered behavior all the more confusing for people around me. It makes no sense to them — how could it? They don’t know what I’m experiencing, and I’m doing everything in my power to shield them from that.

I could feel that rush of anger, that temper flare, that wild spike of emotion… it tore through me like one of those microbursts I’ve seen on the Weather Channel… and I was starting to get freaked out… and go into one of those wild rages that’s like a forest fire tearing through my head.

Then I checked myself. Something in me — the something that has been observing myself with increasing knowledge of TBI over the past few years — told me to take a break and just give myself time to catch up with myself.

So, I stopped and took a breath and thought about what was happening. And when I took a break from my downward slide, I realized:

  1. I am still tired. I did not get enough sleep, and I am groggy.
  2. When I am groggy, my neuropsych has told me that I am more prone to agitation.
  3. When I am groggy, I also can be uncoordinated. I don’t need a trained expert to tell me this. I have observed it countless times.
  4. When I am uncoordinated, I tend to bump into things.
  5. When I am groggy, I tend to propel myself through events on adrenalin — because I need an extra “pump” of energy — energy I  don’t have from regular sources (like getting enough rest). When I’m fatigued, I have to pump myself up just to do the basic stuff… because otherwise I can’t get going.
  6. When I pump myself up, I move faster.
  7. When I move faster, and I am uncoordinated, I hit things with greater force than I would, if I were rested and had full motor control.
  8. When I’m fatigued, my brain’s constant restlessness and agitation is worse, it makes me snappier and more extreme in my reactions. I am also more physically sensitive, and I feel everything more intensely.
  9. And finally, I remembered — from what I’ve read and what I’ve been told by my neuropsych — this type of reaction from me is actually quite typical of TBI survivors. It’s just what my brain does, when it has to operate on too little sleep/energy.

So, there it was –this drama I was experiencing, standing in front of the bathroom sink, freaking out over hitting my hand on the spigot had everything to do with my brain/body AND it had NOTHING TO DO WITH ME.  It wasn’t me being an asshole loser who’s emotionally inept and a worthless use of space. It was just my brain and body doing what they did, when I am tired and out of it and I am moving too fast.

I did NOT need to make a big deal out of it — just recognize what was happening… And I also realized that it was actually my brain sending me warning signals about what was amiss in my day, thus far. I recognized that this little snap of mine was like a gift from the gods — a hint about where I was at, that day, which I could use to inform the rest of my day to make better choices.

I also realized that if I didn’t take steps to stop this flash in my brain-pan, I was going to start the day on a really BAD note. Temper flares with TBI survivors tend to be quick-on, quick-off affairs, instantaneously coming up out of nowhere and disappearing just as instantaneously for no apparent reason. I realized I just needed to occupy my attention long enough for my system to calm down, and then I could get on with my day.

So, I took action. I kicked into gear and did something with all that agitation and energy — I channeled it into a constructive activity. I looked at the spigot that I’d hit my hand on, and I realized that it was slippery with soap on the handle. I studied the handle and felt where the slippery soap was, then I ran the water and rinsed off the handle, until it wasn’t slippery anymore. That made me feel a lot better. Then I dried my hands and went downstairs to make my breakfast.

Again, I had more trouble with uncoordinated blunders downstairs. I was off-balance and I was clumsy, getting my coffee stuff together. But I remembered what I’d noticed upstairs — I’m tired. I’m uncoordinated. This is not about me, it’s about my brain and body. When I am this tired, it’s perfectly normal — for me — to be agitated and restless and make mountains out of molehills. But it has nothing to do with me and my character… Forget about the supposed stupidity and ineptness and all those other words I use to attack myself. It’s about my slightly broken brain which has trouble when it’s tired, and I know what I can do to make it better — take it easy, take things slow, don’t push myself like crazy, and cut myself a friggin’ break, already.

So, that’s what I did. And by the time I got done with my workout, my day had re-booted nice and fresh. I’m still tired, but I’m not wiped out like I could be, because I made changes to how I was doing things. I had a good solid workout, and I lifted shorter sets with fewer reps, because I realized my body needed to catch up with the heavier weights. I also focused more on my exercise — I had been letting my mind wander more, over the past week or so — and I didn’t lose track of where I was with my workout, like I had been, in the past few days. And as I was planning my day, I made a point of scheduling just a fraction of the number of activities I’m prone to schedule for my day, which takes the pressure off, right off the bat.

AND instead of checking email from friends first thing in the morning, as I’ve been doing for the past few weeks, I am waiting till later in the day to do that, because there is a lot I need to get done, and I cannot be distracted from the work that’s waiting for me to finish it.

All in all, even though the day started out on a rough note, it was for the best.

Because I stopped and thought about what was happening. I learned about the experience as it was happening. And I used my tools. I used the info I got from my neuropsych, and I used the knowledge I had of myself. I used the opportunity to stop and think to really appreciate what was going on with me. I cut my brain and body a break.

I am also planning to lie down for a nap later today. I’m working remotely, plus the weather is not good right now. I can get a lot done, if I focus on what I’m doing. And with the appreciation of how tired I am, I can make the extra effort to take care of myself, take my time at what I’m doing, and manage my energy with intention and discipline.

All because I stopped for a moment and thought about what was really going on with me.

This is progress.