Resources & Inspiration for Life with Brain Injury

One Thing At a Time – Being More Successful with an Injured Brain

by Linda W. Arms

A while back, I came across an article “10 Steps to Mindfulness” by Leo Babauto.   As I was reading it I realized it had many good tips for people in general but especially those with a brain injury.

After a brain injury, many things are difficult or impossible to do.   Instead of constantly attempting to do things as you did before and fail, realize that it’s best to focus on one thing at a time.   You will be more successful and be less frustrated.   After my TBI, I really did not have much choice but to approach everything slowly and methodically.   My brain did not allow me to do any more than that.    I realized that having 1 or 2 tasks (besides getting up, dressing, showering and eating) was often more than enough in one day.

Even today, I have to often step back and remove the multiple tasks I have before me.   I select a few that are most important and concentrate on doing them well.   When I have too much on my plate, I become easily overwhelmed, fatigued, clumsy and cannot move forward successfully.   Here are the first two steps from Babauto’s article:

  1. “Do one thing at a time. Single-task, don’t multi-task. When you’re pouring water, just pour water. When you’re eating, just eat. When you’re bathing, just bathe. Don’t try to knock off a few tasks while eating or bathing or driving. Zen proverb: “When walking, walk. When eating, eat.””
  2. “Do it slowly and deliberately. You can do one task at a time, but also rush that task. Instead, take your time, and move slowly. Make your actions deliberate, not rushed and random. It takes practice, but it helps you focus on the task.”

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It’s Your Choice

January 6, 2013

I just read an inspiring article I want to share with you.   First, I’d like to highlight this quote in the article.   It is from Brad Snyder, who was blinded in Afghanistan. “Choice — that word means a lot here,” said Snyder, 28, a former Navy bomb-disposal expert. “‘Choice’ puts everything on a level playing field. Each of us faces a plethora of daily choices — when to get up, what to eat for breakfast, what to say to your family before leaving for work. You can choose to be positive. Or you can choose to be a victim. “You can choose to move forward with grace. Or you can choose to succumb to negativity.” Please read the rest of the article, it is really good:   Alive Day – MSNBC.com

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New Beginnings

by Linda W. Arms

As we begin the new year, many of us think about our lives, the year ahead and make resolutions to improve.   I think many of us with TBI have another “new beginning” each year that causes us to contemplate our lives. That time of year is different for each of us, and it is the date of our accidents that caused our TBI. It’s probably a date that brings us sadness and a little more grieving for the person we used to be, but it’s also a date to consider the progress we have made in getting better and other things in our lives that are positive.

The door on who I was closed seven years ago on January 15. Although a lot of “me” came back, I’m also very different. That difference has brought several positive traits that I am grateful for. I’m more patient and not driven to perfection. I’m much more grateful for my family and friends who stayed in touch even when I couldn’t. I’m much more forgiving of imperfections in people around me. I have much more compassion for others.   I appreciate the simple things in life, I’ve learned to stop and smell the flowers because my brain doesn’t want to be filled with all those details it was capable of handling before. I’m happy……. and sometimes frustrated.  Sometimes I get frustrated when I can’t do things like I used to but those times are becoming less each year.

I’m grateful for the progress I’ve made in the last seven years and know that I’ll see more improvement this year, even if they are small things.  I’d like to share this posting from Facebook with you as you start the new year.   I received this by accident from someone I don’t know but I related to it because of my seasons of life associated with TBI. I do not know who the creator of this is so I can not give credit but thank you to whoever you are.   Click here to view Seasons of Life – THEN CLICK ON THE ARROW IN THE LOWER LEFT OF THE PICTURE TO START THE VIDEO.  Note that there are multiple pictures in the video, it moves through the pictures slowly so some of us with brain injuries can read it.

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Starting the New Year with Improvement in Mind – Remove Clutter

by Linda W. Arms

Even before my accident I would set news goals for myself when a new year started.   I continue to do that and would like to share some ideas with you.   All of us with injured brains need to make our lives as easy as possible.    A big part of this is to simplify our surroundings so we don’t have so many things to look at that make our brains work harder than they need to.   The more things around you, the harder it is to find what you need.   Too many pieces of paper, books, knickknacks, and other stuff on your desk makes it more difficult to function.   Too many things in your closet make it harder to figure out what to wear or to find what you are looking for.   Start your new year by eliminating that clutter.   Move things that you don’t use or hardly ever use out of the way so you don’t see it.   You will be more productive at your desk if you can focus on just a very few things at a time.    It will be easier to find your clothes and decide what to wear after you move things you don’t use out of your closet and drawers.    Each thing around us is a piece of information our brain has to deal with.   It has to process the visual input, it has to decide “is that what I want or am looking for”, it might have to decide that you have to pick something up and move it, and many other things.  Don’t make it harder on your brain than you need to.  By simplifying your surroundings you will reduce brain fatigue and be more successful.  So get started and get things out of your way!   I have to work on my space too, its gotten a little overwhelming again.

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Being Prepared During the Holidays

by Linda W. Arms

Since we’re still in the middle of the holiday season we all need to prepare ourselves to make it through the holidays without too much more fatigue or stress. We need to be ready for that party, dinner, driving to an unfamiliar place, or something else we may not often do. We also want to try to get some enjoyment out of it.  Here are some tips that work for me:

  1. Pace yourself – don’t commit to more than you can successfully handle. Give yourself a quiet day before going to that party or dinner.  Take a nap or just lay down and rest.
  2. Eat properly throughout the day to nourish your brain so it can do a better job for you. Drink recommended amounts of water.
  3. Determine how to get where you have to go before you leave.   I like doing this the day before so I can study the Google map and try to think about it for a while before I get on the street.  I even do a “street view” in Google Maps so I can be familiar with the area I’m travelling to.   My TBI resulted in me losing the map of where I’ve lived for the last 30 years and not having a good sense of direction anymore.
  4. Determine how much time you need to get there.   Give yourself some extra time since stressing causes an additional load on our brain which we want to avoid.   Write down what time you have to leave, what time you need to start getting ready.   I have trouble with time and remembering the numbers.   I write it down so I don’t have to re-think this 10 times before I go.
  5. Determine what you need to take with you or what you are going to wear.   Doing this well ahead of time saves that last-minute pressure that makes it difficult to function if you have a brain injury.
  6. Determine, in advance, your way out of the social situation or other activity if things are not going well for you.   You may need to find a ride home.   You may need to leave early before the dinner is over.   You may need to cancel before you even leave the house.   It’s good to let others know that you may have a problem and that you just have to escape before you can’t function well enough to get yourself back home safely.
  7. If you’re going to a new place for dinner, study the menu on the Internet before you go.   I found it very hard to focus on a new menu and figure out what to eat when I just couldn’t keep up with the busy restaurant environment and people at the table talking to me.   It’s easier to decide in advance if possible.
  8. Try to get a table in a quiet, less busy part of the restaurant.   I often get a table away from the hub-bub and I sit facing the wall so I don’t have to see the movement in the restaurant.   I sometimes asked the waiter to turn down the music.

The idea is to save brain energy so you can have a good time.

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The Kitty Bites!

Years 1 – 3, after the accident, I rarely went to stores and barely survived the shopping experience.   Years 4 – 5, shopping was less painful but I  realized I couldn’t interact with the clerks or others when they spoke to me about other things.   Year 6, my goal was to start saying something to the clerk and others while I was checking out or doing other shopping.   Just today, in year 7,  I discovered I’ve become quite assertive!   I spoke up when I felt I wasn’t being treated well as a customer.    I think I might have been a bit too blunt.   I guess the kitty bites!

The Year I Ran Away From Christmas

by Linda W. Arms, dated Dec. 20, 2012

Six years ago, in 2006,  I could not face Christmas at home as I did in my past.   In January of that year I had the accident that caused my TBI.   By December of that year, I had not made much progress in my recovery.   I could not face the Christmas decorations and products that I saw in stores already in October.   I would get tears in my eyes.   The difficulties I had just in being in a store became even worse because of the emotions that my brain was having to deal with.   I was OVERWHELMED  by the thought of putting up a tree, buying presents and doing any of the things I normally did in the past, including always having a big holiday get together  at my home.   I just couldn’t face it.   It just was not possible to be who I was before.   So I, my husband and daughter, ran away.

We went to a place I used to live growing up and that I have many fond memories of.  We went to Germany where Christmas is still celebrated in a much quieter style.   We stayed in a small village.   We bought a tiny tree about 12 inches tall with a few decorations already on it.    We enjoyed some very low-key events in this village that did not allow cars on many of its streets.   I could face Christmas here.   I did not have to try to be the person of my adult past.   I took many naps.  I could not count the money to pay for things.  I could not sort out many things I used to know about being there.  I leaned on my family.   Even with all these things in my way, it is still a wonderful memory that I have of this special time when we ran away from Christmas .   Today, six years later, Christmas is still much, much simpler compared to “before the accident” but I don’t feel I have to run away.   I am getting better in small doses.  I hope all of you are finding yourself better than last year. Have a Merry Christmas!

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A New Problem ???

I’ve mentioned before that noise is a problem for me.   It seems there is more to just noise than I realized.   I just started “trying” to listen to an audio book using my iPod earphones. I was on a plane where there were many others sounds and conversations.   Even though the sound coming through the earphones was very loud, I had a very difficult time focusing on what was said.   I had to close my eyes and really concentrate.   After a few moments I experienced something unusual where I felt there was a back and forth sensation going on in my head.   It’s the same kind of thing I feel when I try looking through binoculars.   What is this?   Have any of you noticed something like this?   The experience created a lot of fatigue for me which often includes my eyes watering a lot as if I’m crying.   It was not a great experience (but I’ll keep trying).

Pet Peeve – one of many

Those of you with TBI – what are your pet peeves when you are out and about in the world?  These are the things that get in your way of functioning well or cause your brain to go on overload pretty quickly.   One thing that really interferes with my ability to shop is the music that every store seems to have going.   It is just another thing my poor brain has to process as I find my way around the stores to locate what I need and select what I want.

In the early years after my TBI, I avoided stores as much as possible and often walked in and right back out, taking a nap when I got myself back home.  Even today, I often struggle to tune out the sound so I can think.  I still find myself just leaving the store and sometimes leaving behind the items I already put in my shopping cart.   I don’t want to have to work my brain so hard and it just doesn’t feel good.

Oh, and how about those nice sales people who try to help you and keep talking at you while you’re trying to think  about what it is you are trying to do.   I have frequently told sales people I just need some time to think by myself.   My husband has even intervened a few times when he sees me struggling with my need to think quietly about my shopping decision while the clerk keeps going with suggestions and questions.

 

Our Hearts, Lungs, Breasts But Not Our Brains

Why is it that many of our other body parts get so much attention from ourselves and the medical profession?   We get checkups, eliminate “bad” foods, exercise, and do other things to keep those parts in good working order as we age.   Most of us pay little attention to keeping our brain healthy.   Our brain is essential to our being alive and defining who we are.   We don’t spend a lot of time being  “brain aware”.      Whether you are a person with TBI or you do not have an injured brain, you need to take action to maintain and improve brain health.   I have collected a number of articles that give good advice on brain health for everyone.   Find out more on my page  Brain Health.

Holiday Challenges

Everyday can be challenging for someone with TBI but the holidays bring even more challenges.   We have to do a lot of extra things such as buying gifts, putting up decorations, and interacting with more people.   We have to maneuver around very busy stores and all the holiday hubbub on the roads and parking lots.   The holidays can also be an emotional time because we might think back to our past selves when we could do so much more.

TBI survivors and caregivers should take extra care during this time for rest, finding quiet spaces and doing less of what is expected during the holidays.   Those of us with TBI probably are much more settled and can enjoy this time better if we don’t have ALL those decorations all around us.   They are overwhelming for our poor brains to process.

You also need to learn to say no to some things.   I’ve turned down large family get-togethers in these past years because of all the challenges of interacting, a lot of noise and making your way through the groups of people.   And then, of course, we have to remember that when we over-do-it one day we have to pay for it the next.

Find ways to enjoy the holidays with quieter times and less “stuff” that ends up all around us.   Keep it simple and you’ll enjoy it more.

Noise!!!!

Noise – there was so much noise after my brain injury.   Just about everything became noise that I could not tolerate.   I could not listen to music, birds, the splashing sound of cars going through puddles, talking, TV,  and so much more that is all around us all the time.   After a few months I discovered that I could listen to and was actually soothed by listening to just the music on Deepak Chopra’s CD called Chakra Balancing: Mind, Body, And Soul Pt. 1.    I would listen to it on my iPod to keep the other sounds away.      It would sooth my jittery mind that often felt like I had butterflies or a wave motion going on in it.   Almost always I would fall asleep.   It was almost like a drug to calm me.   I’ve listened to it hundreds of times in the last years.    Gradually over the last 7 years my tolerance to sound has improved greatly.   I rarely spend time with pillows on my head or use my special earplugs to keep out background sound.

Brain Injury and the Vision System

by Linda W. Arms

Brain injuries often cause many problems with our vision system.   I’m not talking about a problem with the eye itself but about the work our brain does to allow us to see and interpret what we see.   Problems with our vision system cause or worsen many of the symptoms associated with brain injury such as fatigue, cognitive problems, balance problems, and coordination.    In all the testing and rehab efforts, our vision system is often overlooked and as a result, we continue to struggle to improve.   In my case, the problems with my vision system started being addressed after about 6 months but the final rehab effort did not occur until my 4th year into rehab.    I had a number of problems with my vision and I suspect they had some of the biggest impacts on the difficulties I had in functioning.

Damage to our visual systems cause problems such as:

  • Difficulty with eye movements
  • Double vision
  • Sensitivity to light
  • Reduction of visual field
  • Problems when shifting gaze from one thing to another
  • Difficulty focusing
  • Problems reading and comprehending what is read
  • Visual mid-line shift
  • Sensitivity to visually busy environments
  • Problems with walking and balance

If you are having problems like this, your brain must work extra hard to get you through your tasks which then causes even more fatigue.   Frequently a full comprehensive vision exam is not performed on people after a TBI and these problems are not identified.   I know I had to keep pushing to get my “eyes fixed”.   I went to 3 different specialists who each worked with different parts of my vision problems.    Today I only have the “discombobulated” sensation occasionally thanks to the various therapies.    I still cannot look through binoculars without my head wanting to shake.    I’m not perfect but a heck of a lot better than I was.

Testing for these vision problems is not routine after a TBI.    It is important to find someone who specializes in diagnosing and treating vision problems that result from a brain injury.    The military recently added these specialized tests in their polytrauma centers for TBI, however, testing is not the usual protocol for most TBI patients who do not end up in one of these types of centers.

The Center for Neuro Skills provides a good overview of visual problems associated with TBI:

http://www.neuroskills.com/brain-injury/post-trauma-vision-syndrome-1.php

http://www.neuroskills.com/brain-injury/post-trauma-vision-syndrome-2.php

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Things Not to Say to a Person with Brain Injury

I came across a blog recently about what not to say to people with brain injuries and I thought “how appropriate”.     Recovering from TBI is a challenge in SO MANY ways and its disheartening to hear certain comments from people.    Most people just don’t “get it”.     You look fine, you can speak, you can walk…   they just don’t know how hard it might be to speak and walk!     When someone told me “but you look fine”, it was like them telling me “there is nothing wrong with you”.    Or how about, “it’s what happens when you get older” – WHAT!   – did I age so much in a 24 hour period after I was hit on the head and I’ve been steadily “un-aging” for the last 7 years?   Then there was “it’s like a broken leg, you have to wait until it’s healed to run again” –  REALLY!   a broken brain is like a broken leg?

Here is what Dr. Rowland had to say in her blog 9 things NOT to say to someone with a brain injury

 

The Accident

The Accident

On January 15, 2006, my daughter and I were spending the Martin Luther King weekend in the mountains to ski and enjoy ourselves.   We decided to go to the ski area early so we’d be there close to when the lifts opened.  We planned to leave mid-day so we could rest up and go out for a nice dinner and not be too tired.

At around 9:30am, my daughter and I got on the ski lift with a man riding along with us.  There were 3 of us on the quad chair.  I sat to the far left, my daughter sat near the middle and the man sat on the far right.   We were getting close to the top of the lift and something hit my head.  It was a very hard hit and it felt like the top of my head was taken off because it felt like whatever hit me slid across the top of my head.  Also, when I was hit, my teeth were hit together several times as if whatever hit me vibrated on my head several times.  I did not know what hit me at the time.    The next thing I remember was lying on my back, my skis were off and my daughter was next to me looking very closely in my eyes.

I felt very cold and it felt like liquids were moving in my head (nose, face, around in my head).  My head hurt very badly.  It felt like it was burning and I thought it was bleeding.   I felt sick to my stomach but never vomited.  My daughter kept looking in my eyes and saying “Mom, stay with me”.  I think I just wanted to close my eyes.     I was very scared because I wasn’t really sure what happened and what condition I was in.    I actually thought I was going to die.  I cried because I was in pain and very scared.  I still did not know what happened.

Hope for TBI Awareness

After my brain injury in 2006, my husband and I looked for answers on how to recover from a brain injury.    There was not a lot of good information about TBI and treatment options.     As we looked for answers, even among my medical providers, we realized that TBI treatment and recovery was a challenge.

I am hopeful, however, that things are changing since 1 out of 5 veterans returned from Iraq and Afghanistan with a brain injury, and since the NFL and hockey teams are being challenged by players who have experienced brain injuries.     Because of them, we are seeing more TBI research and more awareness campaigns.   The US military has FINALLY acknowledged TBI and PTSD as a problem among returning veterans.   The sporting world is recognizing the dangers their players face when heads are injured.   But even with this new attention and awareness, brain injury is way behind in research and funding.   The TBI awareness campaigns just don’t get the attention compared with heart disease, breast cancer and other diseases.

According to the Centers for Disease Control and Prevention an estimated 1.7 million people sustain a TBI annually.

Of them:

  • 52,000 die,
  • 275,000 are hospitalized, and
  • 1.365 million, nearly 80%, are treated and released from an emergency department.
  • TBI is a contributing factor to a third (30.5%) of all injury-related deaths in the United States.
  • About 75% of TBIs that occur each year are concussions or other forms of mild traumatic brain injury (MTBI).
  • Direct medical costs and indirect costs of TBI, such as lost productivity, totaled an estimated $60 billion in the United States in 2000.

People still do not understand a brain injury until it happens to them or someone close to them.    People often believe someone with a brain injury is faking it.    Much more needs to be done for TBI.    March is TBI awareness month but comes and goes with little notice by most.   This needs to change.

 

The Birth of Mina Kitty

In January 2006, I was between two major milestones in my life.  I just turned 50 and was preparing to retire from my high stress job.  I was looking forward to retirement from being an information technology manager and ready to venture off in new directions.  I felt I was at my peak professionally and mentally.   I felt very healthy and strong.  I felt good about my personal life, my family, and my friends.  I was very driven, always wanting to be out and about.  I had prepared myself well and was ready to reach for new challenges.   I enjoyed hiking, skiing, sailing, diving and other activities which I felt I had never been better at than when I turned 50.   I felt so good and so much was going on and being planned on.  It was great!

On January 15, 2006, I faced an abrupt end to what I was.    I was suddenly toppled from what I thought to be my personal peak into a deep hole by a freak accident that left me a victim of traumatic brain injury.   That is when I became Mina Kitty.  I became someone who was always tired, walking around the house slowly, laying down a lot in different places in the house, taking naps, rarely leaving the house.    It was like being a house cat.  I felt like a house cat.   Before the accident, my husband sometimes called me Willie (short for Wilhelmine, my middle name).    But now Willie no longer fit.    My nickname was transformed to Mina, and Kitty was added for the house cat characteristics I now had.   I became Mina Kitty, birthdate – January 15, 2006.   I actually do “celebrate” it…..

 

The Gift

A while back,  I received an inspiring message from a friend.   It was a YouTube video by Louie Schwartzberg, an award-winning cinematographer and innovator in the world of time-lapse, nature, aerial and “slice-of-life” photography.   After watching the video it reminded me of “the gift” I was given as a result of my TBI.   I’ve shared a link to this video later in this post.

Nearly 7 years ago I suffered a traumatic brain injury.   Like most of you, I’ve had many problems as a result of the injury.   The accident took away things I can never get back.  On a personal basis many things are gone.  Professionally I lost everything in terms of income and my capabilities. The accident took away things I can never get back.   I keep improving, even now, but I don’t want to lose “the gift”.

Prior to the accident I could never have enough to do.    I was very driven and always wanted perfection in what I did and the people around me.    On January 15, 2006 my world changed but I was also given a gift that I am grateful for.    With much despair after the accident I worked hard to get better and I learned many things that are important.

For the first few years my thinking capabilities were very difficult.   I could describe it as cotton balls muffling everything in my brain, muffling my thinking; or as muddiness where the thick murkiness slowed everything in my head.    My view of the world became very telescopic.   I could only focus on a very small piece of what was before me.   Since my brain was now not cluttered with a million other thoughts, I saw the world very simply and was able to connect to the quietness and beauty of nature.   I could let the beauty of what I was seeing or feeling into my relatively empty brain and really experience it.

I learned to see and feel the quiet and healing of nature.   I watched butterflies, stared at flowers, felt the breeze, smelled the soil in my garden.   I enjoyed very simple things.   I saw and experienced many things most people around us are not capable of in our busy world.   I watched the blur of activity of other people racing around in their lives and I thought “they are not really living”.    They do not see our world.   I could not see or feel our world before my accident.   Although, in rare times, I stopped for a split second and saw the glimpse of a beautiful flower it was a fleeting, shallow experience.

As a result of TBI, I can truly feel and appreciate the beauty and comfort of nature.   I love viewing the nature around me, inhaling it, feeling it throughout me.   I love the silence of nature and am comforted by it.    I can sit and enjoy the sky, the birds or flowers or just feel myself exist and feel connected to the world around me.

It is a wonderful experience that I can now have as a result of my TBI.    I hope all of you can find a gift that you were given as a result of TBI and be grateful for it.

Let me share with you the video that inspired me to write post.   Once you are redirected to YouTube you will need to click on the video to start it.

http://tedxtalks.ted.com/video/TEDxSF-Louie-Schwartzberg-Grati

To My Medical and Legal Service Providers

I’ve come to you because my brain is injured.   I come to you because you specialize in services to brain injured people.   Why then do you have an office environment that causes me “pain”?   Music from the radio that was not tuned in  and filled with static.   Waiting rooms with way too much bright light!   Waiting rooms filled with tons of stuff (plants, knickknacks, and more stuff).   Confusing hallways to get to your provider’s office. Glass walls that don’t keep the chaos out.   Web sites that overwhelm with too much – words, fonts, moving components.    Why do you have office staff that talks way too fast, especially on the phone?   Why does your office staff  not call me back and, if they do,don’t try to simplify what it is I’m asking about?  Why don’t you take better care of me?

What’s Wrong with Mina Kitty?

Mina Kitty looks fine when you see her but after spending a few days with her you’ll start noticing that she’ll often seem weaker and off balance in the evenings.  She’s slower to get up out of the chair after spending a long meal talking to others, or slower getting out of the car and starting to walk after driving or being the passenger in a car.   Sometimes she’ll tip to the right side when just standing there or walking.   Those are just the small physical things you might see.

Mina Kitty’s biggest problem, however, is how her cognitive functions are working in her brain.  These are the things that control your speaking, understanding spoken and written words, seeing, memory, analyzing,  doing math,  handling emotions, noise, stress, illness…..      Your brain and how it works is the essence of who you are.   Once it becomes injured it can change many things about you.  Injuries can result in subtle little changes or in absolutely devastating, extremely disabling changes.

Whether you are a victim, caring family member, medical provider or you’re just interested in the story, I hope you come away with a greater awareness and understanding about this disability.

Who is Mina Kitty?

This story is written from my heart.  My brain is broken.  This is the story of a journey with an injured brain.

Who is Mina Kitty?   That’s a good question, one I’m working on.   My age is 56, but Mina Kitty came into being on January 15, 2006.   How can this be, you ask?    It’s because of the invisible injury over 5 million Americans live with after a traumatic brain injury.     I never expected anything like this to happen to me but it did and it changed my life – forever.

Disturbing Chaos

Early after my injury, I knew I was lost in the world.    I slept a lot, my world became very, very simple — all I could do was stare at the wall with no thoughts.    My life’s purpose and interests no longer existed.     I had to figure out how to exist and go on with my MILD traumatic brain injury.   This injury that caused the person I was to be gone.    I became Mina Kitty, a new life entity.   My purpose and interests in life stopped.  I had to learn how to just exist in the world around me.    The world around was chaotic and disturbing.   Motions, sounds, emotions, sights, concepts, music, birds singing, water splashing, music, things moving, family expressing, art displaying, opinion sharing, and so many other things became a very big burden.   Life became very difficult in many ways.

Trying to Exist in the World with TBI

Who am I?   Our existence is fragile.   After a brain injury you try to find your old self.   You look for who you were physically, mentally, emotionally, intellectually, professionally.  You look for your worth as a person in all aspects of your life.      Most of the time, in the early stages after a brain injury, you work hard to live your life but its at a much lower level of existence depending on the extent of your injury.     As all this is going on, life is changing around you, inevitably your environment changes.      Some of the changes are a result of life and the world just going on without you, some of it is a result your injury has had on others and the world you knew.