Friday, October 16, 2009

Head injury

As I mention in my description of myself, I sustained a head injury in 2001. I was lucky enough to survive. This piece is posted on the Brain Injury Association website but is worth reprinting here. It tells, roughly, the story of what happened.

My Time in the Dreamtime, Or, A Head Injury Victim’s Recovery and Adventures
By Alan Borer

It all started with a dream.

It was a most peculiar dream. I was in my grandparents’ home in tiny New Riegel, Ohio. I was there, out of money, needed something. But the dream dragged on. I knew somehow it was a dream, and that sooner or later I would wake up. But I didn’t. It just went on and on.
That may have been when I realized I was coming out of a coma.

Another dream from which I couldn’t awaken. I was in a rolling wheat field and needed to have the wheat cut. But no one seemed able to help me. The wheat field was pleasant but there was something unnatural about the too-blue sky. Again I seemed to be stuck in the dream, and it went on and on.

By then, I was aware that I had a tracheotomy. Nurses cleaned it twice a day. The process was a little painful towards the end, and it made my breathing a little, shall we say, odd.

I had an idea that I was in one hospital and then moved to another. That may be a fitful memory of one of my transfers between the hospital, a bad nursing home, and the rehab hospital in Green Springs. I was in the coma for almost four moths between the end of July, and my fitful, not entirely understood awakening, which happened slowly for the days around November 15.
During that time, I have no real memory of what was going on. In reality, my memory of July even before the accident is gone. I’ve thought since then, maybe this will be what dying is like: no memory of what happened, but still existing in an altered state.

I know from hearsay that I had a bicycle accident on July 27. A stick got caught in one of my spokes, and I was thrown head over heels over the handlebars. Surprisingly, I was not rendered unconscious at the time of the accident, but my consciousness slipped away through the evening and I entered a world of no dreams, no nightmares.

I had a “closed head injury,” a term was going to hear a lot of in the coming months. Instead of cracking my head open and allowing the blood to pour out freely, I bled more dangerously inside the closed skull. To fix it, my head was cut open like a ripe watermelon and the pressure was relieved and clots were removed.

When consciousness returned, I was aware mainly of the tracheotomy, but there were other things wrong. I could not speak. I was being fed through a tube winding its way into my stomach. I could not feel the pressure of the pillow on my skull. My left hand was rendered a clawed, enfeebled mess. And I had no idea how I was relieving myself. In a way, my first act of recovery was being able to turn from the left side to the right side to allow the aides to change the sheets when I wet the bed. I was grateful for the clean sheets.

I was receiving therapy six times per day. Two sessions of speech therapy, (which was laughable since I couldn’t talk), two sessions of occupational therapy (which mainly consisted of moving one jar of beans to another, or doing agonizingly slow jigsaw puzzles), and two sessions of physical therapy. The PT sessions were the most challenging and in some ways the most difficult. There were warm-up exercises for every session, manipulation of my limbs by a therapist, and best or worst of all, walking. The PT aides dragged me, four at a time, round and round the building, even while I was still comatose. Later, after I woke up, I was able to do it with two or one at a time. The PT gang was led by W, who was very helpful, and a girl with a gorgeous figure, whose name I no longer remember. They pushed and prodded me into such recovery as I accomplished.

I spent many long hours in PT. Half the room was given to outpatient rehab, but I was usually assisted by the inpatient group. As my recovery stretched into December, there were constant offerings of Christmas music. I didn’t exactly enjoy this, but hearing the staff gossip about who was doing or getting what for Christmas kept the dreams away. It helped me remember that a world, and a holiday world at that, was going on outside my walls.

My girlfriend urged me to go to a holiday concert put on by the local high school choir. This was fun, and was the first time that hearing music was not sadness to me. We also had a visit from Santa Claus one evening. I much appreciated this although a tube feeder like me could not partake of the orange he gave me. But it was a nice thought, anyhow. Another time, carolers walked the halls. Very young children, kindergarteners maybe. I wish I could tell them now how much I enjoyed their visit.

I’m afraid I treated my girlfriend, now my fiancĂ©e, very badly in those early days. She had stayed with me as constantly as she could during the coma, and then made weekend visits to Green Springs to see me there. In my confusion, I didn’t even know what to make of her at first. Who was this strange girl who felt the need to be with me more than I could handle? Then as my memory of who she was returned, I had to send her home early because I just wasn’t sure how I felt about her. Also, I wanted very badly to sleep away my boredom, and in those confusing days I saw her as a distraction to my sleep. Some nights I asked her to leave no later than 8 PM. I realized it hurt her feelings to get sent away so early, but I was distracted and either couldn’t speak to her or could just get some slurry croaks out. Fortunately she has forgiven me, and now, I realize, her patience and frequent visits speak so well of her as human being that it is one of the reasons I have asked her to become my wife.

I slid down in bed constantly. The aides insisted on keeping my head elevated. But this made me slide down in bed, creating a nighttime climate of tangled sheets, flailing arms, and too frequent requests for help.

Another dream. Dr. Yuhas, who had taken on my case since coming to Green Springs, was seeing me in a cafeteria. My folks asked him several intelligent questions, but I couldn’t get rid of the thought that I was in the wrong place. Confusing. I could hardly believe it didn’t happen.
Even before I regained my speech, I could feel my days falling into a pattern. Up in the morning for a tube feeding. PT, ST, and OT, in that order. A nap (more often staring at the ceiling), in late morning. ST, OT, and PT for the afternoon.

I was given two showers a week by the aides. The pushable chair I sat in for showers hurt my behind. Then I would lay awake waiting for tube feedings, shots, bed changes, anything to pass the time. Never a good sleeper, insomnia gripped me, and I would lay awake into the wee hours, until finally, mercifully, I dozed off.

Some days my biggest worry was what to do in late afternoon. On a good day, I would find an aide who would put me to bed around 3:30 or 4:00. I would then sleep, rest or fidget the whole time away until next morning. In the early days, before my voice returned, I would lay in bed waving for help to every passerby. Sometimes I would get desperate if the curtain was drawn and I couldn’t be seen for all my waving.

Do you know how hard it is to have no speaking voice and have no way of calling for help?
I had an odd relationship with the TV. Looking back, I know it would help me kill time. But perhaps because the accident was interfering with my brain, I could not bear to have the TV on. It was a constant refrain, no, I didn’t want the TV on, or in some cases, please turn the TV off. Confined to a wheelchair, I had no way of turning it off when I wanted, and therefore felt I was prisoner to a TV that was on.

Another dream. I was in Bowling Green, patronizing a fruit and vegetable market. It was hidden; you couldn’t see it from the street. They had any number of fruits and vegetables, though. I visited this market several times in dreams, each time seeing it slightly differently, but each time seeing it as somehow hidden.

Notable people in my life were the three pastoral care assistants, Father Ray, Sister “Sam,” and Pastor Moe, who were given the unenviable job of tending my spiritual needs. Pastor Moe was the protestant chaplain. Although I am a Catholic and he was not, he always had a friendly word for me and waited patiently (at the end, in vain) for me to recover enough of my speech to share my interest in church history with him. Sister Sam I saw less of but she was pleasant and gave me a lovely book as a parting gift.

Father Ray was my connection to the Catholic church. He was literally a godsend. He came to my room, but often visited me during therapy. Sometime I saw him leading exercises for the outpatient group. He had a great sense of humor, always complimented me on perceived changes in my condition, and brought me holy communion. I often wept at what he said and did, but I was an emotional wreck at that time, and in spite of the tears, I was glad, glad to see him when he visited.

The return of my voice changed my routine somewhat. A swallow test on December 31 convinced my keepers that swallowing, while difficult, was at least a theoretical possibility. On January 2, 2002, I was sent to the dining room for the first time and given a soft meal. Y fed me dinner the first few times. I was carefully instructed to take two spoonsfull of liquid for every one bite of food. Although hardly a news flash, I ate with gusto not because of hunger, but to relieve boredom. I took my time eating to stretch out the contact with whoever was feeding me. I coughed and choked plenty, don’t get me wrong. I’m sure I needed to eat slowly for therapeutic reasons also.

Another dream. I was a professional soccer player. Not only that, but one of the most senior members of the team. This dream came around several times. I had one dream in which I was hiding some of my teammates to prevent their arrest for a crime they didn’t commit. Truly a nightmare, considering my lack of interest in sports.

Weekends were both worse and better. Usually on Saturday and Sunday afternoon, my mother and father would come by. They talked about members of the family, the course of my recovery, and wheeled me around to see the halls and the chapel. I regret now that my parents had to make the long trip to Green Springs so often; but at the time I savored their visits and couldn’t wait to see them.

It was the rest of the weekend that was a pain. The physical therapists often did a quickie PT routine Saturday mornings, but then would leave me set for later family visits. Sometimes that wait would stretch for two or three hours. I would distract myself by reading, or sitting in the hall watching people go by, but inevitably boredom descended or worse, my butt started to hurt. Then I would sit in the room with my teeth gritted, watching the empty hours, minutes, and seconds go by, waiting for either my folks to come by or waiting for someone to put me to bed.

One time I got the bright idea to kill some time by wheeling my wheelchair about. Trouble was, I had IV feedings running into me through my J tube. My wheelchair could only go so far, and besides, I could only roll the wheelchair right-handed at the time, causing me to go in circles. I was reduced to yelling for help when the IV lines reached their limit, and putting myself at risk of another butt-agonizing trip to the county seat or the big city to have the tubes reinserted.
When my folks did arrive I was glad to see them, but also a bit afraid of what I might be asked to do or say because they were there. Dad especially I was glad to see because he, and he alone, could make me laugh. One particular afternoon I wanted to go to bed so bad, and both Mom and Dad asked me to wait. I was in so much pain that I was practically on the verge of tears. Mom went to find an aide while Dad stayed and I could tell he was on the verge of tears himself because his 39 year old son was in such acute distress.

Another weekend I did cry because they were late. I assumed the worst; they must have had a car crash on the way from my hometown to Green Springs. When they did come I sobbed with relief that I was not left alone in my temporary prison.

On days my folks visited, I liked to be wheeled to the Chapel. The rehab hospital was owned by an order of nuns, and although there weren’t many nuns left, the Catholic chapel was open for business. I only felt well enough to go to Mass once, but I found my weekend visits to that calm chapel very gratifying. Mom and Dad would push me up to the communion rail and let me just quietly look at the Jesus (with Mary and John) on the stained glass window above me. I never actually found myself praying, just meditating.

Mom and Dad were the heroes of my accident because they cared for me so well. They helped me to sit up, moved me from bed to wheelchair and back, fed me when the feedings finally started, helped me address and send Christmas cards, took me to and from therapy and hospital visits, and ran interference with the nurses. It helped to have a mother who was a RN, but actually it helped that I had a mother who loved me and looked out for my welfare. I can never repay my debt to them.

Another dream. I was in an unnamed town with a large waterfront marina district. I knew that someone was coming to see me, but there was definitely a feeling of being snubbed or otherwise left out.

Another dream. There was an Appalachian family living in a small cabin and arguing about G tubes and J tubes. The odd thing was the hills looked more like the Rockies, and I could look down on the cabin from a great height. Somehow I felt the need to join them, but couldn’t quite reach the cabin.

My time at Green Springs seemed to come to an end very suddenly. By the month of February, they decided there was nothing more they could do for me and that what I mostly needed was ongoing therapy. My insurance dictated a transfer temporarily to the Wood County Nursing Home (in my hometown), and then a few weeks later, to my parent’s home. The transfer terrified me; I was a young (ish) man in a home for the elderly. My folks did get to bring me home Sundays, and I had a nurses’ aide named Rita who was very nice to me. But I was sleeping better by then; staying up later, too. I’m glad not to have to live in a home. The very thought of nursing homes depresses me still. But it was probably a necessary step, and the county home sent me on my way to such freedom as I now enjoy.

So the dreams have eased off a bit. I dream more normally now, although in my dreams I can speak plainly. Most days I’m not particularly depressed about the accident. Sometimes I think that surely, I’ll have another accident and all my recovery will be wasted. I also worry that surely, as I grow older, my injuries will come back to haunt me. But my life goes on. I’m getting married this fall, I eat well, my therapy is going well, and although not recovered, I’m making progress.

It is only in dreams that it sometimes comes back. Dreams that the accident never happened, or dreams that I spent my life in the hospital with a tube rammed into my stomach. I have these dreams, and I pray to whatever God spared my life that my dreams don’t come true.

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