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Perspectives: Facing the Challenges of Head Injury: A Nurse's Perspective Winner of the 2008 RNJ Writer's Contest
When I was first asked to speak at the 2007 ARN Annual Educational Conference, the thoughts kept running through my mind that I was neither educated enough nor qualified enough to teach the audience anything of great importance. It felt so “weird” that I was going to stand up and speak to everyone about “me.” I know that most of us can talk on and on about ourselves, but I had to do more than just think about me and talk about me. I had to pass on some wisdom. So, the first thing I tried to do was open everyone’s eyes a little bit. I tried to explain how it feels emotionally to have major life changes, how I learned to accept those changes, and how medical professionals need to reach out to meet the emotional needs of our patients. I shared my story.
I am a survivor of head injury. The brain has different lobes—frontal, temporal, parietal, and occipital lobes—as well the cerebellum and the brain stem. They all have different functions. The only lobe that I will specifically discuss is the frontal. That’s the one with which the dashboard and I had a problem. The frontal lobe controls complex intelligence, emotions, inhibitions, creativity, personality, cognition, and speech. My problem areas were complex intelligence, personality, and especially inhibitions.
I was 27 years old when I suffered a brain injury. I had been a licensed practical nurse for almost 5 years. I worked on a neuro step down unit on the weekends. During the week, I went to a community college to receive an associate’s degree in nursing. At that time, I had a little more than 5 months until graduation. Family was important to me, but at that point in my life, gaining knowledge and working as a nurse were my main focuses. I was like a sponge. I could read something, I would remember it. The instructors would lecture and I would remember it. My grades were As and Bs. It was wonderful. I could never learn enough, I had so much drive, so much initiative. I would always take on extra responsibilities—anything to further my education and further my career. In addition to my intelligence, I had a very likeable personality. I was quiet and soft spoken. I had never had an enemy or a disagreement with anyone. I got along well with everybody. I hadn’t thought of it at the time, but I liked “me.” I was a smart, hard-working, and likeable girl with a lot of drive and ambition. Life was wonderful. Life was easy. I had such high hopes and big dreams.
I’m sure that college was on break during this time because it was December 21. I’m also sure that I was going home to visit my parents in Virginia, and that we were going to have a wonderful Christmas celebration. But, I will never really know. One day, I was leading my usual, wonderful, everyday life in December. The next day, it was the end of January.
I don’t remember the exact moment that I “woke up,” so to speak. I have retrograde and anterograde amnesia of a period of approximately 1–2 weeks before and 3½ weeks after the accident. When I woke up, I was a patient on the rehabilitation unit in the facility where I worked. I was told that I had been in a motor vehicle accident with my fiancé. He had been killed instantly. I, on the other hand, was alive and well. Well, sort of. I had sustained a closed-head injury, which I figured out because I had no hair on the left side of my head. I had multiple broken ribs and facial fractures that required surgery. I had a contused heart and liver. I had a couple of pneumothoraxes, a couple of chest tubes, and was on a ventilator. I had a subdural hematoma and an intracranial hemorrhage. I had a Camino bolt screwed into my brain to monitor my intracranial pressure. Thankfully, the intracranial hemorrhage reabsorbed itself, and I didn’t have to have a craniotomy.
At first, I didn’t pay attention to all of my deficits. I had double vision and left-sided weakness, which is my dominant side. I talked all of the time. I had no inhibitions whatsoever. My frontal lobe didn’t process anything. As soon as a thought came to my mind, it was on the tip of my tongue and out of my mouth. If I had never seen you before and you had ugly shoes on, I would tell you that you had ugly shoes on. I couldn’t retain information. I could only remember two or three words out of five.
I remember sitting on the bed in my room at rehabilitation. I showed no emotion, but I was mourning. I was mourning two deaths. I was mourning the death of my fiancé. I didn’t know it at the time, but I was also mourning my own death. I didn’t realize that I had deficits. I didn’t realize that I was so sick. I showed no outward emotion, but I was crying inside. I was dying emotionally and inside, but this was a burden that I would bear alone. No one addressed my emotional needs. I would be okay though because I had many goals. I had a lot of initiative. I was the little engine that could. I knew about head injury. I knew all of the signs and the symptoms. I would be okay.
I was at the rehabilitation unit that I was familiar with for a few more days. Then I was transferred to a rehabilitation facility in Durham, NC, that could better meet my needs. Physically, I was taken care of really well. I would even go off-site and work out at a gym. I got to go to the movies. I saw Mrs. Doubtfire. I will never forget that. The sadness of the movie brought out some of my grief and I was sad the whole movie. I got to go bowling. I had double vision, my dominant left side was weak, and my ribs hurt badly. But, I went bowling.
Occupational therapy helped me improve my left hemiparesis. Speech therapy helped me work really hard on my memory and cognition. It was at that point that I started to notice my deficits. I actually cried with visible tears for the first time after the doctor told me that my double vision may never completely improve. But that’s okay because I knew about head injury. I had the will to fight and the initiative to improve and to make myself be all that I could be.
I was at that facility for a month. Then I went home. My fiancé, with whom I had lived, had died. My family lived in Virginia. I had double vision, left-sided weakness, and was at risk of having seizures. I went home all alone to live in my two-story house, which scared my Momma to death. I couldn’t drive. I was picked up by a person who worked at the hospital in the outpatient program and taken to outpatient therapy. I was in the acute care hospital for a month, rehabilitation for a month, and then I had a month of outpatient therapy. Regardless, I still had that drive and that ambition. That’s all that I knew. That’s who I was.
By April, 4 months after the accident, I returned to work. I worked a few hours a day until I was able to work a full 12-hour shift. I also returned to college in April because I had goals. I was going to be a registered nurse. That’s who I was.
As time went on, I realized that I had changed. I had a harder time at school. I would listen to a lecture, read it, tape it, and study it, but I still had a hard time retaining the information I had to learn. I guess you could say that I had diarrhea of the mouth. I said anything on my mind. Remember? I used to be quiet and reserved. I used to keep my thoughts to myself. I noticed that my relationships with other people were quite different than they used to be. I now had a personality that I had never known. My double vision and left-sided weakness were improving ever so slowly. But I struggled to be an average student and a likeable person.
Deep inside, I knew the person who I used to be and who I wanted to be. No matter how hard I tried, the person who was smart and loved by everyone was gone. She was gone and I couldn’t bring her back. I was a new person. The more time that passed, the more depressed I became. I really hated myself. No one understood what I was going through. No one even asked about what I was going through. Those who knew me knew about my personality changes. On the outside, I may have looked healthy. On the inside, I was still dying.
I was confused. I thought that I knew about head injury. I had always been able to overcome any obstacle that had confronted me. Not only had I let myself down, but I had let my patients down. In the past, I was very good at meeting my patients’ physical needs, but I had never addressed their emotional needs.
My own personal grief and depression continued. Every day of my life, I was nauseated. Every day of my life, I had a headache. Every day of my life, I hated my head-injured self. A few years after my accident, I eventually went to a neuro psychologist. After several months of therapy, I learned to let go of the person I used to be. I am not that person anymore and never will be again. I am now an opinionated woman of average intelligence. The most important and valuable lesson that I learned from therapy was that I am not a victim of head injury. I am a survivor of head injury. Actually, I was always a survivor. The problem was that nobody ever told me. It was something I had to figure out on my own.
Now I don’t always like myself. I want to be the sponge that can retain anything. I want to be the best all-around girl. But I have to let it go because I’m not. I may not always like who I am, but now I finally love myself.
In closing, I want to return to my original focus. The main topic that I wanted to address is that all of us always need to offer more than just assistance with patients’ physical needs. We need to care enough to help them with their emotional needs as well. We need to picture ourselves on the other side of the bed.
I thought that I had it under control. I thought that I had the drive to meet all of my needs. I thought that I knew about head injury. I needed more than that. I needed someone to talk to. I needed someone to ask me how I felt and talk about what I was going through. I needed someone to tell me about the adjustment phase and the acceptance phase that I would go through. During the acute and the rehabilitation phases, the patient may not be able to fully grasp what their deficits are and that their caregivers are trying to reach out to them. They are not ready to face reality.
It is up to us as healthcare workers to educate our patients and their families. It is just as important for patients’ families to know the phases of recovery as the patient because the families are always there to lend an ear and a helping hand to get through the hard times. If we don’t take the time to ask patients what is in their hearts and on their minds, all of the physical assistance in the world will not get them through the storm.
When my accident happened, I was a neuro nurse. I was familiar with the signs and symptoms of head injury. However, when I was on the other side of the bed, it was unfamiliar territory. If I hadn’t known what I did about head injury, I would have thought that I was really losing my mind. My past experiences got me through that tough time of my life, which was lucky for me. But I guarantee that other patients with head injuries don’t have the same past experiences to rely on. Please educate them about the adjustment phases and bond with them to help them open up because I know their hearts are heavy.