Thursday, March 27, 2014

another day another doctor, part 2

Yesterday I went with Karl to see his neuropsychologist. She wrote off all the research I've done about TBI causing neurodegeneration. She is of the complete opposite opinion that mild TBIs don't often cause long term damage.

I asked for studies to prove her side. I asked where she would look for studies to support her.

"Well," she said, "I would start with PubMed."

"Have you ever heard of The National Center for Biotechnology Information?" I asked, referencing the website where I pulled all of the TBI and concussion studies in my pamphlet.

"No," she said, "I haven't."

Late last night I was having trouble sleeping. I started second guessing myself and the research I've done. She seemed so sure that mild TBIs don't cause long term damage. She explained that pain can cause decreases in memory and attention . She explained that PTSD can cause decreases in memory and attention. She explained that PTSD and chronic pain combined can certainly cause deficits and that it is impossible to know exactly why Karl has memory and attention problems.

At times she seemed to hear me and understand my frustrations, although she seemed completely flabbergasted that I have no hope Karl will get better. She wanted me to have hope. She wanted us both to believe Karl could get better. So we explained, patiently, that when we expect his brain to work, we are disappointed in devastating ways. I cried, frustrated that she wants me to believe he will heal when I have watched him steadily decline for seven years. She brought up the speech therapy he's doing now. In her defense, she honestly believes that the memory training they're doing twice a week for an hour will make a difference. It is not making any noticeable difference, but I suppose it might..... I doubt it, but it might. My best hope is to stop the decline or slow it. The neuropsychologist wants us to fix it. (Even the civilian doctors tell us it is unfixable.)

We talked about the accommodations Karl already makes. We talked about how Karl seems so normal because he is very intelligent. We agreed on several points. She seemed very reasonable, which is why at midnight I went and looked up PubMed, where she said she would start looking for studies... especially since she had never heard of The National Center for Biotechnology Information.

I discovered something that both amused and saddened me.

This is the web address for PubMed: http://www.ncbi.nlm.nih.gov/pubmed

It is hosted on The National Center for Biotechnology Information (http://www.ncbi.nlm.nih.gov), which the neuropsychologist has never heard of. I hope she discovers that when she goes to pull up studies for me to look at to support her position. I hope she is chagrined. I hope she feels foolish. I hope she is willing to give the information I gave her a more thorough look, putting aside her preconceived notions. I hope she is willing to second guess herself after our conversation as I second guessed myself.

Tuesday, March 11, 2014

it's not fair

Our relationship isn't fair.

This is obvious - one of us doesn't use the stove and the other one handles all the bills and appointments. These are just easy examples of our unbalanced relationship. I am a caregiver, but in many ways, I have the better deal.

I have a spouse who asks me before he makes almost any purchase, but I buy whatever I want (although I often do consult him if it's something expensive). If my husband is sitting on the couch doing nothing, I question him about what he's doing, but he encourages me to relax and take a break or take a nap while he handles things. I have a husband who will go out of his way to make sure I am happy and comfortable. My husband has a wife who goes out of her way to make sure he's doing what he's supposed to be doing.

My husband is nicer than me. I wouldn't say he's more considerate or more thoughtful, but he is nicer. I am not nice. I am thoughtful and considerate, but I'm not nice.

Part of being a wife is taking care of Karl, which I do and do well. I am not nice about it though. I make sure he does what he needs to do, which means I remind and remind and remind and harass and harangue. I nag. I write notes and send texts and call to make sure he's doing what he needs to do. I micromanage. I interfere and referee. I tell him, often, to apologize.

I do not doubt that Karl functions much better because of me and because of my help. I know I make an enormous impact in his quality of life - I enable him to take classes at school and to parent our children in a respectful way and to function daily in our society - but still, I am not nice.

It must be exhausting to have a spouse who views you as work, who is constantly trying to make sure you are functioning at optimal levels. I wouldn't know. I do not have a spouse who takes care of me. I have a spouse who cares for me, which is entirely different.

Wednesday, March 5, 2014

Another day, another doctor

"I just want you to know, in terms of the brain injury, there's nothing we can do."

Karl and I nod.

"We know," I say.

"I just don't want you to think we can do much."

"You don't want to give us false expectations," I say. "We know."

She refuses to take my TBI pamphlet, letting me know she won't have time to read it.

I don't mind because apparently she is already familiar with the idea of neurodegeneration. She wants to get Karl's neuropsychology and speech pathology notes to see what they're doing for him, but she doesn't have anything else to offer.

She also wants to see any X-rays we have. She asked if he has ever had steroid injections in his back. She confirms that the notes on his X-rays mean that he has degenerative arthritis in his spine.

"A lot of people do," she tells us, explaining that she isn't sure it is a good enough reason to give Karl a handicap placard for his car. She signs an order for a two month temporary disability pass. This is long enough to allow us to get another appointment with his VA doctor, who is supposedly more familiar with Karl's issues.

Hopefully, the VA primary care doctor will give Karl a permanent disability placard... if I don't leave the room, if I make sure Karl talks about the pain he is in constantly, if I bring up the X-rays that doctor ordered. The civilian doctor today also mentioned that they usually do MRIs for severe back pain, so now I know to ask for one when we go back to the VA doctor.

"He's only 30," the doctor said today.

"We know."

We know he is young, but he is not. For Karl, 30 doesn't look like 30 did for me. I am 31 and I feel young. I can sit or stand for long periods without any pain. I don't wake up in the morning listening to my bones grind and pop against each other. I don't turn my heated car seat on regardless of the weather to ease the ache in my back. I do not limp at the end of the day. I still enjoy road trips when I spend 6 hours in the car at a stretch. After all, I am only 31. Karl is not only 30.

One doctor, years ago, told him he had the life experience and body of someone over twice his age. Karl remembers this because it resonated with him. He is not like other 30 year olds. He has a degenerative brain condition and a degenerative body condition - medical studies and doctors tell us he is falling apart and there is nothing they can do to stop it. His age is not a defense against his symptoms. His back doesn't hurt less because he is 30. He can't remember where he is because he is 30.

I think what the doctor meant today is that she sorry, but she doesn't believe he is in that much pain. Maybe she believes that although there is nothing to do for his mind, his body could get better. Maybe she meant he has a long life ahead of him and he should just get used to the pain.

When Karl drove over a bomb, he was only 24. It didn't save him.

"I want you to know there is nothing we can do."

There is nothing anyone can do. He drove over a bomb.

Tuesday, March 4, 2014

a love letter to WWP

Last night on the way home from California, I turned to Karl to tell him "thank you," and I was suddenly overcome with emotion. I couldn't get the words out because I was fighting the urge to cry. I was just trying to say that I appreciate that he is my sidekick and goes along with my crazy schemes.

I live my life by the first rule of improv. If you google "first rule of improv," you will see lots of variations on a theme. The first rule of improv, as I understand it, is: Say yes. I don't do comedy (although I like to think I'm funny and I especially like people who think I'm funny), but I agree to things. Karl, bless his heart, goes along with me when I say yes.

Last fall, I got an email from a woman at Wounded Warrior Project (WWP), who had gotten my name from another woman, who wanted to know if Karl and I would be interested in filming a commercial spot for WWP. I said yes, of course. Actually, my first email literally said only "of course!" Then I told Karl.

Karl was less than enthusiastic. In fact he complained about it up until a three person team showed up at our house with cameras. Then he stopped complaining long enough to be interviewed. After they spent three days interviewing us and filming our daily lives, they left and Karl continued complaining. I was recently told that they have seen the first rough cut of our commercial. Karl complained. While he's complaining though, he's going along with me, doing whatever it is I signed us up for.

Most people I know only know about the retreats WWP does, because those are the things I have been fortunate enough to do as a caregiver. My husband didn't come home to a hospital and I had no idea about the peer support WWP offers until we had been in counseling for years, so the things I talk about experiencing with WWP are retreats.

The retreats I have been on have been invaluable. I have met women who are like sisters to me, who know what I'm talking about, who get me. The first retreat I went on was a writer's retreat. It was perfect timing for me as an essay I had written in a book was in the process of being published. It was also perfect timing because I was learning to let go and take time away for myself (something I have since become very good at). I met women from all over the US who were in various stages of writing - some wanted to be published eventually and some wanted to learn to journal and some hadn't written anything but their names since high school. We hung out with published authors and playwrights, who told us to write. We split into small groups of caregivers and mentors (published, experienced writers). They encouraged us to find our voices and to let them out in whatever way was most comfortable for us. The weekend was filled with tears, but also with laughter, lots and lots of laughter.

It was so freeing for us to be able to make jokes about brain injuries and amputations with other people who would laugh about it. It was also eye opening for the writers who served as our mentors. They had no idea what communications home were like and as we compared the phone availability in 2003 to the phone availability in 2009, they said, "write about it!" So we did. We wrote about phone calls home and how often they came and how much was said or left unsaid. We learned just how little the average person knows about what we think is normal.

I had known before going on the writer's retreat that I wanted to write about my experience as a caregiver for a disabled veteran. I had already started writing about Karl's traumatic brain injury and how it affected us. I didn't know just how much I had to say though, until I sat in front of a yellow legal pad with 15 minutes to address writing prompt after writing prompt.

We got to go back six months later for another round. The second weekend of the retreat fell on the weekend we closed on the sale of our house in Texas. I was so sad. I desperately needed that weekend away, not only because I needed to write, but because I needed to see my people. I had only seen these women (and one man!) of my small group once, six months prior, but they were my people. They got me and they liked me and they let me cry as I wrote this time about leaving Texas behind and moving to a place where I knew next to no one. They reminded me, with their friendship, that I can make friends anywhere and that I have friends everywhere, even when I'm feeling lonely.

Months after we moved, we were all having a rough time. One of the women who works for WWP emailed to ask me how I was and I emailed her back, unloading about what a tough time I was having. She found my daughter a therapist with Give An Hour, which provides free counseling services to military families who need it, and put me in contact with my local WWP office. I was then invited to go on a spa retreat. I wrote after the spa retreat about how nice it was to have an evening of being normal.

When we were asked to do a commercial for WWP, they wanted to focus on what I, as a caregiver, had gotten from retreats. I have no idea (since our commercial isn't yet finished) how much of our commercial is about what WWP has done for me and how much is about what I do on a daily basis caring for Karl.

This past weekend I went on another big, flashy trip with WWP in Los Angeles, California, being pampered and spoiled. The women who accompanied the cameraman to our house in December invited us to go on a weekend trip with other couples and individuals who had filmed commercials for WWP. It was a way to thank us. I said yes almost immediately, after making sure my mom could take care of our kids for the weekend (thanks mom!), then told Karl we would be going to LA. He complained about it up to and including the night we got there.

Our first full day in LA included the WWP Style and Beauty Suite, our first event. We spent the day receiving presents like glass water bottles, slippers, jewelry from companies who were there. There were also spa services like facials and massages. By the time the event was complete, Karl had stopped complaining and started saying thank you to me for signing us up. He thought it was "weird" to receive gifts and he told this to most of the company representatives there, but he loved getting a massage and a close shave with a straight razor.

Our next day in LA was spent on a studio tour where we got to sit on a couch used by Friends in Central Perk. Karl and I dated during and after high school on and off again, when Friends was on. In one episode, Phoebe tells Ross that she knows he and Rachel will end up together, because he's her lobster. (YouTube video here.) This is Karl and I's thing, or one of our things, he's my lobster. Our wifi network is named lobster. I once got him to guess Friends during Pictionary by drawing a lobster. So it was really cool for us to get to sit on the Friends couch.





Our last day in LA we got on a bus to drive around and look at famous people's houses. The best part of this tour was when our bus driver pulled over to point out the most visited house in LA.

"Something big happened here five years ago," our driver said.

Silence.

"I'm not leaving until someone figures out whose house this is," our driver said.

"Come on, man," yelled Karl, "I've got a brain injury!"

The whole bus cracked up. This was the best moment for me because not only could Karl make a joke about having a brain injury, but he was surrounded by people who laughed with him. There was nothing uncomfortable or hesitant. They got it. It was awesome.

Sunday night we went to an Oscars party. I, through the power of google, was able to predict the second most correct winners at the Academy Awards, so I won a guitar. It was a nice guitar, specially designed for smaller hands and frame, billed a "girl guitar." Our eldest is left handed, so even if they were interested in playing the guitar (nope), it wouldn't quite work for them. As we got back to the hotel I started chatting with a veteran who works with another nonprofit that gives veterans guitar lessons. I happily donated the guitar to her cause.

I love the connections I have made through WWP. I love the sense of community. I love the family reunion feeling I get when I meet people who get us and what we're going through. I love being able to give back to this community through the TBI research I compile, the guitar I was able to pass on, and the writing I do - telling their stories to what I hope is a wider audience. I love the feeling of interacting with the WWP staff who all seem to genuinely care about me, my husband, and my children and who will help us or put us in touch with someone who can help us, regardless of our needs. I love the stories I hear through interacting with everyone at WWP events.

The best story I have ever heard about WWP is one I hear again and again and I'd like to tell it now, especially to people who question what a difference WWP makes.

Imagine a soldier who has been severely wounded and airlifted to a medical facility. This soldier has been burned or had a limb detached in the field. Their uniform, covered in blood, has been cut off their body. They are now recovering and they have nothing. They have a hospital gown that opens in the back. They don't have any of their comrades with them. They don't have any of their uniforms with them. They are struggling to hold on to their sense of self and their sense of dignity. Then someone brings them a backpack and a pair of shorts and a t-shirt. It is the first gift they will receive in their new role and their new life. It is from Wounded Warrior Project, who further promises to be there throughout their recovery. Wounded Warrior Project will put them in touch with peer support and adaptive support. Wounded Warrior Project will put their spouse in touch with peer support. Wounded Warrior Project will not leave them behind and will help them find a road map to their new life.

I would like to personally thank WWP staff Dana D., Dana B., and Ashley M. for the difference their presence has made in my life. There are so many more (Danielle D., Jamie Y., Aimee F., Aaron R.), but it is impossible to list everyone, so I would just like to thank everyone who works for and with WWP for the difference they are making in the lives of my family and my extended family - everyone who has served and sacrificed and their families. It is nice to know we are not alone.

Saturday, March 1, 2014

they laugh in the face of danger

"I reached for my gun but my flesh slid right off."

I shivered as the young man in front of me continued his story. He was injured 10 years ago, the same time my husband was on his first deployment to Iraq.

His story is his and he tells it with humor and grace, laughing as he recounts flopping around like a seal while in recovery because he couldn't get his hands under him to lift himself up. I say "young man," but I am guessing he is my age. He isn't old, but the majority of his life is post-injury, with scarring on his face and arms.

Another man yesterday told of the time an RPG hit his Humvee. He kept reaching for the door with his right hand, then finally moved his left hand to where his right arm should have been. It wasn't there any more.

I am in awe of these men. While I never joined the military, it isn't their service that humbles me. It is watching them laugh. The man with the scarred face makes jokes about a meth lab explosion. The man who lost an arm cracked up an audience recounting the look on someone's face as they realize they've lost a golf game to a one armed man. Yesterday a man in a wheelchair and I laughed about how he's smarter than me because he brings his own chair everywhere.

After tragedies, Americans so often get caught up in heroic actions and the indomitable human spirit. These are the things I see when I look at these men, more than their scars. Their scars do not define them, but they are part of them. What defines them is the grace with which they lead their lives.

I am humbled and honored at living my life serving one of these men. Every time Karl says, "oh brain," in response to a mental lapse, I know we are okay. As long as we can laugh, we are okay.

I feel uncomfortable with the word hero and I know many soldiers do too, but heroes are the ones who run into danger. Heroes are the ones who conspire together during lock down drills to go find the invisible shooter. This is my husband. These are his people: the ones who have been trained to save the rest of us; the ones who laugh in the face of disfigurement and degeneration.