A Change of Plans

We were going offbase; my friend turned the car onto a main boulevard into glaring sunset. I teased him for the accumulation of fast food sacks on the passenger-side floor, stirring them with my feet. Approaching a stoplight turning green, the left lane looked clear so he changed lanes. Suddenly, it was all too apparent why there were no cars over there: a broken-down flatbed semi blocked the intersection. Four skidding tires could hardly slow the momentum of this big Lincoln Continental, sliding forever into impact. Ducking into amnesia, my almost-last-words were a philosophical, “Oh shit.”

Soldiers get skull fractures from IEDs or mortars on dusty foreign soil, on their way back from hot firefights defending the frontline. Heroes aren’t 18-year old girls training on a base in Tennessee.

He had attempted to evade impact, so the car hit at an angle on my side first. Not wearing a seatbelt, I must have flown forward, my head cracking the dashboard as I crumpled into the footwell, unaware that the flatbed’s bumper was smashing thru the passenger windshield above. The flatbed had attempted to bury the two of us under, but the Lincoln’s huge hood halted fate at the axle, preventing carnage under dark iron. The bumper stopped just shy of decapitating my now luckily unoccupied seat and spared my friend. In the shocked silence, glass rained down. Unseen, my brain had been traumatized, and a few fragile shards of my self-identity and personality joined the slow, pulverized, airborne debris.

Unconsciousness is the mind's frantic attempt to re-wire neurons and jury rig broken connections, as if a surgeon is making desperate attempts to re-attach, then resigns to stand back saying, good enough.

I woke several hours later in the ER and began asking Is he ok, repeating it like a broken record, knowing I should stop but I couldn’t. It felt so odd, the first indication of a brain that had begun to mutiny. There was also perhaps a joke about an Excedrin headache I repeated a dozen times, trying to lighten the seriousness. The doctor didn’t fully appreciate the humor, attending to the bloody gash not knowing it didn’t hurt. He said couldn’t give me pain medicine with a head injury as he scraped a metal tool across my skull. Cleaning the debris before stitching, the sound reverberated surreal between my ears.

I woke again the next day, alone, in a larger hospital for observation. Still kinda bleeding, I rang a button for a nurse. She came in, largely glared at me in disregard, turned and left… for an hour. Returning for a moment, she brusquely dropped a useless ace comb, gauze, and indignity on the bed at my feet before abandoning me again. I felt shamefully puzzled; I thought she was supposed to care? But this was a VA hospital, before the era of quality control.

I made my way to the bathroom awkwardly attached to an IV pole, and objectively examined my face in the mirror. A jagged line of stitches marched drunkenly across my forehead above one swollen eye; blood crusted my half-numb scalp. Aside from That’ll leave a mark, I was ok. Bending to the bowl and gingerly rinsing my hair, the water ran pink in white porcelain.

It was morning, and since there was no such thing as time or purpose or feelings, I wandered to the hall with my only companion, the IV pole. Looking out a wall of windows, I was, what, ten or twelve stories up from the streets of a much larger city. The hall was warm and brightly sunny as I wheeled my companion to a blocky square vinyl chair to sit next to a pay phone. I didn’t have any thoughts at all, or care about it. Interestingly, although focus became separated from willpower and concentration was like herding cats, the world had become intense, one single moment unfolding. My sense of self had literally dissolved into morning dust floating in a sterile hospital sunbeam.

The present had released its mooring from the past. My name was down the hall; words and the desire to speak were on a different floor. After about an hour my first name floated up, then with some concentration my last name. It took the rest of the morning to remember I had a brother 2000 miles away and with effort pieced together his phone number. My one prolonged existential moment began to include loneliness.

Twenty five years later , a military neuro-psychiatrist eventually figured out what had happened. Tragically from the recent decades of war, there is more experience recognizing and working with Traumatic Brain Injuries (TBI), and he recognized the particulars after only a few appointments.

Hypothalamus partially disconnected from the Pituitary Gland. Linked with a few tiny fragile neurons and capillaries, the Hypothalamus regulates hormones that keep the body in stasis.

Right Frontal Lobe damage to Executive Function. Executive function acts as a filter for perception, and modulates the response. Without it, the brain is full on, both in and out, vulnerable to overstimulation and impulsivity.

Damage to Emotional Long pathways. Emotions are largely the brain's interpretation of visceral reaction to the world at large; the frontal region helps control emotional memories and prevents responses that are no longer useful.

Understanding the scope of the injury sooner would have sent me to proper rehab instead of a mental hospital. Recovery might have been possible instead of purgatory for twenty years that ingrained the damage. It would have saved the life of my first child. But they just didn’t know.

An injury to the brain separates a life clean like a semi-colon; before and after are separate selves. The past tells me, its easy, do it like this, but the present doesn’t understand.  

Concussion cold-clocked me away from a part of myself, like getting knocked out of one sees life brokenly.  The new life entails a continuous second-guessing of perception and behavior, a small pause of thought between the old script and the new speech.  It’s as if the movie has broken chaotic then is hastily patched together; the story trips into confusion. Comprehension eventually settles in, but with a frustrating disconnect because the sound will never again quite match the film.

There is some sense, some hint that most things are the same but something else is off. Its like reading a book that awkwardly ends because the author died. I pick up part two, but an amateur has altered the plotline and jumbled the characters, then I discover I’m the author.

“Before” feels like life; “After” feels like metaphor, where my thoughts are usually saying, it feels like...

The wind of fate has ripped my map out of my hand.  Perhaps “identity” is established through my awareness of my place; self-assurance  is knowing who I am through confidence in my surroundings.  Luckily, though, I can gingerly salvage it from a mud puddle. Now it only almost matches reality in a curious way. The “You are here” arrow has dissolved in the muck, and the route I planned has melted, unreadable. That’s what my new day with brain damage feels like.

It feels like my journey was shaken, and a few foundation cobblestones have tumbled loose on my path.  Simple things like “small talk” or “what happened yesterday” now require focus, cautiously unsure. Perhaps my “self” is rooted in willpower. But now I've had to start the trip over, learning from square one some of the most basic things before confidence could be regained. This is when I was told over and over, it shouldn’t be so hard; it’s all in your mind.

It is as if the rudder of life is suddenly missing from my hand, and the sails are gone too. Not damaged beyond repair, but gone as if they never existed.  My "spirit's" intention used to be two feet on the ground, a sure path, (or was it a sailboat?) is now a little dinghy tossed about in a storm.  What the heck just happened?  I am not the captain anymore, now just hanging on for the ride.


Reduction

Amusing, me a poet, but where's a muse?

words plucked from ether, dissolve escaping.

Patience, Time, while the minutes peruse.

Blank white paper inspires airplanes;

daydreams sail across the room,

through windows, to cloud shapes,

White swans, dragons, loons...

fly elsewhere's way

in sky blue

erased

too

.


Back then in the early 80’s, physicians didn't understand the damage behind close head wounds. I could walk and talk and gray matter wasn’t bleeding out my ears, so it was only a concussion. But a host of scattershot physical problems arose, and each problem was treated individually with educated guesses, diagnoses pitched at me like a batting machine, pharmaceuticals thrown at me like darts.

Over the next three weeks, my blood pressure was unstable, sometimes so low that drawing blood caused my veins to collapse even with baby needles. (diagnosis: Underweight.) I had to learn to live with randomly crashing blood sugar. (diagnosis: Stress-induced Hypoglycemia) I had little energy and the day felt like swimming through jello, wading through mud. (diagnosis: Depression.) It turned out my thyroid had shut down completely. (diagnosis: Stress-induced Hypothyroid) They prescribed synthetic thyroid hormone and antidepressants. Aside from all those physical symptoms, mood swings arose, usually tears or rage from little things, or unrelated to specific causes at all. (What-The-Fk, she is just plain Mental.) By chance there was a new word for severe mood swings. (diagnosis: Bipolar.) But she doesn’t lose touch with reality… (diagnosis: Bipolar II.) I was put on Medical Hold, termed “Unfit for Military Service.”

Overall, it is plausible that five major separate issues had mysteriously manifested themselves in weeks. Or it could have been one thing: the tiny connections between the hypothalamus and pituitary gland frayed behind the eye, causing: fluctuating blood pressure, hypoglycemia, hypothyroid, reduced oxytocin, Raynaud’s, extended arrhythmias, sensitivity to meds, and mood swings.

The one immediate striking difference in the way I felt was intensity. The filter of the Executive Function in the Right Frontal lobe was damaged. Without limits on surges of hormones, and with the Long Emotional Pathways interrupted; emotions were triggered randomly and once started they built to seizures of rage, or bliss, or sadness until I lost perspective. 

The second day of observation in that large hospital, I slid sinking into crying. The neurologist on his rounds asked, "what's wrong?"  I had no idea, sitting on the edge of my clinic bed crying, but it was my fault, right?   Not knowing what else to do with me, he released me early, back to the base, to live on the empty 6th floor of that hospital on medical hold.  

Feelings became exaggerated, behavioral reactions were inappropriate, and impulsiveness reigned.   Getting a haircut, the wave of endorphins from gentle contact on my head put me to sleep in the chair.  Perceptions became black-and-white, always or never. A friend and I stopped for a bowl of cereal at the commissary. Pouring milk from the small carton, mine came out in curds, expired. Devastated that I would always have such bad luck, I cried right there.  The handful of friends I had made in boot camp dwindled away.  

A couple other sailors were in limbo up there too, but they had things to do, places to go. We would occasionally pass each other with a “hi.” The only task I could manage was filing medical records, a quiet ghost in a roomful of green folders. How is this possible? I had been gifted all through school, skipped a grade, doing well on the PSAT, becoming a National Merit Scholar, participating in Model United Nations. I had missed only one question on the entire military entrance exam.

Three weeks after the accident, I over heard remark of “she’s kinda weird,” and succumbed to a tidal wave of despair.  I had not yet learned  to separate myself from my feelings. that I am not my emotions.   A pit deeper than I had ever experienced opened up below me at the end of my rope, and I could no longer hold on.  By the way, those warnings one hears on TV ads for anti-depressant meds, the one that says watch for suicidal thoughts?  They found this out from guenea pigs like me.  I wrote a short note of apology.  I was doing the world a favor.  A small prayer, Jesus, I’m just sorry.  I just wanted to go home. I went full-on, taking a month’s supply of anti-depressants in several mouthfuls of floaty capsules. It should have worked; waiting for a friday evening.  The other guys on medical hold wouldn’t have been back to find me until they came back from their weekend.

Yet, I was improbably discovered in my sleep just as my heart stopped, unconscious as a medic delivered blows to my chest. Surviving a four day coma, I woke up unexpectedly cheerful. I had gone down with a rejecting attitude of No, and somehow came back up feeling Yes

 “I guess there’s some reason God wants me here after all,” I thought. The harsh anti-depressants had damaged my heart though; arrhythmias put me in intensive care for a week with charcoal milkshakes to absorb the poison. Every few minutes I could feel the backwards pressure in my head, as my heart pounded out of my chest confused. Pointing to the machine I’d say, “there it goes again,” and the EKG would respond with wild random scribbles, down instead of up and skipping quickly.  It felt like a game; I had no way to explain to the worrying doctors that I knew I was going to pull through.

With nowhere else to station the medical confusion I had become, I was transferred from intensive care to the Third Floor, "assigned full time" to the psyche ward. I had crossed the line from medical puzzle to mental illness, from hope to failure, from compassion to disgrace.


Two locked double doors defined the boundary of the Mental Ward from the Real World. Just in from them, there was a heavy door on the right to the “Quiet Room.” The hall continued straight inside, its long, bright emptiness functioning like a fortification. It emptied out into a large central room with a TV on one wall, some couches facing it, and a long counter desk at the back like a bank, the friendly kind with no glass. Arrayed around the perimeter, various doors led to meeting rooms, a small clinic, sparse rooms with one or two beds, and offices. For entertainment there was a rack of old magazines missing the address corners ripped off: Time, Veterans Today, Sports Illustrated. An the activity area had one wall of cabinets, thoughtlessly stocked with games that belonged in a yard sale, and model kits suitable for middle school kids.

Please don’t imagine that a military psyche ward was a nurturing place for healing and recovery. There were no compassionate sessions with a patient nurse, or equitable meetings with doctors to discuss rehab strategy, or yoga and tai-chi for spiritual balance. There were group sessions twice a week to dredge up problems to share, and one-on-one sessions once a week to discuss just how many ways one could be neurotic. Welcome Home.

The day would begin with the Lt. Commander Dr. Rogers making his typical entrance through the double doors, strutting loudly, his forceful heels hitting the floor somewhat duck-like and his chin up, arrogant with his freedom. Greeting the ward with a haughty smile, the presence of his barrel-chested ego seemed bigger than his shirt, with buttons straining a little. He wore the physician’s confidence born of privilege, but not of empathy. It’s a hell of a day in the neighborhood.

At the first session, his tone seemed somewhat indifferent. “I don’t have a lot of time,” he said, studying my intake file. “It says here you saw a school counselor in high school. What was that about?”

Note to self- I should never have put that down on the form.  Lesson learned.  even now, I wrestle a life-long fear to put pen to paper. Writing is too permanently incriminating. Friends thoughtfully gift beautifully crafted blank journals distinctly lined which end up preserved new in drawers. The paper is more valuable than my words.

“I had to be put in a foster home. They sent me to a psychiatrist to check me out. He said I was ok, just stressed.”

“Why was that?”

To myself I think, Oh, must we talk about the past.  Most other people have a caring God that only gives what one can take, and answers prayers like Santa.  Most other people can’t relate to my life, the details that bring up awkwardness, pushing people away into silence while they grasp for something to say. I've seen it happen often enough. I’d rather say… I was raised by elves, but never have the courage.  Besides, in this place you never know what that would lead to. So I shrug.

Instructing me with disdain, he says, “I’m your Commanding Officer.”

So I say, “Look, it doesn’t make a difference, talking about what happened back. It doesn’t change anything.”

As he gives more attention to the pad, I’m thinking, why should I open up to him? I don’t even like him. How do I know he’s honest? Even though I already sense his opinion of me, I challenge him out of turn.

“Do you think I’m a jerk?” I ask, and leave the question in the space between us.

He recognizes his dilemma, looking up, sitting back, contemplating his answer as if its a chess game. If he told the truth, that he doesn’t like me, he would lose just about all of my trust in him as a therapist. If he lied, he would lose all of it. But now he seems more interested.

“Yes.”

Now I respect him for telling me the truth, because self-esteem doesn’t seem to matter.

Then he said, “Where are you from,” but it wasn’t really a question.

I think to myself, people can never relate, we don't come from the same place... I’d rather lie, but the truth wells up regardless of my wish. “I don't know really, Washington? California? We moved alot, three different 3rd grades.”

He jots on the yellow pad. “It’s important that I know about your parents, your mother?”

I delay, trying to think of the right words.  Schizophrenia is as hard to explain as it is to spell.  Mom didn’t know how, really, to mother but she did the best she could. Feeling protective, I don’t want someone else to bring judgment against her; I've judged her enough myself. Plus, I am trying to persuade myself that I am not like her, as I’m sitting in a crazy ward talking with a psychiatrist. So I give him only this much, “She has some mental problems.”

More notes. “What about Your father?”

I think, Which one? My first foster dad? The second? Or my real dad?

“Dad died by the time we were in California.”

Another pause as he writes. “How old were you? How did he die?”

I don’t want to tell you he killed himself. By suffocation from a grocery store plastic bag… Daily I'm reminded by fine print on the edge of every bag: please keep away from children.  Why did I, a child, have to go to the morgue to identify his body?

So I say, “Eleven. Heart Trouble.”

But he studies me, reading through the subterfuge. I just never liked where the truth puts me, on the other side of pity. It feels like my truth separates me.

“Suicide.”

And he writes more. “You know children of suicide are three times more likely to attempt it themselves.” I hadn’t made that connection, but it made sense. The option had been left on the family’s kitchen table, real, with one live bullet in the chamber.

He asks, “You have one brother?”

My stomach knots up. Mom doted on him; he was her priority, her rock. I was his power trip and punching bag. The first foster home was a lifesaver; the second not so much.  So I say, “Family is Relative.”

After a studied pause, the doctor throws a curveball at me. “Why does a chick break out of its shell?”

The randomness of the question comes out of left field, but the answer seemed obvious. “Because it will die if it doesn’t.”

I didn’t know it at the time, but the doctor was trying to figure out my point-of-view. Self-centered, I had not thought there could be other reasons, like curiosity, seeking love, or feeling the warmth of the sun. I had reacted to trauma so often that I anticipated it, so the reason was as extreme as death.

“Why did you enlist?” he asks.

“well, when we were growing up…”

The doctor interrupts, “You tend to say we… You should be saying I.”

Not aware of it, I had to concentrate as if it was a riddle… I was there, but so was my brother.

“I? … We? What’s the difference?”

If he was seeking to dig out problems, he must have thought he struck psychologist gold. This could mean therapy sessions for months. Since they hadn’t discovered things like “Executive Function.” his specialty understood “neurotic.” He said my IQ was 145 and my emotional maturity was 3.

Not eighteen, but three years old. He explained, not a low self-esteem, but no self-esteem. (diagnosis: Borderline Personality) I had the rare opportunity to literally grow up again and be able to describe the process. At first I had a vague sense of boundaries, or what defines a “self.” He was irritated that I kept mixing pronouns. "I and me" meant the same to me as "we and us." If someone had asked if my name is Ann or Anna, it was too much for me to compute. Does it matter? So I’d reply, “Whichever you prefer.” (He almost diagnosed Multiple Personalities because of this. Almost, because even I knew this litany of problems would have finally resembled outright farce.)

By no means could I function in the real world, which concerned him the most. Ignoring the red scar of stiches traversing jaggedly halfway across my forehead and curving down the side of my temple, his specialty was psychiatry, so that’s all he saw, winning the Freudian lottery.

He did know to work on re-building a self-identity. First, he would change my world-view. It used to be, “It is what it is,” but he made sure it became “you are f-cked up.” That’s the reason de’etre of psychiatry, after all. 

During those first weeks of therapy, he worked to disassemble my foundations. My mother was not capable of nurturing; it was not my fault when she could be so hurtful. A caring brother shouldn’t hurt his younger sister; it was not my fault when I lost all those fights. It was not my fault that Dad killed himself.  They didn’t love me? I could literally feel my perspective change to the clarity of emptiness, as if these epiphanies wiped all my senses clean, leaving me utterly alone.

The problem is, what to replace it with? Brain damage had left me a blank slate and home was now a psyche ward, so I soaked in a new self-identity of brokenness.

(This vulnerability to believing everything the doctor was saying is related to damaging the right side of the frontal lobe, naively accepting just about anything as true. Boundaries are fragile, distinguishing other’s opinions from my own, with little grounding to distinguish truth from lie.)

Sometimes I do appreciate the serendipity of this accident though. By chance, the drastic reset helped remove the twisted burden, the guilt from the failure to take care of my mother and the guilt of my father’s death.


No Chance for Chance (poem)

What is Serendipity?

Seen miraculous,
Some thing done there,
Something done.

What isn't Serendipity?
The unseen miraculous.
What miracles undone in time,
in time, as never happened.

Everything?
Nothing?

It cannot be a good thing-
Fortunate for you is
lost fortune for who...
Self-fulfilling for Jungian prophecy
or prophecy fulfilled for Schrodinger's Cat.

It cannot be a bad thing-
In agreement
with yes...
Self-fulfilling for Jungian prophecy
or prophecy fulfilled for Schrodinger's Cat.

The doer or the deed,

I think,
so I think I am caught

between
a wave and a particle.

.

.

.






Next Chapter: ch 2- The Best of Them