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Thoughts Gone Missing By Kathleen Toomey Fresh powder snow had fallen overnight when a friend called and said We have to go skiing! They picked me up about midmorning and off we drove, chatting happily and singing about the awesome day ahead of sunshine and knee-deep powderevery skiers dream. No worries, no cares, no fears Within minutes of home even before we were out of the neighborhood, a car backed out from behind a snow-berm driveway at the bottom of a small hill, crosswise of the road. My friend braked only to have our vehicle fishtail. We were too close. Looking to my right I came eyeball-to-eyeball with the driver of the other car as we side-skidded into him. The force of this impact careened us back into line with the road and straight into a utility pole. An ambulance took me to the hospital for fear of a broken neck; attendants x-rayed, administered pain medication, and considered me fine. As I did not have any broken bones or lacerations, the doctor on duty only required minimal consultation before declaring me fit to go home. I was not fit. I felt cold all over, a deep penetrating cold, complaining to the attending nurse. He merely covered me in more blankets and propped my leg up to ease the pain from my knee. I still could not get warm. Finally he administered some hospital drug that instantly warmed me up along with easing the pain radiating from my kneecap. Where I could not walk on my own before; I could now, leaving the hospital with a limp and in a daze with no instructions or precautionary measures to follow. My friend still eager to go skiing hefted me into a rental vehicle, as their car was rendered no longer drivable, and drove off for the ski resort. Still in a physically stunned state and emotionally paralyzed, I went along. Not until we actually arrived at the ski lodge and sat in the bar did the severity of the accident hit. Embarrassed, I could no longer sit up straight, talk

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without flipping or garbling my words, even come up with a relative thought let alone ski. I acted inebriated without having anything alcoholic to drink, and could barely walkagain! My right knee hurt so much I could not put my full weight down limping badly. I felt desperate, begging my friend to get me off the mountain, pick up the prescriptions phoned in earlier, and just take me home. I seemed to be in a trance-like state without the ability to express myself, without the ability to discern and assert my needs. Not until four months later would I learn this is all classical behavior of a person suffering from trauma to the head. The next morning, I shuffled into my kitchen to make myself a cup of tea. I opened a kitchen cabinet, took down a mug, and set it on the counter. I took a tea bag out of its box and laid it next to the mug. And just stood there, looking at the twoside by sidenot knowing what to do with them. The relationship of putting hot water to tea in a mug no longer existed in my brain vocabulary. I knew I wanted a cup of tea but could not mentally focus clearly enough to connect-the-dots. My sequential thought processes of mind, to eye, to hand, coordination had left me. My thoughts were gone missing. Only I didnt comprehend this at the time and simply went back to bed. In subsequent days, I slept mostly. I lived alone at the time and worked from home so nobody knew of my circumstances. And I didnt have the wherewithal to call for help as my mental faculties were malfunctioning all over the placeonly I didnt quite comprehend this yet. When the hospital drugs wore off; I resorted to using crutches and slouched my days away, getting up late each morning, shuffling to the living room to stare out the picture window, and back to bed again in the early evening. Sleeping was never an issue. I slept long and hard, easily eight to ten hours each night, awakening in the morning still feeling unrested. I usually stayed in bed for another couple of hours trying to feel more rested but really only feeling guilty. Most days I never even showered or dressed. Taking a shower required far more energy than I could

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pull together. The lifting of my hands and arms over my head to wash my hair required a great deal of preliminary concentration to make sure I could complete the task once started. There had been times while trying to wash my hair I drained of energy so completely I had to leave the shower and go back to bed, soap still in my hair. I went on like this for months, even into the next year I suspect for along with my physical fatigue I lost my ability to time frame. My physical body gave me fits, this I physically felt and was very aware of. Thinking time would heal, and the aches and pains of being battered around would go away, I slept on and gave myself the weekend to rest. Come Monday I said just one more day, and then another, and another. Months went by like this. Work waited for me at my desk but I couldnt bring myself to sit down at the computer to write. Sitting requires energy and I had none. Immobilized I spent my days in a La-Z-Boy recliner with my feet up facing the picture windows staring blankly out over Avondale Pond. Immediately shame and guilt over my presumed laziness set it. Only once did I have the energy to wait in a doctors office only to be told to go home and buck-up. Basically the doctor told me to stop faking it and just go back to work, using crutches was no excuse. Even the doctors front receptionist treated me with distain and his assisting nurse gave me looks of disapproval. I never went back to mainstream health care again. Instead I switched to holistic care, acupuncture, message, herbalists, shuffling from one practitioner to another. Each proclaiming they had the answer, never really explaining what was wrong, just taking my money and scheduling me for an indefinite amount and time of treatment regimen. Finally a chiropractor suggested I might have a head injury referring me to an attorney. Not a neurological doctor but an attorney and only after requesting I sign release papers making him my primary care practitioner with all insurance monies to go thru him. Fortunately I was in such a fog I couldnt comprehend the fine print and never signed. On occasion in my flimsy state of mind I did

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something right. I had lost the ability to be cognisant, to assert myself, to counsel or argue for myself. People with head injuries badly need an advocate as they lose the ability to do so for themselves. Shortly after the doctor debacle, about mid-week after the accident, I woke up one morning and gasped, horrified at my reflection in the mirror. Starring back at me was this huge set of purple raccoon eyes, purple coloring that went all the way around the edges of my eyes, out to the sides across my eyelids but mostly below my eyes. At the time I didnt connect my purple ringed eyes with anything and went about my day just trying to survive the guilt and shame that was getting worse with my inactivity. It wasnt until I met with the attorney for the first time answering his copious questions that the seriousness of my condition became real. He immediately wrote out the name and phone number of a neurologist telling me to set an appointment as soon as possible. It turns out our eye sockets are the only skull orifice from which brain bruising can bleed and be readily seen. Behind the ears is another place but this is not so evident a place for visual exposure as is the eyes. The neurologist informed me I had suffered what is called brain-lash. He explained how brain-lash is similar to a whiplash of the neck only brain-lash takes place inside your skull. The human skull on the inside is not smooth but rough and jagged. When my head went to the right hitting the passenger side window, rapidly back to the left, and possibly to the right again with a traverse forward when the car hit the utility pole and hitting my head on the front windshield; my brain became badly bruised from being scraped back and forth across this jagged interior of my skull. The neurologist told me all of this in laymans terms. In the medical industry raccoon eyes is a much used term for periorbital ecchymoisis or a sub-conjunctive hemorrhage that occurs when damage to the brain meninges (membrane that envelops the brain) causes blood to seep into the soft tissue around the eyes. Raccoon eyes are a good indication a

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person can be suffering from trauma to the brain. Problem is it does not show up on X-rays and like any bruising it most likely will not present itself and become noticeable until days after the trauma occurs.

The medical industry estimates close to two million people are diagnosed each year with having received a traumatic brain injury (TBI). Of more frightening importance is the indeterminate number of TBIs the Brain Injury Association of American calculates as unreported or not taken seriously, such as my case. This unreported number of head injuries the medical industry calculates far exceeds that of the reported TBIs but no one can tell for sure because they never show up on anyones medical radar. People such as me who are taken to medical care facilities with no outward signs of physical impairment are simply released out of the system with no instruction for following up. And it can take two to three days for signs of injury to show up. Why did the hospital attending physician, nurses, x-ray technicians, emergency attendants and the list goes on, not instruct me to seek medical follow-up? Why did the doctors I sought out a couple of weeks later not take me more seriously? I have asked these questions many times because the trick to helping someone with a head injury, I later learned, is to take action and address the injury right away. Like stroke victims, the sooner you get treatment the higher your chances for recouping your cognitive faculties. The problem is very few professionals in the medical emergency industry seem to have a definitive course of action. Medical practitioners refer to people with a head injury as the "walking wounded. We walk we talk on the outside we look to be functioning just fine, especially if no broken bones, lacerations or other physical impairments are sustained. On the outside we are looking

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good. On the inside we are vacant, null and void absent gone missing. Our cognitive abilities, our thoughts are gone missing. How was I now supposed to know what it was I did not know? Driving to the grocery store one day, I approached a four-way intersection. The same four-way intersection I encountered every time I left home. Upon approaching, I could tell you to my right on the corner stood a stop" sign. I could even tell you what it said: STOP. I could also describe to you the presence of another car. I knew I was supposed to do something but I could not comprehend what. I could not generate a cognitive thought to what this all meant. So I simply drove on through to angry honking, shouting, and hand waving. I cringed realizing I had just done something inappropriate and coming round to the realization that something was amiss but what exactly, I did not know. These and many other misplaced actions, I can only guess, slipped by without my notice. Most times a recollection of doing anything out-of-order did not compute. And as neurological doctors finally explained to me, because I did not get help immediately after the accident the chances of full recovery of my cognitive thinking looked pretty slim. What I had for brain functionality at that time was all I would have from here on outfor the rest of my life! Days, weeks, months passed without my being fully aware of time passing. In fact, I have since realized I spent most days that first year simply staring mindlessly out the window in a trance of thoughtless euphoriasomewhat like a yearlong meditation. Only I fought to have thoughts not minimize them. Midway through that first year, nine months after the accident when the 9/11 attack on the World Trade Center in New York City happened, I sat in my Lay-Z-Boy watching the TV with absolutely no emotional reaction. My life had become a null and void existence. Only then did I start to get a sense of my dire straits writing down a list of what I could and could not do, or should I say what I could follow through with. I may be lacking in

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cognitive thinking abilities, I wrote, but I had not lost my intelligence. I still had my intelligence and started mapping my activities as to what I could do and what I shouldnt for the safety of myself and others. I started my own therapy of walking, painting, and eventually resuming my passion of horseback riding. I also started staying close to home, going out only for the most immediate needs and then only in the closeness of my neighborhood driving during the least busy times of the day, and only after fully rested. Fully rested meant dimming down my life. No loud noises even the TV or radio constituted too much, along with bright lights, fluorescent lights, telephone ringing, or any whirl wind of color and movement. People with head injuries are over sensitive to stimulation of lights, color, noise becoming overwhelmed quite easily causing them to malfunction. Even a simple autopilot function becomes confusing such as not knowing which is the brake and which is the accelerator pedal while driving and needing to make a quick reflex action. I stopped driving but once a week to the grocery store only a few blocks away. I would have walked but I could not take a walk without fear of getting stranded. When going for a short walk, I would suddenly become exhausted and realize my uncertainty of not having enough energy to retrace my steps and get myself back home. This didnt happen from physical exhaustion it happened because of mental fatigue. When you lose your cognitive capabilities it takes a huge amount of concentration to maneuver around, even the most simple of tasks become an enormous undertaking and energy drain. I began a daily regimen of walking my dog, Metallica, striving to walk a little greater distance each day. English Point is a Sierra Club recreation site near my home at that time with great hiking trails, all within a fairly level five acre park. Metallica and I set our course on a trail loop of just one mile. My intention was to hike as far as I felt comfortable, turning round when I

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sensed myself starting to get tired. The first time we did this I got as far as the first turn in the trail not more than five-hundred yards when I had to turn back with great trepidation that I might not make it the fatigue overcame me so bad. With each successive try we went a little further until one day I found myself almost midpoint of the trail loop and decided to push on, thinking to turn around meant retracing almost as much of the trail as was left to hike the loop. I could not believe how fast and how strong the mental fatigue hit me that day. When the sun set and the late fall temperature dropped so immediately, I started to panic. Granted I was only in a five acre park with roads nearby but I realized I hadnt the strength to get myself out. Mental fatigue rapidly drained me of my ability to walk let alone stand. Bent at the waist, hands on upper legs, I took one step after the other, counting: one step, next step, one more step, and another step, and another. Slowly very slowly I put one foot in front of the other, over and over. This effort required extreme concentration, a very humbling and scary experience. I grew up in the mountains, logging camps in my youth and camping in the back country of Idaho all my life. How could I not maneuver myself around in a simple five acre park? If I made it out what was to become of me, could I live and work successfully from here on out? It amazes me just how sudden mental fatigue can set in with a TBI. And as in my case, a person does not have to be hit in the head to suffer the effects of a head injury. I have a much better empathy now for people who play contact sports with their heads jostled around. The injuries of pulled ligaments, bruised muscles, broken bones and lacerations are visible. At no time during my accident, immediately after the accident, and subsequent days, months, years of hard work to regain my cognitive skills back did I have any physical pain outside of the pain in my right leg at my knee. I suffered horrendous mental distress and anguish but not physical pain. It is the physical pain our society requires to prove someone really is in need of help. Head injuries being at the bottom of the list for receiving tangible help from the medical industry.