I have a mild traumatic head injury. At 46, when I hit my head on shelve 14 years ago, I knew who I was, where I was headed, and knew I had the knowledge and skills to get there. A simple bang to the head left me without skills that were second nature to me and thus without any clear idea of who I was.

Music filled my days. I loved to dance. I drove up to 1000 miles a week, loving every minute of it, even in traffic. I read for hours on end. I kept track of my bank balances in my head, reconciling the account up to three months at a time. The figure I held in my head was always only a two or three dollars off actual. I never made lists and seldom forgot anything. I knew whatever happened to me professionally and/or financially I could earn my living keeping books. All this disappeared when I hit my head on a shelf. But fatigue was the worst.

Fatigue both consumed me and exemplified the intangible enemy I faced. It has been the hardest facet of the injury to understand and to explain. It is not just, or even, being tired, wanting to sleep. It is different and deeper than that. My cognitive processes can slow down to a point where they seem stop. Immediately after I hit my head, sitting and grazing out a window, I would sometimes stop breathing. Literary. I would notice my chest had tighten, slowly realize it was because I was not breathing, and then I would have to consciously, with full concentration, breath until the automatic process started again.

Even now, if I do too much if I use my brain too much my cognitive functions seem to stop. At worst, I have a very difficult time speaking and feel as though I must force each word from memory to my throat . I do not want to see anything, particularly movement. I do not hear anything: not music or voices or birds singing or traffic. I do not want to move, or rather make the mental calculations necessary to move without hitting something. I cannot think. It is almost like I am in a perfect meditative state.

This might seem like depression, and in fact has been interpreted by doctors as depression. But after an hour or so I feel better, and come out of the state. At worst when my reserves are spent, it can take a couple of weeks of limited activity before I reach what is now my full strength. At best, lapsing into such a state for just a few minutes can restore me.

Nor is the fatigue a matter of building stamina. Over the years I tried to increase my strength and endurance, still continue to do so in different ways, as though if I sneak up behind the fatigue I can surprise it and it will go away. My attempts always fail. What I learned is how I become fatigued: I can recreate my fatigue now in a variety of ways, always with surety.

Before I hit my head I was a problem-solver, a trouble-shooter and used those skills to determine early on that when I hit my head I destroyed certain visual and audial data processing pathways in my brain. These pathways had probably been weakened by earlier mild hits on the same area of my head. My brain rebuilt the pathways, and they are not as efficient as the old ones. Thus, I use a lot of energy just getting through the day, and thus the more I try to do, the more tired I become.

Doctors have generally agreed in their non-committal way that my theory could be correct, but because there was not now physical proof no CT or MRI picture of the torn, twisted or stretched nerves found in autopicies no doctor has ever been entirely comfortable with that explanation. Or any other.

Doctors have yelled at me, dismissed me, shown great concern and interest and then given up when no simple answers were to be found. One doctor announced, after reviewing tests that spanned the ten years since the injury, that I should be glad she could state I was not a fraud. A neurologist said I simply had a trauma, neither physical nor mental (what other kind is there?). One doctor says I am mentally ill, another says I am not, though both agree that there could be some combination of injury and illness (caused by the injury or genetics) at work. I have been on lots of drugs, trying this and that, sometimes feeling better but eventually my ability to function deteriorated to alarming levels. My work performance was marginal before I started the drugs; afterwards I was forced to go on disability.

I have been off all psychiatric drugs for three years and function better than I have since I hit my head. Despite several highly stressful and emotionally-charged events which have occurred during the three years, I have had no emotional swings that characterize mental illness.

I am finally able to put my fatigue in a framework that allows me to be conscious of the fatigue, without being preoccupied by it. This framework helps me focus on what I have learned over the years. I know quiet is important to me, no matter that before the injury music filled my days. I know routine and structure are important to me, no matter that I used to revel in change and spontaneity. I know rest even for a few minutes when I start to tire restores me, no matter that it makes my life intermittent. If I do these things, be quiet, stick to a routine, and rest, I can maintain a fairly consistent level of activity, no matter that it is far below what I once expected. If I don t, my energy levels vary and it is more difficult to accomplish what I want to do. The trick is of course as it always has been, to accept this new self.

I wrote this four years ago - ten years after the injury. I still have trouble accepting my new self, though am better at it. Yet, I still hope that some miracle will occur. The latest: I have learned of NeuroOnline which provides cognitive rehap excerices over the internet. I am waiting to hear from a doctor about whether she will provide the required referral.

Email Carol