In the hustle and bustle of our busy days, full of faxes, phone calls and a thousand and one errands, it is really easy to get caught up in the daily details and forget what's important in life. Unfortunately, it often takes some kind of trauma - to wake us up to what matters. After all, no one on their deathbed regrets not spending more time at the office. I've always thought of myself as a good person who wanted to do something to make a positive difference in the world. I was paralyzed by the sheer scope to make a difference, to obtain a successful career, and to obtain my degree while continuously striving to accomplish successfully in all my endeavors. On July 22, 1996, I was involved in a terrible accident, suffered a serious head injury, in fact I died, but God performed a miracle and gave me new life. I survived a coma, two brain surgeries, and paralysis and loss of memory. As Eleanor Roosevelt states "Happiness is not a goal; it is a by-product".

No words or feelings are adequate to express the comprehensive sorrow, pain, anger, disappointment, and hope shared by persons and families changed and challenged by the impact of a head injury. While the reaction of the family varies according to the severity of the head injury, subsequent losses, and potential for rehabilitation, a common denominator for families is that their lives have been changed, forever. This change is a result of complex and long-term demands placed on the family system. In this essay, I will describe the impact of the head injury on the person, the impact of head trauma on the family, the impact of the support system, how recovery can be initiated by hope and optimism, and how health care providers can provide dignity to assist the brain injured person. For documentation, I have included a copy of the police report and copies of my bills for hospitalization. As a survivor of a traumatic brain injury, I know that the injury can be as damaging to the personality as it is to the body of the person. I was not aware of my accident until five weeks later. I came out of a coma three weeks after the accident. During that time, I had two brain surgeries to remove a blood clot and pressure due to hemorrhaging of the brain. With the second surgery, a permanent shunt was installed to alleviate the build-up of fluid in the brain. Between the fourth and fifth week after the accident, I awoke but was not alert. I was transferred to a rehabilitation hospital and at that time I started the recovery rehabilitation. During the fifth week, my husband, although I did not know that he was my husband, but sensing that this man deeply cared for me, gave me a hand-held mirror to look at my reflection in the mirror. While looking at the mirror, because of my memory loss I was not sure what I was looking at, my husband stated "Honey, I want to tell you that you are beautiful, you were involved in a serious head injury and I want you to look at yourself." I could not believe what I saw......the reflection of that person looked like a freak. It was not me....this person had a shaved head, black eyes with puffy cheeks. Not only did I suffer from a brain injury, but all my facial bones were also broken. It was at that moment, I looked at the walls, and I realized that I was not at home.......it seemed at that very moment my memory was starting to come back. I looked at my husband, as tears were rolling down his cheeks, I started crying. Coping styles include the varied modes of dealing with the challenges ranging from pain, perceived losses, an uncertain future, redirection of goals, and relationship changes. These coping styles, whether they are more problem-focused, such as seeking information and support, or emotion-focused, such as releasing one's anger or accepting the situation with resignation, are constantly changing cognitive and behavioral efforts to manage specific external and internal demands. These demands are viewed as promoting the resources of the person with an illness or disability.

With head injury, grief is a profound sadness or sorrow due to the significant changes or reduction in such life areas as health, independence, sense of control over life, established roles inside the home, sexuality, familiar daily routines, and means of productivity. The grief is often accompanied by feelings of anger and helplessness, with anger often directed toward others. The day I saw my reflection in the mirror, process of my rehabilitation began. The foley catheter was disconnected and I was expected to use the bathroom. Even though I was paralyzed on the left side, nurses began teaching me on how to use the bathroom.

It is only now that I realized why my husband wanted to be near me as I saw my reflection, he was concerned that I would be upset and would not be able to cope with the shock. I thank God, that my husband knew how important I needed his presence during this traumatic experience. Not only did I realize that I was injured, but from the day I saw my reflection, my ability to remember began. It is strange, but I lost five weeks of my life, but I believe that I was reborn. I was determined to walk, talk and return home. Although, I did not have complete use of my limbs, I did have determination. I refused to use a wheel chair during my rehabilitation. The wheelchair represented failure to me and I often became hostile and agitated if I was forced to sit in a wheelchair. Since I became agitated several times, the rehabilitation hospital taught me to use a walker. With a smile on my face, continued physical therapy and the support from my family, the walker gave me the opportunity to exercise my limbs and within a couple of weeks I graduated to a cane and was discharged to an out-patient brain rehabilitation center in Berkeley. Finally, I started the journey to live with uncertainty and ambiguity. Though denial of one's limitations caused by a head injury is a frequently recognized characteristic of individuals with head trauma, the different unpredictable cognitive, physical, and emotional aspects of head injury during the indefinite post-trauma period can be quite troubling to an individual. It may be a long time before there is symptom stability, and for individuals who are accustomed to having a measure of control over many life events such as health, career, and family life, living with the unknown and episodic occurrence of symptoms may bring continued anxiety, irritability, and impatience.

The impact of head trauma on a family challenges the core values and resources of the family system. Not only must the family adapt to the emerging needs of persons with a head injury, but also it must continue to maintain a sense of unity by re-grouping its members, refocusing its resources and re-defining its functions. There are many causes for why the family reacts as it does to illness and disability in general and head injury in particular. When a life crisis represents a totally unfamiliar event, the family will usually display confusion and have a difficult time focusing its resources. How the family understands head injury will depend on the kind of information that has been imparted to family members, when and how it was given, and the ability of family members to hear, understand and believe what is being said. Coping resources include various emotional strengths that family members may possess to deal with head injury. Satisfying work activity, the support from extended family, the availability of necessary community resources, anticipation of planned activities, and self-help groups can be helpful in times of the continued stress associated with the head injury experience. Each family stage brings the necessity of accomplishing certain tasks such as raising children, and maintaining financial security for the family. The family members' perception of their relationship to the person with head trauma is a critical component in how the family will adjust. If they perceive that the injured family member, prior to trauma onset, was an energetic contributor to family life, then their adjustment to the injury may be characterized by lingering feelings of loss, a reluctance to accept significant differences in the injured family member, and even a false hope that pre-injury functioning will be quickly restored. As family members become aware that their injured family member is not going to be physically, emotionally, and/or intellectually the same as pre-trauma, issues of blame, guilt, anger, and depression emerge. Sibling responses may include increased rebelliousness and verbalized resentment. Individual family members will gradually adjust their life to the caregiving demands, role re-allocation risks, and perhaps family finance changes. Although grieving can take on a chronic nature, many families do eventually work through feelings of denial, optimism, anger, and depression to a degree of adjustment.

In addition, family members need a good support system to help them control family disruptions, anxieties, and uncertainties for the future and feelings of grief and loss. These strategies include positive comparisons formulated by family members and friends, entertaining beliefs that the patient will improve. Fortunately, my family is a close knit family. I have been married over twenty-seven years to a caring husband, and have three devoted children. My son, Brandon twenty-three years old, my middle daughter Missy, twenty-one and my youngest daughter Sara, sixteen years old were able to cope with this crisis. I thank God, that they had each other to support each other. The first week after my injury was the most crucial point of my recovery. The doctor's were not sure that I would survive each night, but with prayers and my support system, my family was able to deal with this crisis. After the fourth day of the injury, a blood clot and fluid in my brain threatened my survival. The surgeons spoke with my family about performing surgery within a few hours to relieve the pressure on the brain. My family was informed by the surgeons that they were not sure the surgery would be successful, but they informed my family that without surgery, I would not live the night. The surgeons informed my family there was a possibility that I may end up in a vegetation state as a result of the surgery. My family and a very close friend of mine talked amongst themselves and decided that they wanted me to live and they would risk the chance of me being in a vegetation state. I thank God that my family had a good support system. Not only did they have each other, but also my co-workers supported my family throughout this crisis. I work for a Catholic hospital in the Bay Area and my co-workers have been my extended family throughout the fifteen years of employment. Having healthcare professionals as my extended family, following my recovery, they were involved in providing my family with support and also providing guidance to my family. The hospital even had a prayer service in the hospital chapel where the employees prayed for a speedy recovery for me. The Sisters of St. Joseph, stationed at my employment, cooked meals for my family. As I look back on the support my family received, I feel so fortunate in having such loving caring friends.

Recovery for the brain injured can be initiated with hope and optimism. Hope is first and foremost for ourselves. When life is tough, why should we add pain to our heart and soul? It is easy to be discouraged and harden our hearts when your future is uncertain. A brain injured person can soften their burden, by holding their hope in their heart and exhibiting optimism. When a baby cries, one responds by holding the baby in their arms and tenderly soothes the baby. That is what one brain injured person should do with their optimism. In their heart, optimism and hope will thrive and flourish. Healthy emotion, reasoning and goal exploration are essential. As human beings we tend to view the negative aspects to daily life. And once we discover the negatives we tend to dwell on the wrong aspects. In order to be optimistic and flourish with hope, we need to learn to see our negatives in their real context. We need to open our eyes and hearts wide enough to drink and smell in all the beauty and joy that is always around us no matter what is going on with our lives. When we are afraid, we contract - our muscles tighten, our vision narrows, we physically pull away. When we believe that we are limited, ineffectual, we seal ourselves in a cocoon of apathy. When we see ourselves as "not good enough; we constantly-recreate a lonely and self-limiting world.

After being in a coma for three weeks, I was paralyzed on the left side. Not knowing if this paralysis was permanent or just a part of the recovery process, I decided to start my path to recovery. Because of my support system, and the encouragement I received from family and friends, I started my journey bursting with hope and optimism. It is only when we can move beyond our obstacles, when we can see our path with open eyes loaded with optimism can we achieve our hopes. By the fifth week after my injury, I was able to walk with a cane. Proud and eager, I was on the road to recovery.

After, the fifth week ended, I was released home. But before I could be released, my husband was informed by the healthcare professionals, that my family was not to let me cook for fear that I would not be cognitive to remember to shut off the oven. That was okay with me, because cooking was not a goal of mine to accomplish. I will never forget the day when I entered my home after being in the hospital for five weeks. My house appeared to be my castle. I was in love with my blue rugs, they felt so soft against the soles of my shoes, and my senses were overwhelmed. My knickknacks seemed magnificent and I remember feeling proud to have a home to come home too. My husband was overwhelmed and he was afraid to leave my side. That evening when it was time for me to go to bed, my husband walked me to bed, and tucked me in. Unfortunately, I had to go to the bathroom and since he secured the blankets I had to wake him up to help me. He hovered over me; in fact, he smothered me and treated me as a child. Communication is very important for the brain injured and the family and having patience is required.

Within a couple of weeks my husband realized that he needed to cut the strings and let me stand-alone. Thank God, the love we shared enabled us to deal with the uncertainties. After being home for less than a week, I started rehabilitation in a brain rehabilitation in Berkeley as an outpatient. Since my driver's license was revoked, I depended on transit services to take me to Berkeley, thirty-five miles away, and return me home at the end of the day. At first, I felt uncomfortable taking transportation designated for handicap individuals. Even though I was not in a wheelchair, a vehicle indicated for handicap individuals transported me. Coping with this unfortunate transportation was minor, because my goal to recovery was now in progress and I was eagerly filled with optimism needed to recover.

Healthcare providers need to provide dignity in assisting the injured person. My stay in the rehabilitation hospital has left scars on my soul. Fortunately, since I work with a heathcare facility, I was aware of the patient's rights and with this background I was able to assert my rights as a patient. In the beginning, I was not allowed to dress myself. Even though my healthcare providers allowed me to take a shower, I was not allowed to dress myself. This did not make sense to me and I refused to take orders from the healthcare providers. Several times I demanded the administrator on-call assist with my requests. My healthcare providers often would state that I was brain damaged and temper tantrums along with aggressive behavior were normal and that I should respect their wishes. Experts state that following a brain injury, a person's mood can be labile and easily change from good feelings to depression for no apparent reason. I understood what my healthcare providers were telling me, but on the other hand they were not listening to me. If I was able to shower by myself, then I should be able to dress myself. I knew my rights and I knew what my abilities were. After speaking with hospital administrators and contacting my physicians, my healthcare providers allowed me to dress myself. Not only was dressing myself important, but also, I wanted to be able to drink water at my request. My healthcare providers would not allow a pitcher of water in my room, they asserted that I might choke and they did not want to be responsible. I did not understand their reasoning, since I was able to walk to the dinning room for my meals, I still thrived to drink water when needed. Again, I called the administrators on-call and told them my requests. I also instructed my husband to bring me paper cups and I hid them in my nightstand so that in the middle of the night when I became thirsty I would go to the bathroom and drink from my paper cups. The day before I was discharged, a water pitcher appeared at my nightstand. By then, I was eager to go home, I did not need to fight for my rights in this hospital, I was thankful to be alive and I was tired of fighting for my rights.

Brain injured people have rights, and they strive to live a normal life. Our energy for the recovery journey is needed to deal with the desire for recovery of lost abilities. When times are tough, it's easy to shut out the rest of the world. And sometimes it is necessary to turn inward, feeling the depth and breadth or our sorrow so that our wounds can heal. By healthcare providers providing dignity with assistance to the brain injured, as in my case, my demands in dressing myself and letting me have water were never addressed. Ultimately, I have learned that brain injured people need to come back out into the light, scars and all, and allow their suffering to make them more compassionate toward others. Precisely because we have known pain, we can empathize more truthfully with the pain of those around us; we can offer the example of our own journey to healing as encouragement for those still taking the first steps. In so doing, we not only inspire fellow sufferers; we make sense of our own pain. Rather than close off our hearts and sink into despair, we can let hardship hone us into a vessel overflowing with wisdom and compassion.

While I was in the brain rehabilitation center, my self-esteem plummeted. On a daily basis, I was reminded that I was brain injured and there was a good possibility that I would become depressed. Every morning I would attend a memory class, having to recite the months of the year and play alphabet games. These memory classes were a waste of time. I had regained my memory and I knew all the exercises. Unfortunately, I was placed in a class with quadriplegic patients who were not able to speak. During the class, I verbally answered all of the questions, since I was one of the few who could speak. During the day I would have a speech class, and a session with the psychologist. I was not impressed with the psychologist, most of the time she tested me. I was reminded that eventually I would become depressed and that she would be there to help me. After three weeks, seeing the psychologist each day and hearing how I failed the tests and being asked if I had any seizures, I decided to take the next step in my journey. The next step was to leave this rehabilitation center because I was tired of hearing negative feedback. I wished that I would have made my decision earlier, but maybe I was not sure of my future. Since I was filled with hope and optimism and this brain rehabilitation was draining my ammunition, I decided to stop this treatment. As I look back, six months later, I have never regretted my decision. Now, I felt that I was in control and in my heart and soul I no longer had any negativity to hold me down.

When we are very young, we fearlessly devour our world and reach out to people with eagerness. As we grow up, surrounded by the daily outpouring of bad news, we become more and more afraid and too often end up retreating farther and farther into our isolated shells. We find ourselves looking at the world in terms of control, possessions, and power instead of growth, understanding, and feeling. But after being brain injured we can begin to connect with the world. During my hospital stay, I was told that the future was uncertain and I was told to prepare myself for accepting small gains if they occurred. Luckily, small gains did occur, then some bigger ones came. Brain injured people need to have a support person who can represent their needs to the health provider. Some brain injured persons are unable to communicate their thoughts, thank God, I was able to communicate my demands. When a brain injured person looses their dignity they lose their will to live. If we blame ourselves for our failings, we tend to get discouraged and give up. But when we remember that loving ourselves is a direction and not a fixed destination, we simply pick up the compass of kindness and begin our journey again.

Providing kindness does not require extraordinary gestures. If healthcare providers would practice kindness, they simply would bring happiness and joy to those who are injured and assist them on their journey. Love and kindness are not physical things that will be lost or diminished when they are given. They are instead like the miraculous breath of life. We are all born with the capacity for great kindness--it is deeply woven into the very texture of our souls. My advice to healthcare providers is to really listen to the patient....take a look at what they are saying.....service is a process of self-realization.... treat your patient as you would treat yourself.

In conclusion, when we are rushed, we can easily lose sight of the precariousness of life. Since I am recovering from my brain injury, I value the gifts of life. What have I learned from this experience? Plenty, an almost miraculous transformation took over me, my love for my family seems over-flowing. Not only have I learned and experienced the impact of the head injury on the person. I also have learned that coping styles include the varied modes of dealing with the challenges ranging from pain, perceived losses, an uncertain future, redirection of goals, and relationship changes.

With head injury, grief experienced is a profound sadness or sorrow due to the significant changes or reduction in such life areas as health, independence, sense of control over life, established roles inside the home, sexuality, familiar daily routine, and means of productivity. The grief is often accompanied by feelings of anger and helplessness, with anger often directed toward others. I also have learned and experienced how the family experiences the loved brain injured family member. Family members need a good support system to help them control family disruptions, anxieties, and uncertainties for the future and feelings of grief and loss. These strategies include positive comparisons formulated by family members and friends, entertaining beliefs that the patient will improve. I have also learned and experienced how the recovery for the brain injured person can be initiated with hope and optimism. Hope is first and foremost for ourselves. When life is tough, why should we add pain to our heart and soul? It is easy to be discouraged and harden our hearts when our future is uncertain. If there is a way you can soften your burden, hold your hope in your heart and exhibit optimism. Healthcare providers need to provide dignity in assisting the injured person. My stay in the rehabilitation hospital has left deep scars on my soul. Fortunately, since I work with a heathcare facility, I was aware of the patient's rights and with this background I was able to assert my rights as a patient. Brain injured people have rights, and their needs to live a normal life is essential. Providing kindness does not require extraordinary gestures. If healthcare providers would practice kindness, they simply would bring happiness and joy to those who are injured and assist them on their journey. Love and kindness are not physical things that will be lost or diminished when they are given. They are instead like the miraculous breath of life. We are all born with the capacity for great kindness-----it is deeply woven into the very texture of our souls. My advice to healthcare providers is to really listen to the patient and take a look at what they are saying. Service is a process of self-realization, treating your patient as you would treat yourself. As Daphne Rose Kingma stated, "In the end, nothing we do or say, in this lifetime will matter, as much as the way, we have loved one another."

TOO CONTINUE AT A LATER DATE!!!!!

PLEASE NOTE: On August 4, 1998, I am recovering from my third brain surgery. This episode was quite a shock, a month before I was told that I had less than 6 months to live. But, by having this third surgery, I have a very good chance to live a normal life. I am still recovering, and once I complete my recovery, I plan to write about my last experience. I can say, that before I had my last surgery, I outlined my wishes…………and they were granted!!!!!

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