Before the Iraq and Afghanistan wars, most people were familiar with the term ‘concussion.’ We’d here a neighbor or a co-worker refer to someone having a concussion and not think much about it. That is, unless we were one of the unlucky individuals that received a concussion and then we suddenly understood just how much this condition impacted our daily lives.
We didn’t see a psychiatrist or a mental health worker like so many in the armed forces now do. But perhaps we should because our world, as we knew it, had been turned upside down. Those of us that were fortunate were immediately referred to a neurologist, and not just any neurologist. We were referred to one whose practice was devoted exclusively to brain trauma.
You might ask, why I’m writing about my experience with concussions, or Traumatic Brain Injuries (TBIs), as they are now listed on medical forms. My answer: I’m appalled a soldier is expected to return to combat after they experience one TBI, let alone multiple traumas.
Traumatic brain injury is considered one of the signature wounds of soldiers fighting in Iraq and Afghanistan, (now well into their eleventh year), but the military medical system is still failing to diagnose the injuries in many troops.
The Centers for Disease Control and Prevention states a TBI is caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain. Not all blows or jolts to the head result in a TBI. The severity of a TBI may range from mild, i.e., a brief change in mental status or consciousness to severe, i.e., an extended period of unconsciousness or amnesia after the injury.
The first of my three traumatic brain injuries occurred in 1995, the result of a vehicle accident in Washington, DC.
The impact of the other vehicle caused my head to break through the safety glass of the window in my vehicle and the entire right side of my body left an imprint in the steel frame of my Toyota Camry. Before loosing consciousness, I heard and felt my bones breaking in multiples and knew I couldn’t see.
My life changed forever on that spring day in ’95. The cherry trees had been in full bloom and my husband and I had been to the tidal basin for a picnic. There’s not much that matches a picnic with the man you love. We used our ‘Out of Africa’ picnic basket and marveled at how lying under the cherry blossoms and looking up met our imagination of being under a blanket of pink whipped cream. We had no idea I’d be in the hospital that night hooked up to countless monitors.
When I was released from the hospital ten days later, I was horrified that I couldn’t go back to work immediately. After all, I’d been hired by my current employer and moved from the west coast to ‘come in and clean house.’ My reputation preceded me. I couldn’t appear weak. I was furious. What did the doctor mean? I had to have a home health nurse. Weren’t those for old people? My vision was coming back but I still stumbled around and numerous eye surgeries were on the horizon.
My emotions had a strangle hold on me. I was invincible; I could do it all. And where had this fool who had hit me come from anyway? I wasn’t fighting an enemy in combat; I was enjoying a Saturday afternoon.
I had work to do, places to go and generals to report to. They hadn’t hired me to be on bed rest.
My doctor said, “Your orders are: no reading, no television, no music, no telephone, no walking your dog, no visitors. Absolute bed rest. Your home health nurse will help you with your IV Lock Port and filling your syringes.”
I couldn’t imagine being shut away on bed rest with no reading, no updates from my staff, and no music. At the time, I didn’t understand the brain needed total rest and that anything that stimulated the brain was a detriment to recovery. Anything. I didn’t grasp the only safe activity was sleep.
Returning to work two weeks later against medical advice, prevented my brain and other parts of my body from healing properly. The results were migraines requiring daily pushes of medication through an IV Lock Port in order for me to function. I’d never had a migraine before the accident. For two years after the first TBI, the migraines came on with such intensity they’d start in the middle of the night with projectile vomiting. For a workaholic, this was torture, and the symptoms were relentless. For a soldier in combat and those around him, this could lead to certain death.
Additional symptoms included intense sensitivity to light, inability to tolerate loud noises, balance problems and a complete loss of tolerance in multiple arenas. I was also diagnosed with trauma induced fibromyalgia. I didn’t like it when the rheumatologist told me I could no longer scale tall walls and drop to the another side, along with a number of other skills I’d always taken for granted. How could I run everyday when I now walked with a cane?
My second TBI occurred two short months after the first and impacted the base of my brain. The first TBI had affected the frontal area. The second was caused by an attack in an underground garage. I knew immediately I’d sustained another TBI because the nausea started immediately. I couldn’t be stubborn this time. In the two months since the last TBI, I had lost some of my ability to concentrate. My communication skills had also slipped. I searched for words that didn’t come. Cognitive rehabilitation was necessary. I had to let my brain recover. I didn’t want to take the time, but what choice did I have?
Just before the second TBI, I’d accepted a promotion and transfer to Walter Reed Army Medical Center, an unforgiving location at which to work. The pace was fast and the workweek always eighty hours or more. There was no downtime.
I’d decided after five grueling years in DC, it was time for me to leave. I sent out resumes and the offers arrived. Fortunately an even better offer arrived from within the beltway for what I knew would be a challenging and rewarding position. I’d have the opportunity to further affect change in healthcare legislation. But the responsibilities would be enormous and I’d be home even less than I had been to that point.
I told a friend of mine, “If God doesn’t want me to take the position here in DC, he needs to knock me on my head and let me know.”
I’d had enough. I accepted a transfer to Oregon and my husband suggested that the next time I asked for God’s advice, perhaps I should think of a gentler form of communication.
My world of work in DC was dangerous. It was my job to discover the wrongs that were quietly being played out in government. As a civilian working for the government, I could determine my exit strategy. Unfortunately, soldiers in combat don’t have this luxury. They are returned to combat repeatedly.
From experience, I know traumatic brain injuries change numerous aspects of the human body and–most important—the body must be kept out of harms way.
As a result of my own TBI’s, I’ve experienced debilitating migraines, unexplained bouts of nausea, numerous vision problems, lack of concentration, sense of balance problems to include waves of dizziness, loss of memory, personality changes, bouts of depression when I’m unable to accomplish what I want, exhauston, and I’m now tempermental. I also require numerous prescriptions and each time I have even a slight bump to the head I must have a scan to check for blood clots on the brain, and I still require medical care seventeen years later relating to my traumaatic brain injuries. The medical team that follows me are all a direct result of my first TBI. Further, as I age, old and new complications become life threatening.
Our service members should not be returned to combat when they have sustained a traumatic brain injury. I refuse to believe that when they signed to serve their country, they signed to do less than the best job possible. It’s impossible to do your best when you are suffering from a traumatic brain injury.
General Peter Chiarelli, former vice chief of staff for the U.S. Army, is now CEO of One Mind for Research, a nonprofit organization dedicated to finding cures for brain disorders. I agree with the retired general when he shared an idea on National Public Radio (NPR) recently: “A traumatic brain injury doesn’t affect just the soldier, but it affects the soldier’s entire family.”
A fact sheet published by NPR reported that approximately 1.7 million people sustain a traumatic brain injury annually in the United States. Additionally, the exact number of soldiers having TBI is hard to pinpoint. The Pentagon says about 115,000 soldiers have mild TBI, while the RAND corporation study suggests the much higher number of 400,000 total TBIs, the majority of which are mild.
The bottom line, a TBI stays with the individual for life. It attacks a person’s thinking in the form of memory and reasoning; the sensations of touch, taste, and smell; language communication, expression and understanding; and emotion in the form of depression, anxiety, personality changes, aggression, acting out, and social inappropriateness.
Of further concern, TBI can also cause epilepsy and increase the risk for conditions such as Alzheimer’s, Parkinson’s, and other brain disorders that become more prevalent with age.
Repeated mild TBIs occurring over an extended period of time (i.e., months, years) can result in cumulative neurological and cognitive deficits. Repeated mild TBIs occurring within a short period of time (i.e., hours, days, or weeks) can be catastrophic or fatal.
Leon Panetta, Secretary of Defense, and Congress is calling for a drawdown of our Armed Forces. This puts our service members at greater risks than ever. Drawing down will require multiple deployments for remaining personnel and multiple deployments will likely result in irreversible injuries. A human body cannot sustain repeated injuries and continue to function normally. If less than 1% of the eligible population is willing to enlist, perhaps we do need to bring back the draft.