Traumatic Brain Injury in Veterans

Richard

Age at interview: 59
Outline: One evening in 1986, years after he retired from service in the Navy, Richard was involved in an altercation outside a Washington DC bar and was seriously injured when his head slammed against the pavement causing a concussion. Although he was told he didn’t lose consciousness, he has no memory of anything after hitting the ground. He remained in the hospital for a week and was told that it would take two years to recover from the closed head injury he had sustained. Richard lost his sense of smell, became hypersensitive to sound, and suffered from memory loss, symptoms he still struggles with today. To cope with symptoms from his brain injury, Richard has learned to reduce stress and walk away from tense situations.
Background: Military branch: Navy

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Richard is a Vietnam-era Veteran who served six years in the US Navy, two of them on the Chief of Naval Operations personal staff. In September 1986, years after retiring from Naval service, Richard was involved in an altercation outside a Washington DC bar and was seriously injured when his head slammed against the pavement causing a concussion. Although he was told he didn’t lose consciousness, he “has no memory of anything after that.”

Richard was taken to the hospital and released “after 14-hours with no special instructions and vomiting.” The next day a co-worked sent him to see his doctor, who in turn sent him to the hospital where he remained for a week of observation and was given steroids to keep his brain from swelling. The neuropsychologist who treated him said it would take him two years to recover from the closed head injury and that he “would need to self-pace.” Richard says he “did not realize how damaged” he was and that it took him a long time to be convinced that he was seriously injured, but he slowly began to notice abnormalities with his cognitive abilities. He lost his sense of smell, became hypersensitive to sound, and began to have difficulty with his memory. “I was looking at the MRI and there were these white splotches in my brain, and it’s permanent brain damage. It’s not going to better. And it’s like wow, I am damaged, I’m damaged goods.”

This was especially difficult as he was just starting a writing career. Now a widely published writer and author, Richard still grapples with anxiety stemming from memory issues, especially when having trouble remembering words. It hasn’t always been easy, and he says the hardest thing about his injury is the impact it has on his writing and ability to do his job. “When I can't find a word, which is not abnormal for anybody, especially when you deal with a lot of words, what happens is that an anxiety kicks in because my brain is still badly programmed… I’d always been able, you know, I mean, even people who just didn’t like me used to call me a smart ass, I was always smart, and then all of the sudden I’m not as smart as I was. As you know intelligence is the ability to quickly process information. And it became longer for me to do that.” 

To those newly diagnosed or struggling with a brain injury, Richard recommends they surround themselves with a team of professionals to help negotiate life their condition. If possible, he suggests they have “one, a lawyer; two, a social worker on the team; three, a neurologist; and four, a mental health professional of some sort.”

 

After his injury, it took a long time for Richard to realize how damaged he was.

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After his injury, it took a long time for Richard to realize how damaged he was.

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I got out and the world was a lot different to me. I did not realize how damaged I was. It took a while. One person I talked to who had witnessed what happened said, "When your head hit that pavement, I heard a sound I've never heard before, and I didn’t know how anybody could survive that," but there wasn’t much pain associated with it. Now I, of course, haven’t done it myself, but it was as though I was having menstrual pains in my head. It was nowhere but everywhere at the same time, and there's so few nerves in your head that you don’t know. I had no insurance, but as a writer, I didn’t really bully the doctors into seeing me, but it's Washington, and so, I did get some follow-up care. I was examined by a neuropsychologist, and to make it even weird, at the same time, I was on probation for a civil disobedience action. He wrote a five-page letter to the judge saying that I should - it's going to take me about two years to recover and I need to self-pace. She said - and this is common with someone who suffered a closed head injury - "You look fine to me. You have to still do your community service." Well, he explained the damage, and the damage was I had contusions to both frontal lobes, which as you know is where words are formed and where executive functions are made. See in this weird way our human body developed - our most important functions are right there, right in front, and some get temporal lobe damage, and my olfactory nerve was mangled. I have no sense of smell, and it took a while for me to realize that like many head injured persons, I initially got well, and then, I entered a period of regression, and I was doing some strange things.

 

After being released from emergency care, Richard experienced brain swelling and returned to the hospital for an additional week.

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After being released from emergency care, Richard experienced brain swelling and returned to the hospital for an additional week.

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The emergency care was horrible, terrible. I was released from the hospital after 14 hours, no special instructions and vomiting, basic biology text Victor and Adam's head injury, vomiting, 72-hours observation. The CAT scan didn’t show any damage, but it was taken too - right away, it takes. So, as you know, one of the sequela, one of the things that happens afterward, is that - well, if I hit here or you get hit here, it swells up, it goes down, everything's fine, but with the brain, the swelling has no place to go. And, if it's not treated, you run a serious risk of brain swelling and cutting off your brain stem, and you can either die that way or become a vegetable - it's not that unusual, and they don’t really know. So, I went back to where I was staying and did the worst thing I could do, fell asleep. Well, that morning, I had uncovered some dirty dealings with a mafia-run company for an investigative firm. The person I reported to called me up and said, where's your documentation you were going to bring us. I don’t remember what I said, and I went back to sleep, and immediately, the phone rang again and he said, "there's a taxi outside.  It's been blowing its horn for five minutes. It's going to take you to my doctor."  So, he did. I walked in the doctor's - he came out in his lobby, took one look at me and I think my eyes were crossed, and said, you're going to the hospital, and I went in and I was there for a week. The kind, warm surgeon came by and said, "Well, if the swelling doesn’t go down, we're going to put in a sieve," and I remembered from John Gardner's Death Be Not Proud about his son's brain tumor where he told a friend, "Yes, I could hear them drill." Anyway, but the steroids that they gave me prevented it from swelling too much. So, I got out after a week and I wasn’t feeling all that great.

 

Richard describes seeing white spots on his MRI and realizing that he had permanent brain damage.

Richard describes seeing white spots on his MRI and realizing that he had permanent brain damage.

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Yeah it’s, again, it’s literally, I was looking at the MRI and there were these white splotches in my brain, and it’s permanent brain damage. It’s not going to better. And it’s like wow, I am damaged, I’m damaged goods. And realizing that. You know, in the end all of the qualifiers, we’re, all of us are brain damaged to some extent, dududududu. Yeah, cause I’d always been able, you know, I mean, even people who just didn’t like me used to call me a smart ass, I was always smart, and then all of the sudden I’m not as smart as I was. As you know intelligence is the ability to quickly process information. And it became longer for me to do that. 

 

As a writer, work was harder for Richard and everything was kind of slow, as though there was gum was stuck to his shoe.

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As a writer, work was harder for Richard and everything was kind of slow, as though there was gum was stuck to his shoe.

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I had no money, which was very difficult as well, and I'm not working really well at all because all of a sudden, everything was kind of slow. It was as though I was - gum was stuck to my shoe or as one of those old deep-sea divers in one of those big outfits with the leg, yes, and things just weren't - as I know now, the brain was working to rewire, and because sides of the brain, when this side does something, the other side has a sympathetic response, but because of my damage, it was getting like nothing. It was not - it just was not good, and I couldn’t understand it. 

 

Richard describes feeling like damaged goods, but learning to accept his strengths and weaknesses.

Richard describes feeling like damaged goods, but learning to accept his strengths and weaknesses.

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I got in touch with my mortality, and I was pretty messed up for a while.  Coming to that realization was not easy, at all. I have a lot friends who helped me. And, yeah, without them I don’t know what -

I: Can you tell us a little bit about the ways that they helped?

It’s not unusual, after you suffer serious head injury, to become suicidal and I became suicidal. And, I have become suicidal since. You know, it’s just you’re damaged goods and you have to accept that. I’ve got some strengths and some weaknesses. Yeah, I’m a pretty good writer, and keep that going, yeah, so…

 

After his injury, Richard says he has a greater appreciation for life and is grateful for the help he received from friends.

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After his injury, Richard says he has a greater appreciation for life and is grateful for the help he received from friends.

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You do appreciate life more. Of course, you know how brutal it can be, and hit the pavement, I mean, that’s pretty brutal. Three blocks from the Capitol. Yeah, yeah. But again, friends help me.  And I then had this series of heart attacks, was homeless. Send me money. No one would accept a penny in return. They simply wouldn’t do it. You know, I’d send them a check, they won’t cash it, and stuff like that. And they just helped out just a lot.  And it was, unfortunately my family, my biological family helped out like negatively, which, which was not good. 

 

Richard learned to separate the psychological damage from the physiological damage, grieve the loss, and move on.

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Richard learned to separate the psychological damage from the physiological damage, grieve the loss, and move on.

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And, sure you grieve the loss. And seeing the MRIs and the white spots in my brain that are permanently damaged and simply won’t get better. But then I grieved that loss and that was key. I needed mental health care for that. And so, I voluntarily checked into a top-notch psychiatric hospital. My dad’s well-to-do, so, on occasion he decided to be my father - visit every 10 years or so, yeah, he helped with that. And that’s where I learned to separate the psychological damage from the physiological damage, grieve the loss, and move on. Again that’s, that’s where words are formed and all of the sudden, you know, I started on Newsweek, and dadada.

 

While inpatient at a psychiatric hospital, Richard took part in group therapy.

While inpatient at a psychiatric hospital, Richard took part in group therapy.

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Yeah. It was when I was inpatient in the psychiatric hospital, and I was a member of 11 groups that met up to six times a week. That was dynamic, it was fantastic. The whole idea was to, they, they, they pushed you to get sick, you know. They wanted you to show your pathology interacting with other people. Yeah. And that was very important.

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