I Really Am Brain Dead...No Jokes

Retrieved from https://www.pinterest.nz/pin/341077371764547543/

Following my fall there was no immediate cognitive malfunction.  The week we were in Rarotonga for I managed to hold conversations, read for a reasonable length of time and not struggle to focus for longer than an hour.  I was, for all intents and purposes, feeling as 'normal' as it gets for me, give or take the odd headache.  That said life was running on island time - I was getting plenty of sleep in spite of my head bang and the sinus cold I contracted on the plane to Rarotonga (love air conditioning!), we spent the afternoons lazily watching the waves roll in and crash on the reef from our balcony and spent time hoping to see the migrating whales - which I was lucky enough to experience.  Mornings were spent out and about - a safari trip, finding the brewery just out of Muri, wandering the market on Saturday in Avarua.  No pressure!

It was on our return as I tried to launch back into the busy-ness of work, home and study that things deteriorated.  Initially it was the head ache that got worse and, after two days at home, I began to curl up on the couch and sleep at random times of the day feeling sick and shaky if I did not do this.  A workshop I was running on the Friday (day 3) after our return was time adjusted as I knew I would not last the distance to the advertised finish time.

The weekend is always busy with washing for our household, my parents-in-law who are in a home and prefer their whites to stay that colour, as well as getting things organised as I prepared to launch back into time away from home working, and of course trying to get my brain out of island time and into the study for my Learning and Behaviour university paper that was now to be my focus. By the end of the weekend I realised I should not be driving - my processing times were appalling and I was an accident waiting to happen.

Following my two days away attempting to work, and with my lovely husband driving me on his days off, it became obvious something was really wrong.  I had two half days of meetings and work with students, with the other parts of the days supposed to be spent on the follow up paper work online.  I struggled through the time with the students - could not get myself to write neatly by the second day, struggled to focus on the assessment answers I was being given that day and my brain was so stretched by the end of that morning that I could not work out how to choose the right-hand tap from a set of three.  Actually I could not work out how to work that out...that was the moment it hit home.  My brain was severely injured.

I have now spent two and a half months in this state with incrementally small movements forward.  My concussion is actually now called a mild traumatic brain injury.  I have problems with memory, speaking, spelling, typing, focus, and retention.  I cannot do more than one thing at a time and even then struggle to complete it.

Memory - recall of words, information people are telling me and even basic things like whether I have brushed my teeth today.  I was tempted to create myself a visual timetable like the ones I use with my students.  As I progress and it is not just the basic hygiene things I need to remember I may well need to do this.  Google Calendar and its notifications has been amazing.  The only appointment I have forgotten is one that was not put in there. Part of my recovery toolbox included the need to use the three P's - Plan, Prioritise and Pace.  I found myself writing lists on a daily basis then shifting things that had not been high enough on the priority list to the next day.  Pacing has been my hardest thing to master.  I am used to being able to go like the Energiser bunny for the day and into the night with very few brain breaks or feeding my brain caffeine in the form of Coke Zero.  I am now faced with needing to take regular micro breaks where I close my eyes and use mindfulness techniques to let the brain rest.  Initially it was every 5 minutes while I was on a screen which has now extended to every 10 minutes. If I did not do this there was no way I could remember what I had read for my assignment work.  Pushing myself means that my memory is a Swiss cheese with more holes than cheese. I keep reassuring myself that this too shall pass and have some wonderful friends who have been in this situation reminding me I need to rest if I am to improve.

Speaking and processing what I am hearing - I have struggled at times to understand what people are meaning when they say certain things and have felt like a complete idiot more than once through misunderstanding the intention of what was said.  Not great for your self confidence.  Living in a household that survives on wit, puns, play on words and jokes has also been an uncomfortable place to recover - I do not always get what is meant and say things that are picked up on to be made fun of.  I now completely understand how an autistic student feels when they can only understand the literal meaning of what was said - confused at why people are laughing, upset that I made a mistake, and a little less confident to say something the next time I am in a similar situation.  I have found myself at times letting my husband do the talking.

The other side of that is trying to speak.  I cannot always get the connection between my brain where the sentence is well formed and my ability to get that well formed sentence out of my mouth to co-operate.  I find myself almost stuttering, using the wrong words between the time the sentence has been cleared for take off and when it actually launches into space, and if I am over stimulated I sound like a drunk by the end of an hour.  Words are slurred and I cannot actually form the sentence fully in my brain anymore.  If we are out and about that is a sure signal that it is time to leave and get some quiet time...actually that boat has sailed and I should have gone to the loo for quiet time well before that.  I am slowly learning to read the body signals before they become flashing red lights with alarms going off!  If I was a child in this situation in a classroom I would need never mind want to get away from the noise and the need to make my brain work.  This is something teachers need to be aware of and ask about when a child asks if they can go and work somewhere else.  I now know that desperate need for quiet and peace.

Spelling and typing - this was a shock for me.  I have always prided myself on my spelling, something that was drummed into me as a child.  Typing was also something I learned at secondary school and passed Pitmans exams in.  So it was uncomfortable to be typing a response to an email and not be able to work out what was wrong with the word exersize.  I knew it was wrong, that it didn't look right. In the end I actually had to put it into Google to correct it.  Talking to one of the Occupational Therapists (OT) led to the understanding that the brain sees these tasks as superfluous to all the other functions that it is trying to repair connections for.  As far as my typing goes I press the correctly positioned key on the opposite end of the keyboard eg a 'k' instead of an 's' or I will transpose letters inside the word - particularly at the end of the word eg 'liek' instead of 'like' or completely leave letters out as my brain has said I included them when I actually didn't.  Thank heavens for the backspace button - mine will be worn out before long.  This is now something I will ask a child about if they have had a bump on the head, been in some kind of traumatic event or seem to be struggling with this area when it has not been an issue in the past.

I guess it is a little like the repair on the road infrastructure in Christchurch following the earthquakes - important and heavily used routes were repaired and opened first with repairs to streets within suburbs coming later as they were further down the infrastructure list of importance.  Spelling and typing will improve I am told, but it will take time.  They need to join the queue for repair.  Until then I am very thankful for the lovely little red lines that alert me to incorrect spelling or typos as I complete the work required for the online forums for my Massey paper.

Focus and retention - at the moment my focus length with new learning/information is somewhere between 40 and 60 minutes.  My concussion OT is very quick to pick up that my eyes have gone glassy - often recognising my need for rest before I do.  I have moved from needing to sleep after that length of time to needing to just close my eyes and listen to meditation music for between 15 and 30 minutes.  I am struggling to retain the information gathered as I read for my paper and find myself rereading the highlighted parts several times as I put together my response to it.  I have learned to get the key points of what I want to say into my doc first then go back and flesh it out.  What used to take me about half a day to complete can now take up to four days due to the need for breaks, the shortened length of time I can work for anyway, the mistyping of my response leading to the need to reread and make corrections more than once, and the inability to retain the details like I used to be able to do.  I am managing to complete the online forum work for my paper but that is it.  The assignment work - creating and gathering artefacts showing my learning progression - will need to have an extension.  I am so thankful to the wonderful Wendy who has been such a support through this.

Cognitively I sound fine for about an hour, I cannot remember things I am told - for example, some days my son will have to tell me three or four times what time he is finishing his shift at work - and I have lists everywhere.  It is literally as the quote says at the top of this post sometimes I think I am coming right as I amaze myself, other times I can barely remember whether I brushed my teeth that morning. I am looking forward to the bruised brain beginning to function as sharply as it used to.  I will feel a lot less frustrated.

And just like that suddenly everything was different...

I found this quote online and it really sums up my current situation.

I had joked before heading to Rarotonga that I needed to get off the bus that was the madness of my life - travelling, working, studying and somewhere in there being a wife and Mum, never mind finding time for myself. However, the Universe answered back with a completely different version of getting of the bus than I had intended.

We were delighted to return to the island that had seen us relax and reconnect with each other the year before. The sights, the beauty, island time, cocktail hour and of course being away from the world at home due to their expensive internet and mobile phone services were welcomed with excitement as we flew out of New Zealand on Tuesday, landing in Rarotonga after time travelling back to Monday.

Following breakfast on our first full day we had headed to the resort booking office to book the island safari tour we had decided would be a great way to see the interior of the island, and then head for a walk along the beach. However the office was busy so we decided to switch and go for our walk first.

The tide was heading out as we arrived but not to the point that the little fish and crabs had gone from the rock pools. The beach is mainly sand with the odd areas of rocky atoll poking through as the tide recedes as in the image below. The rocks were a little slippery and, as we came to the end of them in front of the building we were staying in, I went to put my foot down - I remember being about to place it onto rock with the step onto the sand being just a little too big. That is the last thing I remember about the fall - thankfully. I do not remember the slip, the probably very ungraceful and definitely fast descent to have my left hand, shoulder and temple impact with the rocks. No, the next thing I remember is pulling my very sore head off the rocks, checking my hand as it was sore, but not registering either of them were bleeding as I was seeing more than one of them at the time. I was pretty dazed - too dazed to be frightened. My husband waited for me to signal I needed a hand up. He reports hearing a noise and catching the last second of the fall as he looked around from his position slightly in front and to the right of me. Getting up brought on a wave of dizziness as did an attempt to continue our walk. Little did I know that those few seconds, which I did not realise I could not recall at all until about three weeks later, would change my world for possibly the next two years.

I had just stepped off the bus.

The rocks in the foreground are the ones I slipped on... how silly do I feel with the damage they did!

As I attempted to walk more I registered a growing red patch on my shirt where my hand kept brushing against it and realised I needed to get back to the room to clean up the bumps and scrapes on my hand and head before they became infected, as well as rest until the dazed and dizzy feeling went away. I washed out my shirt as best I could with the hotel soap, cleaned myself up, applied Voltaren gel to the growing lumps on my hand, shoulder and face, and tried to tell myself I was okay - get up, dust self down, move on was my feeling. We planned to go into Avarua later in the morning to stock up on plasters and Dettol.

As we returned to the booking office to sort out our trip I had said to my husband that I thought we should delay until Friday if we could so I had a bit of recovery time (the accident occurred Tuesday in Rarotonga time, Wednesday our time). However the booking agent let us know that this was not a good idea as not many had booked for Friday at that stage and the trip may not go - so we booked for the following morning.

By the time this was done I knew I was concussed. My head was throbbing, I could feel the bruising and swelling starting and needed to get both Panadol and ice sorted. We are both trained in First Aid - hubby's is current, mine has lapsed - and were aware of the treatment for concussion. Had I vomited or actually realised I had lost consciousness at that point we would have made the trip to the hospital. I had done neither so we treated it as we knew it should be. Ice, rest and seek medical help if anything changed.
But nothing did - the whole week of the trip. Sure I was tired after our amazing trip the next day, the black eye appeared, I had to get hubby to read for me as my glasses had saved me from a complete rock smash to the temple but the arm on the left was now broken and they were sitting on my face skewed. Our days consisted of mornings out and about, afternoons resting and sleeping, evenings in search of dinner away from the resort and I still had a cocktail or two from the third night until we left. Even the flight home was only made uncomfortable as I had developed a sinus cold with the change in climate and my ears felt like they were going to explode as we descended into Auckland.

The black eye was not even that bad - there was a line hidden by my hair where my glasses had bruised my head and scrapes also hidden by my fringe.

However, after we returned to normality things changed. As I tried to return to normal function I found myself incredibly tired and with an almost constant headache. I still finished the planning for and facilitating of a final session in a series of workshops I had been running. I rested over the weekend but one trip into town in particular alerted me to the fact I was not doing so well with my driving. As a result my husband used his days off to take me through to Ohakune and drive me to the schools I had to visit for my job in the back of Taihape on the Monday and Tuesday. Feeling carsick was a new experience, dizziness on turning, falling asleep on the couch for an hour in the middle of the day and then sleeping a solid 11 hours at night were also new and not normal experiences - all occurring over the space of those two days. I could not make my writing as neat as it should be, and the final straw was not being able to work out how to work out which of three taps was on the right. Something was seriously wrong.

A visit to the doctor the next day had me diagnosed with concussion, a week after my initial visit where all the bangs and bumps were recorded for ACC but during which I had had no sign of the impending concussion. The doctor assured me this was normal - the symptoms I was experiencing can appear up to two weeks later. He put me off work for two weeks. Little did I know that two weeks would grow and at this point I am wondering when I will actually return to work.

I was referred to the concussion clinic which I previously had not known existed. I have been assigned an occupational therapist to help me with managing my symptoms, particularly the fatigue. I was also assigned a concussion physiothrapist who was able to get my nausea under control with manipulation of my head which, apparently, shifts the crystals floating where they shouldn't be in the middle ear back into their rightful position. Before this happened properly I was living on anti nausea medication, unable to cope with being in the car (eyes were shut), feeling sick as the hairdresser moved around in front of me during my haircut (eyes had to be shut), unable to manage being in an environment with people moving around. Fast moving TV shows and movies were out which I had not realised until my daughter asked why I was watching a lot of slow moving or depressing drama (Handmaid's Tale, Downton Abbey are two examples). There was not a lot of movement and I could focus on a face or just shut my eyes and listen to the story.

I have researched what happened and why my recovery seems to be going at a snail's pace. When I hit my head imagine the ball in the image below is the rock I landed on. Not only did I have impact as shown there, but impact from standing, therefore add in speed and my not insignificant weight and my poor brain was pretty bruised up. Not only did I bruise the side of the brain where the impact happened but I also made a good job of bruising the brain on the right side towards the back where the counter blow as below was situated. I have whiplash symptoms in my neck as well. A CT scan has come back clear for any brain bleeds and I am reassured - a little - by the doctors insistence that it is a matter of time, rest and patience.

Retrieved from http://mayfieldclinicblog.com/?tag=concussion

I have definitely stepped off the bus - but who knows for who knows how long? I am accepting it with the mantra that it is what it is and things will improve over time.

What is Hauora and Why Am I Finding My Way Back?

According to the Māori Dictionary hauora is defined as the state of being 'fit, well, healthy, vigorous and in good spirits'. It is the overall health of the individual.  Others have broken it down further, with the most common metaphor being Mason Durie's Whare Tapa Wha model.  This breaks the individual's health into four areas that all need nurturing - te taha hinengaro or our psychological health, te taha whānau or our family health, te taha tinana or our physical health, and te taha wairua or our spiritual health.  Western medicine has been slow to come to grips with the ide of an individual's health needing to have each of these four areas in balance, but examination of other cultures has led me to find similar understandings to that of Māori.

Retrieved from https://sites.google.com/a/tamaki.ac.nz/health-centre/whare-tapa-wha

So what does this have to do with me?  Well I know my whare tapa wha is out of balance and, in some areas, has been for some time.  

Te Taha Hinengaro - My Psychological Health

Many who know me would not pick up that there are issues in this area as I am good at putting on the mask that covers it.  I should have been diagnosed with depression at least twice in my adult life but managed to fight my way back before it got to that.  After a fall that has left me with ongoing concussion symptoms a few months back I am not entirely sure I am not heading back there at the moment.  I am my own worst critic and worry about the things I do and say after the fact on a more than regular basis.  After my own upbringing I have very low self esteem and often feel I am not good enough or faking my way through situations.  Again something those that know me would not necessarily recognise in me either.

Te Taha Whānau - My Family Health

The family I have created as my whānau with my husband is a healthy, tight and loving unit of four.  The family I came from was violent and dysfunctional.  I know looking from the outside in at my friends families that it still is.  The healing that comes from my own children and my immediate family unit now outweighs the negatives that just keep on coming from the family unit in which I grew up.  

Te Taha Tinana - My Physical Health
As a child my health was pretty good - the annual cold usually.  As a 7 year old I contracted a vaccine failed dose of whooping cough.  I can still be frightened if I end up with a cough that feels like my lungs are turning inside out, and thankful that there is not the blood in my hand I remember from that time.  Hayfever has also been an issue with the initial allergy being to cats and shifting over time to pollens.  I also ended up with glandular fever as an eight year old which, aside from the usual measles, rubella and chicken pox meant I was relatively healthy. 

As an adult it has been far less plain sailing - a TIA at 37 due to not looking after myself as I taught and mothered at the same time, surgery on my shoulder following the fall I had with the TIA, pneumonia, constant sinus infections leading to an allergy to sulfa based antibiotics, a range of accidents some involving head injuries.  There have been those that have joked about wrapping me in bubble wrap to keep me safe following this latest and biggest fall.  The final issue is one I have battled with in one way or another since puberty - Poly-cystic Ovary Syndrome (PCOS).  It has caused issues with acne, hormones, facial hair and most of all my weight.

Putting these four walls together leads to a whare nui in need of some tender loving care.  If I do not do something about making all of the aspects of my whare tapa wha a priority I am heading for some fairly major physical health issues.  The time off with this head injury has allowed me space to reflect on decisions made, lifestyle choices and where I need to go from here to make it through the next few years which is how long my recovery could actually be.