One of the sad consequences of brain injury is isolation. People just don’t understand the situation when the wound is invisible. Slowed or altered social responses and disinhibition (saying or doing whatever pops into your head without considering whether it is politic or tactful) can put off friends and family. Personality changes, some trivial (the friend who inspired my interest in TBI now likes vegetable he used to spurn), others more disconcerting, also can puzzle and turn off people who don’t understand. Veterans are used to teamwork. This sense of connection is one of the facets of military life that spurs re-enlistment among healthy military folk, and one of the things they miss during recovery from injuries. Some survivors are isolated in remote areas, others by the effects of their injuries. In any case, helping them reconnect with peers who actually understand their situation is a smart approach to treatment.
This story supports my belief that working with groups of veterans and helping them connect online is a good idea:
Depression is such a common malady for TBI survivors (and probably their caregivers if anyone ever pursued that issue) that it seems like a good idea to look more closely at this condition and some ways to cope with it now that we are entering “the bleak midwinter” (TS Eliot may think “April is the cruelest month” but I vote for almost any month in winter).
Causes of post-TBI depression are pretty obvious: changed abilities, circumstances, and prospects; concerns about the future in terms of finances, social relationships, independence, and productivity; in some cases, ongoing pain, sleep deprivation, and other physical problems. Winter can make things worse because of SAD (seasonal affective disorder – what happens to some people if they don’t get enough sunlight in the winter), reduced opportunity to enjoy the outdoors because of cold and the fear of falling on icy surfaces (thus making exercise even less appealing), holiday blues from Thanksgiving through New Years with Valentine’s Day fast approaching.
So what can a survivor and family do to short-circuit winter blues? Even if you can’t walk outside, malls, stairs, treadmills, and stationary bikes offer exercise opportunities. You can use weights and do leg lifts in your recliner while you watch tv (I confess that I do). Seek out humor - Readers Digest jokes, comic strips, tv shows that make you laugh. Find music that peps and cheers you up – maybe exercise to it. Don’t compare the current you with the pre-accident- you. Look at how far you have come since the accident, and set reasonable goals for the future. Learn something new. Research shows that effort invigorates. Investigate the exciting ideas of Dr. Martin Seligman who has developed a very sensible and upbeat approach to life with his work on Positive Psychology. http://www.authentichappiness.sas.upenn.edu/Default.aspx
Help make a list of people to contact – focus on email or phone numbers for people whom you can text. Help prioritize: who needs to know right away versus who might want to know but doesn’t need to immediately.
People who will need some outside help: children living at home or aging/ill parents for whom the caregiver or patient is responsible in some way.
If children living at home – will they need a place to stay or someone to stay with them overnight? Will they need transportation to school? Will you need to help with arrangements for events they must attend or help to cancel other activities for the time being? Focus on the next few days at this point.
Other people for whom this family is responsible – aging or ill parents, etc. Who is a concern and what is needed in next few days? Is there someone else who could step in for now?
Pets – list names, types, food (how often, where stored, supply), safety issues (friendly or ferocious, escape artists). Is there a neighbor who could feed, walk, let out? is there someone else who does often this when family is out of town? Any other possibilities?
Housekeeping issues – check to be sure
stove is off,
heat or air conditioning set to keep utility bill low,
someone will take out trash in necessary,
doors are locked,
lights are on a timer (or turn on a hall light),
someone will bring in the mail and keep newspapers from piling up in the yard.
Paperwork – help caregiver
set up an easy to carry file box (office supply stores have cardboard ones that work great) or a large notebook for all the paperwork;
go through the most essential papers to see what needs to be done, what the hospital offers in the way of support, what material will help the caregiver to understand the situation;
start a journal to record what happened, what the doctor said, what questions should be addressed to hospital staff, what needs to be done, etc.
Self-care – Caregivers are in emergency mode and unlikely to eat or sleep regularly. Their health may seem to them like the last thing to worry about, but exhausted and ill caregivers are not up to the task at hand.
Hospital cafeterias are infamously boring and may not even offer the best nutrition, but surely they have smoothies, turkey sandwiches, apples, bananas, maybe even a decent salad bar. If the caregiver won’t go, pick up something you are sure he/she would normally eat, and then try to make sure it gets eaten before you leave.
Health bars, milk shakes, and takeout salads from outside the hospital can be smuggled in to caregivers who are sitting in waiting rooms or at the patient’s bedside.
If the caregiver won’t go home to sleep, try to scare up an afghan or blanket (hospitals are kept cold to discourage germs).
Offer to sit with the patient while the caregiver gets outside for a 15 minute walk.