7: Invisible Bruise

7: Invisible Bruise

From Chicken Soup for the Soul: Recovering from Traumatic Brain Injuries

Invisible Bruise

Better to light a candle than to curse the darkness.

~Chinese Proverb

I walked past the cracked-open door of the conference room, and overheard the health department director speaking to my supervisor. “Melissa needs to be fired.” I ran back to my cubby, trembling, and shuffled protocols from one pile to another without purpose. I paused at one that needed revising, but the algorithm of circles and squares looked like Rorschach inkblots.

Maybe the director had heard about my misunderstanding with a coworker a few weeks earlier: “The protocol isn’t ready to be submitted. I told you it needs another revision.” Maybe my supervisor had told the director about my experience at the pediatric clinic. The brightly-lit windowless rooms and wailing infants had made me dizzy. By the end of day one, my head felt as if it had been filled with jelly and my body like it was stuffed into a box. At the time, my supervisor had agreed that it was not the place for me. “I think you’ll do better working on specific projects.” Did she know something I didn’t?

Despite the threat of being fired, I continued to go to work. During meetings, the other nurses spoke too fast and their voices sounded distant, as if they weren’t in the room with me. I had never felt disconnected from my peers before. My eyes twitched with fatigue, and I jotted notes just to keep myself awake. But the notes quickly turned into stars and moons and crosshatched lines.

After two weeks of little sleep, I confronted the director. “I heard you say I should be fired.” From behind her regal desk, she said, “You’re not fulfilling your job description. If things don’t change, the firing process will take place.”

I wanted to scream. I had never failed in the workplace before. I walked out of her office, wondering what was wrong with me. After all, my coworkers had said, “You look great. You don’t even look like you’ve been hit by a car.”

Rather than be fired, I searched for another job, and accepted a part-time position at a pediatrician’s office. “It’s been a long time since you’ve worked in a clinical setting,” the doctor said. “Do you think you’re capable?”

“Oh yes,” I said, with false confidence. For two weeks, I watched a veteran nurse measure patients’ heights and weights, then plot them on graphs. I watched her prick babies’ heels for blood samples. I can do this, I thought. I’ve done this before. She administered vaccines to toddlers, pinning them down as they kicked and screamed and spit. My ears rang and my heart thumped behind my ribs.

I misread vaccine labels and administered the wrong one to a toddler. I misread measurements, and when I plotted them on patients’ graphs, my dots fell far below or far above the others. There were too many dots, like a pointillism painting. I hoped no one would notice my mistakes, so I didn’t tell anyone. I answered calls from parents, but fell behind in the conversation, because I couldn’t scribble notes fast enough. When I looked back at them, they made no sense: is that an M or an N? A three or an eight? Coworkers often said, “Can you explain what this means?”

“How do you think things are going?” my supervisor asked during my first review two months later.

“Pretty good,” I ventured.

She then listed my failings: inaccurate patient measurements, insufficient blood samples, too much time assessing patients. I agreed to a one-month probation. The month passed. “Melissa, your ability to keep pace is still concerning,” she said. “Do you think this job is a good fit for you?”

“I enjoy working with kids,” I stuttered.

She offered another two weeks probation. That same day, I had to re-administer an eye exam to a three-year-old, because the first time I had used flashcards designed for older children. During the next review, the pediatrician met with me. “Parents are dissatisfied with your injection techniques,” he said, slapping his palm against the desk. “Calls aren’t being returned, and you continually use the wrong forms to document babies’ feeding history.” Another slap. “Have you had problems in the workplace before?”

“No, never.” I didn’t want to tell him about the health department.

When he offered me another chance, with reduced work responsibilities, and pay, I said I’d think about it—I was ashamed to accept the pay cut. The next day, I scheduled an appointment for neuropsychological testing to assess the reason for my difficulties in the workplace.

I spent an entire day in the neuropsychologist’s office, where he tested my attention span, memory, language skills, and executive function—the ability to engage in complex thinking. He showed me a photograph and asked me to name it. I twisted my lips, chewed on them. The word was so close.

“Sph,” he hinted.

“Sphinx!” I yelled.

He asked me to draw a simple diagram from memory, but the pencil tip grated against the page, making random lines and obtuse angles. Then he asked me to recite words beginning with the letter T. “Top, tired, toy, trumpet . . .”

“Time’s up,” he said, and clicked the stopwatch.

A few weeks later, I received the report in the mail:

“Melissa’s cognitive functioning is guarded, as it has been three years since her injury and research suggests that most cognitive recovery following a traumatic brain injury takes place during the first two years. Mild recovery could occur if she engages in cognitive rehabilitation.”

I crumpled the report into a ball and threw it across the room. I caught a whiff of the roses on the dining room table, and realized I was actually relieved. I un-crumpled the report. Finally, I knew why I moved slowly, why bright lights made me dizzy, why I misread vaccine labels.

The neuropsychologist referred me to a cognitive therapist. She explained that the parts of the brain cells called axons were likely damaged, resulting in a disruption in communication between neurons: the reason for my unusual fatigue and difficulty with multitasking and concentration. She encouraged me to pace myself and keep an activity schedule, even for things like brushing my teeth, which I regularly forgot to do until the afternoon. She introduced me to the name game where you repeat a person’s name back to them when first introduced: “Hi Margaret. It’s nice to meet you, Margaret.” She taught me a method for evoking images to recall things like groceries: balancing my feet on a gallon of milk or putting a pound of green beans on my head.

It took me years to train and accept my rewired brain. Living with a traumatic brain injury connected me with professionals who offered hope, ways to cope with multiple stimuli, whether at a party or in the grocery store. They reminded me that TBIs are often not visible. Now, a decade later, people still say, “You look great. You don’t even look like you’ve been hit by a car.” I twist my lips, trying to find the right words. Finally, with a smile, I say, “Thank you. You don’t either.”

~Melissa Cronin

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