An Invisible Injury

Physicians rely on various tests to diagnosis a TBI. The Glascow Coma Scale (GCS) measures three areas: ability to open eyes spontaneously, to speech, pain, or not at all. The ability to speak: is the patient confused, unable to speak coherently, or not able to speak at all? The ability to move: does the patient respond appropriately to painful stimuli? Are there abnormal movements?

Each area is scored. The best possible score is fifteen. Thirteen or greater indicates a mild TBI. Nine through 12 suggests a moderate TBI, and 8 or lower is likely a severe TBI. Since the GCS scores the initial injury, it is not a predictor of the patient’s recovery and functional ability. If a 13 is assigned to the initial injury, the patient may still exhibit long-term deficits like difficulty processing new information. My GCS score at the time of my injury occurred was fourteen.

Symptoms are also helpful in diagnosing a TBI, such as clear fluid (spinal fluid) draining from the ears or nose, irregular breathing, dilated pupils, coma, paralysis, numbness or tingling, vomiting, and loss of bowel and bladder control.

In TBI’s there may be brain swelling and bleeding, which can be seen on Computed Tomography (CT scan) or magnetic resonance imaging (MRI). CT scans are not as sensitive as MRI’s, but take less time to complete – the reason why they are taken in the acute phase of treatment. However, both techniques cannot detect torn neurons, or microscopic bleeding (see post: The Brain: A Delicate 3.4 Pounds). For those who sustain neuron damage, but no swelling or significant bleeding, it’s difficult to diagnose a TBI. This was the case in my injury. It’s easier to diagnose patients who show obvious signs of a TBI (see symptoms above). But in those that do not, physicians must rely on subjective input from patients. That’s why many people go years before being diagnosed. If you have heard of TBI’s referred to as an “invisible injury,” now you know why.

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Cognitive Feedback Therapy: How a Stop Sign Silences the Screams


My EMDR treatments for PTSD  included Cognitive Feedback Therapy, which focuses on the individual’s thought processes and how they affect behavior and beliefs. For example, it did not take much for my mind to swirl with negative thoughts when my husband traveled out of town for music gigs. I imagined him sprawled on the side of the road after being hit by a car. At night, I would wake and watch my husband’s chest for movement. In the dark, it was difficult to see if it was rising and falling, so I’d gently lay my hand on his chest, feeling for life. Or I’d snuggle close to him, waiting for him to exhale. These negative thoughts would lead to other negative thoughts or images: sometimes I’d see myself in a hospital bed struggling to breathe, with doctors hovering over me, sticking needles into my arms.

Like any successful project, cognitive therapy involves homework. My therapist instructed me to keep a log of events that triggered negative thoughts, sensations, and emotions. One day, I felt weak and feverish, as if I had the flu. Even though I did not have a fever, I thought something was wrong: I should go to the hospital, because I might have an infection. What if I need antibiotics? What if I don’t go to the hospital? I might die. As a nurse, it was easy for me to scoot down this irrational path. And since my spleen – an organ that destroys bacteria and is part of the immune system – had ruptured in the farmers’ Market accident, I couldn’t help but be anxious about dying from an overwhelming infection. But an uncountable number of people live productive and healthy lives without a spleen. By categorizing my thoughts into what my therapist labeled “faulty thinking patterns,” such as drawing conclusions or exaggerating the meaning of an event, then forming positive ways of thinking, I learned to halt the unraveling of irrational thoughts. I no longer keep a log, though I’m not completely free of negative thoughts and images. Instead, when they intrude on my sleep, or my daytime routine, I envision a huge stop sign. Sometimes I hold my hand up and say, “Stop!” And just like that, I’m unburdened by blackness, screams, and blood.

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Stepping Beyond an Eclipsed World


While writing the initial drafts of my memoir I engaged in an exercise: I read the start of a chapter I had written about the earlier days of my recovery from the multiple injuries I had suffered after an elderly driver struck me. I focused on each sentence, each word and visual detail, then created a list of elements –objects, emotions, as well as the atmosphere of the piece – I anticipated would continue in the chapter. I then read the remaining pages, realizing the tone of the entire chapter smacked of self-pity in my telling of how I felt about the many bruises I suffered. I had failed to see beyond my own marred body, or ahead of me – that I would eventually heal (perhaps I needed the element of time to create emotional distance). In other words, the prose I had chosen was drowning in self-absorption.

Particular questions surfaced: would I continue to wallow in the bruises I sustained? Or would I be able to see beyond my eclipsed world shadowed by pain and, instead, recall the children I had cared for as a nurse, with the intention of showing how others suffer too?

Reading the chapter again, through the lens of my list, forced me to examine the self-indulging narrative I had crafted from a more objective stance. Even though my body would never be the same as it was before the accident, it would come to function quite well. On the other hand, a child who I had long ago cared for as a burn nurse, who I initially included in the chapter, did not regain even half the function she once enjoyed. Hopefully, in stepping back from the page, we return to it with 20/20 vision. In doing so, we are primed to craft a story that is unique on its own merit, yet universal, for we all encounter suffering at some point in our lives.

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Eye Movement Desensitization Reprocessing: In Need of a Computer Geek

How exactly does EMDR work? Francis Shapiro, who discovered the treatment, explains it through the theory of the “Adaptive Information Processing Model.” The theory sounds metaphysical, but it’s not. The assumption is that all individuals have an information processing system, which takes our experiences and stores them in a section of our memories that is easily accessible. These experiences are connected to particular images, emotions, sensations, and beliefs.

Think of a computer. If you’re like me, you might have several folders filled with documents dotting your desktop, because you need the information to be readily available – the click of the mouse. One of those folders might hold information that reminds you of something that evokes negative feelings. For instance, a folder has photos of your deceased parents. Every time you turn on the computer, you see the folder, and images of your parents fighting in front of you when you were a child return. You hear them screaming at one another, one of them saying, “I wish I never had children.” Each time you drag the folder into another one, so you won’t see it, the folder bounces back onto the desktop. You’re computer is malfunctioning, so you need to take it to a computer geek.

Of course, individuals are not computers; we are human beings. Yet, our brains are very much like computers. In PTSD, the trauma – the negative images, emotions, and thoughts – are stuck in the easily accessible part of the brain. The processing system in our brains is working ineffectively, so each time something triggers memories of the trauma, like a car backfiring, you exhibit PTSD symptoms, such as panic. EMDR helps transfer the trauma and related images from your brain’s desktop into the part of the brain, or folder, that effectively processes the event.

When I speak to others about EMDR, they shirk from me, as if suspicious – maybe I’m looking to recruit them into a cult. But EMDR is not a cult at all, I promise.

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“Melissa has turned life into art”

“Melissa writes with surety and much fine purpose. She [has] found the perfect structure for her memoir as well as a compelling voice with which, she, as a narrator, [has] turned life into art.” ~Sue William Silverman

Award winning author of the memoirs The Pat Boone Fan Club: My Life as a White Anglo-Saxon Jew, Love Sick: One Woman’s Journey through Sexual Addiction, Because I remember Terror, Father, I Remember You, and Fearless Confessions: A Writer’s Guide to Memoir.

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