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Sunday, September 20, 2015

Writing - An Essay Contest

The Bean recently added a half-day on Thursday morning to her daycare week, so that I can start doing and stop talking about this dream of mine to "write." My practical writing goals are all over the map, from children's books to personal essays to a study skills guide. To jump start myself I entered a personal essay contest for the magazine Real Simple. I just submitted it last night. The prompt was to write about a single decision that changed your life. The first things I thought of, mostly trite and cliched, were about deciding to turn right instead of left off Mount Rose Highway, and then parking in that Tahoe World parking lot and meeting Alex for the first time. Or about the decision to move to Block Island the summer my mom died. Or about deciding I was ready to get pregnant with The Bean. But I pushed myself to think a bit outside the box, and wrote about the afternoon in graduate school that I decided to go to a presentation on PTSD, and it propelled me into a career working with veterans with brain injury. I'm under no guise that my essay will rise above any other entries and win me $3K, but it's definitely a good starting point, and I'll count the fact that I entered as a win for now. And I'm posting it here, so that I have it on record that this is where I started.


Serving Those Who Served
By Joanna Close
"I was blown the eff up," he tells me, employing his strategies for clearer speech - a slowed rate, increased volume, and over-articulating each sound.
"That sounded really great," I encouraged. "Now, can you remember to tell me when that was?"
"2010. No, 2012. I graduated high school in 2010 and went straight into the Army. I went to Afghanistan. And I was blown the eff up. In 2012. Hey, I like your shoes. You look pretty, as always."
Devon, a 23 year-old former Army specialist, has been a patient of mine for just a few months. He is seen regularly - very regularly - at our Veteran Affairs (VA) medical center. As a speech-language pathologist, I am helping him with difficulties related to a traumatic brain injury (TBI) he sustained when he stepped on an improvised explosive device (IED) while serving in Afghanistan. He had just two weeks left on his tour. He was the most seriously injured of any of his fellow troops. But he's still here. Alive, and able to tell the story. Or, alive, and working to tell the story that he has pieced together from repeated accounts from others.
It’s been more than three years since his injuries - he sustained a severe brain injury, lost both of his legs, several fingers, and suffered numerous broken bones. Today, he uses a power wheelchair to mobilize, his speech is jilted and imprecise, he needs reminders to keep certain thoughts to himself, and his smile is crooked but nearly always present. He relies almost entirely on his wife, family, and paid caregivers to manage the activities most of us take for granted, from bathing and toileting to scheduling and finances.
He continues to have significant difficulties with attention, memory, reading, speech, and social communication, among other things. Right now he is working hard to develop and practice a personal narrative, one that includes significant events and dates - high school graduation, Army enlistment, Afghanistan tour, injury details, wedding anniversary, family birthdays. He wants to be able to share his life experiences without relying so heavily on his wife, Rebecca. That’s where I come in.
***
Flashback to 2010, Winter Term. I was a student in the Communication Disorders and Sciences program. Graduate school was demanding, and I loved it. I spent nearly all of my time in class, in clinic, reading, researching, writing, and studying, and I loved it. I was particularly engrossed and inspired that quarter by a course called Cognitive Rehabilitation, taught by the program director and professor who literally wrote the book on the subject. We learned about brain injury and the role of the speech-language pathologist. We learned ways to assess and treat attention and memory problems in children and adults who had been in car accidents, fallen out of windows, had tumors removed, and survived strokes.
When the professor suggested we attend a campus lecture for the Counseling graduate students, hosted by a VA social worker about posttraumatic stress disorder (PTSD), I waffled about whether or not to go. I had hours of schoolwork ahead of me. I also needed to exercise, do laundry, call my dad, and I wanted to eat dinner with my fellow-grad-student husband. The presentation wasn’t exactly within my professional field, but our beloved professor had recommended we attend. And the psychology of trauma had always piqued my interest. I knew I would have to stay up late to study for a midterm later that week. And get up early the next day to prepare for my client. At the urging of my husband, I ditched yoga class and put off laundry one more day in order to go to the lecture.
“Does anyone here know what OIF or OEF stand for?”
I didn’t, and neither did any of the other graduate students attending the presentation.
“Operation Iraqi Freedom and Operation Enduring Freedom, named for the conflicts in Iraq and Afghanistan. And OND, or, Operation New Dawn, which refers to our involvement in Iraq after 2010," he explained.
The social worker showed us video clips of military personnel in the Middle East. Images of men dressed head to toe in camouflage and carrying large weapons. Of far away explosions. Of young men remembering friends lost along the way.
I was disheartened by both the visible and invisible consequences of war. Saddened by brain injury as the “signature injury.” Curious about the long-term consequences of posttraumatic stress. I was also inspired and moved to action. I itched to learn more, and was particularly interested in how best to support the veterans returning to college on the GI Bill. I learned that our campus clinic was forming a professional relationship with the VA. I asked, even begged, to be assigned a veteran client.
My professional aspirations changed when I met Ben. I was already interested in working in a medical setting, but he inspired me to work with veterans in a medical setting, and specifically with veterans who sustained brain injuries. Ben was a 40-something retired Army staff sergeant who ran convoys through Iraq on three different tours. He walked, talked, and acted like anyone you might expect. Because the injuries he incurred in combat were invisible. He and his family of 7 experienced significant hardship upon his final return stateside, including homelessness and substance abuse. He was diagnosed with PTSD. He sustained multiple concussions from IED blasts and mortar attacks. Against the odds, he enrolled at the university with goals of becoming a civil engineer. But he had difficulty listening in class, taking notes, concentrating on homework, retaining what he read, writing papers, and taking tests. Over several months I taught him strategies to support his attention and learning, and he ended the term with a 3.5 GPA.
I truly learned more from him than he ever did from me.
My experience in the campus clinic with Ben propelled me to apply for my student internship at the VA medical center. Then I completed my fellowship training at the same facility. And I now work on a specialized rehabilitation team assisting veterans with brain injuries.
***
A few of my patients look like Devon - disabilities obvious to even the untrained eye. But most of my patients look more like Ben.
Jon was medically discharged for injuries related to his ankle. He returned home and experienced significant difficulty adjusting to civilian life, including attention and memory lapses, even forgetting to feed his children lunch on the days his wife worked as a nurse. He enrolled in graduate school to work toward his MBA, but experienced tremendous difficulties, despite being very intelligent. I taught him strategies and exercises to improve his concentration and make his academic learning more efficient.
Lucas was an infantryman and sustained multiple concussions related to blasts. He first noticed difficulties with mind-wandering and distractibility when he transitioned home. Leaving his stove on. Missing appointments. Forgetting why he went into a room. Taking incorrect exits while driving. He worked with me to improve cognition, but continues to struggle with his job filing in a university mail room.
Angela is a military sexual trauma survivor, and also had a concussion following a ladder fall while enlisted. She struggles with chronic pain, anxiety, and disordered sleep, as well as difficulties with organization, planning, and follow-through. At just 25 years old, she doesn’t work, is not in school, relies on her family for financial support, and feels hopeless about her future.
Craig is always impeccably dressed, but his affect is flat and it doesn’t come as a surprise that he suffers from severe depression. He recently had his leg amputated above the knee, to address extreme pain caused by a traumatic neuroma after first losing his lower leg following a blast injury. He prefers the company of animals to people, and otherwise isolates himself. No treatment so far - for depression, for PTSD, for attention, whether pharmaceutical or behavioral - has contributed to significant gains in Craig’s functional life.
Sometimes it feels as though I have nothing to offer these former service members - no magic pill, no universally endorsed rehabilitation program. Sometimes I even feel hopeless about my clinical work. And then I think of Ben. He inspired my passion to help this particular population of veterans, often my peers. So I continue to hold out hope for more promising research, and believe that cognitive strategies and supportive counseling offer at least something in the meantime. If it weren’t for that seemingly random presentation for the Counseling graduate students, I wouldn't have requested to work with a veteran. I wouldn’t have met Ben. I wouldn’t have gotten to work with Devon, Jon, Lucas, Angela, or Craig.

I am typically uncomfortable saying this to my patients directly, for fear of sounding trite, but I do, in fact, thank you for your service. And I thank you for allowing me to now serve you.

(All identifying information has been changed to protect privacy.)

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