A Matter of Panache

Debra Sanders, Outskirts Press, Inc.
A Matter of Panache

A Career in Public Education, a Traumatic Brain Injury, a Memoir of Surviving Both

School psychologist Debra Sanders doesn't believe anything is wrong after crashing her pickup through Bluff, Utah's "Welcome" sign one day in April 2003. After all, she feels no bumps, breaks, or even bruises. Then the trouble begins — difficulty concentrating, poor memory, excessive sleeping, and extreme irritability. And that's just for starters. Suddenly, someone who has built a thriving career serving public school special education students is in need of help herself.

This excerpt — taken from Ms. Sanders' book — takes place in the hospital after her crash. Her truck is 45 miles away, totaled, and being hauled away from the crash site. She has been evaluated and released. Feeling enormously lucky to have emerged from the crash unscathed, she sits quietly in the hospital visitor's lounge, looking straight ahead and having no idea what to think or do next.

Chapter 17: Keyless Gates

Sheltered by the Abajo (Blue) Mountains on the west, and the San Juan Mountains to the east, it is rumored that at one time in the 1800s, Monticello harbored so many fugitives that it was known as the Outlaw Trail. It's hard to say if this is just folklore or not, but it's easy enough to imagine bandits, cowboys, and American Indians finding enough places to hide in the mountains and canyons surrounding the town to think it could be true.

Twenty-five miles north of Blanding, and with a slightly smaller population of about two thousand residents, Monticello is the county seat for its fourteen thousand citizens. Although the Lymans received their revelation in Blanding in the late 1800s, fulfillment was not to occur until 1998, which is when the Mormon Temple was built and dedicated in Monticello. And while there are numerous wards throughout the region, Monticello houses the only Temple for the area's thirteen thousand members.

Monticello also houses the county's only hospital.

Shortly after arriving at the hospital, a state trooper met me in the X-ray room in order to take my statements. Confidently, I assured him that I was unscathed and functioning perfectly well. No, I hadn't rolled the truck or lost consciousness, I told him. I described for him where the accident occurred on the north side of the canyon, and in answer to his question, I explained that no, I hadn't made it to Bluff.

"Well, actually," he said, "you did make it to Bluff."

I looked at him in surprise.

"Yeah, you rolled your truck on the south side of the canyon, not the north. You were just on the outskirts of Bluff."

"Really? Wow." I was sure I hadn't gone through the canyon, despite recalling the splintering of the Welcome to Bluff sign. I obviously was not making any sort of logical connection between these two facts.

"Oh, well." I smiled, still somewhat perplexed after hearing that I had actually been on the other side of the canyon. "I'm just glad no one was hurt, and that I'm coming out of this without so much as a bruise."

Actually, once the technicians began taking their requisite scans and X-rays, I did discover that the bottoms of my feet were slightly bruised, as was my hip bone, where I must have seriously challenged the seat belt's ability to keep me confined.

Still, aside from these inconsequential owies, and the oddly constricted feeling around my head, I was pronounced fine and released to go home.

My truck, forty-five miles away, had been declared totaled and was in the process of being hauled away from the accident site along with my now defunct bike.

I was sitting quietly in the hospital visitors' lounge. I had no way to get home, and I couldn't imagine what I should do at that point.

I apparently looked as confused as I felt.

"Can I help you, honey?" I glanced up at the woman behind the receptionist counter, thinking how kind it was of her to call me honey, even though we must have been approximately the same age.

"Oh...no, I'm okay, thanks," I said. I thought about this for a second and added, "Well...actually, I was in an accident this morning, and I...I don't have a ride home."

"Are you from here?"

"No, Blanding."

"Well, is there someone you could call to pick you up? A husband, a friend?"

"Oh, no, they're all working." It never occurred to me that this might be a legitimate reason to call someone and ask if they could help me out.

Actually, it never occurred to me to make a call at all.

I fretted over this dilemma while the receptionist stared at me. Most likely she was contemplating the oddity of my not having family to call on for help. The large and extended Mormon families that heavily populate Monticello and Blanding make it very unusual for a person to be without someone nearby to pitch in and help out in a crisis.

Or, maybe she just wondered why a fairly well-dressed and professional-looking woman was acting like a lobotomy patient from the state hospital.

"Excuse me...maybe, well, actually, maybe I could call someone I work with. May I use your phone?"

"You bet, honey. Just dial nine first."

I placed a call to my office in Blanding and spoke with my coworker and friend, Alta Begay. Alta indicated that she (and pretty much everyone else) had already heard about the accident, and she would be happy to pick me up.

Within less than two hours, Alta had me back at home, and I was sending out emails telling everyone about my morning — describing how lucky I was that absolutely nothing was wrong.

Then I crawled into bed and promptly fell asleep.

* * * * *

I woke up Wednesday. At least that's what I remember doing. Apparently, between Monday afternoon and Wednesday morning my mental Palm Pilot experienced an electrical outage. As far as I could tell, I had slept the better part of nearly forty hours.

Walking into work early that morning, my head felt like it was stuffed with a mountain of cotton batting. Gosh, did I even feed my dogs? Oh, I must have. How odd it is that it is Wednesday. Did I eat? This is so weird; I can't believe it's Wednesday. Jeez, I feel like a Martian's taken over my brain.

The thoughts bobbled around like anchorless buoys in high seas.

Oh, well. I shrugged. This will clear up once I've been awake a little longer.

Sitting at my desk with a child's testing protocol in front of me, I attempted to complete the mindless task of scoring it. It was a simple task: add up a small column of one- and two-digit numbers and put the sum in the little square box at the bottom. It's a menial, tedious task that I had been routinely doing for the better part of the last twenty years.

I added.

I added again.

I couldn't seem to make my mind work. I tried again. I used my fingers. I still could not get past a couple of numbers. I could not add the column.

My friend Sandra, a teacher in the next room and a lead paramedic for the county, came in to check on me. She took one look at my face and with concern written all over hers, asked: "What's wrong? You're really pale. Are you all right?"

I stared at her, an uncomprehending look in my eye and a tight knot in my stomach. "Sandra...something is very, very wrong. I can't add. I can't think. Something in my head is very, very wrong."

Immediately plopping me into her ever-present paramedic car, Sandra drove me the twenty-five miles back to the hospital. I have no idea what she did about her students that morning; I only know that she kept me from panicking during a time when fear was beginning to suffocate the very breath from my lungs.

How could I not add simple numbers? What was wrong with my head?

* * * * *

I was kept in the hospital under twenty-four-hour observation, with the nurses waking me up every hour to ask me orientation questions. Despite the fact that I had no memory of being awakened a single time, and that I was shocked to find out it was suddenly Thursday, the nurses told me I was doing fine and would be able to go home.

"Well, so, how'd I do?" I asked the nurse, who was starting to give me home-care instructions.

"You did fine, honey (maybe everyone called me honey at the hospital). You did great on everything except knowing the day. You just kept telling us it was Monday."

"I did? I kept telling you it was Monday? That's weird," I said.

"Yep, every hour. But not to worry," she reassured me. "You have a mild concussion. You just need a little time. You'll be fine."

Unlike my first experience at the hospital three days prior, no one was about to leave me to my own devices or abilities to plan ahead. My friends, Jimmy and Ila, came to pick me up, making sure I had the paperwork and information I needed before leaving the hospital.

Ila and Jimmy, then in their early to mid-sixties, had been a couple since they were young teenagers in high school. The consummate Mutt and Jeff duo, with Ila standing all of five feet tall on her tiptoes and wearing outfits that boasted of nice material and sophisticated design, and Jimmy towering over her with his six-foot-plus frame outfitted in jeans and boots, they shared the same generous nature and concern for others' well-being. They were both born to grandparenting, and neither one was any happier than when their granddaughter, Victoria, came to visit from out of state. True, I wasn't young enough to be their granddaughter (or daughter for that matter), but I think in the absence of Victoria, they took quite naturally to the roles of being a fairy godmother and godfather to me. And I was quite happy and relieved to nestle into their care.

As we arrived at my house, still convinced that this would pass in a day or two, I assured Jimmy and Ila I didn't need a thing and would be just fine home alone with my dogs. I don't think they believed that, but I am quite sure I stated this adamantly and with conviction. Given that I am a grown woman, I don't suppose they felt comfortable trying to force me to go sleep at their house; and I suspect that while they were worried about me, they didn't really want my two eighty-pound, four-legged children to enjoy the kind of free roam in their house that they clearly had in mine.

Jimmy and Ila, making sure I had what I needed to feel safe and comfortable, left that afternoon, but for the next twelve months continued diligently in their caretaking of me.

That day — when Ila and Jimmy said their good-byes — we were all completely unaware of the road I had embarked upon. While they were more aware than I was that I certainly was not "fine," none of us had any idea just how many dramatic changes were in store for us.

At the time, I simply crawled into bed thinking how odd my head felt: as if there were a locked gate in front of my brain and I had no key. Without a key, I thought, my brain and thinking processes are totally inaccessible.

Drifting off to sleep and believing that behind the gate lay my only access to clarity, I tried to figure out where to find the key.

But before I had any ideas at all, I was deep into another thirty-six-hour nap.

The image of a keyless gate haunted me for many, many months.

* * * * *

Days and nights blended in a drugged-like state of altered consciousness. Each day during my awake-times, I discovered more and more oddities: I couldn't brush my teeth and think about breakfast; I couldn't do any two things at one time. Headaches had started to plague me; my tongue felt thick and too big for my mouth; I couldn't seem to distinguish smells and tastes; and I was dizzy and nauseated when I was up, so when I did eat — which wasn't much — I would do it lying down on my bed.

I was sleeping eighteen to twenty hours a day, and yet I would never wake up feeling rested. Instead, I would putter around in a haze until the overpowering need to sleep would overtake me again. It was two and a half years before a sleep study—with its graphs of waves and spikes indicating that I never enter Stage Four of sleep—suggested that my sleep center had been damaged in the accident. Stage Four is the time in the sleep cycle when the brain not only helps repair the wear and tear on the body, but when the consolidation of spatial and procedural memory takes place. The fact that I never enter this sleep cycle helps explain why I continue to need medication to remain awake, rarely recognize visual landmarks and faces, and generally walk around in a subpar state of alertness.

But I didn't know any of that at the time. All I knew is that the nurses told me I had a mild concussion, and that I just needed a little time before I would be fine.

With that information and no visible signs attesting to post accident trauma, I berated and chastised myself with increasing intensity.

This is ridiculous. I should be back to myself and functioning normally.

It is just a mild concussion; why do I feel like I'm getting worse instead of better?

Am I imagining these things? Am I a hypochondriac? I should be able to think clearly by now.

It was embarrassing how much I was sleeping, and I felt deeply ashamed for not bucking up and getting back to work. Each day I made a renewed commitment to it being my last day at home: Tomorrow. Tomorrow, I'll get up and go to work.

Each day I failed to live up to my resolve.

It is remarkable to me that no one at the hospital forewarned me that symptoms such as disorganization, memory impairment, foggy thinking, and distorted perceptions might possibly emerge over a period of weeks—or even months. Nor did they let me know that if I did experience these symptoms, I should seek further medical treatment. I have since learned that every year 1.1 million people with traumatic brain injuries are treated and released from hospital emergency rooms, and I can only hope that information about possible aftereffects is conveyed more often than it is not. Certainly, had I been told that these symptoms might emerge, I would have been far less frightened and confused—far less hard on myself, believing that I simply was not rising to the occasion and moving forward.

No one mentioned these things to me, however, and even though as a psychologist I had worked with children recovering from traumatic brain injuries from the likes of accidental gunshot wounds, I had no clue about "mild concussions." No clue that the term itself, mildconcussion, is really a misnomer. Certainly, there was nothing mild-feeling in the discovery that I could not rely on my own memory and perceptions of a conversation, much less a day's events. There was nothing mild-feeling in the discovery that life had begun to resemble a series of disconnected snapshots, providing vague memories out of context from which I was supposed to navigate.

But the term mild concussion is a medical term, not a psychological one. Still, had anyone at the hospital prepared me for even some of the effects that were to surface, things could have been much easier to manage emotionally, even if they were not easier to manage in a practical sense.

It wasn't until many months later, when I was finally referred to a neurologist in Durango, Colorado, that I first became aware that what I was experiencing was well within the realm of "normal."

"Close your eyes for a minute," Dr. Willner instructed. "Okay, keeping them closed, tell me what you are smelling." She waved a vial of something under my nose.

"Oh...um...wait! I know that smell. I know I know that smell. Hold on..."

"That's okay, try this one," she said as she quickly waved another vial past my nostrils.

"Oh, rats...wait...wow, I know I know this smell...give me a minute." It was such an odd sensation—as if my brain were separated, with one part recognizing the smell, but being unable to access the part of my brain that would let me identify it. It wasn't a matter of recalling the right word—it was that I wasn't able to identify the smell even though it was so familiar to me.

"Orange!" I popped out, happy it had finally occurred to me.

"Close," said Dr. Willner. "You're in the right ball park of citrus. Actually it's lemon."

"Lemon?" I said. "Really? Not orange?" I was sure I had figured it out correctly.

"Nope," Dr. Willner stated cheerfully, moving right along to vial number three.

Dr. Willner spent more than an hour with me in that first visit, and at the end, when she said I was a textbook case and that all my symptoms were quite real, I threw my arms around her, giving her a tearful bear hug.

I suppose as a neurologist specializing in head injuries, Dr. Willner was used to surprising emotional outbursts from her patients, even if I was not used to expressing them. But to me, Dr. Willner was not just a neurologist. She was a savior. A saint.

Everything I was experiencing was real!

* * * * *

About three or four weeks after the accident, I insisted on attending a meeting with Sandra and the father of a teenager I had evaluated the first week in April—just a few days before the accident. It was important to me to be able to explain to this boy and his parents what was causing his learning challenges and assure them that there were strategies to put into place that would help. I felt it was my responsibility to attend this meeting, and I was quite certain that I should be able to do so without difficulty.

Sandra had been teaching special education for more than thirty years. Small in stature, she had a pleasantly round figure and long, sandy blond hair that probably hadn't strayed in style in about as many years as she had been teaching. With her compassionate blue eyes and a demeanor that lent itself to being called "mom" by just about everyone, Sandra was one of the first teachers I met when the school year began. Over the previous eight months, we had developed genuine respect and affection for one another, and she had been a wonderful support to me as I made the transition from living and working in Alaska to living and working in this small Mormon community.

Sandra's dress code for school was a loose-fitting blouse and a pair of jeans, and she was rarely seen with a pair of shoes on inside a school building. I know she kept them there, but Sandra was a woman of comfort—relaxed and calming and always putting others at ease. Shoes were not comfortable for Sandra, and rules be darned, she didn't wear them.

I knew if I were to present myself as a complete dullard or somehow otherwise embarrass myself at the meeting, Sandra would be able to rescue the situation.

"This is our psychologist, Debra Sanders," Sandra said as she introduced me. "She's the one who did the testing on Justin."

For a few minutes, I think I did quite well—explaining what kind of tests I had used, and in a very down to earth way helping this concerned parent understand the results of the testing. I have to say, I was feeling quite pleased with myself—if perhaps a bit dizzy and out of sorts. See, I'm just fine, I thought. I can do this just fine!

Thinking I had better quit while I was ahead, I stood up, shook hands, and said my good-byes. Turning to head for the door, dizziness overtook me, and I leaned against the wall for support. And then, in my best Scarlett O'Hara imitation, I slumped to the floor.

I am not sure exactly what Sandra did, but I am quite sure that she found a way to explain that I really was quite a competent school psychologist, and no one should let today's meeting undermine their confidence in the test results or recommendations.

"Cognitive overload," the people at the hospital called it.

"Not to worry. It will disappear soon."

Not soon enough, I muttered as I retreated to my sleep mode.

Not soon enough.

* * * * *

In the early months following the accident, people stopped by to visit, and I tried describing the frustrating realization that memories were not being created. That I simply did not recollect the previous visit, the conversation, the book I tried to read.

"Oh, shoot, we all forget things," people would comfort, but I wanted to rail against them as they told me of their memory challenges. This wasn't like them at all. This wasn't a small glitch in word finding, a temporary loss of recollection regarding what I ate for dinner last night, or an incidence of getting to a store and not remembering what I wanted to buy. This was a dark hole I was living in. A foggy, vapid, and suffocating hole that I was utterly petrified would encase me forever.

I desperately wanted people to understand my panic and confusion, yet I found myself continually trying to hide how muddled and turbid my thoughts actually were. It was humiliating to feel so opaque in my thinking. It was mortifying to think people would notice I had become stupid, like Charlie in Flowers for Algernon; and yet, it was terrifying to be alone with my awareness.

From A Matter of Panache: A Career in Public Education, a Traumatic Brain Injury, a Memoir of Surviving Both by Debra Sanders, published by Outskirts Press, Inc. Copyright © 2008 by Debra Sanders. Used with permission. www.debrasanders.com.

Posted on BrainLine January 30, 2009.