Family Concerns

While no family is ever prepared for the life changes a brain injury brings, almost every family following a brain injury wants to know how they can help during the recovery process. Immediately after a brain injury, it's common for families to place all their energies and focus onto the person with the injury. As the person begins to move through the rehabilitation process, family members begin to ask questions that extend beyond the person's physical well-being. They want to know what kinds of programs and services are available, and they may even seek out a brain injury support group to help gain additional insight about dealing with brain injury.

After some time has passed, families begin asking questions about the long term. They want to learn ways they can minimize the damage caused by the injury, and they want to find ways to improve the quality of life for everyone in the family.

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Relationships After TBI

Relationships After TBI
[Rosemary] "Which rules are we playing?" It's such a simple scene--a husband and wife playing a game after dinner, teasing each other, laughing. For Rosemary and Hugh Rawlins such an evening was a long time coming. The ability to interact like this was destroyed in Hugh 10 years ago when a car crashed into his bicycle at 50 mph. [Hugh] It was very severe. The people in the EMS said that I had a 1% chance of making it back. The doctors at MCV Hospital in Richmond, Virginia, did everything they could to save Hugh including removing part of his skull to make room for the brain to swell. And then he wakes up from the coma, and he looks so different--not at all like himself. He can't really speak. It's just frightening. Rosemary and Hugh faced months of physical therapy and occupational therapy for Hugh's traumatic brain injury, or TBI. It was a long, hard slog, but it was really only half the battle. One of the things that's happened over the last 10 years is that the survival rate and ability to care medically for patient's with brain injury has improved very significantly. Dr. Jeffrey Kreutzer is a neuropsychologist and family therapist at Virginia Commonwealth University. He's been studying the impact of TBI on relationships for over 25 years. Where we haven't come a long way, and where we're focusing now is on this emotional and psychological recovery. Working and maintaining quality marital relationships. Hugh had gone from being Rosemary's best friend and partner to practically a stranger, and it was devastating. People would say, "It's such a miracle that Hugh survived the accident." And I would think to myself, "I don't know if he did." He couldn't connect with me emotionally at all. His eyes were very vacant, very blank. He didn't speak at all like himself; sort of very slow, staggered, kind of speech. It was pretty terrifying. This was the period of time--it was over a period of months-- that I felt like I had truly lost him. Hugh's memories of that time reflect that emotional disconnect. I really didn't feel much when I first got home. I didn't feel like it was a home with the comfort feeling. Dr. Kreutzer's colleague, Dr. Emille Godwin, explains the tumultuous affect TBI can have on relationships. Many survivors talk about being a different person before and after the injury, and many caregivers feel that way too. They're taking on new roles, new responsibilities. And so the two people that are in the relationship after brain injury are not really the same two people that were in the relationship before brain injury. The brain injury turned Rosemary into a single parent of their 14-year-old twin daughters, and Hugh needed his own kind of care. I was very much the maternal, nurturing mother, but I had to be tough, and I had to be more like him, not like me. So the first time I screamed and yelled at him-- I just lost it when he wouldn't get up for rehab. He was exhausted. He wouldn't get up. And my husband has once told me that--he said, "It was kind of like you had 3 kids. Like I was the rebellious teenager who wouldn't do anything you said." And he's right. To be taken care of is the most difficult thing. Not being able to do things like get in the car and go down and buy a bottle of Coke. I couldn't drive. And it was--not necessarily demeaning, but no sense of independence at all. And for me it was very difficult. Sometimes relationships fall apart after a brain injury. But about 9 months after the crash, Rosemary and Hugh got help from Dr. Kreutzer. He and Dr. Godwin are 2 of the few researchers in the country focused on helping couples sort through such challenges and build a thriving marriage after TBI. "Hi, I'm Dr. Kreutzer." With funding from the National Institute on Disability and Rehabilitation Research through a program called The TBI Model Systems, they launched the evidence-based Brain Injury Family Intervention. The program is essentially marriage counseling combined with education about the impact of brain injury. Seeing Dr. Kreutzer about our relationship challenges was a little bit unsettling at first. Because I think we were both careful of each other's feelings. When you go into a counseling session you're like, "Well I can't say that in front of him." And he's like, "I don't want to tell her how I feel." That sort of--it's just a little bit uncomfortable. But Dr. Kreutzer is pretty good at asking questions, and we started to open up and really talk more honestly. Understanding the new normal after TBI is one of the most important steps. Dr. Godwin starts by talking people through a list of common results of brain injury that they might not be aware of like communication challenges and social challenges. They say things like, "Did you come into my house? How did you know exactly what our life is like.?" And to have the experience of knowing that while the changes they are going through are very difficult, they are not unusual or unexpected can be very, very comforting for people. [Rosemary] I think I might pull this stuff out. [Hugh] What is it? Just like in regular marriage counseling couples work to communicate more effectively. I said, "He just doesn't like doing this stuff, and he doesn't do what I ask him to do." And Dr. Kreutzer said, "Well--" And Hugh says, "Yes I do! I always do what you want me to do." And I said, "You don't." And we we have this--we're starting-- and Dr. Kreutzer says, "Well Rosemary--all right--stop guys. How do you ask him?" And I said well I'll say, "The garbage is overflowing." And he says, "But did you tell him to take it out?" And I'm like, "Well I don't give orders. That's not my way." And so he says, "Hugh, how did your mother used to ask you to take the garbage out?" And he said, "Well she would say, 'Hugh, take the garbage out.'" So I said, "So that's all? That's what I have to do?" And so we went home and during the week I said, "Hugh, do the dishes." And he did, and I was stunned. So it was simple communication tools. To be successful counseling couples dealing with TBI therapists need to have a knowledge of TBI that informs their treatment. For example, rather than helping couples recall happier times, a traditional marriage therapy technique, therapists working with families dealing with TBI need to help them accept their new life. The exact words that Dr. Kreutzer said to us were, "Take some time to grieve for your old life and build a new one." And so he gave us that definitive ending that we would not allow to happen. We were stuck in our dream of going back to our life, and he gave us that beginning, grieve for your old life but start a new one. And after we really felt miserable about grieving for our old life together, we went home, and we talked about it, and we cried about it. And after that we started talking in a whole new way about, well, what can we do? We've got this gift. You're back home. You're with us still. What can we do to work with that? He effectively was saying is what you had before is what you had before, but you have to really shape what you have now and moving forward. When I talk to my patients I say, "You will get there. You may not believe that you will get there right now, but just for the moment I would like you to trust me. We're going to find a way to help you find the positives in your life, the parts to feel more hopeful, and to feel optimistic. You will get there, and I promise you that you will feel that your life will feel a lot more like a life worth living in the future." Hugh and Rosemary have made a lot of progress. And Dr. Kreutzer is not surprised because they are like a lot of his successful couples. They are people who recognize, who openly recognize, what's happened to them. That their lives are different. They are people who recognize that success comes with patience and persistence. They are people who learn to trust others in their life, and that hopefully will include the doctors and therapists that they are working with. And the other thing that I would say is, if you're a loving, caring person-- a person who shows their care for other people-- things will turn out way better. As difficult as things got, Hugh and Rosemary were committed to behaving in a loving, positive way towards each other. There were times when, for example, it was cold to put on shampoo. So I asked her to microwave it for me--for it to warm up. But she didn't call me an idiot and all this other stuff. She took it into consideration, and she made sure that the water in the shower was warm. Hugh called me on the telephone while we were in the same room. He did some quirky things like that, but it was kind of romantic. So if I didn't freak out about it like, "Why are you calling me? I'm in the same room," and instead walk into another room with my telephone and actually have this loving conversation with him-- it was very binding and it helped us rebuild a relationship. In some ways the Rawlinses make it look easy. Two years after the crash Hugh was back surfing and biking and working full-time as a CFO. Rosemary's written a book, but it's been a long road. TBI is like this waterfall gushing on your head. You're slipping and sliding and trying to get out from under it. You can't find your balance at all, but then eventually you do. When something this devastating happens to the person you love I think it's a moment of truth in your relationship. And for me, I absolutely couldn't imagine losing him. From that moment on I think we both fought very hard to get him back, back to himself, back in the family, back in the community. And when we succeeded to the point where we--we are so grateful. I can't even tell you how grateful we are. It's just amazing. This video is a product of the Model Systems Knowledge Translation Center and if funded by the National Institute on Disability and Rehabilitation Research.

Changes in Family Roles After Traumatic Brain Injury

Caregiving and Brain Injury: Chages in Family Roles
Traumatic brain injury affects the family in a variety of ways. One of the biggest ways is that there are role changes after traumatic brain injury, and every family has certain roles. Some of them are really concrete roles, like someone goes to work and makes money, someone does the house work. And then there are also different emotional roles, so sometimes a person may be the rock of the family-- the person that people turn to in times of trouble. Or someone else may be the joker of the family, so they make everybody laugh when everybody's feeling stressed, so there are a lot of different kinds of roles that family members can have. After traumatic brain injury, there are a lot of role shifts and role changes, and what often happens is one family member may take on too many roles and they can get what you call "role strain." So the most typical example of this is when a male has a traumatic brain injury and maybe the male was the primary breadwinner before the injury, and his wife may or may not have worked, but even if she did work, after the injury, she may be in the position of being the primary breadwinner-- being the only source of income to the home. And at the same time, she can't really relinquish other roles, so that people who--or husbands who are home after the injury and are not able to return to work cannot necessarily take on other roles, like being the primary person who transports the children back and forth. They may not be able to drive after an injury. Or they may not be able to manage the finances because they have cognitive difficulties which give them trouble with that. So it ends up being that one person-- maybe the wife--but different people can assume these roles-- had to take on a lot of different roles, and that results in a lot of stress and the people becoming overwhelmed. Now, some of the other family changes that happened are more in regard to relationships. So one is that there can be a lot of changes in communication after injury. Some of them are due to the direct effects of the injury. So for example, the person with injury may have what we call "impaired social communication," where they may not be able to pick up on nonverbal cues that other people give them, they may not be able to read emotions in other people; not have the same empathy that they did before, and that, of course, results in changes in the family relationships. Also, after an injury, everything in the family seems to revolve around the injury. So whereas before, they may have sat at the dinner table and talked about their day, now they talk about how they're going to get money, or how they're going to get services for the person with injury, so that just the normal day-to-day family interactions become very focused around the injury and they lose that warmth and affection that they had before. I think if you had a good relationship before the injury, that you're able to maintain that after injury, even though it's difficult at times. And naturally, people before the injury have various types of relationships so any problems that were present before the injury are going to of course be exacerbated after the injury. I think that the communication patterns are extremely important, so if there are problems, if people feel comfortable sitting down and talking with their family members about the problems, then that's going to result in more strengthening, and if they didn't have good communication patterns before, then it's going to be problematic. Family therapy can really help, and unfortunately, that's not one of the things that's focused on after injury. Many insurance providers won't even pay for family therapy unless it's specifically to help the person with injury develop better cognitive strategies or go back to work. So the focus on the family as a whole and the family relationships is often not there, but therapy can really help to repair relationships. You have to develop good communication patterns, so if they were not there before, the important thing to do is to find new ways to communicate. You should not communicate when you're angry, so it's important to find time that you can sit down together and talk about any problems that exist when you're not very emotional. And when you become very emotional, it's important to take that time away. And I think after a brain injury--especially for the primary caregiver who's the primary person who is caring for the person with the injury-- that person often does not have much time away from the person with the injury, so all their interactions are in situations which might be rather tense. And so, it's important for the caregiver to take that time away and then to be able to come back and talk about any problems that exist in a calmer way. There are a couple of different ways that caregivers can find time for themselves. One is that if they have the support of family and friends, they can ask someone else to come in and sit with the person with injury and then they can go take time for themselves: go to a movie, go meet a friend for coffee. Now, sometimes, caregivers don't have that support, and if a caregiver does not have that support, and they feel like they are always in the home with the person with the injury, there are still some things that can be done. There are very few people with injury that actually require someone to be sitting in the room with them 24 hours a day. Mostly, it's the case that the person with the injury just needs someone in the home, so there are different things that can be done. The caregivers can plan into their schedule that at a certain time each day, they're going to go into a room by themselves, take a hot bath, have a cup of hot chocolate, watch a movie, whatever they find to be relaxing. So you get really overwhelmed when you're in the same situation, day in and day out, and so it's really important to plan those activities. It sounds silly, but if you don't schedule them, they often don't happen, so having into your schedule some planned time for yourself is really important. It's really easy for family members to become stressed when other people are offering them advice and they feel like the advice is not good, or even if the advice is good, they feel overwhelmed because so many people may be giving them different advice. So it's important to remember that these people are trying to help, so while it's easy to become overwhelmed and become angry, people are meaning well and each person doesn't know that there are tons of other people offering you advice, so if you take that perspective, you might think about it differently and not be as upset. If you are upset--which is a natural reaction-- then the best thing to do is to remember that you know the person with the injury best, and that you are the person who is best equipped to help them and to know exactly what circumstances are happening in their lives and in the home, so you're the best judge. So listen to advice, try to process it calmly, and then really make your own decisions, and seek out what other information you need. You may have to find professionals that you trust and ask for answers. So the doctor that you see may not be the person to give you advice if you're not comfortable with that person, but there are a lot of different supports and a lot of different websites that you can go to to try to find advice that you feel comfortable with, and in the end, it's going to be your decision to make. Social isolation is one of the most common problems after traumatic brain injury and it's not just for the person with the injury but is also for the family members, and part of that is that people that were once friends often don't understand the changes that the person with traumatic injury has gone through. And in the beginning, right after the injury, there's a lot of support for the person with the injury and their family, and people are gathering around, even acquaintances that didn't know them well before--are gathering around, bringing food over, really providing support, and as time goes on, that support dwindles, and people go back to their lives and the person with the injury and their family become increasingly more isolated. An important thing to help with that is to get out and try to develop new relationships. Sometimes it's easier to develop new relationships than to go back to the old relationships because the people that you meet after the injury don't have a comparison to compare how things were before the injury. And one way to do that is to go to social group meetings like church meetings. The YMCA is a great place because they have a very all-inclusive philosophy. So try to find community organizations like the YMCA, like multi-service centers, like church groups, where people are generally more accepting of a diverse variety of characteristics in people and that can usually lead to formations of new relationships. And if it doesn't lead to formation of really close relationships, it at least has the person with injury out in the community socializing, feeling productive, and feeling good about themselves. Unfortunately, there are very few guidelines and very little research into the effectiveness of different community integration programs. When you think about community integration, one thing to think about is it means getting out into the community and doing activities that everyone else is doing. So if you're looking at rehabilitation programs which propose that they're helping people with community integration, one of the things to look for is are they taking people out into the community, are they involving them in activities, or do they have them all the time sitting behind a computer and doing computer games, computer programs? Sometimes, there are certain computer strategies and computer games that can actually help people develop certain skills that they can then use in the community, so I'm not saying that all rehab involving computers is bad. But you really need to look at the amount of time that the rehabilitation staff are getting people out into the community. After traumatic brain injury, things are going to be different and people are going to have difficulties with activities that were once very easy for them. And so the most important thing is to get them involved in an activity-- like, for example, learning to ride a bus-- and then, they're going to have problems, but you cannot always predict with 100 percent accuracy what types of problems they're going to have just from looking at them in a rehabilitation setting. So it's best to get them out into the community doing an activity, figure out what problems they're having doing the activity, and then develop strategies to help them with those problems. So again, the most important thing--and even if you're not in a rehabilitation program-- the most important thing is to get the person with the injury out, doing activities, looking at the situation, figuring out what problems they have, and then coming up with strategies to get around those problems because that means that the strategies that you teach to them are going to be generalizable to their real-world setting and help them to get back to their community activities. One of the most important things that could happen to improve the field of rehabilitation is that overall public awareness of traumatic brain injury be increased. So one of the greatest barriers to people having community integration is that people don't understand traumatic brain injury. If you talk to the average person, they've never heard of traumatic brain injury. Many people have heard of stroke, but most people have not heard of traumatic brain injury, and people with traumatic brain injury usually look normal. If you look at them, they don't have a lot of physical disabilities. There are exceptions, but for the most part, physically someone looks like nothing is wrong. But they're still having difficulties with some cognitive abilities, and they're still having difficulties with processing emotion and with some social interaction, so people in the community often don't understand what's happening. In today's society, we really have made a lot of accommodations for people with physical disabilities, and so we have ramps for people in wheelchairs, and people--if a person is in a wheelchair, usually people want to help them. But no one really understands if someone has a traumatic brain injury, how to help them. And in fact, they may interpret some of the things that a person with traumatic brain injury does as being a personality characteristic, and that is offputting to a lot of people. So increasing overall public awareness of traumatic brain injury, I believe, is the best way to help people become integrated into the community. And going along with that, more resources are very important. I think that increasing public awareness is a first step toward getting more resources for persons with brain injury. Some different states in recent years have been able to lobby the Congress to pass laws to increase funding for cognitive rehabilitation, but I believe that in some states, it's still the case that cognitive rehabilitation is excluded from some insurance companies' policies, and so it's really important to increase awareness of needs so that there's more funding and more resources for persons with traumatic brain injury. Most people with traumatic brain injury do not get rehabilitation and there are a lot of rehabilitation facilities but most of them require insurance funding, and unfortunately, the majority of people who have a traumatic brain injury do not have insurance. So there is an instance of a person that I worked with who did not have insurance who I saw in the county rehabilitation facility, and I referred them for post-acute cognitive rehabilitation services at the TIERS challenge program. And unfortunately, if someone has an injury and does not have insurance, in Texas, there's only one way that a person with traumatic brain injury who does not have insurance funding can get rehabilitation services, and that is to go through the state Vocational Rehabilitation Agency. And so there is unfortunately a wait list for those services, so a person that I referred for services got onto a wait list and in spite of frequent calling to their project manager for their case with the state rehabilitation agency, was unable to get into a post-acute cognitive rehabilitation program until almost a year after injury. Now, of course there's spontaneous recovery that happens within that first year, so that person was getting better every day without having rehabilitation but not making as much progress as he could have made if he had gotten the rehabilitation early on. So by the time he was able to get entry into the post-acute cognitive rehabilitation program, he had made a lot of gains to the point that they did not think that he needed intensive services, so they did not have him in daily services, but they had him going a couple of times a week, which was appropriate for him at that time because he actually had made a lot of advances. But he could have returned to work earlier and could have gotten out into the community earlier if he had gotten those services within the first 3 months after his inpatient rehabilitation discharge rather than 9 months later. So that is one of the frustrations of working with people with traumatic brain injury--especially those who don't have insurance, like in the county hospitals, because you know they need services, there are very few finding sources to get them these services, and this particular person that I worked with had tremendous family support, so he was able to be happy in spite of the fact that he was not doing the activities that he wanted to do, and not feeling extremely productive. Many people don't even have that family support, so it's really important to increase funding services for persons with brain injury and not just with private insurance because traumatic brain injury is not an equal opportunity disorder. It actually happens more to people from minority backgrounds and more in people from disadvantaged socioeconomic backgrounds and these people are unlikely to have insurance. So most of the people who have traumatic brain injury actually do not get services even though a lot of rehabilitation is focused on the people who have gotten services and a lot of the research that looks at rehabilitation effectiveness of course, is looking at people who got rehabilitation, to look at the effectiveness. So there's this whole other group of people who have not gotten services and who are sort of lost to the system. The brain is going to heal on its own, naturally, over time. There's a certain amount of spontaneous recovery that happens in the first year to 2 years after injury, and there's nothing that can really be done to speed up that process. However, there's a lot that family members can do to help people not become mentally inactive during that time period where they may not be working or may not be getting out of the house much. So while doing computer games or doing crossword puzzles may not actually speed up your brain's recovery process, it can at least keep people mentally active, and that's important. Also, there's a lot that family members can do to help the person with the injury develop compensatory strategies that can be used in the home. So if a person has memory problems, there are different strategies that can be used to help them get around those memory problems so that it doesn't have as much of an impact on their activities. And there's actually information on different types of cognitive strategies that family members can use on a website that we have as part of our rehabilitation, research, and training center grant, and our website is www.tbicommunity.org. And on that, there's a project called Training Family Members as Paraprofessionals that has slide presentations in it that contain different strategies that caregivers can use to help the person with traumatic brain injury develop compensatory strategies in the home. The number one advice that I would give to caregivers is to take care of yourself. Caregivers find this extremely difficult to do. They feel that they should be focused on helping their loved one to get better after injury and that they should not be focusing any time on themselves. But if caregivers don't focus time on themselves and don't manage their own stress, they're not going to be able to help the person with the injury, so the best thing that caregivers can do is make sure that they keep themselves mentally and physically healthy so that they can be ready to help the person with the injury. So that means taking time for yourself, planning time into your schedule to do little things that can help you relax, and also getting as much support as you can-- reaching out to other people, reaching out to brain injury associations, making sure that you have the support that you need.

Lee Woodruff Speaks on Supporting Intimate Relationships

Lee Woodruff Speaks on Supporting Intimate Relationships
We are all warrior wives. We're wives who were willing to take the cards that had been dealt and love our men because we saw and knew what was inside and not worry about the package on the outside. I've met so many warrior wives in my journey in the last two and a half years since Bob was injured, and it never ceases to amaze me the resiliency of the human spirit, the ability for families to heal together, the overwhelming power of love in healing a family and bringing a person back. When I told Bob--he was flying back on a red eye from Seattle today-- where I was today, he said, "You're not going to talk about our sex life, are you?" [laughter] So can't talk about erections, can't talk about this, but I will say this: Our sex life is the sex life of anyone who's been married for 20 years, has 4 children and 2 careers, and one of us is a morning person and the other one's a night person. So that's all I'm going to say. [laughter and applause] We are well below the national average, and we always were. But there's always room for improvement. [laughter] When Dave was talking--and I have so many emotions about our Vietnam veterans because I was a girl on the--well, I guess I was probably in puberty, but it was my friends' older brothers who were going off to war. And I saw how we treated those veterans when they came back. I saw how we dishonored them. I saw how we blamed them for the war. I was recently speaking at a veterans center in Ohio, and one of the color guards told me that he was in a parade in New York when he came back from Vietnam and people threw rocks at him. It's so hard for me to imagine that today, looking at people like Ted and people like BJ who have given so much and are such honorable, honorable people. It really shocks me. And when I talk, I really need to remind everybody that what we really need to do together in this war is separate the war from the warrior. It doesn't matter what your politics are. It doesn't matter whether or not you thought that we should or shouldn't go into Iraq or what you think of President Bush. This is about treating those who have served with dignity when they return home and giving them the highest level of care that they deserve for their service to their country. [applause] I think that for any of you who ever saw the movie Coming Home and there was one movie that seared in my brain forever--it's Deer Hunter. And I remember as a young girl--I don't know quite what year that came out in the '70s, but I remember crying through that entire movie, knowing that that was the fate of some of the brothers who died on my street, Pinedale Avenue in Delmar, New York, outside of Albany. And I think one of the most sort of shocking things to me as a young girl but one of the most amazing things was the wheelchair scene. Is it Kris Kristofferson? I should have done my homework before I came here. [crowd response] Jon Voight. Father of Angelina Jolie, by the way. [laughter] Who knew that little trivia fact? Jon Voight and Jane Fonda? Do I have that right? Okay. I can picture the bodies; I don't quite have the faces. And it had never occurred to me how somebody with a disability would return and go back to their world. And probably the thought of intimacy with someone who had a disability was something I didn't think much about until that very searing scene which was bittersweet and poignant and all the things that Dave talked about and BJ talked about in terms of facing yourself after you come home with a loss and a change and how is that person going to love you. And as I tell my story a little bit, I'll go through our moments--Bob's and mine and the children. I'll start by just saying that we're a very, very blessed family. I still don't know why, other than I think that Bob was spared for so many reasons. The biggest reason was to be able to cast a light by using his 15 minutes of fame on our wounded veterans, particularly those with brain injuries, who were returning and who most people in America had no idea were coming back in these kinds of numbers with these kinds of life-changing injuries. And frankly, these people didn't survive in Vietnam. Dave is another walking miracle. I've had more physicians--many of them in the military, many in civilian-- who said if this had happened in the civilian world, he wouldn't be alive and if this had happened in Vietnam with these kinds of injuries, he never would have made it out of country. And obviously, that's incredible medical advancement that's amazing and much more advanced body armor as well. There are many reasons, but we are bringing people home in numbers with a diminished quality of life in some cases. For some of the mothers who probably thought they were sending their son out of the nest and ready to cash that 401(k) in and go to Jamaica like Chervon Phillips' mother or Nellie Makanjo, mother of Jose-- both very severely brain injured servicemembers who as mothers now are by their children's bedsides 24/7-- not the retirement they had dreamed. I had a chance to talk to Senator Dole while he was waiting to go on, and we were talking a little bit about what our foundation is doing. Bob and I started a foundation to help traumatic brain injured servicemembers. Our definition in our foundation of a brain injury encompasses not just the severe TBI but PTSD, combat stress, personality disorder. In my mind, those are broken brains. And I was having a little fun with him out there because I'm not sure he could completely hear me all the way, and I said, "New Rand study. Five million bucks they spent, "and they came back with statistics which we pretty much knew "from our buddies at VA and DoD-- "15 to 30 percent of the 1.65 million who have cycled through Afghanistan "and Rand study confirmed I think it's 320,000 will come back "with some form of a brain injury." And he was still sticking to his 2,500 to 3,000 figure of wounded, including amputees. I think it's time that we face up to the fact that we can't define an injury by something that's a laceration or a bullet hole or somebody who bears the scars that Bob do which are quite obvious and go around the side of his head, as so many servicemembers you've seen. So many of the injuries are so much more complex. And certainly today's conversation about issues of intimacy point to some of those finer points that are so difficult not only to voice but to quantify. It's hard to quantify damage in a human being. I've argued for a long time that we need to be doing a baseline on our servicemembers before they are deployed so that when they come back they don't have to fight as hard to say, "No, but he wasn't like that before," or "He really enjoyed sex with me before, and now it's like sleeping with my brother." I can't tell you how many times I've heard that from wives. "I feel like I'm sleeping next to my brother." "There's nothing from him. When I put my hands on his body, he doesn't respond." "He rolls away." You talk to a 24-year-old woman--I'm almost 50 so I'm fine with that in my bed, okay? [laughter] I'm done with that. But you talk to a 24-year-old woman who has just been married 6 months before her husband was deployed, and that was not what she dreamed of when she walked down the aisle. She imagined a life full of laughter and children, like Abbey and BJ were blessed to have. And what she didn't imagine is that she would be sleeping with her brother, that she would turn to an emotionally flat husband who really had nothing more to give and couldn't understand why his life had ended sexually before he had really begun living. I think Davey hit on a really essential element of this journey, and that was humor. You cannot undergo a journey like this without a sense of humor. We had so many moments--and I capture some of them in the book but not nearly all of them--where you just have to laugh because otherwise you would cry. There were the moments that Bob pulled his stomach peg out. There were the moments that we would walk in and he was in his medically-induced coma for 36 days and we were all calling him half-head over his bed as his skull was removed and his brain was swollen out of it like a popover. You have to look at the situation, and you have to say to yourself, "I need to find a glimmer of hope." "I need to find something in this journey that I can take away that revives my spirit." The medical community is not set up to give you that at all, and I think that I've had so many conversations with families about the statistics that we all hear that are so front loaded when you walk in the hospital, the pronouncements that everybody is so quick to make, the percentages he won't do this or he may be able to do this. I was told that Bob probably would never be able to work again. No one knew whether he could talk or not. It was interesting to hear Davey talk about Brenda and superimpose her needs for love on him because my question to Dr. Armonda, who is an incredible neurosurgeon who works between Walter Reed and Bethesda, was, "Will he love me?" "Will he be so altered and so damaged that he won't remember "what we shared for the 18 years at that point of our marriage "and how much we love each other?" Because to me that was the most important thing in the world. It wasn't that he was anchor of World News or he had taken over for Peter Jennings or that he spoke three languages; it was that we had just the best relationship of anybody I knew as a couple and we had all of the pieces intact. And sure, we fought and sure, he leaves his dirty underwear on the floor and still does after his brain injury and now he blames it on the brain injury which is even worse. [laughter] But I would have done anything to keep that relationship intact. I think I talked about this in the documentary, and I'm sure I talk about it in the book. I haven't looked at the book in so long. But what Dr. Armonda said to me was that he had never seen anybody come back with a brain injury who didn't love the people that they'd loved before. And then what he told me after the book came out was that he went home to his wife Heidi and told her that I had asked him this question and told her what he had told me. And she said, "You idiot! You have no idea whether or not that's true." "Why did you tell her that?" [laughter] Luckily I found that out many, many months later when I knew Bob did still love me. But I'm glad that he lied to me at that moment in time. I loved Abbey's story about the fingernails, and I have my own story like that. It was that Bob had been named anchor, and along with television come a lot of things that Bob Woodruff hated and still hates, like pancake makeup so your five o'clock shadow is gone and like the fact that he has a unibrow so they have to kind of tame those brows and pluck them. And when I walked in the room at Landstuhl and I saw not my husband but a Frankenstein monster lying naked on a table with just a sheet over his groin and 14 centimeters of his skull removed with a brain swollen out of it in a way that I hadn't imagined the human brain could swell with the whole left side of his face basically sort of ripped off in those early days, I looked at his brows. And my first thought was, "They have really done a nice job in that makeup room "shaping those." And I just recently read a book. It's called Your Mother, My Mother. It's a book about nursing our elderly parents toward the end. It's about slow medicine, a concept I hadn't known much about but a lovely concept for elder care. And in the book the author talks about denial. And he said that actually denial is a wonderfully effective tool for the person in the middle of the maelstrom as long as all of the people around that person are not in denial. And when I think about how I moved in those days, that was exactly how it worked. I was like the queen bee in the hive--and I write about this-- and I chose to be in the zone. And the zone was a place where I would only let certain information in. Everybody around me I know was talking to the doctors and finding out what they needed to know and perhaps acting like advance men for me. But in my mind, the doctors didn't know my Bob and they didn't know how much he loved me, they didn't know how much he loved our four children, they didn't know how strong he was and how much he had to live for, and there was this factor that the doctors couldn't measure, and that was the human spirit. And so my thought was that until Bob woke up from that coma and until we had a baseline, until we knew if he could talk, if he could think, if he could recognize us or remember us, I was not going to listen to anybody's pronouncements. And that was a very useful tool for me. So I challenge all of you who are counseling patients or are dealing with them on the physiological/medical front, do not rush to judgment. Use hope with your realism. Everybody that's in a caregiving situation needs to believe that they could have a miracle. They need to believe that their loved one might be that person who might be within that 10 percent. There is no reason to take a baseball bat and beat that out of that wife's heart in that first week or that second week. My contention is that human beings are not only mostly smart when it comes to their loved ones, but they're intuitive. And if the situation is terminal, if the case looks like it's vegetative, we will discover that on our own terms. We will realize in week three or week four that this isn't breaking the way we thought it might be or we'll understand that things aren't going our way. But how can anyone in that hospital possibly expect the person to be able to put the oxygen mask on the patient if they can't possibly put it back on themselves. And so you need to talk to your patients and your caregivers about all kinds of things. You need to talk about the power of touch and the power of music and the power of family and the power perhaps of alternative medicine, the power of massage. All of these things come into play when you're healing. I'm going to go back really briefly. I'm sure some of you know Bob's story, but I'll just encapsulate it because I feel like I've jumped ahead a little bit. He had been named co-anchor of World News with Elizabeth Vargas after Peter Jennings' death from lung cancer, and it was his I think 28th day or something on the job officially in the anchor chair. It was President Bush's State of the Union address that was coming up, so Bob had reported on the elections, the Hamas victory in Palestine, and hopped on a plane and headed to Iraq where he was going to go into the field. And this was the point of the war where the US troops were going to stand down and the Coalition forces were going to stand up, so it was really important that Bob take a look firsthand at how the coalition forces were doing and how the handover of power was doing. This was his ninth time in Iraq. He was no stranger to covering wars. He had covered the Kosovo conflict and two hours after the Trade Centers were hit and toppled. We at that point in time were living in London. He took a plane to Afghanistan, was diverted to Pakistan, and spent the next nine weeks there and then also was embedded in 2003. So he was not somebody who was a novice to these situations. What happened to Bob is what happens to our servicemembers every single day. Riding down a road that was supposedly safe and swept for IEDs there was a remote controlled device packed with rocks, and about 20 feet away, as he was in the tank and happened to be up at that point in time, the IED blew off and hundreds of rocks shot into the left side of Bob's face and head. The concussive force cracked his skull. One of the rocks sheared his helmet off. It just happened to hit the chinstrap. That may have actually saved his life because that was the rock that after cracking the bottom of his jaw passed all the way across his throat and came to rest but did not perforate the carotid artery on the other side. That was one of the first amazing miracles of Bob's injury. Recently I was in Ohio not so long ago, and we were talking to physicians at one of the rehab centers there. One of the docs had been in the hospital when Bob came, and he told me something I didn't know, which was that written next to Bob's chart was the word "expected," which as you all probably know, means expected to die. And they told me that they weren't sure, they couldn't tell if the rock actually had perforated and was just holding itself against the artery like a finger in a dike, and they weren't even sure they could transport him, which they did. And with the unbelievable military medical care, which I know you all know, that was really the first line of defense for Bob was the alacrity with which everybody operated, the amazing precision. I can't say enough about military medicine. I laugh when I give speeches in front of people who are part of the military. I always say my very first thought--because I was in Disney World at the time with four children when I got the phone call-- my very first thought was, "Oh, my gosh." "We have to get him out of the hands of the US government." "They botch everything, including my taxes. What are they going to do with his head?" But of course that was the absolute wrong-- Not being a military person, not coming from a military background and assuming that all of the best medicine resided in cities like Washington and New York, that was my very first response. And it couldn't have been more wrong. That was driven home to me when I was here in Washington staying at a friend's house when the children would come down. Bob was in a medically-induced coma for 36 days, and the children would come down on weekends to see him, and so it was a very big dance to kind of figure out when was it right for them to see their dad and how can we keep them entertained on weekends without making this seem like a funeral every time they come down. I walked outside of my friend's house one of the weekends, and there was a little shrine on the sidewalk. It was a flower and candle. I said, "What is this? What happened?" She said, "That is such a sad story." "That was the New York Times bureau chief here in Washington." "He was retired and he walked outside, some boys came by with a baseball bat "and hit him on the head." "They got $14 out of his wallet." "Another neighbor, luckily, came by soon thereafter, called an ambulance, "but it was a human error and he didn't go a level four trauma center "so they took him to an ER where they assessed him as drunk," because, as most of you know, TBI can often present as somebody who is just off and perhaps has had too much to drink, "and he died "when they got him in on the operating table." And I thought, "Okay, here's my husband in a third world country, in the middle of a war zone, and they got his skull off within 47 minutes." And that's coming out of a complex gunfight where medics landed the helicopter after they were given the order not to land. They turned the radio down. We've since had the opportunity to meet these young men and women who were in Portland at the time. Pretty amazing stuff. These are the people that are serving our country. These are the brave young men and women who are serving. They got him to Baghdad, they assessed him as critical, they got him to Balad where in a hospital made of tents and generators with people operating in body armor, 47 minutes, his skull was off. I don't have to tell you what the diagnosis was. At first I wouldn't learn anything about a brain injury. And what I kept saying when the doctors would try to talk to me about it, I kept saying, "Go macro, go macro. I am not ready to hear this." "I need my time and my space." But it was day 35, and Bob was not waking up. He was not responding to commands, he was not able to open his eyes, squeeze my hand, none of that. And so I was off sort of hunting around for nursing homes, which I was told would really be the next step because in order to do therapy, as you know, you need to be able to do two hours of therapy at least a day to go to a rehab facility. So it was time to learn more about a brain injury, and I asked the neuropsychologist at the time, "Okay, give it to me. Tell me everything I need to know." And it was probably a somewhat masochistic way to find out about brain injury, perhaps only less masochistic than going on Google, which would have, frankly, been incredibly frightening. And I don't recommend that. But what I heard was a really amazing litany of things. What I love about Chris Fasher is when he asked me to speak, he sent me excerpts from the book that I could use as talking points, so I didn't even have to do the homework on this. Let me just read what Chris has highlighted in yellow for me here. [laughter] He's an incredible guy, incredible guy. "When many patients first wake up or even afterward, "they can be easily angered and rattle off strings of expletives." "Abnormal behavior might simply become part of what Bob's therapists would teach me "to call the 'new normal'"--a term that I came to hate, by the way, and still do. "With most brain injuries, the filter in our heads that we use to get along in society slips "and people lose their inhibitions in ways both shocking and painful for their loved ones." "One woman I spoke with after Bob's injury confided in me "that her husband was masturbating continually in the hospital in front of other people." His inhibitions were gone, and she was unclear, "What do I do with this? Is this going to happen for the rest of his life?" My thought was, "Am I ever going to be able to go to a cocktail party with Bob?" "Is he going to be whipping things out in the grocery aisle with the lettuce?" This could be an issue. "Then there was the horrible story of the Marine's wife "who had to be put in a safe house because her husband, "her high school sweetheart, had tried to strangle her in her sleep "for the third time after his head injury in Iraq"-- a closed head wound, by the way, probably one of the people that might not fall in Senator Dole's figure of 3,000. "My voice began rising, and I tried to control it." I'm sorry. That was a different part which I won't have time to go into. "I remember lying down with Bob." Abbey, I did lie down with Bob. He had eight tubes coming out of his body. They had warned me that he could be angry and agitated. In fact, the neuropsychologist had told me, because he was becoming more agitated, that I probably shouldn't get too close, that he might swing at me. And I thought, "No, he's not." One of our jokes was that I was the horse whisperer because I could come in, and I would get my face down really close to his ear and talk to him and soothe him. And you all, I'm sure, have seen someone in a medically-induced coma. It's not the lily crossed with the hands over the chest like the movies. It's an incredibly disturbing thing. Bob was strong as an ox when he was injured. He continually tried to get up out of bed. His eyes were open, but there were no lights on behind them. There was no connection to anything. He would continually try to pull his tubes out when we were not there. He was restrained with wrist restraints, and he had to have a corpsman by his bed at all times. The corpsmen were amazing, amazing people. We tried to keep family around him as much as we could. We played music, we took the DVDs of our life and brought them in on a DVD player so he could hear his children's voices. At one point in time two and a half weeks into Bob's coma, it was time for my children to see their dad, and that was probably the most difficult thing I have ever done, more difficult than walking into that room for the first time because I can relate to Abbey too. I didn't want any prep, I wasn't going to faint, I understood their concern in Landstuhl when I got to Landstuhl, but all I wanted to do was see my husband. I wanted to lay eyes on him. And if I could start with the fact that he was alive, that would be enough for me at that moment in time. I would take anything else as gravy. And so, as I said, it was about two and a half weeks and my daughter Katherine, who at the time was 12 years old and is very close to her father, was the first one to come in. And I think a big part of what has to happen in a hospital-- and I have to say at Bethesda Naval they were wonderful about this--is dignity. I would always continually try to shut that curtain in the ICU. I hated the fact that the family jewels were on display at all times because no one can keep those gowns on in a brain injury. They're constantly up around your neck. I was continually shutting the curtain and asking the nurses to keep it closed. One of the greatest acts of love and kindness from the nurses was they figured out a way to cut boxers so that Bob, despite all the tubes coming out of his front and back and his groin, was able to have a modicum of dignity. I loved them for that. There is a little group in Ohio that our foundation just cut a $40,000 check to. It's called Sew Much Comfort, S-E-W. It's a bunch of self-proclaimed grannies who have figured out how to take T-shirts and boxer shorts and rip the seams and put Velcro in. It started with cancer patients, but it's moved on to help the men and women at Walter Reed and Bethesda. There was a very high-ranking official who was at Bethesda whose wife and I have spoken on numerous occasions, and he's actually a doctor. When she and I were talking, I'm sure like Sarah, like Abbey, like myself, we have been so honored to serve as the person to talk to others who are coming in the footsteps after us, to be able to provide counsel for those. And so she and I, like many other wives, have had many conversations. I said to her, "Here we are. We don't have young husbands." "And here they are, displayed for the world in the ICU." This was very disturbing to me. She said, "I'm so glad you said that." "It's so hard to see my husband naked in front of all of the young nurses "and the young doctors and the people that he used to command." And I said, "Let me send you some T-shirts and shorts." I got an email from her about two weeks later, and she said, "The clothing arrived, and my husband is wearing it, "and I can't thank you enough." "You've given us both back a little bit of dignity in a place "that is intent on stripping you of every ounce of it." So it's those little things, it's those tiny acts of kindness that one can offer that make such a difference along the journey. When I brought my daughter into the room, I brought her around to Bob's good side, and she bent down after she sucked in her breath and saw her father, which was not a pretty sight, and she said, "Daddy, let's play the kissing game." The kissing game was their game that they would play because I stopped being able to do math homework in about third grade, believe it or not--it's because I'm blonde, I think. I would say, "Call your dad wherever he is, in Syria or Africa or Afghanistan." She would call him with the beauty of satellite phones, they would work out their math problem and they would kiss into the receiver. And the first person to give up, to stop kissing, was the loser, so of course he always let her win. And so she bent down to his good cheek and began to kiss him. This was about two and a half weeks into his coma. About 20 seconds later, a tear came out of his good eye. It was the first time that we thought, 'He's in there and he hears us somewhere, "and maybe this will be okay, maybe he's going to pull through this." I'll never forget what the nurse said to me. She said something I will always remember. She said, "You know, it's that connection that a parent has to its child." "It's the kisses and the midnight cuddles and the reading "and the snuggles, and if someone is going to reach a person, "it's going to be their child." And I thought that was a really beautiful thing. I also thought, "Okay, I've been here for two and a half weeks." [laughter] "What am I? Sliced liver?" We do kind of tease ourselves about that one. I give him a hard time. It became really difficult to see my husband the way that he was. I wanted intimacy, I wanted to be with him, I wanted him to kiss me, I wanted him to wake up. I didn't know whether he would remember how to do any of this, and I remember distinctly toward the end I decided to ignore the neuropsychologist's orders to stay away from him. He had swung at a servicemember, and I'll never forget what the neuropsychologist said. She said, "Well, at least he hasn't bitten someone." And when I called in from the nursing home that I was touring up at Johns Hopkins, my sister said, "He just bit someone." I'm laughing now, but that was another serious low point because that to me, as she said, was sort of a brain stem reaction. That was just not good that he was getting more violent. It was that night that I kicked off my shoes and I climbed in the tiny bed with him. I wish I had known that there were double beds too because that was pretty tough to do with bedrails and eight tubes. I tried to move his tubes around so that I didn't lie on them. I laid my arm carefully over his chest, and I nestled my head next to him, balancing against the bedrail. Wow. I haven't read this in so long. I've been on the road for a year and a half telling this story, and I think that when you tell your story over and over again, I'm so amazed at Davey because I am burned out of telling my story, and I'm going away for the summer to our wonderful place in the Adirondacks where we all heal, and I'm going to recharge my battery because it is so important to tell your story. But every time I tell my story, I put myself right back in all that world of hurt. I've decided that that's not always such a good thing. And then I go home and I look at Bob and I think, "Oh, but you're better." "You're good. We got through that." "We still have our challenges, but look at you." "You're walking and you're here." And I think for everybody that tells their story--and Sarah, you're working so hard and you're such an amazing woman, but I hope you get to take a break too because it's been a long time that we've been telling our stories, isn't it? I thought about Dr. M's words about agitation and physical violence, and they rang in my head. She had warned me not to get too close in case he became angry at me in his confusion. But I saw no violence or malice in my husband's eyes, just unending sadness and fear. I loved him more than I could imagine. "Damn the doctors and their predictions and cautions," I thought. I was unafraid. This was my husband, and somewhere inside that broken head he knew me. He loved me too. But he was so scared and confused. And for the next two hours I whispered to him softly, pulling him back down every time he sat up. He didn't say a word the entire time, and sometimes he would roll onto his stomach and then get up on his knees, mumbling. I snuggled him and I urged him to sleep, but his eyes kept opening with a startled look as if he was terrified. By 7:30 a.m. I was exhausted. I had to get back to the kids. Feeling defeated and low, I slipped out of Bob's room and back to the hotel, wondering what would become of our small family. One of the few moments alone together in those early days, I had a bizarre thought. I thought about all the couples who had been in this situation-- the car accident, the war, the factory, the sudden fall off the roof, the head injury skiing. How many of those husbands had decided maybe they didn't really love their wives long before the moment that changed them forever? How many couples were simply going through the motions? It occurred to me that while some of those wives might never envy me per se, maybe some of them could have used a little brain injury to jolt their husbands back to reality. This is where the sense of humor comes in, guys. Maybe there was a husband straying or one who was just a little too fond of the Barcalounger and the remote control. A little brush with death might help remind him exactly what they did mean to each other, get those old priorities straightened out. Tragedy had the potential for real opportunity in a foundering marriage. But here was the baffling thing: I couldn't for the life of me figure out why this had happened to me and Bob. We had had our share of big bumps in the road, but for the most part we were a couple who appreciated what we had. I wondered many times what it would be like to sit out a lonely vigil at your husband's bed, all the while infuriated over his transgressions with the little trollop he had met at the office. I was grateful to feel only love, the pure white heat of emotion that cleanly burns out other feelings, be they anger, guilt or even rage. I saw so many and have seen and met so many young wives who I don't think are going to stick it out. And I've talked to their mothers-in-law as they come to my talks. They come to visit with me, and the mothers of the brain injured sons say, "She's got nothing that's keeping her here." "There's no children, there's no intimacy, "there's nothing that's keeping them together." It's exactly what Abbey and BJ described. She wants to go out to the bars. She's a young woman. She doesn't want to throw away her life taking care of this person. I had the benefit of a huge foundation of marriage. I don't have time to go into it here, but Bob and I had done so many things together, and we document them a bit in the book. We had traveled, we had lived overseas, we had lived with absolutely nothing, I had worked all my life and supported his desire to switch from being a lawyer to a starving journalist. We were a team. And I worry so much for the marriages and the couples who, like Abbey, are sort of told, "It'll come back," when especially at that vital point in your life and those early years of your marriage where you just can't kind of wait to get that person home and take their clothes off, what it must be like to turn to someone who has absolutely no ability to give that back on the intimacy front. I don't recall anybody addressing the issue of sexuality with us. I do know that Bob was on and still is on anti-seizure medication. His dosage has been lowered. But I was told that in the early days, that would definitely put a damper on sexuality and desire. Bob was on so many medications in the early days that I realized that that was part of it. I will tell a tale out of school, as long as nobody tells Bob. I remember that we were home. We must have been home from the inpatient. He was still missing his skull, which would not be replaced until Memorial Day of that year, so he was injured at the end of January, and he would have to wear a helmet and live without a skull for that many months. I loved him so much, and I missed him so much, and I wanted so much to connect with him in such a visceral way that I essentially jumped his bones, to use a term that I would have used in the '70s when I was growing up. He was still a frail person, but it was that lack of communication-- as much as Abbey and BJ say you have to talk about it, sometimes I think you just have to do it. And that's exactly what I did that night. I took the bull by the horns, and I wanted to show Bob how much I was still attracted to him and how much I missed him. And I had to be careful and I worried about his head, but I will tell you that it will probably in my dying days when I think back on all the highlights of our marriage, it'll probably be in my top 20, that moment. Were we rolling around like Demi Moore and whomever in one of those movies? No. We couldn't roll with that head. But we found other ways to tell each other that we loved each other. And I think that you can communicate and talk until you're blue in the face, but I think sometimes it is just a hand laid on a chest or it's just a look that you can give somebody. There are so many wonderful nonverbal ways that after so many years of marriage you can tell somebody you love them. And certainly Bob and I talk and we communicate all the time, but I think sometimes so much more is said without words than not. And so I urge you when you're counseling your patients or talking to people to channel both ways and talk about it both ways. I will also share with you something else that I think is valuable. I've had to do a lot of armchair psychology. I tried to go to grief counseling which was suggested to me. I guess complicated grief is what it's called. And I hated it. It was Thursday at 9:00. I had to go cry somewhere. And maybe I had woken up on Thursday and I was having a good day. And it was 9:00 and I had to go pay $120 and sit there and cry. And my issues weren't that I'd married the wrong guy or that my husband was a jerk; my issues were that my husband had been gravely injured and I had no idea where this was going to end up because this was the slowest, most incremental, most torturous injury you could give somebody. I finally just stopped seeing her I think after three times and two boxes of Kleenex, and I went to Bob's neuropsychologist who was at Mt. Sinai at the time and I said, "Mary, I want to talk to you because I don't need all kinds of therapy "about what's wrong with my marriage or how I was beaten as a child." I said, "I need to know how Bob is doing." And she said something that was a huge compliment to me. She said, "I normally wouldn't counsel both a husband and wife, "but you two seem so much in lockstep, "and I can't see that you have any other issues, "and he loves you and you love him, so I will talk to you separately." And what she would do was one of the most valuable things in this entire journey for me. She was able to take a writing sample of Bob's from two weeks prior and then a writing sample from that week and say, "Lee, read these two." And I could see this one's more cogent than this one. And you'd have days in the roller coaster--I hated the roller coaster analogy. I actually rewrote analogies for the docs at Bethesda because I was so tired of, "It's a marathon, not a sprint," "It's a roller coaster." Come on, Sarah. What are some of the other ones? I've forgotten. I've banished them from my brain. "The new normal." But she actually was able to concretely show me how Bob was improving, and that was one of the most valuable things as a counselor that she could possibly give to me. I knew it was slow and I knew it was painfully slow. And we would play the limb or the brain game in Bethesda, and that was, "Which would have been worse for Bob Woodruff, "to have lost a limb or to have had a brain injury?" And as active as he is, there wasn't one brother, one family member who didn't say that a brain injury would possibly be the worst thing that you could give somebody and that there were so many times that I had wished that someone had taken Bob's legs or taken his arms. You can't wish that on somebody, and you can't know how somebody would turn out if that had happened, but I am here to tell you that a brain injury is absolutely the worst thing, I believe, that can happen to a loved one because you're taking that person, you're taking that thing that you've fallen in love with, that spirit, away and you're immutably changing it in a way that you can't possibly know the outcome of for years. That is a form of torture. Okay, so no one's going to tell Bob that I did that making love story, right? I'll be in big trouble when I get back. All right, Chris, I'm going to wrap this up in a second so people can ask questions because that's always the most valuable part. I will say this: I did a lot of research once Bob was awake and healing, and I did a lot of reading. I read everything I could get my hands on. I don't think anybody really knows the divorce rate for a brain injury, but I know it's much higher. And lately I've read statistics that are it's close to 80 percent. And I would have to believe that that is right. Again, Bob and I were spared. Bob's issues are aphasia, definitely some short-term memory issues and fatigue. Beyond that, he's essentially the same person. His personality is the same, his intimacy is the same, whether or not we're able to get anything done at 10:00 at night. His sense of humor is the same. His cognition has absolutely been affected, but that's all coming back. He reads much slower than he used to. Interestingly enough, when he woke up--and I'm skipping over that part but then you'll just have to read the book-- he was speaking Spanish and French because languages that you learn apparently after the age of 6 are housed in a different part of your brain. And so those languages were not as damaged, and Bob's was a left temporal lobe injury, a very specific injury. It was not a penetrating brain injury, but of course he had all the concussive effects of a brain injury. I've talked to many wives about this issue. And Bob would tell you that one of his residual issues is he's probably quicker to anger than he was before. He always got angry before--and sometimes more depression than before. He always got depressed before, one or two days. He would just call them his blue period. I called it male PMS. And he still has that, and I think it's about in the same proportion. He would have a trigger point when he got angry about something that isn't vastly different than it is now, but it's a little bit different. It is different. And we just yesterday were arguing about something. I wanted him to do something, and he told me how busy he was, which is really not something you say to a mother of four who has a career and has been on the road for a year and a half [laughter] raising money for the wounded soldiers. And so it ballooned into a really great fight, which I believe all couples need to have every now and then. I called him back later and he said, "I'm sorry. It's just me. I'm different." "These are my issues now, and I need to deal with them." And I said, "You know what I need you to do?" "I need you to deal with them with somebody else." And he said, "Lee, I don't think I understand what you've been through." "I can't possibly understand what you've been through in the last two years." And I said, "You can't, and what you don't understand is the level of PTSD that I have "because any time you start to get a little bit angry, "I hear that neuropsychologist in my head saying, 'He's going to hit you, "'he'll do this, he could be angry, he'll be depressed,' "and I see that person lying on the bed with a head swollen out of his skull, "with the eye swollen shut who I was sure was deaf and blind "and I see the person who was so broken who they told me "would probably never work again." "And so the minute you get a little bit angry, my mind goes, 'Oh, God.'" "'Okay, how are we going to do this? How are we going to control this?'" I said, "So you can no longer lay that stuff with me." "We used to be able to do that." "We used to be able to lie there in bed and talk about everything." "And we can still talk about 99 percent of it, but that 1 percent of it-- "your fears, your worries, the places where you feel inadequate-- "I don't think I can hear that anymore." "You're going to need to go back to Mary and set up some regular appointments with her "and put all that stuff with her." "You're going to need to go back to your therapist." And he thought I was talking about cognitive stuff. He said, "No, you're really the best therapist for that stuff." "You're a great writer, and if I'm giving a speech, I give it to you "and you make the sentences better, which is always what we've done in our marriage." I said, "I'm not talking about the writing exercises and the cognitive stuff." "I'm talking about your emotions because in order for me to heal, "for us to heal as a couple, for me to find you sexy, "for me to want you and for me to respect you, "I need to still be able to see you as that person that I so respect "for who you are, as that person that's in control, that's strong, "that's male, that's virile, that's all those things "that those pheromones that we're laced with attract us toward." "And if you're scared, I don't think I can hear that anymore." This is a revelation I just had about two days ago, and this is a revelation I pass to you because that may not be the message that you're giving couples in therapy. And maybe the wife who was in such lockstep with her husband felt like they can always try to work everything out. But I'm here to say that somewhere in there, that wife is going to drown and somewhere in there, that wife may lose love for that husband if she continues to be the nursemaid and continues to be the catchall and the repository for every single emotion. You can't unvalidate--is that a word? You can't discount the caregiver's PTSD. We wives have seen it all at a time when they were incapacitated, knocked out, in a coma. They will never understand what the families go through. And thank God because I used to say to myself, "If Bob could see us now, if he could see what he's done to this little family, "he would feel like killing himself." I don't ever want Bob to know exactly how black it was. No one ever needs to go back to that place. But I can no longer be the therapist that I was before his injury. And so I urge you to urge patients that long after the healing is done, long after the outpatient therapy is over, that person still needs to be able to put those fears and their worries and their weaknesses--an extra layer of it, at least-- in some professional hands. Well, what do we need? We need to be able to talk about these issues, and this conference is a wonderful step for this. We need a strong collaboration of public and private. Bob and I are truly advocating for that through our foundation. We firmly, firmly believe that families heal together, that as wonderful as the VA is, it's not always the answer for brain injuries because brain injuries are long-term heals. And if my husband is sent to Richmond and I live in Iowa and I work at Walmart and have three children, why should I be forced to make that choice to go by his bedside and be his cheerleader or to leave my children with whom and quit my job? Every single wife I met at NNMC had to leave their job. I think there was only one or two wives or mothers whose jobs were able to give them leave because of course this turns into a long, longer than two week-- It's like Abbey saying, "Oh, pack some warm things. You're coming for a week." It's not a week with a brain injury. It's years or it's a lifetime. Those families need to be given access to private facilities so that the mothers can do what I did, which was drive every day to Mt. Sinai with my children sometimes, not at other times, spend the night next to him in a cot that they wheeled up next to his hospital bed, and fall asleep holding his hand. You can't heal without love, you can't heal without touch, you can't heal without family, and woe to the 19-, 20-, 21-year-old servicemembers that I saw in Bethesda without family members that were able to come. What happens to them on the journey of rehab? What happens to them when they get to the VA? Who's holding their hand at night? Who's horse whispering in their ear, "I love you. I'll never leave you." "You're safe with me." That was my mantra. We need to give these servicemembers everything because they have given to us. There's that wonderful inscription in Iwo Jima: "They gave of themselves today so that you could have your tomorrows." That is never more relevant than in the case of a brain injury. I'm going to end with my story of healing, which is my story of my daughter Nora who is eight now. She's a twin. She's the runt of the litter. She's hearing impaired, and she wears hearing aids, and she's the sweetest little person in the world. It was a year after Bob's injury, and I knew that on the news that night there was going to be a story about how it had been a year since Bob Woodruff was injured. I told the older children because I knew that they might hear about it in school or see it, but I chose not to tell the twins, who were 6 at the time. Little kids have ears, and so somewhere along the line they must have heard me on the phone with somebody. And it was a sad day. I believe the body has a memory, a physical memory. It was the day he had been injured, and I just woke up feeling lousy. And I really wasn't talking on the phone. I didn't want to talk to anybody. I was going to just sort of take care of myself that day. And it had been a long day. I can't remember where Bob was, but he wasn't there. I was tucking them in, and little Nora began to cry, and I said, "Nora, what's wrong?" And she said, "I'm just so sad about Daddy." And I said, "Well, why are you sad? Dad's doing great." And she said, "Well, he used to have a perfect body "and now he has scars all over his back." He took a bunch of rocks that shattered his scapula. "And his face has all this red stuff on the side and all these scars, "and now his hair sticks straight up and now his head is kind of an oval." And I thought, "I thought they did a really good reconstruction job on his skull." And she said, "And he doesn't always have all the words." And I said, "Nora, he's getting all the words." "He's getting better every day." "You can watch the words come back, and this is going to keep going in this direction." And she looked up at me the way little kids do with just their whole black and white outlook and she said, "But Mommy, I think this Daddy loves me even more." And so if that's the takeaway, families heal, families are resilient, but families need to heal together. Families need to talk about it. There needs to be candor. If humor is your thing, use it. It's an incredible tool. If I didn't laugh, I would be crying. And you know what? Miracles do happen. People heal in amazing ways. Look at Abbey and BJ. What an amazing couple. I met a young man at BMC Intrepid Center for Fallen Heroes, Aaron Mankin. I don't know if you guys know Aaron. Amazing guy. I was down there visiting the center and got a chance to see Merlin German, who came to a fundraiser that we had last year. Merlin passed away a couple of weeks ago. He was a miracle that he survived that long after his burns. But Aaron touched my heart. Bob had done a story on Aaron. He had just gotten a new nose. Aaron has endured I don't know how many surgeries, and Aaron is one of the brightest and happiest people I have ever met who has come out of this war. He pulled out of his pocket with his hands that have definitely undergone changes with the burns his wallet to show me his most beautiful daughter-- I want to say Tiffany, and I'm not sure that's the right name now-- and he looked at me with a big smile and he said, "We've got another one coming in three months." And I thought, "Aaron, if anybody needs to worry about intimacy after an injury like this, "all they need to do is look at you because you are the picture of resilience "after war and after a horrible, horrible disfiguration." I guess in a way it's like being married to Bob, who I know is a handsome man, and I have many women tell me that, but after 20 years you stop seeing that. What you see and what you love is the person inside. And when you spend five minutes with Aaron, you don't see those scars and burns anymore; you see the spirit inside. And so thank you for listening today. I want to leave plenty of time for questions. I hope that I've shared some nuggets of wisdom. I kind of strayed off the points that you wanted me to talk about, Chris, but I gave you some new ones which are off the record, correct? [laughter] [applause] Okay, nothing is off limits. [male speaker] I'm just curious as to how the experience of writing about traumatic brain injuries came together. I think the writing of the book was incredibly cathartic. It was part of my therapy. I have always been a writer. I've always written when things got tough. Many of the passages in that book had been written far earlier. When we were in China together as a young couple, that was written back then. When Nora's deafness was discovered, that was written back then. So the book was kind of--we could cut and paste the back parts of our life. I began to keep a journal in the hospital because I prayed that Bob would wake up and when he woke up he would as a journalist want to know everything that happened. And for any of you that have spent any time in an ICU, you know it goes 9,900 miles an hour, and I knew I would remember nothing. So I began at first to do it for him, and then I realized I was doing it for me to make sense of my day, to find some order. I wrote dialogue down, I wrote humorous things down, we looked for signs in everything. There was a white deer at the Chinese embassy. That was a good sign that Bob would heal. My wedding ring cracked. That was a bad sign. What did that mean? I just kept track of it all, and I think for me it was the only place in my day that I had any control. It was Dr. Armonda who said to me in the hall of the ICU one day, he said, "Lee, I understand you're a writer." "Somebody needs to write a book about this because there are thousands "of these young men and women cycling through the halls here in Walter Reed, "and nobody in America has any idea." And I took that to heart. I thought about that. And I tell Dr. Armonda he's the main reason. Bob and I didn't need to write a book for us. We didn't need to tell our life story. What we kept hearing from people is, "Nobody even knows what TBI means, "and nobody understands that it's out there." So that was an honor. That has been an honor to speak for the servicemembers. [female speaker] Thank you so much for telling the story. Thank you so much. [Woodruff] You just like the sex part. [laughter] [female speaker] Yeah, I do. [laughter] I'm sitting next to a sex therapist over here. [Woodruff] We'll talk privately. >>[female speaker] I'm between two sex therapists. You used a very powerful term, warrior wives. Have you met warrior husbands along the way? [Woodruff] Much fewer. I have to say that my experiences have mostly been with wives. I don't know what the statistics are on men injured versus women. I know it's dramatically skewed toward men. But the people that happened to be in NNMC while I was there or at BMC when I was visiting there or the VA hospitals that I visited, they all have been, for whatever reason, injured men. Bob has met husbands who are the caregivers. I've met caregiving husbands in other walks of life with brain injuries outside of the war. But when I say warrior wives, I'm not using it in the military sense; I'm using it in the advocate sense, that you have got to go to battle, you've got to question everything, you've got to be the person who's saying, "Really? Does he really get that medication "because the shift just changed, and is this the right thing?" It's an exhausting and mind-numbing job, but it's one done out of love. You know that. I'm not telling you what you don't know. [female speaker] There's lots of information coming out right now about wounded female veterans, particularly as they're returning to their parenting roles. But they're often returning alone, so I'm looking for stories about warrior husbands or warrior men. I'd love to hear them. Those are noble stories because I've often said that men aren't-- and this is not a knock against men, but men aren't socialized to be caregivers the way women are. And as I watched a good friend of ours wife who just died from a very rare form of cancer and I watched her husband become the caregiver and take this really noble mantle on to do this, I saw the awkwardness with which he first undertook this role. "Is it okay to leave my job at 3:00 and go home and see her and relieve the nurse?" And I think it's not something our society has typically cast men in and yet they rise to the occasion as beautifully as women do. They need more support. [male speaker] Lee, thank you for a wonderful keynote address. Now I definitely see why you were asked to be the keynote speaker. In my program, your book is going to be required reading for all of the families because I think it really will mean a lot to them because you've been there and done it. And I don't think any of us think that there's anybody else who ought to play you in a movie. We won't need Angelina Jolie. It'll be Lee. >>[Woodruff] Wow! But I think you should tell them what Bob's first words were to you when he woke up. [Woodruff chuckles] I sort of skipped over this part, but he woke up very dramatically in a nontypical fashion for this kind of an injury. He just was wide awake. On the lowest moment of my journey, on the 36th day when I was realizing I didn't like the facility in Johns Hopkins only because the proximity wasn't going to work for us, my family was falling apart, we needed to be together, I needed to find a place in New York so that we could see him and I could be with the children, I walked in that day after having said a prayer that night to God to pray that Bob would wake up and to Bob, which essentially was, "Honey, there's nothing more I can do for you. You are out of the acute phase." "You have to do this. Our family is falling apart." And he was wide awake. He had been awake since 3:30. The corpsman said, "I think he's speaking Chinese and French "and I think he's doing a broadcast because he keeps saying, "'Bob Woodruff, ABC News'" [laughter] which I would really like to have a tape of. I walked in the door with my jaw dropping, and he just looked at me and said, "Sweetie, where have you been?" [laughter] just like I had gone out for coffee. There's so many moments of humor and, bear with me, I'll just tell you two of the funny stories. It was interesting and painful to hear Dave talk about the mirror because I remember the first time that we gave Bob the mirror. He found it under the hospital table. We had tried to hide it. He had sort of felt around at his head, but to look in the mirror and see all the shrapnel on his face and to see that he was missing part of his head and to try to explain that to someone who is awake on day two of a traumatic brain injury was a really, really difficult thing. We had been told, "Don't give him all the information." "He will freak out and all these things will happen." We got some really kind of funny information is that we were not allowed to refer to it as a helmet because that might evoke images of war, so we all had to call it a hat. And so we would all say, "Okay, you need to put your hat on now." And he'd look and he'd go, "That's not a hat." But he couldn't come up with the word helmet because of his aphasia. [laughter] The story I'll tell you is that he was starving when he woke up, as I'm sure any of you who have been there can-- that gross brown liquid dripping into your stomach. He passed all the swallow tests with flying colors. I don't understand why, but this rock that truly was the size of a marble passed across all of that valuable real estate--vocal cords, trachea, esophagus--without damaging anything. The damage that it did was in his teeth, which he is still suffering from, but I'm like, "Your teeth? Forget it. I don't even want to hear you complaining." "You don't even know what we went through." He woke up and he wanted something to eat and he said, "I want one of those [imitates chewing sound]." And so we said, "Sandwich." He said, "No. No, no, no." I gave him a piece of paper to draw it, and it was a horrible drawing. It looked like a hamburger. I said, "Hamburger?" He said, "No." And I said, "Okay, well, what is it?" And he went [imitates chicken clucking]. And I go, "Chicken! You want a chicken sandwich." He goes, "No." And he goes [imitates popping sound]. I go, "Egg! You want an egg and bacon sandwich." He said, "Yes! Yes!" [laughter] So this was how he communicated for the first little while. [applause] I've got a lot of those stories.

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