Dr. Wendy Law Takes a Detailed Case History of a Marine Corporal

Taking a detailed case history is crucial for tailoring a recovery plan for service members or vets with TBI.

NOTE: The name of the service member is not included to protect his confidentiality.

Dr. Wendy Law: Hi, I want to start just by getting some background information from you before we actually talk about what brought you in today because I just need to get to know you a little bit. What branch of service are you with? Cpl: Marine Corps. Dr. Law: Marine Corps. And what's your rank? Cpl: Corporal. Dr. Law: So that's E4? Cpl: Yes, correct. Dr. Law: And what's your primary job? Cpl: Infantry. I'm a Mortarman. Dr. Law: Okay, thank you. Are you active duty? Cpl: Yes. Dr. Law: And what's your enlistment date? Cpl: I actually EAS in November. Dr. Law: Can you explain EAS? I'm not sure. Cpl: It's my end of active service. Dr. Law: Okay, so November was your beginning as well. Cpl: Yes. Dr. Law: In what year? Cpl: 2007. Dr. Law: That was when you first came in? Cpl: Yes. Dr. Law: Okay, and have you deployed? Cpl: Yes, twice. Dr. Law: Twice, okay. We'll come back and talk about that a little bit more in a little bit. I just want to get the background right now. Okay, so before we go into some of your military experiences because I want to hear more about that. I want to get some background information. I'm going to ask you about things even when you were a little child-- Cpl: Okay. Dr. Law: --just give me some context. Where were you born and raised? Cpl: I was born in Philadelphia, lived there for 3 to 4 years, and then moved to Pittsburgh. Dr. Law: And you grew up there? Cpl: Yes. Dr. Law: Okay. So really still in Pennsylvania? Cpl Rumbaugh: Uh-huh (affirmative). Dr. Law: And how old are you? Cpl: 21. Or 22. [Laughter] Dr. Law: 22, alright. Okay, thank you. Who did you grow up with? Were you raised by both parents? 1 parent? Cpl: Yes, both. Dr. Law: Okay, and did you have any brothers and sisters? Cpl: I have 1 brother and 2 sisters. Dr. Law: Where did you sit in the scheme of things? Cpl: Kind of right in the middle. I have a younger sister, older sister, and older brother. Dr. Law: Okay, what was it like for you growing up in the home with having both siblings around you? Cpl: Well, having an older brother there was-- he liked the same things that I did. He played a lot of sports and stuff like that, so he was kind of like a mentor, more of like a guide, showing me what I need to do in order to be like him, which is what I wanted to be when I was younger, anyways. Dr. Law: How much older than you is he? Cpl: He is 30, so-- Dr. Law: So a little bit older. Cpl: Yes. Dr. Law: Oh, okay. And did you have a lot of friends growing up? Cpl: Yeah. I mean, for the most part. Yeah. Dr. Law: Did you make friends easily enough? Cpl: Yeah. Dr. Law: Okay, were you in a little bit more area that didn't have as many people around that you were in school with? Cpl: Our high school, I think, had around 600 people, so it wasn't that big, but it wasn't one of your smaller schools that you would find in PA. Dr. Law: Okay, and how much formal education have you completed? Cpl: Just high school. Dr. Law: Did you graduate from high school? Cpl: Yes. Dr. Law: And some college? Cpl: Yeah. Dr. Law: Did you have any difficulties learning how to read, write, or do math in school? Cpl: Nothing. Dr. Law: Have you ever been diagnosed or treated for learning disabilities or attention deficit or anything like that? Cpl: No. Dr. Law: Okay. You mentioned that you played sports in school? Cpl: Yes. Dr. Law: What sports? Cpl: Football, baseball, and basketball. Dr. Law: Were you good? Cpl: I was alright. Dr. Law: Okay. And did you do other things for fun, or were you pretty much sports focused? Cpl: I was pretty much sports. Dr. Law: You were pretty invested in that. Cpl: Yeah. Dr. Law: Okay, prior to coming into the military and obviously being injured, did you have any other serious illnesses or hospitalizations? Do you have any things in your background before you came in? Cpl: No. Dr. Law: Were you ever in any motor vehicle accidents? Cpl: No. Dr. Law: Did you ever have any accidents or get hit in the head when you were playing sports, like in football? Cpl: Nothing too serious. Dr. Law: What was your position? Cpl: I was a wide receiver and kickoff returner. Dr. Law: So you didn't have too much head-to-head contact? Cpl: Not that much. Dr. Law: Did you ever get dazed on the field? Cpl: I think I was--I actually was hurt more in baseball than football. Dr. Law: What happened? Cpl: Several times I was--I played centerfield, and I dove to catch a fly ball and hit my head off the fence, but it happened like 2 or 3 times. Dr. Law: Did you ever see stars? Cpl: No. Dr. Law: Not that you remember. Were you able to pick yourself up and get back in the game? Cpl: Yeah. Dr. Law: You were never taken to the hospital, or have to-- Cpl: No. Dr. Law: Okay, have you ever been hospitalized overnight for anything before this? Cpl: No. Dr. Law: Okay, and has anybody ever said that you had a concussion of any sort where you maybe fell as a kid, or did you fall on the ice or anything else? Cpl: No. Dr. Law: No history at all. Okay. Have you ever seen anybody for emotional or behavioral problems when you were a child? Cpl: No. Dr. Law: How much do you drink? Cpl: I don't at all. Dr. Law: None at all? Cpl: No. Dr. Law: Did you drink in the past? Cpl: Yes. Dr. Law: How much? Cpl: A good bit. Dr. Law: Okay. You did drink previously? Cpl: Yes. Dr. Law: When did you stop? Cpl: When I got hurt. Dr. Law: Okay. When was the last time you were drunk? Cpl: August of 2010. Dr. Law: Okay. And did you ever have a period after drinking when you didn't remember what had happened? Cpl: Yes. Dr. Law: Okay, and you're no longer drinking at this point? Cpl: No. Dr. Law: Have you ever been arrested? Cpl: No. Dr. Law: And are you married? Cpl: Yes, but I'm going through a divorce. Dr. Law: Okay. How long have you been married? Cpl: A little over a year--year and a half. Dr. Law: Do you have any children? Cpl: No. Dr. Law: Do you have other friends or family who you can go to to talk with? Cpl: Yes. Dr. Law: So you have good support? Cpl: Uh-huh (affirmative). Dr. Law: Okay, good. Thank you. Dr. Law: Alright, now I want to go to some of your deployment experiences. Cpl: Okay. Dr. Law: You've told me you've deployed twice. Cpl: Yes. Dr. Law: When was your first deployment? Cpl: April of 2009. Dr. Law: And where did you deploy to? Cpl: Iraq. Dr. Law: Iraq. How long were you there, sir? Cpl: 7 months. Dr. Law: Did you complete the full deployment? Cpl: Yes. Dr. Law: And your second deployment? Cpl: September of 2010. Dr. Law: And when did you come out? Cpl: November 29, 2010. Dr. Law: And that was due to injury? Cpl: Yes. Dr. Law: We'll go into more detail in just a minute here. Let's look at your first deployment first in Iraq. Were you in a combat-related type of experience there? Cpl: Not at all. Dr. Law: Did you have any exposures to blasts or small arms fire? Cpl: Nothing. Dr. Law: Never fell, never hit your head? So nothing at all. Cpl: Nothing. Dr. Law: Uneventful in the scheme of things--7 months. Did you have any difficult emotional experiences or see things while you were there? Cpl: No. Dr. Law: Okay. So now we'll come to the most recent deployment in September 2010? Cpl: Yes. Dr. Law: And that was also to Iraq? Cpl: Afghanistan. Dr. Law: Afghanistan. I'm sorry if you said that I didn't write it down. You were there approximately 2 months? Cpl: A little over 2 months, yes. Dr. Law: While you were there, you were in some combat experiences? Cpl: Everyday. Dr. Law: Everyday. Did you have any blast exposures? Cpl: 3 to 4 times. Dr. Law: Okay. And what types of things or blasts that you were exposed to? Cpl: Just IED's. Dr. Law: And IED's are--? Cpl: Improvised Explosive Devices. Dr. Law: Those are sort of created bombs? Cpl: Homemade bombs. Dr. Law: Homemade bombs, okay. Thank you. So you had 3 or 4 exposures. Did you actually get effected directly by those explosions, or did you see them in the area? Cpl: Every single time I was around one, it was within 5 meters--5, 10 meters. Dr. Law: So pretty close. Cpl: So I was either knocked out or dazed pretty good each time. Dr. Law: So you had 3 to 4 times when you were knocked out or dazed. Okay. Do you remember each of them pretty clearly? Cpl: For the most part, yes. Dr. Law: I want to ask in a little more detail if I can about those experiences. If we can think about--do you remember the first blast exposure that you were in? Cpl: Yes. Dr. Law: And what happened? Cpl: We actually were taking contact from this building, and we-- Dr. Law: Were you out on patrol or were you--? Cpl: We actually were on the FOB at our base. Dr. Law: On the Forward Operating Base area? Cpl: Yes, and they would always come to this 1 building and shoot at us from it. Dr. Law: So you knew that this was an area of risk? Cpl: Yes, and we called in an air strike on that building, and everytime you call in for an air strike or some type of heavy artillery, they want a BDA, which is a Blast Damage Assessment. Dr. Law: Okay. Cpl: So we have to go see exactly what we destroyed. So after we did that--it was me and like 6 other guys--my Platoon Sergeant-- he was there, and on our way coming back, he stepped on an IED, and I was directly in front of him. Then from there, I just kind of got blown through a wall and then probably like a minute or 2 later, we all came together and then found out that he got hit. Dr. Law: He stepped on it. You were in front. It threw you--the force of the blast. Cpl: Yes. Dr. Law: And threw into a wall? Cpl: Yes. Dr. Law: And did it knock you out? Cpl: I don't think that I was unconscious, but I really don't remember directly what happened afterwards. Dr. Law: Okay, so certainly were dazed. There was some confusion. Cpl: Uh-huh (affirmative). Dr. Law: Do you remember getting up or did somebody help you up? Cpl: I remember getting up. Dr. Law: Okay, and about how long were you feeling that kind of dazed and confused? Cpl: For the next 3 or 4 hours. Dr. Law: Okay, I want to look really closely at the acute period. Did you know what had happened when the blast when off? Cpl: No, we didn't know that it was an IED. We thought that maybe it was mortars or something like that. Dr. Law: Some sort of explosion had occurred, and you knew that, and of course, he was behind you, so you didn't see that. And you got thrown, hit something--what's the part that's unclear to you? Cpl: Pretty much I don't know how long he was laying there before we responded to what happened. Dr. Law: Okay, would you guess it was less than 5 minutes? Cpl: Yes. Dr. Law: Okay, so it was a period of time, but still brief. Cpl: Yes. Dr. Law: And it took that time for everybody to get their heads cleared and realized what had happened. Cpl: Exactly. Dr. Law: And where did you go after that? You, particularly. You picked yourself up Cpl: — And went straight to him. Dr. Law: Okay, were you injured physically? Cpl: No. Dr. Law: Other than having been thrown against a wall? Cpl: Just think I had maybe some scratches, some cuts, but nothing serious. Dr. Law: Okay, and then you were saying you had some symptoms afterwards for how long? Cpl: Probably like a week. Dr. Law: Okay, and what were the biggest symptoms you remember from that period? Cpl: It was a constant headache the whole time. I didn't have trouble remembering things, but it seemed like somebody would tell me something and I wouldn't comprehend it as fast as I really could, like normally. Dr. Law: So slower than you expected? Cpl: Uh-huh (affirmative). Dr. Law: And that was for about a week? Cpl: Yes. Dr. Law: Now during that week, were you still going about your usual business? Cpl: They wouldn't--the normal protocol is if you get hit by an IED, or if you're close, you're not supposed to patrol for a certain period of time, so I didn't really do anything for 3 days, and then after that, I started back to the everyday process. Dr. Law: So the latter part of that week, you were still having difficulties, but you were sort of back into business. Cpl: Yes. Dr. Law: Okay. Thank you. You said you had several type of experiences like that. Of the others that you had, what was the most significant, in terms of how dazed you felt afterwards? Cpl: Probably the last one, where I got hurt. Dr. Law: Okay. Can you tell me about that one? Cpl: One of my friends--he stepped on an IED, and I was back at the FOB again, and it was probably like 300 meters away. So I got my team, and I grabbed the stretcher, and we sprinted to where he was at to pull him out, and as I was going in to grab him, I stepped on one too. Dr. Law: Okay. Cpl: And then-- Dr. Law: What happened? Cpl: I got thrown up in the air, and I hit the ground, and then I tried to stand up again, and I couldn't stand up because both my legs were gone, so-- Dr. Law: Do you remember sort of--were you aware you stepped on it? Cpl: Yes. Dr. Law: Were you aware you were in the air? Cpl: Yes. Dr. Law: What was that like? What were you sensing as you were there? Cpl: I really didn't know what to think. I didn't know that my legs were gone at first because I've seen people step on IEDs before and then not lose anything. So I kind of really didn't know what was going on. So my first reaction was, alright, stand up. Make sure everybody else around me is fine. Dr. Law: And that's when you discovered-- Cpl: Yeah. Dr. Law: Do you remember hitting the ground? Cpl: Yes. Dr. Law: Okay, so it doesn't sound like there was any point during that particular incident that you actually were dazed or confused, other than you didn't know that you'd lost your legs until you tried to use them. Is that correct? Cpl: Yes. Dr. Law: Okay, so after that you had a lot of difficulties. Obviously, you were medically evacuated. Let's go back again to before that incident. You had another couple of blast exposures, I think. Cpl: Yes. Dr. Law: Okay. Can you tell me about the second one that you had? Cpl: The second one--I'm trying to remember. Dr. Law: Or one that you remember prior to that last one. Cpl: Okay. We were on a patrol, and we were actually heading back to our FOB, and there was this area that we were unsure about, so we were looking around because it looked like there should be an IED there. Dr. Law: Were you on a vehicle or on the ground? Cpl: We were on ground. We were always on ground. We were never in vehicles. Dr. Law: Did you have vehicles with you? Cpl: We had them, but we rarely used them. Dr. Law: Okay. That's called dismounted patrol, isn't it? Cpl: Yes. We heard that there was possible IEDs around here, so we were looking for them. We happened to come across something, and we found that the person that was supposed to set it off was sleeping in a bed. There was a hole in the wall where he could see where we were coming and everything, so it just happened to be that he was sleeping, and he couldn't set it off. We actually--all of us were all standing right on top of it, so thank God he was sleeping, but we found where it was at. We started pulling it out, and we got everything out. We called EOD, the Explosive Ordnance Disposal Team. They're the ones that blow them up. Dr. Law: That's their job? Cpl: Yeah. Dr. Law: Okay. Cpl: And they ended up getting all--pretty much all the IED, and they blew it up, and I was probably standing 20 meters away, and it was actually-- they didn't think that it was going to be that big, so I don't think that it was a homemade explosive or whatever. We think that it was military grade because the blast ended up being like 3 or 4 times bigger than we thought it was going to be. So instead of being 50 meters away, we were only like 20, so — Dr. Law: So you all thought you were a safe distance. Cpl: Yes. Dr. Law: Okay. And it affected you? Cpl: Yeah. Dr. Law: Did it throw you back? Cpl: Not so much. There was a mosque--like a church--and we were standing behind that, but it still--I mean, it was to the point--it was the first time I got blown up, basically. I was unsure about what was going on. I didn't know if maybe there was more of them tied together with the one that we just blew up. So everybody was-- Dr. Law: — Watching, alert. Cpl: Yes. Dr. Law: Was anybody injured in that blast? Cpl: No. Dr. Law: Just surprised at how big it was? Cpl: Yes. Dr. Law: And did you have symptoms afterwards? Cpl: Nothing--I mean, it happened to me before so I was--I knew--I expected-- I knew what was going to happen, so I guess I didn't really freak out like I did the first time. Dr. Law: Sure, sure. Did you have to stay away from duty for a couple of days? Cpl: No. Dr. Law: Should you have? Cpl: I don't think so. Dr. Law: Okay, so it was a lesser blast? Cpl: Yes. Dr. Law: Alright, and was there one other one before you were injured? Cpl: Yes. Dr. Law: Do you remember that? Cpl: Okay, yeah I remember it now, actually. A few of my other guys were on patrol, and one of the Afghan Army-- they work with us a lot--one of their guys stepped on an IED and lost both of his legs. So they called us to come and EVAC him out, and on our way over there, there was 3 or 4 more that we found in the one area they were at, and then actually one of our guys stepped on one. He was probably 15 meters away, diagonal from me, and he stepped on one, and thank God it didn't go all the way off, so it just broke his ankle. Dr. Law: Okay. Cpl: So that was probably only 2 pounds of explosives that went off, so it wasn't really that bad. I mean, it was still loud--hurt my ears, but it wasn't anything like the other ones. Dr. Law: Did you have ringing afterwards? Cpl: Yes. Dr. Law: Okay. Did you have ringing in all of these? Cpl: Yes. Dr. Law: Even the last one when you were injured? Cpl: Uh-huh (affirmative). Dr. Law: Okay. Thank you. And what you've just described with me--did you feel dazed after this last one? Cpl: No so much. Dr. Law: Okay. So based on not so much, but a little bit? Cpl: Yeah. Dr. Law: Was it dazed where you couldn't quite get your thoughts together briefly or was it more startled? Cpl: It was more-- Dr. Law: Oh, here it is again. Cpl: Surprised. Dr. Law: Yeah, surprised. Okay. Thanks. So what you've just described from me, it sounds like the first one, you clearly had a concussion. Did they diagnose you with a concussion? Cpl: Yes. Dr. Law: The others don't sound as though you had a concussion, although you certainly had significant experiences, and those are not good things to experience, but it doesn't sound like your brain was shaken up in the way that it might have been otherwise. Okay. And that makes sense to you, too, based on what you understand? So I want to go back a little bit more now to when you were injured. What was the date of that injury? Cpl: November 29, 2010. Dr. Law: So you didn't have any loss of memory at the time, and then you realized that you'd lost both of your legs. What happened next? Cpl: A few of my guys hurried up, jumped on me, started applying tourniquets to my legs to make sure that I wouldn't bleed out. Just basically made sure that I didn't have anything stuck in my throat, so that I could breath. They called in for more guys. They came down, brought a stretcher, called in the helicopter, and we just waited for it to get there. Dr. Law: Do you remember all of that, or is that what you've been told? Cpl: I remember that. Dr. Law: Were you given any medications at the time? Cpl: I think I was given something for my pain at the time, but I really don't remember. Dr. Law: Do you remember being in pain? Cpl: A little bit. Just my arm. My legs didn't hurt at all, but my arm, I think, was broken. Dr. Law: What overall were you told was the nature of your injuries, once you were finally seen medically? Cpl: That I lost the tip of this finger, my pinky, all of the tendons were torn, my wrist was fractured, and I lost both of my legs. Dr. Law: When they picked you up, where did they take you? Cpl: I don't remember. Dr. Law: Okay. What's the last thing you do remember? Cpl: Getting carried onto the helicopter. Dr. Law: Okay, and has anybody said what happened from that point forward? Cpl: No. Dr. Law: What's the next thing you remember? Cpl: Waking up in Bethesda. Dr. Law: Do you know how long that was afterwards? Cpl: No. Dr. Law: Approximately? Cpl: Maybe a week. Dr. Law: Okay, and what did they say was going on with you during that week? Cpl: Basically, I woke up in ICU, and I really don't remember. Dr. Law: Okay. Once you woke up, sort of ongoing memories since then? Cpl: Uh-huh (affirmative). Dr. Law: Okay. How long were you in the hospital being treated? Cpl: About a month. Dr. Law: About a month. Cpl: Yes. Dr. Law: And what happened when you were released? What was the next phase of your treatment? Cpl: I went to Walter Reed. I moved into the Malone House there where I was staying. I pretty much just started working on getting back to walking. Dr. Law: Okay. In a rehab program? Cpl: Yes. Dr. Law: Okay. Were you using a wheelchair at that point? Cpl: Yes. Dr. Law: Thank you. So in all of the things that have happened with you, you came in today because you've been having some difficulties. What's going on now? Cpl: Well, it's kind of hard for me, basically, just to remember anything. I have trouble remembering my appointments, phone numbers, just basically anything. Dr. Law: Okay, and have you seen anybody about that yet, or is this the first time you've mentioned it? Cpl: This is pretty much the first time. Dr. Law: Okay, and when did you start noticing these problems? Cpl: At first, but I thought it was because of the high dose of medication that I was on, but then I started tapering off my meds and everything was still the same, so-- Dr. Law: Okay. Cpl: I kind of figured something else was wrong. Dr. Law: Are you still taking medications now? Cpl: Yes. Dr. Law: How much? Cpl: I take OxyContin--small dosage of it, just because I tried to get off of it once and went through a withdrawel, and that was probably the worst thing in the world. Dr. Law: Sure. Cpl: That's about it. I really don't have that much pain right now, but when I walk sometimes. Dr. Law: Sure. Yeah. The OxyContin--you're taking just to wean yourself off of it, and get done with it. Cpl: Yes. Dr. Law: How are the memory problems affecting you? What are you noticing? Cpl: Just sometimes we'll have--all the Marines will have a formation once a week, and sometimes I'll forget that I have that formation. Dr. Law: Okay, and that's pretty unusual? Cpl: Yes. Dr. Law: Yeah. Cpl: I'll have an important appointment that I'll have to go to at a certain time. I'll remember that I have that appointment, but I'll forget which day or what time I'm supposed to be there. Dr. Law: Okay. You mentioned that after the first blast exposure we talked about, you also had noticed some slowed thinking. It was taking you longer to understand people. Is that occuring now, too, or is that not still-- Cpl: Yes. Dr. Law: Little bit. Okay, so some of the same things you had before. Cpl: Yes. Dr. Law: Is this new, or is it just something you're becoming aware of now? Cpl: I think it's just something that I'm finally accepting and becoming aware of. Dr. Law: It's not something you're suddenly developing. Cpl: Yes. Dr. Law: It's been there since you've come back. Cpl: Uh-huh (affirmative). Dr. Law: Okay. Thank you. How's your mood been? Cpl: Alright, I guess. I mean, I think any person in my situation would be depressed from time to time, so it's nothing that I don't expect to happen. Dr. Law: How's your sleep? Cpl: Horrible. Dr. Law: What's happening? Cpl: I can't fall asleep until late at night, and then I end up waking up early. Dr. Law: Are you able to nap during the day at all? Cpl: I can, but I try not to because I'll spend my whole day sleeping. Dr. Law: And actually if you do nap, that will keep you from sleeping the next night. Cpl: Exactly. Dr. Law: Okay, good. So that's not part of what you're doing. How long have you been having sleep problems? Cpl: At least the past month. Dr. Law: Okay. When did you get released from the hospital--after about a month? Cpl: Yes. Dr. Law: So it's been about 3 months since your injury? Cpl: Yes. Dr. Law: So you had about a month that things were a little bit smoother for you, and then the last month it's been getting a little difficult. Cpl: Yes. Dr. Law: Has anything else changed in that last month--this past month? Cpl: Nothing significant, I guess. Dr. Law: Okay, so you've been in the same place for 2 months, but over this past month, it's become more apparent to you. Cpl: Yes. It's not nearly starting, but you've become more aware of it. Okay. And how's your appetite? Cpl: I normally eat 1 to 2 times a day. Dr. Law: Is that usual for you? Cpl: No. Dr. Law: What's usual? Cpl: 5 times a day. Dr. Law: Okay. What changed? Cpl: I just don't really have much of an appetite anymore. Dr. Law: Okay. How's your sense of taste? Cpl: I really just don't want to eat. I don't know why. Dr. Law: Can you taste the flavors? Cpl: I guess. Yeah. Dr. Law: Okay. What about your sense of smell? Cpl: Yes. Everything's there. Dr. Law: That's fine, okay. How's your hearing? Cpl: Horrible. Dr. Law: When did that start? Cpl: Probably after the first blast. Dr. Law: So sort of ongoing since the very first one. And you mentioned that after each one, you had problems that were further exacerbated so it just got worse and worse. Cpl: Yes. Dr. Law: You're able to hear, obviously, in this context because I'm not talking particularly loudly, but you're aware of it. Cpl: Yes. Dr. Law: What does it feel like to you--the hearing problem. Cpl: I don't know. I guess my hearing was never really that great to begin with, but it seems like after all this happened, it just got drastically worse and worse and worse. Dr. Law: Okay. How's your vision? Cpl: Good. Dr. Law: Any sensitivity to light or anything? Cpl: No. Dr. Law: Any particular sounds that are more difficult for you than others or just that you can't hear as well? Cpl: Just can't hear as well. Dr. Law: Do you have ringing now? Cpl: No, but sometimes it comes and goes. Dr. Law: Okay. Cpl: Or like static in my ears. Dr. Law: Have you had any problems with headaches since you've been injured? Cpl: Not really. Dr. Law: Okay, and what's your current pain right now? Cpl: None. Dr. Law: Zero, scale of 0 to 10. Cpl: Yes. Dr. Law: Excuse me. Alright. Have things ever been so bad that you thought about harming yourself? Cpl: Never. Dr. Law: What about harming someone else? Cpl: No. Dr. Law: What was the most difficult experience for you in your deployment? Cpl: In the deployment or after? Dr. Law: First, in the deployment. Cpl: Probably just being in that first blast and seeing somebody lose their leg like that. Dr. Law: The very first time that you became aware of what was real. Cpl: Yes. Dr. Law: Okay, and since your injury what's been the most difficult time for you? Cpl: Probably just the whole process of getting back to a normal life. Dr. Law: So it hasn't stopped yet? Cpl: No. Dr. Law: Okay. Thank you. Excuse me just a minute... So you mentioned that in deployment, the most difficult overall experience was the first blast when you saw somebody injured very seriously. And you were there for another couple of months, did that happen early in the deployment? Cpl: Yes, within the first month. Dr. Law: Okay. Did you see other difficult things while you were there, including your own injuries? Cpl: Yeah. Dr. Law: Do you ever find that you have unwanted memories of those experiences? Cpl: No. Dr. Law: They don't just pop into mind? Cpl: No. Dr. Law: With your sleep difficulties, are you having any nightmares? Cpl: Sometimes. Dr. Law: What type of nightmares? Can you describe a typical nightmare for me? Cpl: One night I woke up, and I thought that somebody was in my room-- somebody from Afghanistan, specifically. I thought they were in my house, looking for something, and I woke up screaming. I rolled over, reached for my gun that I don't have because I don't sleep with my gun in the states, so that is basically what happens. Dr. Law: Okay. Does that recur, or was that a one-time event? I think that's happened once. There's-- Dr. Law: --others. Cpl: Yeah. Dr. Law: How often in a week do you have nightmares? Cpl: Maybe once every 2 weeks. Dr. Law: Okay. So that's not the sole explanation for why you're not sleeping. You're not waking up every night. Cpl: No. Dr. Law: At least not remembering that you're having nightmares. Cpl: No. Dr. Law: Okay, and have you ever felt as though you're back in the event that injured you? Have you ever had any--sometimes they're called flashbacks or re-experiencing? Cpl: No. Dr. Law: Okay. Have you ever found that you're avoiding people or things that remind you of the combat experiences? Cpl: No. Dr. Law: No concerns with that. What about any emotional distancing from people that you care about? Cpl: No. Dr. Law: Okay, and what about any problems--do you ever feel that you're paying more attention to the environment around you other than when you woke up from a dream--that you're sort of more aware of things around you, people, or movements that are going on? Cpl: No. Dr. Law: Okay. So sleep is really the biggest difficulty you're describing. Cpl: Yes. Dr. Law: And then the problems with memory, of course. You mentioned some maybe a little bit slow to understand things. Are you finding you have problems with concentration? Cpl: Yeah, that too. Dr. Law: Okay, and how does that impact you? Where are you noticing that? Cpl: Well, I'll have a list of things that I need to get done, and then I'll end up getting none of those things done in a day just because I don't even know where to start. Dr. Law: Okay. So a little overwhelming. Cpl: Yes. Dr. Law: Okay. Okay. Do you know how to get help when you need it? Are there resources available for you at the hospital? Cpl: Yes. Dr. Law: Okay, and overall you came in today because of the difficulties with memory and concentration. These aren't new, but they've become more of a problem for you. What do you think is going on with that? Cpl: I really just think it's just from everything that I've been through. Dr. Law: Sure. Cpl: So I think I'm going to have to live with this forever, so I might as well accept it now and just try to make the best of it with what I can do now. Dr. Law: Okay. Have you ever considered or have you talked with a therapist at all since you've been here? Cpl: No. Dr. Law: Okay. The only reason I'm saying that that if it were something that were permanent it can be helpful in learning how to adjust. What I'm hearing you say is that at this point, the memory and concentration is becoming a little bit more of a worry to you because you're aware of it. It's not necessarily new. You're thinking it's just something you're going to have to live with. You've also told me that you're having a lot of difficulty with sleep, and you've had some nightmares. What you've described to me is very usual for the kinds of experiences you've had. It's not at all surprising. It is clearly the case, though, that if you're not getting enough sleep, that is going to impact your ability to think clearly and to remember things. I heard you say that you have lists, so you're obviously already writing things down, so that's very good. It doesn't sound, right now, that you're not doing a good job coping with the difficult experiences you had. The nightmares are a little concerning, and if you are interested in having some improvement with those, we can have you see your primary care doctor because he can recommend some things. Cpl: Okay. Dr. Law: But I'm not overly worried right now about any of the other things you're talking about emotionally. I think it's also important you clearly had some concussion-related types of incidents, and you definitely experienced a concussion in that first blast exposure. You didn't in the others. You were describing a very full memory from when you were injured, so it doesn't sound as though — even with how horrific your injuries were — it doesn't sound like you had a lot of blood loss before they able to get the tourniquets on you. So it's my belief right now that the difficulties you are experiencing are probably due to the loss of sleep, and as well as maybe some contributions from the medications you're still having to take as you get those down. So I'm hopeful that you're not going to have to live with the memory and concentration difficulties. I expect those to continue to improve as you stabilize a little bit more. Cpl: Okay. Dr. Law: Does that make sense? Cpl: Yes. Dr. Law: Okay.
Posted on BrainLine December 16, 2011.