Living with a traumatic brain injury is a life long ordeal. Some manage very well, and others do not. Much depends upon the area of the brain that is injured. The Marine in this article is very lucky- to be alive, to be able to be on his own relatively speaking, and to have goals for himself.

“The first thing I remember is screaming. I remember trying to stop screaming. You know, that Marine Corps crap about not showing your feelings. Then I heard my Marines. They were doing the same thing. They were screaming, too. So I let go and it went blank. Then I heard my Marines yelling, ‘AP! AP!’ and they were trying to pull me out of the vehicle. Then I went blank again.”

AP was in a coma for eight days.

That was weird, too. He could feel people’s presence and hear them talking. He wanted to tell everyone he was OK, but no words came out.

When he finally came to, he had no idea where he was. He was alone in a room. His hands were tied down.

A nurse came in and saw he was conscious. She called others into his room and when someone talked to him, he recognized an American accent. He spotted a man wearing the chevrons of a Marine gunnery sergeant. Finally, something he recognized. He relaxed. He didn’t know it at the time, but he was at the Naval Hospital in Bethesda, Md.

His mother and sister were there, too.

“Who the hell are those people?” he asked a medic.

“Dude, that’s your mom,” the man replied.

“What’s a mom?” AP asked.

The good part to this is he remembers the event that has left him in the condition he is in. Most TBI victims do not have any recollection of this. They might remember the moments before the event, but they rarely recall the horrors, pain and personalities surrounding it directly.

The other good thing with this is his ability to speak, upon waking from a coma. I have rarely seen a patient in a coma who isn’t attached to ventilators and who has a trach- rendering them unable to speak. Never the less, once a patient gains the ability to speak they do ask questions like, “What’s a Mom?” Often, Mom is with them when they first speak and sadly, the question asked is “Who are YOU?”

Brain injuries come in many varieties. Depending upon what portion of the brain is effected, we see memory deficits of varying degree. It does seem the more violent the cause the worse condition a survivor is left in. Auto accidents by far are the most violent of these injuries…sadly, an IED explosion is nothing compared to being thrown a few hundred feet into a tree or onto pavement. Memory problems come in many degrees as well.

Long term memory loss is when a person forgets their distant past. Distant is defined as more than one year.

Long term memory loss is like living without a past. Imagine not knowing your parents. Your sisters and brothers. Your girlfriend/boyfriend…the town you live in. No memory of going to school, college and all the education you obtained. Your spouse, children, grandchildren perhaps- are all strangers to you. Your a stranger to yourself- looking in the mirror these people will ask,
“Who is that?”

Hard as you try, you cannot place these people in your mind because that part of your mind is gone. Forever. No matter what medical people do, we cannot bring back the very things that make us human- entire lifetimes lost to a moment of intense trauma. Brain matter that has been damaged cannot be fixed, as of yet. We do have ways to help these people manage their lives and they do so very well. But not having a past is very troubling to live with. Eventually some parts of memory might come back but it’s rare, and it usually involves the very recent things prior to the life altering event. The good thing about LTML is the ability to re-learn much of what is lost- not relationships with people, but the tangible educational losses. Speech, activities of daily living (eating, bathing, dressing ect ) simple work, driving, managing the house- can all be re-learned fairly quickly.

People with LTMS are not the same people they were before the event. They change. Many of them become short tempered and at times violent. They live on a short fuse which doesn’t take a lot to set off. Medications help with this, but the person has to remember to take the med. People with LTML are able to live within their community as productive people. While they may not recall HOW they got to be WHO they are, they manage to live good lives. The people who loved them before suffer the most though…for them, they have lost that person forever. Families and relationships are often ruined.

He was in a coma for 14 days. He was flown to Germany and from there to Bethesda. That’s where he woke up.

His mother, father, sister and brother were there, but he didn’t recognize any of them.

“I had some horrible dreams when I was in the coma,” he said. “One of the dreams I still remember, I was dreaming that somebody was chopping all my body into pieces. I was just like, ‘Whoa!’

“I also dreamed I was in the hospital and one of my feet was missing,” he said. “When I woke up, I looked to see if I still had my feet.”

By the time Gomez got to Palo Alto, he knew who people were, but he didn’t know their names. Not even his parents.

He still has a problem with words sometimes. He knows things, but the names and titles escape him.

Short term memory loss is when a person cannot retain recent activities in memory. Recent activity is defined as 5 minutes or so.

Short term memory loss is not as bad in some aspects but it’s devastating AND dangerous. Victims of brain injuries who suffer from this are able to recall their pasts. They will recognize their parents and siblings-but they forget their names; they usually remember their schooling and teachers and other important people in their lives. If they’ve been married long enough, they will remember their spouses…if they have young children though they often cannot remember them.

Short term memory loss lasts forever. Again, medicine cannot fix a broken brain. The danger comes from not remembering that you just came inside from zero degree weather that you were out in for a couple hours…and you go back out. Danger comes when you don’t remember how to drive but you do it anyway; or you don’t recall how to get home. Or when you’re cooking something in the oven and forget it’s there until a fire breaks out. Forgetting to take your medications that prevent seizures or heart problems…forgetting doctor appts. and similar things. The average span of memory for these people is about 5 minutes.

Other realities with STMS are difficult too: Little things like forgetting how much money is in the bank account and writing checks…forgetting to pay bills (because you forget they exist)…some will forget to eat, to shower, to stay clean. Finding the right words to speak doesn’t come easily for these people. Others get into what we call “looping”- when words are repeated over and over again in an effort to come up with the correct term. Ideas get looped as well. Imagine going to the bathroom. Then in 5 minutes, you forget you went…and feel an urge to go again because you cannot remember when you went last. Same with eating. You decide you need to eat because you don’t recall your last meal…even if it was 15 minutes ago. Over and over again this scene plays- sometimes for hours on end..it does effect how a person relates to the world and their surroundings. Spending most of your time in the bathroom because you forgot you were just there doesn’t bode well in most employment settings.

The other, smaller percentage of TBI never wake up from their coma. Others wake up but live in a world of perpetual confusion and illusion- they have no memory of anything and cannot retain recent events. That is the worst of all TBI…I work with some patients with this. It’s terrifying for them. They have no control over their bodies. They cannot communicate. They live in constant need of nursing attention-they depend upon medical devices to breathe and nourish them…and they experience life threatening conditions constantly. While we are happy and eternally grateful for the Marines and soldiers who survive the horrors of an IED attack, there are some who survived but might as well not have. We cannot forget those who have in effect forgotten us. They depend upon us more than the others, to keep their memory alive.

Please support the Semper Fi Fund. They do good work and help take care of those who cannot do this for themselves. They go further than most of the other groups too, in that they provide supports for those injured Marines who have lost everything yet still live, barely. These Marines would probably rather not be alive in the condition they are in…because we don’t know this for sure, we keep them alive in hopes of new treatments and drugs and therapies. Every dollar counts towards their lives. Americans take care of their own….and Marines (and those who love them) always take care of Marines.

Kat has an essay about this that is worthy of reading.

How do we help these victims manage their lives? Discussion is invited about this in comments.