Caoilainn

"I'm sorry to tell you this," the social worker says while holding my hands across the table. "but Tadhg is not the same person he was when you last saw him, Caoilainn."

He's barely finished his sentence before I'm shaking my head in denial at him.

"No," I whisper. "You're wrong. I know you are. He may be hurt but he's still mine, George."

George pats my hand and lifts the corner of his mouth into a half-smile. "You're right, of course, but," he pauses a moment as if to figure out how to put his next words together delicately. "He's also changed, Caoilainn. I have to prepare you for how he is now. Yes, Tadhg's still Tadhg, but he's also been changed."

I rip a tissue out of the box sitting nearby and dab my eyes, sniffing. I take a deep breath and force myself not to cry. When he can see I've pulled myself together George continues, sitting back in his seat.

"Tadhg's injury happened in his right hemisphere. This part of the brain controls many things; how we speak, our emotions, our memories, our inhibitions, our ability to recognize consciously what we see."

"Wait. His speech?" I ask surprised. "But I thought the left hemisphere controlled our ability to speak. My friend-"

"You're partly correct," he says, interrupting me. "You see, the right hemisphere contributes to speech in subtle ways. For example, it affects how we alter our voice; it's pitch, tone, etc. When the right side of the brain is injured people usually keep the ability to speak but you might notice that their voice sounds flat or monotone."

I nod my head while trying to take in what he's explaining. Then I look at George to ask about something else he had mentioned just now.

"His doctor told to me about the neglect. But what do you mean, Tadhg's inhibitions could be affected?"

"Usually, and especially adults," he begins. "we have control of how we respond to things around us. We can maintain a sense of when it's ok to say something or do something and when it is not. We can plan ahead and realize when it's appropriate to behave a certain way."

I sniff and wipe my nose some more. "Ok. I get that."

George reaches out and touches the back of my hand again while leaning forward. "Tadhg's brain has taken a pretty bad hit. He's having a lot of trouble controlling his impulses."

"Do you mean he's acting like a child now?"

George sits back in his chair again and folds his hands in front of him on the tabletop. "Sort of, but not exactly." He frowns and then continues.

"Let me give you some examples of what you can expect. Let's say you're out at a restaurant. You and Tadhg walk by a couple of tables where patrons are already seated and eating their meal.

Now, normally, you and I know that if we see something we like on someone else's plate that it's not ok to reach over and start to eat their food.

Tadhg may not always think ahead in these situations.

He may walk up to the seated people and tell them he'd like to try what they're eating or he may just sit himself down and grab something off their plate without saying anything to them at all."

I look at George with wide-eyes, shaking my head slightly at his words.

"That's an extreme example, Caoilainn. I don't know if Tadhg will be that forward but you may notice him grabbing for things without thinking about the consequences of doing so; like grabbing a hot pan from the stove without wearing oven mittens, or deciding to pick up an object someone else is already using.

During conversations  he may just start talking even if someone else is already speaking. He'll have a hard time waiting to express himself. His brain will think and his mouth may speak without his having thought about when, how or where he should say things.

Tadhg may at times do things without regard to proper procedure.

For example, if he feels bad he may just get up and walk to his doctor's office without calling or making an appointment first. He won't consider that the doctor has a schedule and other patients have appointments.

He thinks or wants and so he may just go off to do something without any pre-planning.

Likewise, Tadhg may also say things that you and I know are usually better kept to ourselves.

For instance, if you and I saw a man wearing a red hat with green stripes and orange polka-dots, we might laugh to ourselves, but we would never go up to a stranger and tell him what we think.

Tadhg may not remember that it isn't ok to do that.

You may find that he says exactly what he's thinking when he's thinking it. You should prepare yourself for situations like this. You may have to put out a few flames on Tadhg's behalf.

Also, Tadhg's not able to control his emotions as well as he used to. Things that make him happy, sad, angry or surprised may come out exaggerated.

He may go from one emotional extreme to another very quickly. It's not that he wants to be this way. It's just that his brain injury is preventing him from regulating his reactions to things around him."

At the break in George's words, I lean forward and put my face in the palms of my hands and hang my head. "Oh, Gosh."

"I know this is a lot of take in, Caoilainn," George sympathizes with me. "But, there's a little more. Please, let me finish and then we can talk about all of this."

"Ok," I say, sitting up as I gulp back tears. "Go ahead."

"There are two issues we still have to talk about before we can move on to his medical care and the seizures.

Do you need some water or something before we continue? I know this is a lot to take in."

I shake my head confidently. "No," I respond.

"No. Just tell me, George. I have to know. Just tell me."

"Ok," he replies.

"First, Tadhg is having a lot of memory troubles. We've started him on keeping a journal. This should help. If he forgets something or someone he can go back and look in his journal. He can see what he did before, in his own words and hand-writing, what happened to him. We've also put emergency contact information in his journal in case he wanders off and doesn't remember how to get home."

Make sure Tadhg keeps his journal with him at all times, Caoilainn."

"Alright, I can do that," I sigh. "But, what kind of memory trouble is Tadhg having?"

"Good," he says, replying to my first statement.

And then, in response to my question, "Tadhg's short-term memory isn't working right, Caoilainn. Sometimes he makes new memories and they stay with him. Other times the memories don't make it into his long-term memory bank."

"So, Tadhg can remember his past, but he can't always remember his present?" I ask, hopeful. Oh, please let him at least get to keep all that we are to one another and everything that's happened to us. Let him at least have his family and friends; the people he's loved and grown up with.

"Yes," George reassures me. "Yes, Tadhg's long term memory seems to be in-tact. But you're going to have to help him with the rest. At times he'll get annoyed. It'll seem like people he's never met or things he's never said or done are told to him. He'll have no recollection of any of it, though. He may get upset or think someone or you are trying to trick him or make him think he's crazy.

That's why his journal is going to be so important for him. He can use it to remind himself of things. It won't be perfect. He'll still get upset but it should help in small ways. If anything writing things down may help him maintain some memories longer.

The more time he has to heal the better Tadhg's memory will get. We don't expect it to be perfect like it was before but he should have small improvements down the line."

When George stops to take a breath I find myself in need of that drink he mentioned earlier. Knowing I won't receive the kind of drink I really need, however, I ask if I can take a break and hit the ladies room instead. When George nods his head yes, I practically bolt from my chair in search of a rest room.

I barely make it into the stall before I have to lean up against its door in near panic. I close my eyes and hold my breath, counting to ten, so that I don't hyperventilate. When I stop counting I hurry up to turn around and sit on the toilet before I become sick.

Coming out of the stall a few minutes later, I use a lot of soap and water to wash my hands. I splash some water on my face as a refresher. I put my hands on the counter beneath me and stare into the mirror and give myself a pep talk. "You can do this, Caoilainn. We can do this. Tadhg and I. We will get through this."

When I return to the meeting room George is sitting at the table and there's a bottle of ginger ale and a plastic cup with ice sitting out. It seems to be in my area. "May I?" I ask him. "Is this for me?"

"Yes," he replies. "I thought you might appreciate some sugar."

"Thank you, George," I say. "I do. I mean, I will. Thank you."

"You're welcome, Caoilainn," he says softly. "Are you ok?"

"Yes," I say after swallowing some of the bubbling fizz. "Yes, let's get this over with."

"Ok," he says, taking a breath.

"So, we've talked about Tadhg's speech, his memories and his impulse control, or lack thereof."

I nod my head for him to continue, which he does.

"The last part is something called, Anosognosia."

I look at our social worker and wrinkle my brows. "Ana-so---what was that word?" I ask him, confused. I don't remember hearing this from Tadhg's previous providers.

"Anosognosia," George answers. "It's a Greek word. Basically it means Tadhg doesn't know he has a condition. He's not aware of all that's wrong."

"Are you telling me that Tadhg doesn't know he's brain-injured?" I ask, incredulously. "How can he not know he's hurt?"

"Tadhg's not as bad as some people; he's aware that something isn't right. But he doesn't fully grasp the extent of his injuries nor will he always recognize that he's impaired.

There will be times when he doesn't know that he's not remembering things. He won't always realize that he's not seeing the left side of things. He won't realize he's being rude when he makes comments about people or when he lets his temper get the best of him.

We have to help him. We have to help him with the issues he's having but we also have to help him become aware. And we have to do it in a way that doesn't upset him anymore than he may already feel."

Stunned, I sit back in my seat and just stare at George. How in the world am I supposed to help Tadhg if he doesn't even know he needs it?

I reach for the soda in front of me and gulp down the sugary liquid. "I don't know how-" I start to say, stuttering, my voice trailing off. And then, "This is a lot to absorb, George."

"It is," he confirms soft and firmly. "I know it is. I understand what you're going through, though. My own father went through something similar. I watched my mother help him for years so I can at least appreciate some of what you're dealing with."

"How did she do it?" I ask, bewildered. "How? It's so much and I---I'm only one person. How can I-" But before I can ramble any more, George leans forward and grasps my hands tightly.

"Together," he assures me. "We're here for you and Tadhg. We're going to help you both.

One way we're going to do that is by getting you a service dog. Well, for Tadhg, actually. If you agree to it, that is."

I'm shaking my head yes before George can even finish. I know how much Sage has helped Jenny and she's been telling me to get a service dog for Tadhg ever since he was hurt.

"Yes," I stammer. "Yes, we want that. The dog will help with the neglect, right?"

"It will," George answers. "And, also with the seizures."

"He will? How?" I ask. I didn't realize dogs helped with seizures.

"He can be trained to recognize and sense an on-coming seizure and this will give Tadhg and you the chance to get him to a safe place, where he can't get hurt or fall, before the seizure happens.

So, not only will the dog help Tadhg navigate, so he's not tripping on things, or walking into walls, doors, tables or anything, but Tadhg will be warned ahead of time in the case of a seizure that's about to happen."

"How long will it take for a dog to be placed with us, George?" I ask, eager for the assistance.

When George frowns again I know I'm not going to like his answer. "That's the thing. Once you apply, it can take up to 18-24 months for a dog to be trained and then placed with you guys."

"18 months?!?" I ask, shocked. "That's almost 2 whole years, George!"

"Actually, it probably will be closer to the two years, Caoilainn," George explains calmly. "The right dog with the right temperament and training has to be placed with Tadhg. The process takes time. Unfortunately, Tadhg isn't the only veteran who needs a service animal. There are hundreds of people on waiting lists right now. I'm afraid two years is about the length of time you should expect to wait."

"My goodness, George! Two whole years!"

I'm astonished.

"I don't even know what to say," I reply. "I am just completely overwhelmed at everything you're telling me today."

George offers me words of comfort and we discuss a few more things before my appointment with him is over. We complete some paperwork, and get as much of the service dog application done as we can, but there's more I'll have to complete for it when I get home and have access to our notes.

When I finally leave the hospital my head is spinning. I look up at the sky above and ask for some strength and guidance.

We're going to need it.

____________

Resource for the YouTube video above:

Title: Hemispatial Neglect 

Topic: Hemispatial Neglect and Anosognosia 

By: K Frech

Published On: November 19, 2013