Category Archives: TBI

Living with a Brain Injury: Them There First Hours

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A few housekeeping things on the front end of this essay. First, no two brain injuries are exactly alike. Second, too many healthcare providers (and others) act as if they are alike and treat us as if they are alike and that does nothing by amplify the already formidable challenge of living life with a brain injury. Third, there are some similarities. One of them I will talk about here, is the fact that our relationship with our injuries changes over time. As we age, our physiology changes and we change.

Before I move on, let me say that the number one complaint I hear from survivors across my state and beyond is they are far too often treated like they are children. It’s true. I’ve witnessed it. Two facts to keep in mind: no one every suffered a brain injury and got younger, and no one ever suffered a brain injury and lost their individuality.  I was 30 when I got shot in the head and when I came to on the ground, damned if I wasn’t still 30 and, by the way, still Peter Kahrmann.

All of us who live with brain injuries face the task of learning how to recognize when the injury’s impact is present and then developing ways of managing that presence. Given that this presence changes, many injuries, for instance, are one experience when we are rested and another when we are fatigued, we are all, like everyone else on the planet, a work in progress.

Over the past months I have been relearning how to manage the first hours of my day. When I wake up in the morning I generally know the things I am supposed to do that day. Go to the store, make a phone call or two, write and answer some emails, get dog food, feed the dogs, go for a walk, work on the book, read, go to the market, and so forth.

Now, pretend for a moment, that everything I just mentioned represents a ball I want you to juggle without dropping. Not easy, perhaps impossible, which is exactly how I feel about being able to complete my day’s tasks when I wake up. Impossible! When I wake up and register the things I am supposed to do that day I am instantly overwhelmed, frightened, and positive I can do none of them. I can’t emotionally do the juggling and thus am unable to envision how on earth I will get anything done.

But there is good news. This early morning flooding is temporary. I have learned it takes my brain time to wake up and gather itself because, after being awake for a couple of hours, what felt impossible now feels very possible. And so, my early morning strategy is reminding myself that this too shall pass. So, I have my morning coffee, relax, read the news on the web, and wait for my brain to wake up.

Before I sign off here, a word to those in the healthcare field who work with us. If you don’t provide us with a non-judgmental environment that recognizes our individuality you will fail miserably in your stated desire to help us grow our lives. In fact, you will make the task of growing our lives and managing our injuries even harder. I know what I say here will make a difference to the many providers who truly do care. I also know what I say won’t make a damn bit of difference to the providers who don’t care. They’re out there too. I’ve seen’m.

Update on NY’s TBI Waiver

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The New York State Department of Health is looking for a not-for-profit entity to serve as the state’s neurobehavioral resource project. At least $400,000 in state tax dollars is available for the first year of the upcoming contract. The current neurobehavioral project has been headed for the past 15 years by Timothy J. Feeney who, as this blog as reported, who misrepresented and continues to misrepresent his credentials.

Mr. Feeney’s contract expires December 30 of this year. The concern now for survivors of brain injury like myself, along with health care providers and family members, advocates and others, is what standards will the DOH set this time and will the DOH be sure to vet those who contract with the state to provide support and services to people who live with brain injuries.

While the Feeney era may appear to be over, it ain’t over until it’s over, as the delightful Yogi Berra says.

The following is the standards the NY DOH is seeking for the director of the neurobehavioral project. While there seems to be an increase in standards, it concerns me that the qualifications being sought are absent any real clinical background in brain injury. In other words, one would have hoped a neuropsychologist or neurologist would be sought. You can review the grant funding application request in its entirety at:

http://www.health.state.ny.us/funding/rfa/0908031109/0908031109.pdf

To be qualified to be the Project Director, the individual should possess substantial clinical experience with persons with a TBI and/or a neurobehavioral disorder in community based settings. Project Director must have one of the following credentials:
(A)
A license and current registration to practice medicine in New York, and board eligibility or board certification in psychiatry with three (3) years of experience providing behavioral services; or
(B)
A license and current registration to practice psychology in New York State, and three (3) years of experience in providing behavioral services or traumatic brain injury services; or
(C)
Master of Social Work, Doctorate or Master degree in Psychology, Registered Physical Therapist (licensed by NYS Education Department pursuant to Article 136 of the NYS Education Law), Mental Health Practitioner (licensed by NYS Education Department pursuant to Article 163 of the NYS Education Law), Registered Professional Nurse (licensed by the NYS Education Department pursuant to Article 139 of the NYS Education Law), Certified Special Education Teacher (certified by the NYS

Education Department), Certified Rehabilitation Counselor (certified as a Certified Rehabilitation Counselor by the Commission on Rehabilitation Counselor Certification), Licensed Speech Language Pathologist (licensed by the NYS Education Department pursuant to Article 159 of the NYS Education Law), or Registered Occupational Therapist (licensed by the NYS Education Department pursuant to Article 156 of the NYS Education Law), and a minimum five (5) years of experience providing neurobehavioral services.

If you have suggestions or comments or concerns, please let this blog know, and don’t hesitate to contact:

Charlotte Mason

NYS Department of Health Office of Long Term Care Division of Home and Community-Based Services Bureau of Medicaid Waivers

99 Washington Avenue, Suite 826

Albany, New York 12210

Attn: Brenda Rossman
E-Mail: tbi@health.state.ny.us

25 Years Later

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Tomorrow marks the 25th anniversary of the day two teenager held me up on a Brooklyn street. One put a gun to my head and fired. He and his accomplice, who was rifling through my pockets when the trigger was pulled, got $63 for their efforts. The bullet is still lodged in the brain and I take great pleasure in feigning disappointment that I do not set off  airport alarms (if you were hoping for a humor free essay you might as well stop reading now).

To this day there are occasions when, upon hearing about the shooting, a person will lean forward, their brow furrowed a bit, and say things like,  "Did it change you?", or, "Is life different?" or, "Do you understand life in a way you didn’t before?" Honest questions all, but I always get the impression that the asker believes being part of an extraordinary act of violence automatically results in a deeper understanding of life. It doesn’t. At least I don’t think it does.

The experience did give me a new appreciation for the importance of ducking. It certainly increased my awareness of the human capacity for cruelty. And, it has helped me to remember to live, not miss the moment I’m in,  and not miss the chance to tell people I love that I love them.

Much has changed in the last 25 years and there is nothing unique in that. Some wonderful things in life have happened as a result of the shooting. I have been given the gift of being able to work with survivors of brain injury, their families and people in the health care field.

The health care field itself exposes you to wonderful people and to people who have a capacity for cruelty that outdoes the cruelty of shooting an innocent person in the head. Health care providers who see and treat people with disabilities as sub-human beings that are on this earth so they can make a profit ought to be jailed. I know one owner of a community-based program who has run clinical meetings for people in the program and doesn’t have one iota of training as a clinician, yet his ego is so distorted and the lack of regulations so prominent, he gets away with it, to the detriment of those receiving services in the program. I know another director of a brain injury program who told the wife of a brain injury survivor, with her husband present, that there needed to be a funeral for her husband because he no longer exists and she and her husband needed to allow this director and his team of sycophants to re-create him. By comparison, the kid who shot me was simply having a bad day.

There is another thing the shooting gave me. An appreciation for having a bucket list, though it wasn’t until the movie came out that I became aware of the term bucket list. I was, however, aware of experiences I wanted  and want to have before my time is up. I want to meet Bruce Springsteen and thank him for the role his songs had in helping me stay alive during some dark times. I’d like to visit the Grand Canyon and spend a week or more exploring the canyon itself. I want to stand in a room that Beethoven was in, and in a room Tolstoy was in, and in a room Dickens was in. I’d even like to get married again some day, really share life with a soul mate. I’d like my daughter and I to have a relationship again before time’s up.  And, of course, I want to write and write and write. The list goes on.

One other thing, I’d like to thank God with all my heart and soul that I am alive 25 years later to even have a bucket list,  and write this essay for you.

 

Living With Brain Injury – Part V: Where Are the Employees?

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It would be interesting to learn how many people living with brain injuries are in management positions  in the companies providing services to people with brain injuries living in the community. Not many. I can think of one provider that has an individual with a brain injury in a management slot.

The last company I was affiliated with was the Belvedere Brain Injury Program in Albany, New York, and, sadly, in Syracuse too. In the end, not a pleasant experience. Once their substance abuse program got underway and a plethora of survivors began to complain they were being denied their right to choice, I began advocating for them. I was soon told to leave.  I have no reason to believe conditions have changed and  no one running the show  has a brain injury. But this affront aside, the larger picture begs the question, how many people with brain injuries are in management positions in companies like Belvedere? Given that the answer is hardly any, the next question is,Why not?

Is one of the reasons why not may be that many still cling to the belief that those who live with brain injuries can’t do the work? Not so. Bob Woodruff, as good and decent a man as God ever created, lives with a brain injury and is back at ABC News dazzling in his work as always. Is another reason that some companies know that someone with a brain injury might not take kindly to the way survivors are treated by the company?  It’s kind of like creating a group of companies to provide services for veterans and not having any veterans on staff.

Keep in mind, there is such a thing as warehousing in some community-based programs.

Wouldn’t you think that any company providing services to people living with brain injuries would work hard to  get  people with brain injuries on staff because, deep breath now, they might be well suited to tell you what it is like living with a brain injury and thus help you design a more effective program?

Perhaps I’m not the one to ask. After all, I have a brain injury.

We Are Not Children, We Are Not Slaves: Living With a Brain Injury – Part II

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It would be understandable but inaccurate to blame the New York State Department of Health for the existence of problematic companies that provide services under the state’s Traumatic Brain Injury Waiver. The DOH does not have unlimited resources in staff or funding.  Over the years I’ve had largely positive experiences with the DOH. There are people there who care deeply about those who live with brain injuries. I do not for a second envy the unwieldy and baffling bureaucracy they are asked to negotiate daily.

Historically, the waiver is new. It only came about here in 1995 and 14 years in existence does not a perfect program make. I think all would agree the waiver is a work in progress and so it should be, always. I think the DOH understands this and I applaud them for their efforts. Yes, there are issues and problems, but is this not the case with all new things?

One of the tools the DOH does not have – but deserves – is enough people to thoroughly survey and expect the companies that provide waiver services. Again, this is not because the DOH does not want to keep track of things. Budget realities and  skewed priorities (not of the DOH waiver staff’s making) get in the way. Moreover, the reimbursement rates the companies are paid for providing waivers services are so low they would be laughable were the results not so tragic. And the tragedy  on this front is at least twofold. Because of the low reimbursement rates these companies are hard pressed to stay afloat (some do not), and those of us who live with brain injury are saddled with so many hours of programming every week  fatigue takes over and puts us at risk in a very real way.

Consider this for a moment. When the brain is damaged, no matter the cause, there is now less brain doing the work. It’s as if you had a car with a six-cylinder engine and one of the cylinders blows out leaving the engine operating on five cylinders. The car still runs, but the engine is working harder. And so it is with brain injury. We still function but our brains are working harder, so fatigue is a major, major problem. When some of these companies pile on the hours of programming, the toll it takes on those of us with injuries is brutal.

Some companies load up on programming hours because they honestly,  but mistakenly, feel it is effective, others load up on  programming hours because they are all about making money and only see those of us with brain injuries as a way of doing just that. The hell with the damage it does. There’s plenty of us to go around. Keep in mind,  something like 1.5 million Americans suffer a brain injury every year.

– to be continued