Chapter 4
Survival: The Third Week
THE HEROIC LIFE IS LIVING
THE INDIVIDUAL ADVENTURE
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STORIES FROM THE PATH
Although my recollection of that period is almost nil, I do recall two things from my month-long coma, probably because accessing them was crucial to the survival of my self. I worried constantly about losing my memory, believing that if I lost my memory I would lose my identity. My social security number was my life-preserver and I repeated it over and over in my mind the way you do to remember a telephone number or a name that someone has told you that you must not forget. It became like a mantra that had to be repeated constantly or my mind might simply slip away and I would no longer remember who I was.
In the dark
spaces of my coma, my mother came to me and was my caregiver, guide and strength
on this inner journey. Her presence pulled me back from the brink. She,
herself, had died the year before my subarachnoid aneurysm burst.
Coincidentally, her name was Grace. She stayed with me through the first 3 or 4
years of my recovery. She rode in the back seat of the car and stayed with us
in our house. When I got stronger she left.
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Near Death Experience (NDE)
The past several years has shown a growing interest in NDE. The first
contemporary work in this area was done by Raymond Moody, who surveyed
individual survivors and recorded their recollections. He found a high
degree of similarity in the experiences they reported. Perhaps the most
interesting and verifiable phenomenon was the change in outlook of the
participants after their recovery. Apparently all had undergone a
transformation that left them more compassionate, peaceful and spiritually
mature.
In most cases reports were obtained from those who's NDE was associated with a traumatic incident such as a car crash that did not involve brain injury. Thus, they could report on their NDE and the change in their outlook that followed. The brain injured survivor may not make quite the same NDE report but a dramatic change in outlook can be observed in the recovery period. From a medical point of view such change may be viewed critically as deviation from normal. For example, from the point view of the serious physician, the patient's laughter may be described as "inappropriate jocularity."
The alternative to considering the patient's laughter as a condition to be corrected by therapy is to welcome it as a pathway to recovery. Similarly, it is beneficial to treat seriously the patient's reports of their experiences when they were in their coma. Some of these experiences can be verified. For example, after she came out of her month-long coma and began to talk, Jane repeatedly used the word "artifact." It was unfamiliar and seemed curious until, in a discussion with the neurosurgeon he used the term with reference to additional aneurysms that had been searched for during surgery because of indications from the x-ray pictures. She had apparently registered at least some of the surgical team's comments made during the operation.
Angels
Given the great degree to which recovery from brain injury is spontaneous and
the great mysteries of neural repair and brain plasticity, angels are probably
as helpful an explanatory concept as any other. Reports by patients about their
out-of-body
experiences are
generally conceived as fantasy and evidence of brain dysfunction. This
may be the case in terms of the medical model, but as an explanation of what happens in spontaneous recovery, the
medical model may be too rigid and confining. It is important to defer to
the patient and to understand where the patient is coming from in order to encourage and facilitate
a process that will continue for an extended period. It can be very
exciting to see the subtle changes that emerge over time and to see the
patient's dependency on angels decline as new skills and abilities take their
place.
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STORIES FROM THE PATH
In the third week of survival crisis in the ICU there is a growing anticipation of a vasospasm that could end it all. Most of your hot buttons are being pushed all the time while you try to stay cool and learn what you need to become part of the medical team and to take control of the situation. Neither the hospital nor the medical team will willingly accept responsibility for the patient beyond their narrow mission and focus on their task at hand. That responsibility is yours alone to bear. Think of the hospital like a car repair center with separate departments for fixing motors, transmissions, radios, body damage, etc. Cars are moved from one department to another until all repairs are made. If you have a problem, bring it back, but the warrantee is for parts only.
Going into the third week of Jane’s coma, eyes dead, lips cracked, tongue like a large wooden dowel in her mouth; still swabbing her mouth, massaging her extremities, playing country and western music to take her back home to Oklahoma, my anxiety is even greater at night when I am away from the ICU, rushing to complete tasks before the next visiting period, sleeping with “what-if?” demons hovering over my head. The full, personal meaning of subarachnoid is like a growth on the soul about which I read, “a delicate, tenuous membrane [like a spider web] lined inside by simple squamous epithelium . . . for deep to the arachnoid is the subarachnoid cavity.”*
Returning
home from the hospital one day, I found in the mail a promotional booklet from
the
Peale
Center
for Christian Living. It was titled “How to Handle Tough Times” and contained
simple, practical recommendations that dramatically altered my pessimistic
victim’s perspective. I dug out the old Norman Vincent Peale book from my
library and became a “Positive Thinking” junkie, subsequently learning 8 steps
to “Overcoming Anxiety and Fear” and “12 Steps to a Happy and Successful Life.”
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Let go, let God
The caregiver's attitude may be the most important factor in recovery. It is important for the caregiver/partner to establish a constructive,
positive, pro-active attitude in the early stages before the patient is
discharged to follow the recovery process at home. The caregiver's disorientation and
anxiety is replaced by self-confidence by being involved as much as possible in
the patient's care from the beginning, by learning about the patient's condition
and procedures being used or recommended for treatment and by developing the tools to help manage all
of the elements in the recovery process.
Given their close relationship, negative attitudes can easily become reinforced resulting in diminished expectations leading to feelings of frustration and failure. Anxiety is the worm that must be destroyed early on, not by denial but by taking specific actions that lead to empowerment of both parties. Anxiety is also overcome by a strong sense of faith that if opportunities are pursued whole-heartedly good outcomes will result.
Power of Positive Thinking
Norman Vincent Peale observed through extensive experience counseling a wide
range of people, that a good
attitude can overcome a bad situation. Although his basic approach was
presented in a Protestant Christian context, it drew on Freud's concept of mind
and utilized other psychological concepts from behaviorist to cognitive
therapies. Obviously, a belief in self-actualization was a key element of
his approach. If he were a practicing psychologist today he would
probably be considered "holistic."
Following Peale's advice for developing a positive outlook involves an active approach to behavior modification. He presents simple common-sense steps that can be taken systematically to affect necessary change. In his book, Have a Great Day, Peale provides a short affirmation for each day of the year based on the positive thinking concept. For example,
The more I see of people the more I'm impressed by their astounding ability to meet tough situations. And their ability to rebound is fantastic. There is a built-in comeback power to you that should never be underestimated.
and:
Attitudes are more important than facts. Certainly, you can't ignore a fact, but the attitude with which you approach it is all-important. The secret of life isn't what happens to you but what you do with what happens to you.
This approach to therapy can also be seen in contemporary
approaches such as that of Phillip C. McGraw who often begins counseling an
individual by asking "how's that working for you?" If the care-giver
develops a positive attitude in the hospital stage they will automatically nurture
the same attitudes in the patient during recovery.
Things to do Checklist
● Locate a psychologist who can help you
work out your hang-ups and anxieties right away, advise you about the brain
dysfunctions of your patient that will be issues. He will also work with
you and your patient after discharge from the hospital to help you develop an
effective partnership and to plan short and long-term objectives. An
appropriate psychologist should be a behaviorist who has knowledge and
experience with neurophysiology, human functioning and strategic life planning.
Look for a neuropsychologist for testing and counseling. Neuroscience is
the broad field of brain and nervous system study where you can find leading
edge knowledge about brain structure and function.
A psychiatrist would not be appropriate for your purposes since neither drugs
nor psychoanalysis would be called for and, in fact, would be extremely
dangerous.
It is a good thing to begin to work on this
issue now before the patient is discharged. The neuropsychologist should
meet with you and the patient after the patient is stabilized and in
intermediate care. The caregiver needs to begin learning about
neuroscience and neuropsychology in anticipation of the transition to
rehabilitation and recovery.
Constructing Your Team
Add a counseling neuropsychologist to your team.
Useful Publications
To browse additional selections click on
Books.
American Psychological Association. Encyclopedia of Psychology.
Washington DC: American Psychological Association, 2000.
Chödrön, Pema. When Things Fall
Apart: Heart Advice for Difficult Times. Boston MA: Shambhala, 1997.
Chopra, Deepak. Creating Health: How to Wake Up the Body's
Intelligence. Boston MA: Houghton Mifflin Company, 1987.
Cousins, Norman. Anatomy of an Illness as Perceived by the Patient:
Reflections on Healing and Regeneration. New York: WW Norton &
Company, 1979.
_____. The Healing Heart: Antidotes to Panic and Helplessness.
New York: WW Norton & Company, 1983.
Dossey, Larry. Prayer is Good Medicine. San Francisco CA:
Harper Collins Publishers, 1996.
Kabat-Zinn, Jon. Full Catastrophe Living: Using the Wisdom of Your Body
and Mind to Face Stress, Pain, and Illness. New York: Dell Publishing,
1990.
Kübler-Ross, Elisabeth. On Death and
Dying. New York: Simon & Schuster, 1969.
Kushner, Harold S. When Bad Things Happen to Good People.
New York: Avon Books, 1981.
McGraw, Phillip C. Life Strategies: Doing What Works, Doing
What Matters. New York: Hyperion, 1999.
_____. Self Matters: Creating Your Life from the Inside Out.
New York: Simon & Schuster Source, 2001.
Moody, Raymond A. Life After Life. Limons Island GA:
Mockingbird, 1975.
_____. Reflections on Life After Life. Simons Island
GA: Mockingbird, 1977.
Peale, Norman Vincent. The Amazing Results of Positive Thinking.
Englewood Cliffs, NJ: Prentice-Hall, 1959.
______. Have a Great Day. New York: Ballantine Books,
1985.
______. The Power of Positive Thinking. New York:
Prentice-Hall, 1952.
Rommer, Barbara R. Blessing in Disguise: Another Side of the
Near-Death Experience. St Paul, MN: Llewellyn Publications, 2000.
Siegel, Bernie S. Love, Medicine & Miracles: Lessons Learned
About Self-Healing from a Surgeon's Experience with Exceptional Patients.
New York: Harper & Row, Publishers, 1986.
Slater, Beverly and Leighton, Frances Spatz. Stranger in My Bed.
New York: Arbor House, 1984.
Useful Websites
Norman Vincent Peale Foundation
www.dailyguideposts.com
Information about pastoral counseling
http://www.proaxis.com/~jjefff/faq.html
American Association for Marriage and Family Therapy
http://www.aamft.org/index_nm.asp
American Counseling Association
http://www.counseling.org/index.html
International Association for Near-Death Studies
http://www.iands.org/
American Board of Professional Psychology (Links to clinical neuropsychology and
behavioral psychology)
http://www.abpp.org/
Dr. Phil McGraw
http://www.drphil.com/
American Psychological Association (referral and background topics)
http://www.apa.org/psychnet/
Authentic Happiness:
http://www.authentichappiness.org/
Go to: Chapter 5