Traumatic Brain Injury Impacts Victim's Family, Too
March 27, 2013
REDSTONE ARSENAL, Ala. -- Rachel Stovall doesn't get mad -- she gets organized.
When Stovall met Josh Wells in November 2010, the damage from his time with Alpha Company, 91st Engineer Battalion, 1st Cavalry Division, in Iraq from January 2004 to March 2005 had already been done, his brain forever changed by multiple IED blasts he sustained throughout his deployment. As she's fallen in love with the wounded warrior, rather than getting upset when Wells forgets something, a symptom of his traumatic brain injury, the flight test engineer for Redstone Test Center has learned to be understanding of the challenges Wells will face his entire life.
"I know it's something that'll be a permanent part of our life, and it'll be difficult on occasion, but it's workable," Stovall said. "You have to keep reminding yourself that it's not the person's fault they can't remember things. There's going to be issues, but if you keep remembering that there's a cause to it, and it's not just because he's a guy, then it makes it a little more workable."
It's not just the Soldier or individual who experiences the lasting effects of a traumatic brain injury, but the family and friends that surround them as well, who have to learn to cope when their loved one is forgetful, can't concentrate or find the right words, is anxious, depressed, irritable or prone to mood swings, all symptoms of a traumatic brain injury.
"The impact of TBI is not just to the patient, it's to the whole family," said Dr. Lynley Ebeling, neuropsychologist and director of Fox Army Health Center's Neuropsychology/Traumatic Brain Injury Clinic. "A lot of spouses and children do not understand what is going on, they get very frustrated when their loved one with a concussion doesn't remember something. For them it may be, 'I just told you that. Why did you forget to pick that up from the store? Why do I have to remind you?' A lot of times they will have to be their loved one's calendar for them, and they're having to remind them of their daily tasks to make sure they're being responsible. That gets very fatiguing and tiring for them. Unless they understand why it is happening, that can be a source of conflict. It's really hard to understand unless you have the symptoms yourself, and we want to include the whole family in understanding."
The Defense and Veterans Brain Injury Awareness Center recommends families try a variety of tips, techniques and coping mechanisms for dealing with their loved one's TBI, beginning with getting involved with the treatment process and becoming knowledgeable about what TBI is and what it means for their family member. Families can also offer insight to medical professionals in areas where the person with a TBI may think they're doing just fine.
"I have a lot of servicemembers brought in by their spouses who would say, 'This is not the person who left a year ago. This person is different. He can never find his keys. He's really irritable and his head hurts all the time. He can't concentrate,'" said Helen Coronel, nurse practitioner with the DVBIC. "Certainly that's going to trickle down to the family and they're going to be more irritable and frustrated. It has effects on life and on their kids."
To combat those negative feelings sometimes brought on by the symptoms of TBI, the DVBIC advises families to spend quality time together, with electronics turned off, doing things that everyone can enjoy, such as taking a walk, playing board games or baking cookies. Communicate feelings in a positive manner, avoiding the word "you" and using "I" instead, and listen to one another. To help your loved one thrive and become independent, an important aspect of rehabilitation and recovery, keep structure and routine in your daily habits, until they're ready for more flexibility. If they have trouble communicating or struggle with reduced judgment and impulsivity, role play events prior to exposing them to trips out in the community. Be prepared to help them through the challenges of day-to-day living -- be understanding when they forget things, and kindly remind them of things when necessary -- but allow them to live life for themselves as much as they can, Ebeling said.
"We really want to have the patient be able to do as much as they can for themselves," Ebeling said. "We're talking about high-level folks, who, upon eyeballing them and talking to them, you'd never know they have a problem. You can't really see it. They walk fine, they talk fine, it's not a physical thing that you can discern. They're at a level where they really need to take ownership of their symptoms and not rely on someone else. We have to coach families to be understanding. It just may be to help remind them of some of the tools that they can use, but we really want to let the patient learn to be as independent as possible."
Stovall has used those tips to her advantage. Whenever Wells schedules an appointment he'll call her, who will write it down and remind him as the date and time draw closer. In turn, if there's something important he needs to do for her, she'll often have him repeat the information back to her. Wells does his part by writing notes to himself that he sticks on the fridge.
"She knows I'm not forgetting on purpose," Wells said.
While the traumatic brain injury has changed something in Wells, to his parents, Barbara and Jerry, he's still the same light of their life that he's always been.
"I think the Army experience was wonderful for him," Barbara said. "I think it helped him realize who he is. It helped him with clear direction and goal setting, and that bonding with his fellow Army buddies and that commitment. He's always been a good person with a good heart and good soul, and very service oriented."
Growing up in St. Louis, Barbara remembers Wells as a typical boy, "an outdoor boy from the beginning of time," who loved sports, the outdoors, running around and simply being active.
"We knew from the beginning that whatever he did through his lifetime, it would have something to do with his being active," Barbara said.
Having spoken with dad Jerry on and off through high school about entering the military, while Wells' parents hoped he would go to college immediately after high school, when the news broke the morning of Sept. 11, 2001, they knew their son's fate was sealed.
"I'll never forget the day of 9/11, because he called me and asked if I knew what had happened," Barbara said. "I had not, so I put on the news immediately. All of that really resonated with him. He said, 'I have to help make a difference in all of this. I'm really going to pursue service.' I knew right then that that was what he was going to do. That was difficult for me in terms of being his mom and wanting to be his protector, I never let go of that. But he had to make that decision, and from the start we were very supportive."
So when Wells deployed to Iraq in 2004, the Wells family put on a brave face for their Soldier son.
"We knew he would call us every single time he had an opportunity," Barbara said. "We knew that and we trusted that, and that is what he did. On our end, I decided part of the way I could get through it was by sending a care package every single week, and that's what I did. I don't believe I ever missed a week. I took it upon myself to constantly be thinking of the little things that he might enjoy and his buddies might enjoy."
Still, when the phone rang, the Wells family worried.
"It's a scary thing, because when you're a parent and your child is there, every time the phone rings you look to see who is calling on the caller ID," Barbara said. "When it says 'U.S. Government,' that's very scary."
That phone call came for the family in the days following the January 2005 IED blast in which Wells sustained a traumatic brain injury.
"Josh had actually called us after he was able to from that injury and told us about it," Barbara said. "When the Army called after Josh had called and asked if I had talked with my son, I was thinking that maybe a second accident had happened and got very concerned. I remember trying to stay calm, asking 'Is he all right?'"
They were, thankfully, referring to the same incident that Josh had already informed them of days before. To this day, the family counts their blessings that the phone call didn't take a different turn.
"We were a very lucky family, because we got him home," Barbara said.
In the time since Wells' injury, Barbara and Jerry have noticed the occasional short-term memory loss in their son, who will sometimes tell them something he'd already shared with them before, but also know their pride and joy has coping mechanisms for dealing with the symptoms of his TBI.
"I know that he makes a lot of notes for himself, which helps him to remember things," mom Barbara said. "I think he's learned to compensate in terms of trying to stay organized and remember, he's got strategies for how to cope with those things."
Learning to take a step back, and allow their son to be independent, has been one of the ways the Wells family have supported their son, not only in dealing with his TBI, but his whole life long.
"We have always wanted for him what he wants for himself, whatever that is," Barbara said. "We have supported him and tried to gently guide him as well, as good parents do, and have just been there for him. We've tried to be good listeners and give good advice without being controlling and telling him what he has to do, just being that good coach."
Editor's note: Follow Wells' story in the Redstone Rocket's four-part series in March in recognition of Brain Injury Awareness Month.