“Life is a journey, not a destination.” —Ralph Waldo Emerson
One thing we are finding when we visit Vernon is that he is on his own timeline. (If I’m honest, I suppose he always has been.) Sometimes he is alert and ready to engage and other times, he can keep his eyes shut for most of the visit…almost as if he isn’t ready to deal with his physical circumstances at all. We have noticed also that sometimes he seems to need to reset for a bit before opening up again to whatever is happening around him. Waking up from brain injury is exhausting work.
On these visits, its important to remember to accept him wherever he is. It is always encouraging to have a story for that day, to see another progression, but this time is about him, not me. He can do this how ever he needs to and at his own pace. This is a great exercise in learning to love a person unconditionally.
According the the RANCHO LOS AMIGOS SCALE (which charts the 8 levels a tbi patient might progress from coma through recovery and rehabilitation) I would say Vernon is between a III and a IV. This is fantastic because just a month ago, I would have said he was still between II and III.
Level III – Localized Response
Patient reacts specifically, but inconsistently, to stimuli. Responses are directly related to the type of stimulus presented, as in turning head toward a sound or focusing on an object presented. The patient may withdraw an extremity and/or vocalize when presented with a painful stimulus. He may follow simple commands in an inconsistent, delayed manner such as closing his eyes, squeezing or extending an extremity. Once external stimuli is removed, he may lie quietly. The patient may also show a vague awareness of self and body by responding to discomfort by pulling at nasogastric tube or catheter or resisting restraints. He may show a bias toward responding to some persons (especially family, friends) but not to others.
Level IV – Confused/Agitated
Patient is in a heightened state of activity with severely decreased ability to process information. He is detached from the present and responds primarily to his own internal confusion. Behavior is frequently bizarre and non-purposeful relative to his immediate environment. He may cry out or scream out of proportion to stimuli even after removal, show aggressive behavior, attempt to remove restraints or tubes, or crawl out of bed in a purposeful manner. He does not, however, discriminate among persons or objects and is unable to cooperate directly with treatment efforts. Verbalization is frequently incoherent and/or inappropriate to the environment. Confabulation may be present; he may be euphoric or hostile. Thus, gross attention to environment is very short and selective attention is often nonexistent. Being unaware of present events, patient lacks short-term recall and may be reacting to past events. He is unable to perform self-care (feeding, dressing) without maximum assistance. If not disabled physically, he may perform motor activities such as sitting, reaching, and ambulating, but as part of his agitated state and not as a purposeful act or on request, necessarily.
“Do not go where the path may lead, go instead where there is no path and leave a trail.” —Ralph Waldo Emerson
We have yet to see Vernon crawling out of bed or scream, but I guess when we do we can be delighted at the progress. It would be very much like Vernon to find out about this chart and do something completely different…just to spite it. I’m warned he might start swearing and yelling out of frustration, but so far Vernon’s laid-back attitude is serving him well. We are noticing that when he does try to speak, his words are often jumbled and phrases hard to decipher. I saw this sign today in the hospital and thought: “yes we could certainly use an interpreter right now!” But it doesn’t matter: once again, its about him practicing his speech, rather than being fully understood. He doesn’t seem to be too frustrated over that yet.
One thing that did happen today, on our second visit to his room (he was too tired to respond much when we took him for a roll outside this morning) is that he was able to say some simple and understandable words, even though they weren’t the correct answers. He said that Justine was 2, Maki was 8, and he was 32. I was so pleased to know that he was at least answering with numbers when I asked the ages. That has to be a very good sign of un-jumbling the words and concepts in his brain.
“What lies behind us and what lies before us are tiny matters compared to what lies within us.” —Ralph Waldo Emerson