Traumatic Brain Injury in Veterans

Margaret

Age at interview: 68
Outline: While working as a nurse in field hospital in Vietnam, Margaret sustained a brain injury and lost hearing in her left ear when her hospital was shelled in a mortar strike. It wasn’t until ten years after the incident that she began to suffer from severe bouts of vertigo, which greatly impacted her ability to live and work as she had been accustomed, and sent her into depression. She has learned to cope with her symptoms by practicing the Epley maneuver, a head exercise that helps combat the dizzy spells.
Background: Military branch: Army

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Margaret enlisted in the Army as a student nurse. She was recruited out of college with an offer of full tuition coverage for her final year of school, including books, room and board, and a living stipend, in trade for two years of service. She initially though her service would be in Europe, but soon found herself working in a small MASH hospital in Vietnam. It was there in early 1969 that Margaret sustained an injury to her head when her hospital was targeted in a rocket and mortar strike. The explosion threw her to the floor, hailing her in “red sparks of hot shrapnel.” When the attack was over Margaret was left feeling foggy-headed, dizzy and dazed. She had lost hearing in her left ear, but for a constant ringing, and felt confused and off-balance. The hospital surgeon checked her over and diagnosed a ruptured eardrum, an injury that would leave her deaf in her left ear. She was back on duty the next day and returned home a few months later.

It wasn’t until more than ten years later that Margaret began to suspect there was something more going on as a result of that incident in Vietnam. Frequent bouts of vertigo started to impact her life. Margaret began to scale back her work as a nurse as she found herself struggling with normal tasks like changing an IV bag. She needed to call in sick increasingly and felt the staff at her hospital could no longer depend on her. Out for a run one day, Margaret fell and had a seizure. At the hospital she went through a barrage of tests, and was referred to an Ear, Nose, and Throat doctor who found damage beyond the drum in her inner ear.

Since then Margaret says her symptoms have gotten worse and “more pronounced with age." She suffers from severe tension headaches, carries a cane with her to keep steady and doesn’t always feel safe driving. She has undergone two surgeries, neither of which were successful, and does regular therapy and specific exercises to keep her ear fluid from drying out and to alleviate some of her symptoms of vertigo. The biggest impact for Margaret has been the “major blow” to her lifestyle and the effect on her relationships. Reluctant to go out because of her symptoms she feels she has become a hermit and admits that her condition has affected her self-esteem and has brought on bouts of depression that she began noticing soon after her diagnosis.

Despite these challenges, Margaret says her experience has made her a more introspective and reflective person. “Those are positive things and I think for the most part for me personally, it’s made me more compassionate,” she says. “I’m a warmer person.” To those newly diagnosed or suffering from a head injury, Margaret says she would hug them and tell them it will be OK. “Seek medical treatment, see doctors, go through the diagnostic tests,” she says. “Do what the doctors tell you, and also tell the truth.”

 

Margaret was foggy-headed and “in a daze” for a few days after hitting her head during an explosion.

Margaret was foggy-headed and “in a daze” for a few days after hitting her head during an explosion.

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OK, well it occurred in Vietnam when I was doing my tour there as an Army nurse. I was there as an Army combat nurse, so, in a small MASH hospital. And we were frequently rocketed and mortared, the hospital was. At any rate, a rocket hit the nurse’s hooch, the, where we lived. And anyway, the explosion threw me to the floor, and I could still see, you know, red sparks of hot shrapnel hailing around me. So that, I – April the 14th of 1969.

I: What happened then?

Then I went back. I got myself back into the bunker, where I should have been in the first place, but I had gone up to get a pack of cigarettes – up into the living quarters, OKy? Our bunker was underground. So I, my initial – I was so shook, you know, that I, I don’t have real close recall of what my physical symptoms were, except that my hearing was gone, my right ear, and there was a loud ringing. I was kind of foggy-headed for a few days, not – sort of walking around like in a daze, or like I had had too much to drink or something, and I don’t drink. So, I wasn’t confused, I knew where I was and all of that, but just felt kind of foggy, off-balance, and this horrible ringing. So, I had one of our surgeons take a look at my ear. I said, “Hey, you know, it’s doing this.” And he said, “Yeah, your ear drum is completely ruptured,” and there was a little tiny bit of blood in there. But that was all. That was all. And within a day or so, I was back on duty.
 

 

Margaret describes how the term traumatic brain injury wasn’t even being used when she was diagnosed in 1969.

Margaret describes how the term traumatic brain injury wasn’t even being used when she was diagnosed in 1969.

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They did. They did, eventually. Yeah. You know, because as I said I was worked up for heart problems, you know a runner passes out, neurology, looking for I don’t know, multiple sclerosis, or something of that nature. And finally ended up in ear, nose and throat, and it was then that the diagnosis was made based on my history. “Well, have you ever been in a trauma? Have you been in a car accident?” You know, all the questions asked and, I didn’t have any, any history that would have caused this except for that severe concussion. So that’s how that, I don’t think you’ll find it anywhere in my records where it says traumatic brain injury. But that term wasn’t even, it wasn’t being used in 1969.

 

Margaret describes what it is like to have a disability you can’t see and the feeling that she was making too much of it.

Margaret describes what it is like to have a disability you can’t see and the feeling that she was making too much of it.

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But people in my circle of friends or family. I felt weak, you see, I felt like I was being a weakling. “Well what do you mean you can’t cope with this, come on.” And that, and so a lot of this was self-imposed, OK? You know, yeah, I felt weak. And it was just like too much to try to explain. And you know most of us, if we can see what’s wrong with you, “oh yeah, you know, you broke your arm.” But with me, you couldn’t see anything, you know. So, I began to feel like I was making too much of it, so it was better to just be alone.

 

Margaret felt like her co-workers couldn’t trust her, because she frequently had to call in sick.

Margaret felt like her co-workers couldn’t trust her, because she frequently had to call in sick.

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I ended up frequently while I was still working, you know, having to call in sick at my job. And that was horrible, for me to do because I, I had the feeling that my staff, my co-workers couldn’t trust me. “You going to be there, you going to show up?” and sometimes I just could not be there.

 

Margaret felt like she lost her sense of self-esteem after giving up her career as an ER nurse.

Margaret felt like she lost her sense of self-esteem after giving up her career as an ER nurse.

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I think that the major, major blow to my lifestyle. You know I had to give up my career. I was a nurse. And that’s a blow. I liked being a nurse.

I: Did you end up going on disability or how how did that sort of -

How did that come about? No, no, not for this. Hu uh. Uh uh.

I: Did you do other work?

I ended up being able to do, I was a telephone advice nurse for a while, so I sat at a desk with headphones and, yes, I did that and I could do that. Yeah. But it, but I’m an action person, I mean I’m an ER nurse, I’m used to getting in there. And now I’m sitting, giving advice to people about their headache. Excuse me, but, it was a big, big change. I wasn’t happy. I lost, I felt like I lost my sense of self-esteem, you know. I was no longer the - I don’t like to call it that but you know - the, hot shot kind of nurse. Now that’s all gone. That was gone.

 

Margaret talks about how her condition has impacted her relationships.

Margaret talks about how her condition has impacted her relationships.

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And another thing, relationships, impacted. You know, friends get a little of tired of me saying “you know, I just don’t feel like doing this.” Or, I was over, I was at the Japanese Garden last year. I’m a member of there. And I was there with a friend, and there’s some stairs there that you have to walk up and down, to get to part of the garden. And I had to just do one step at a time, with my walking stick. And she couldn’t understand well why, what’s this all about. Well, you know, to have to explain it all the time and, relationships, you know cancelling on people.

 

Margaret struggles with her balance and equilibrium and has fallen a couple of times.

Margaret struggles with her balance and equilibrium and has fallen a couple of times.

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The reason why I walk with a walking stick is because my equilibrium - not because I have back or bone or knee problems - but because I, I don’t trust my equilibrium. I have fallen a couple of times due to my own lack of my surroundings. I was out in the garage one day and I wanted to put some boxes in the recycling bin. Well they were kind of big, so I had to make them smaller. So, I jumped on top of one, trying to smash it. Well of course, you know, I lost my balance on this thing that was wobbly, and over I went. I didn’t hurt myself, but it was a lesson. It was a lesson.

 

Margaret has found that taking a stimulant medication helps with her mood, thinking, and energy.

Margaret has found that taking a stimulant medication helps with her mood, thinking, and energy.

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Uh, I’m on an SSRI now, I take Prozac. And I’ve been on an SSRI for years. And I also take Trazadone, which is an older antidepressant, but it helps with sleep. So those two, and within the last, what is it about five or six years ago, I was placed on a stimulant.

I: Do you recall which one that is?

Yeah, it’s Dextroamphetamine, by, nurse practitioners here as a matter of fact. They helped me with that. One of them brought it up to me a year before I ever agreed to do this. “No way am I ever going to take Dextroamphetamine.” And she’d bring it up again and again and, “all right, fine.” And it’s helped me, a whole lot.

I: What has it helped with?

With the depression. Oh yes. Oh, just tremendously. I’ve told her, I said this has saved my life.

Because I was suicidal at the time, you know. And I do take it, I take it twice a day. I don’t abuse it, because that’s all I need. I wouldn’t want to take any more than that. But it keeps my mood more focused. And I, more focused, with clearer thinking. And feel a little more energetic. Other things that help me deal with the depression are exercise, you know but the, the vertigo can get in the way with that. But that is also a little bit better, so I try to walk. I’m a walker right now.

 

Margaret describes the Epley Maneuver exercises that she uses to improve her equilibrium.

Margaret describes the Epley Maneuver exercises that she uses to improve her equilibrium.

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Lie on my bed with your head down

I: Like over the edge? OK.

Head down. Then turn to the right side and hold it for about a minute, with your head hanging.  It’s not comfortable. But I was doing something like that, but I was only doing it for 30 seconds, and this is an adaption of those earlier exercises I was treated - taught. So, this is a little different. OK, go to the right for a minute, then you go to the left for a minute, hanging. And then you turn over on your side and hang your own head over the bed. And then, do you want to hear anymore? You guys are probably getting nauseated by this. But, you know it only takes a few minutes and, it’s helping. I’m quite hopeful.

I: So, this is daily, are you

I should do it daily, not twice a day.

 

 

Margaret learned not to talk about Vietnam because the comments people made were often hurtful.

Margaret learned not to talk about Vietnam because the comments people made were often hurtful.

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That was like, talking about Vietnam was like, ooh, yeah well if you talk about it, the comments that would come back would be so hurtful, and so disrespectful, that I got tired of being hurt by that, you know. Absolutely. You know I remember once I was at kind of a dinner party thing in Philadelphia. I was there at a professional conference and the conversation at the dinner table turned to the Vietnam War. This would have been in late 70s, before this all started. And, you know, a group of the people there started talking about, “geez, these Vietnam Veterans just whine, they’re such babies. They’re babies”. And I remember leaning over my salad, I leaned over my salad so deeply because I started to cry and I didn’t want them to see that. And I remember my tears collected on the inside of my glasses. So those are the kinds of things. Or you might mention it, “what a stupid thing to do. Why did you do that?” Or, another comment, that I heard a couple of times was “wow, lots of men.” Oh, that just used to, makes me angry just talking about it, because I was not, yeah lots of men died, assholes. But, so it was not a popular, it wasn’t a conversational topic. No, Vietnam was not, I learned really quickly, keep my mouth shut.

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