I sat across the table from my client Matt, watching as he clicked away on his Kindle keyboard, presumably searching through his notes for clues as to what we had discussed during our session a week prior. “Ah, yes, found them,” he said a minute later. “It says here we planned a studying schedule for my physics final.”
“Did you follow the study plan we worked on?” I asked.
He paused, waiting for a cue. “I have no idea,” he said after realizing I wouldn’t be filling in the gap for him. “Let me search my notes.”
A minute passed as he searched his Kindle again, and then another while he scrolled through the emails and calendar on his phone. “I did not record any studying in the last week,” he said. “So according to my notes, I did not.”
“O.K.,” I said, recording his answer in my own notebook. “How did you feel after taking the exam?” I observed his eyes scanning the wall behind me, his face wearing the recognizable look of someone who is trying to grasp those just-out-of-reach answers.
“I have no idea,” he said and let out a sigh. “I don’t remember taking it at all.”
A year earlier, while out for a jog in his Philadelphia neighborhood, Matt (whose name has been changed to protect patient confidentiality, as have the names of other patients mentioned) had been hit by a car. His physical injuries were minor – a few broken bones and small scrapes – but a few days into his recovery, it became evident he had sustained a more serious injury. Every time he’d fall asleep and wake up again in the hospital, he’d ask where he was and how he got there.
Matt had sustained a traumatic brain injury, or T.B.I. His memories from before the accident were accessible, but he struggled to retain new ones, like what he ate for lunch yesterday, or the names of any new people he met, or how confident he felt about a test he’d taken last week.
This was not uncommon among patients recovering from a T.B.I., I was learning. I was a junior in college, and had recently started a new job as a brain injury therapist intern, working in a community re-entry program at an outpatient brain injury rehabilitation center in North Philadelphia.
A semester earlier, I had learned about traumatic brain injuries in a physiological psychology class I took at Drexel University, where I was majoring in psychology and on the pre-med track. This is when I first discovered my fascination with the human brain’s structures, and how physical damage to those structures can affect a person’s perceptions and behaviors.
It was also the first opportunity I had to think critically about my own mother’s brain, and the traumas it has endured throughout her life. I remember poring over different case studies, searching for any recognizable symptoms that might be associated with the parts of her brain that had been damaged, anything that would help me understand my mother better.
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Long before I was born, when my mother was 17, she collapsed in her high school’s hallway after suffering a massive aneurysm when a tangle of blood vessels burst in her right frontal lobe, bleeding into her brain.
She doesn’t remember anything between hearing her classmates say she shouldn’t be drinking at school just before passing out and coming to two weeks later in the hospital. Though she’d been conscious the whole time to answer questions the hospital staff had asked, the nurses and doctors startled her when she gained awareness again. She had no memory of them.
My mother was lucky that she didn’t have to relearn how to walk or talk. Though, like some of my clients at the brain injury center, she did experience some short-term memory loss – like not remembering whether she had taken her medicine that morning, or repeating the same story or question over and over again.
Of course, my mother would sometimes come to mind at the brain injury center, though I tried to stay focused on the same mundane tasks interns in all kinds of offices are given: filing, organizing, and ordering lunches. I also got to shadow other brain injury therapists and, eventually, was allowed to work one-on-one with clients like Matt in hour-long sessions. It was a rare opportunity for someone who didn’t yet have an undergraduate degree.
Our collective duty at the center was to help patients who had experienced brain injuries re-learn skills necessary in their daily lives, such as cleaning and cooking, organizing a shopping list, training for a new job, or managing personal finances. Our job was to help people rebuild their lives, one step at a time.
A few years before I started the internship, during the summer before my senior year of high school, my mother had abandoned us. After marrying a man she’d met on eHarmony, she packed up and left me and my 15-year-old sister, Lindsay alone in our house – without any prior discussion or warning. Her new husband’s home was closer to where she worked, in a town a little more than 20 miles away, though she didn’t check in on us often. Our father, who lived 500 miles away, was oblivious to the situation the entire time. We were too afraid he’d make us move in with him, and so we kept it all a secret.
At the age of 17 – the same age my mother was when she experienced her brain aneurysm – I stepped up into the parent role. I worked as a manager at a nearby grocery store, where I’d shop for our groceries. I was the one who made sure Lindsay finished her homework as I drove us to school each morning, and forged our mother’s signature on any school forms that required it. I took us to the doctor when we got sick. With each day that passed, I collected more resentment toward my mother. She didn’t understand how cumbersome it was for us to navigate daily tasks without her, how painful it was to not have our mom around. She couldn’t seem to grasp that we still needed her, and I was too stubborn to admit I wanted her to come home.
I managed to get myself into college, where I majored in psychology – not for any particular reason, though looking back on it now, I can’t help but see it as the first step of my attempt to understand my mother.
Two years later, I helped Lindsay do the same. She joined me in Philadelphia, where she started coursework in advertising at a nearby college, and we attempted to rebuild our lives. We could look ahead to the future, and were finally allowed to imagine what might be possible for us, and for our careers. But we were both still living in the fallout of our mother’s abandonment. We were stuck in survival mode, lost and craving guidance, in need of someone to help us see that our goals were, in fact, reachable.
Feeling distant from my mother was not a new experience for me. Throughout my childhood and adolescent years, I’d often felt as if there was a wall between us. I vividly remember coming to her when I was 12 or 13, frustrated about something – maybe I was annoyed with my sister, or had just had an argument with a friend, or even likelier, was upset because of a boy. My mother was lying on the couch reading a book as I stormed into the living room with tears running down my face.
She looked up from her book and laughed in reaction to my despair, offering only one of her frequent refrains of “oh, it’s not a big deal” or “life isn’t fair” as comfort. Being dismissive of my emotions and concerns was typical for my mother, as was her cold affect, and I never got used to it. The emotional rejection hurt each time.
In the developmental psychology class I took during my sophomore year at Drexel, I learned about attachment theory, how crucial it is for a baby’s development to bond with their mother after birth, and how important it is for their emotional development that they feel safe in her arms. As I sat in that lecture hall, scribbling down notes from our professor’s slides, my thoughts returned to my mother. I’d been told I was a difficult newborn with bad colic, and knew my mother had gone back to work when I was only a couple of months old – two things that explained our lack of connection, or so I wanted to believe.
I raised my hand, eager to find out whether it was ever too late to start forming that bond. By the time my professor called on me, I was too ashamed to ask.
At the brain injury rehab, I’d sometimes suggest the patients and I play a card game like War, Solitaire, or Kings, which proved useful as a way to see how long they were able to maintain focus, noting what they could or couldn’t remember about how to play. To test a client’s spatial awareness, I might ask them to assemble blocks into a certain shape, like a tower. To test their organizational abilities, I might hand a client a stack of postcards marked with different zip codes and ask them to sort them.
I’d frequently act out mock scenarios with clients, like when I assisted Laurie, a single mother of four, with planning a meal from start to finish. We met in the quiet back room that had a computer. “What recipe would you like to make for dinner?” I asked.
“Something simple,” said Laurie. “I get lost if there’s too many steps.”
“O.K., simple is good. We can also print out the recipe for you to follow step by step at home,” I reminded her, and then walked her through using Google to search for possible recipes. Once she had decided on one, we worked on writing out a shopping list.
Over the course of the next few weeks, I helped Laurie work through all the steps involved in booking a vacation, from budgeting expenses to looking up flights and hotels. We discussed what to do if she got a call from the school nurse and one of her children was sick, and typed up a list of tips in her phone’s Notes application for her to reference in the future. When she entered the job-training phase of her treatment, we talked about how she might explain her brain injury to her new coworkers, and if she was even required to do so. She was training for an office job, so we practiced tasks like sorting and filing folders, making copies, and alphabetizing names in a Rolodex.
Some patients grew frustrated easily and gave up. Others, like Matt and Laurie, were motivated to finish the task at hand, but sometimes seemed confused about how to do so. It was my job to help encourage them, providing cues when necessary, repeating steps and reinforcing rules – all a great lesson in patience, a trait my mother had always reminded me I didn’t have.
When I started the internship, my new supervisor explained that some of the most common behavioral and emotional problems people with a T.B.I. can experience include verbal or physical outbursts, poor judgment and disinhibition, impulsive behavior, egocentricity, and a lack of empathy.
“You might feel shocked the first few times you experience an inappropriate behavior,” she warned. “You’ll get used to it.”
But there wasn’t much “getting used to it” that I had to do. I had been raised by a woman who lacked inhibition, a woman who said what she felt and thought at all times, unaware of how it might make another person feel, including her children. I had survived her biggest impulsive act. I was more prepared for the job than I ever should have been.
When I had to fend off aggressive or inappropriate comments, or correct a client’s inappropriate behavior – like when one wanted to know if I was dating my male colleague (I was not) – I’d remind myself they didn’t know any better. Their brains had experienced trauma, and now they were moving through the world differently. They needed to relearn and regain different skills, which required time, patience, and guidance.
One afternoon I was walking through the hospital with Jeremy, a client who was volunteering in the maintenance department as part of his job-training program. As he pushed his cart beside me, he tried to fill the quiet hallways with conversation.
“So, when we gonna hang out?” he said. “You’re pretty hot, you know.”
My initial reaction was shock and embarrassment, and if I wasn’t supposed to be the professional one in the situation I might have turned around and run down the hallway. I managed to stumble out a response.
“That’s inappropriate and unprofessional, Jeremy,” I said. “You don’t speak to people you work with like that.”
“O.K., O.K.,” he said with his head down, embarrassed. “Got it.”
Once my knee-jerk shock reaction subsided, I felt something else for Jeremy. As I was teaching him how to interact in the world again after his injury, he was teaching me a lesson in empathy. And maybe, if I could learn to understand and feel compassion for what Jeremy was experiencing, I could learn to feel empathy for my mother, too.
In the end, the internship didn’t lead me anywhere career-wise. I never made it to medical school, but the experience did unlock my ability to re-think and write about my life – and helped salvage my relationship with my mother.
It’s taken years, but I’m finally beginning to understand and appreciate that she’s a complex person, like all of us are. I now see she’s not only someone who has caused trauma for me, but also a person who has endured and survived trauma herself. Like some of my impulsive clients, my mother’s frontal lobe had been damaged as a result of her brain trauma, an injury that likely impaired her judgment and ability to perceive other’s emotions. Maybe she couldn’t be blamed for her character flaws.
Sometimes I worry I’m just trying to impose a narrative on something that’s unexplainable, but knowing it might not have entirely been her fault has helped me forgive her, bit by bit, and we’re finally working to build the bond I’ve always felt was missing.
A few months ago, I went to visit my mother in the Poconos where she and her husband now live. We went out for dinner, just the two of us, and I ordered a bottle of red wine for us to share. I’d been reading a significant book about trauma called The Body Keeps the Score, I told her, and had lately been thinking a lot about how trauma is something we have in common.
“Yours might be physical, and mine emotional,” I said, “but they’re both considered trauma.”
I watched as she sipped her glass of wine. She nodded with a little smile of recognition. “And we both survived,” she said. “We share that, too.”
It wasn’t the warm, motherly embrace I’ve always dreamed of, but after years of working to be able to see my mother, I was finally able to feel seen by her.
They say the human brain is a mystery, an unknowable enigma, and for so much of my life my mother has been exactly that: a riddle I’ve never been able to solve. But the brain is resilient, too, with the ability to repair damaged cells and grow new neurons, capable of creating connections where there used to be none.