Neuropsychology and Rehabilitation Psychology Division Department of Physical Medicine and Rehabilitation.

Pat #11

DEAR PAT: Six months ago, I had a serious brain injury and have been unable to return to work. I recently found out that my husband is having an affair. I want to confront him, but I am worried about what happens if he leaves me. I’m not sure I can take care of everything on my own.

PAT'S RESPONSE: A place to start may be simply asking him how he feels about you, whether he is satisfied in the marriage, and what he would like to see change to make things better. Talking to your husband about these issues may give you an indication of how he will react if you confront him, and whether he wants to work on the marriage. It will also give you a better idea of how he feels and whether you think the marriage is worth saving.

Before you make a decision about what to do, you need to remember that you are an important, valuable person who deserves to be treated with respect. The second thing to is to remember that you won’t be alone. Your family, friends, neighbors, or religious community are likely sources of support. You are not alone and you won’t be alone no matter what happens. People will be there to support and help you. Don’t be afraid to ask for help.

Ultimately, you will have to make a choice. You really only have two choices.

Seek a divorce

Try to work it out

If you want to seek a divorce, you should consult an attorney before you confront your husband. You need to know your rights and how to protect yourself legally. Don’t just leave the house before consulting an attorney –especially if you have children. In many states, this is considered "abandonment" and can hurt you in court. Seriously consider whether you really want a divorce.

You will also want to talk to family and friends about the type of help and support you’ll need. Find people who will help you around the house or provide transportation. Finding a therapist that specializes in divorce is often a good idea. Many people benefit from talking to an expert about how to adjust to life after divorce. If you have children, consider arranging for family sessions for them to discuss their feelings about the marital separation. Talk to your doctor, therapist or counselor about what resources may be available to assist you should you need them.

If you want to work it out, you have to tell him you suspect an affair. Doing nothing won’t make it go away. You will need marital therapy. Very few couples can resolve the anger, feelings of betrayal and lack of trust on their own. Consider the quality of the marriage before his affair. Affairs can be a symptom of long-standing marital problems, not the cause. Were there problems adjusting following the injury or did problems exist before you were hurt? Is the relationship worth salvaging? How long has it been since you felt the marriage was strong? Was it strong before you got hurt? Remember, if you decide to work it out, you will have to be prepared to work toward forgiveness. Both of you will have to work hard to regain trust, intimacy, and commitment.

If you want to work it out, the hardest part will be facing the possibility that your spouse might not. The thing to remember here is that if he doesn’t, your marriage isn’t going to improve anyway. Talking to him is the only way to find out if he’s willing to try. You may want to consider talking to a therapist about your dilemma. A therapist can help you decide how to approach your husband, and how to cope with things if he decides he doesn’t want the marriage any more. Either way, it won’t be an easy road.

A good man is hard to find. Too bad a bad man isn’t.

DEAR PAT: We are being accused of shaken baby syndrome and we did not do it. We don’t know how it happened. I have bumped my 5-month-old son’s head on the car door and my five-year-old daughter accidentally kicked him in the head. However, I’m told neither of these could have caused his injury. I’ve read other stories saying it doesn’t have to be a hard hit. If you have any information that can help, please let us know.

PAT'S RESPONSE:Shaken baby syndrome is a constellation of brain injuries that occur after the baby has been shaken violently. Infants with shaken baby syndrome typically have subdural hematoma, cerebral edema, and may show retinal hemorrhage. In other words, there is bruising and bleeding in the brain and often retinal damage due to violent shaking. Other injuries consistent with shaken baby syndrome can include neck injuries, skull fractures, or bruising or broken bones to the arms of chest (where the baby was grasped). The injuries result from the force generated by shaking the child violently back and forth. Studies have shown that the forces necessary to cause these injuries greatly exceed those sustained in routine play, infant swings or fall from low height. Certainly your child bumping his head on the car door or being accidentally kicked by a five-year-old would be insufficient for this type of injury. There is no other medical condition that mimics all the features of shaken baby syndrome.

Why are babies shaken? Most often it is the result of caregivers who are frustrated with crying. Shaking the baby often results in the child appearing dazed or drowsy – and the baby often stops crying (reinforcing the caregiver for the behavior). Unfortunately, the baby’s drowsiness and silence is usually the result of brain damage. Shaken baby syndrome can result in blindness, permanent disability, or death. I hope that your child is able to make a good recovery.

DEAR PAT: About 10 years ago, I fell out of a truck that was towing a camper. I was run over by the back wheel of the truck and had numerous cuts and bruises. I was very lucky to be alive! The most serious issue after my accident was a "personality change." Everyone noticed it! My sister said it was like I was a stranger! My taste in food, music, and clothes changed. I even lost a fear of heights I always had! Is this type of change common?

PAT'S RESPONSE: Actually, personality and behavior changes are quite common after a brain injury. Many people experience a decrease in inhibition – making them less anxious about things. On the other hand, it can also make them more impulsive, aggressive or irritable. Some people even describe the person as being calmer and quieter after an injury. It’s hard to predict and sometimes the changes are temporary. Also, sometimes people who experience a traumatic event that brings them close to death make changes in their lives that have nothing to do with a brain injury.

DEAR PAT: Hi! About two years ago I fell and hit my head and was found unconscious. 6 CT scans later no one can find any "damage," yet I still have intermittent memory loss and now symptoms of stroke. What should I do? I can’t afford to keep having CT scans.

PAT'S RESPONSE:CT scans are good at showing many types of physical damage to the brain. However, they aren’t perfect and there can be damage that the CT scan doesn’t pick up. I would suggest that you consider a neuropsychological assessment. This evaluation won’t tell you what your brain looks like. Instead, you will be given a number of tasks related to attention, memory, auditory and visual processing and visual-motor skills to assess how your brain is working. In many cases, it may be helpful to also have a follow-up evaluation in about 6 months to determine if things are getting better or worse or staying the same.

DEAR PAT: I am writing regarding a friend with a brain injury. Do you have any recommendations for a person who refuses to seek professional help to deal with his behavior? He thinks it is going to get better, but it is only getting worse.

PAT'S RESPONSE:The best thing you can do is to continue to provide your friend with feedback about his behavior. If he does or says things that make you uncomfortable or embarrassed, let him know. Encourage other friends or his family to provide feedback as well. Be sure to balance criticism with positive feedback. Remember, if the behavior is due to a brain injury, he may not always be in control of his behavior. Some people aren’t aware of the impact of their behavior on others. Don’t give up. Have faith that things can always change for the better.

DEAR PAT: I suffered a severe brain injury this past August and according to my neurologist I am between 85-90% back to normal. However, I have returned to work in a very busy environment and am still only part time building back up to my full-time position. We had an impromptu meeting last week and I was thoroughly upset. I was sure they were picking me apart even though they told me it was supposed to be constructive criticism. I wonder if that is a normal response and if there would be something that I can do to make this whole transition easier for myself as well as my co-worker.

PAT'S RESPONSE:There is virtually no one who has sustained a severe brain injury that does not experience some difficulties returning to work. Most jobs require a number of skills such as attention, memory, auditory and visual processing, reaction time, and good motor skills. Even relatively minor disruptions can cause problems on the job. Imagine a lawyer who has even slight difficulties remembering case law or a truck driver who can’t pay attention to the road. Even jobs such as working at a fast food restaurant can require people to work quickly in a high stress environment. Many people also find they have more difficulty coping with stress and are more easily frustrated.

There are a couple of things you need to consider. The first is whether or not your employer is supportive of you and willing to show tolerance as you re-integrate into the workplace. A supportive employer is extremely important for people returning to work after a brain injury. If you believe your employer and co-worker are supportive, talk to them about your situation and ask for feedback. If you don’t think they are supportive, find out about your rights in the work place. You may have rights under the Americans with Disabilities Act or other legislation.

The second is whether or not you’re ready to come back to work. Many people simply come back too early before they are ready.

If you haven’t already, consider having a neuropsychological assessment. This can help you identify your strengths and weaknesses. Think about consulting with a psychologist or other therapist that specializes in rehabilitation. They may be able to offer you good ideas, suggestions for compensatory strategies, stress management techniques, and provide a neutral perspective that you can’t get from friends or family members.

If you want more help, a new book titled "The Brain Injury Work Book: A Guide to Living and Working Productively" is available from the National Resource Center for Traumatic Brain Injury. This book is written for persons with a brain injury and provides a number of useful ideas related to working (or not) after injury. Ordering information is available on this website.

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