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My Internship

 

My internship with Traumatic Brain Injury (TBI) patients, at an out-patient day program on Long Island, started recently. I get very anxious before and after my hours, but the adrenalin rush gets me through while I’m actually working there. One of my favorite activities they do there is chair yoga, though, because it gives me a chance to breathe again. I wish I could bring Butterfly with me, for my own sake but also for some of the clients, who could use some of her ambient joy. One of the guys used to have a dog, but he can’t have a pet at all now, because his aide has allergies. If he could just sit with Butterfly for a little while each day, and whisper in her ear and pet her back, it could really help him. I know that it does wonders for me.

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Butterfly, my therapy dog.

The purpose of the day program is multiple: one, just to give the families of our clients a respite; two, to get the patients out of their homes and into social situations, so they don’t feel isolated and lonely; three, to fight off boredom and depression in whatever ways we can; and four, to continue, on a more causal and social basis, the work of speech, movement, and cognitive therapy that they can’t do on their own.

I am most interested in that last part, if only because it holds the most potential for my active participation. But for the clients, I think the most essential part of the program is the socializing part. At the day program they can practice their speech and memory skills without being laughed at (for the most part), and their brain injuries are taken for granted; they don’t have to compete with “normal” people for attention, or be embarrassed or ashamed by what they can’t do.

The structure of our days at the program is a bit loosey goosey, but the clients’ favorite activities, over all, seem to be games: guessing games, Hangman, Pictionary, Jenga, Connect Four, Uno, etc. They’re laughing and testing their social skills and showing off. It reminds me of kindergarten, though, with games like Duck Duck Goose and Musical Chairs, which I found extremely stressful. Those games seemed to exaggerate the possibility of rejection for me, rather than mitigate it. But the other interns, and even more so our supervisor, are much more comfortable with this part of the work. They enjoy the games and know how to stay upbeat and playful, pushing back against the depression and stuckness that might otherwise prevail in the room.

I do well with the clients one on one, and in casual situations, because I’m genuinely curious about them, but I’m afraid of how I’ll manage running a workshop or exercise from the front of the room. I wish I could practice some of my group-running skills on the dogs, but, first of all, Cricket is not a joiner, and second, they can’t hold pens in their paws, or answer my questions in words, so a lot of the exercises would be lost on them.

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Cricket is not a joiner.

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Unfortunately, dogs can’t write.

My supervisor suggested that I use my writing background with the clients in some way: so I collected poems and song lyrics the clients might relate to; and I printed out a page of Cricket pictures so that they can identify the emotions on her face, and make up stories about what happened before the picture was taken (I’m hoping her faces will be a good instigator for discussions on anger and anxiety and joy and relief, all kinds of things they wouldn’t automatically discuss with each other out of the blue); and I made up a list of autobiographical questions for the clients to answer and turn into short essays; and then there’s a group exercise in storytelling; and then I did research on hand drumming and handclapping therapy; and I made up a quilting pattern exercise, using fabric and paper and glue. So, at least I’ve found an outlet for all of my nervous energy.

Early on, my supervisor warned me and my fellow interns that some of the clients can be manipulative, and we shouldn’t believe them when they say this or that, and they don’t want to be challenged, and they can do more than they’ll admit, and on and on. Even if all of those things are true, it’s never as simple as all that. Motivation plays a huge role in what people can and can’t do. That’s not being manipulative, it’s about genuinely needing a reason to take an action and not wanting to just do what someone tells you to do.

Depression also plays a big role. The brain trauma itself can cause depression, and so can some of the medications they need to take to control their symptoms, but there’s also the depression that comes from having your life plan obliterated, and your sense of your place in society taken away from you. It is much harder to figure out motivation when you know that you can’t meet your own goals, no matter how hard you try. You need to not only come up with a new set of goals, but you have to accept that those goals will be very modest compared to the people around you. There’s an expectation that these clients should feel grateful that they have a day program to go to, and people who will pay attention to them, but that kind of gratitude can be hard to come by when you feel like so much has been taken away from you.

I’ve learned a lot from Cricket about how to accept bad behavior that isn’t meant to be hurtful. Her short-circuited nervous system means that she has low frustration tolerance, so she will use whatever behaviors she can think of to relieve her anxiety. She doesn’t mean to be a hellion; she just wants to feel better.

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Cricket just wants to feel better.

I’m enjoying the work, but it’s exhausting. When I came home from my first long day at work (Nine AM to Three PM feels long to me), Butterfly was out of her mind with excitement. She’s not used to me being away for so long and it felt great to be getting such a greeting; those are usually reserved for Grandma after she’s been out gardening for five minutes. She ran around in circles and bumped into her sister, who was hopping and panting and trying to sniff my shoes herself. It’s nice to be celebrated every once in a while.

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“Mommy! You’re home!”

The Brain

I worked hard at gymnastics as a kid, and could barely lift myself up onto the low bar, or walk across the high balance beam. I practiced all the time, but I could never do a back walkover, or hold a handstand for the requisite ten seconds. My body is not smart in that way. My body feels like a group of people who are shouting to each other over mountaintops miles apart. It’s as if the communication system between my various body parts is crunchy and static filled, instead of clear and smooth.

Cricket, on other hand, is an athlete. If she were human instead of canine, gymnastics coaches would be clamoring for her. She’s compact (aka small), and she can run fast and jump high and stretch into unreasonable positions, just like a world class gymnast. I would not send her into rhythmic gymnastics (with the ribbon, and the ball, and the hoop, etc.), because she cannot be trusted with toys, but artistic gymnastics, especially floor work, would be ideal. Butterfly would love to run around the edges of the mat, ready with a bowl of water, or some paw chalk, when her sister needed it.

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Cricket can fly!

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No, really. Butterfly is my witness.

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Butterfly has to work on her flexibility to keep up with Cricket.

The lack of clear communication in my body has always disappointed me. I am in awe of dancers who can speak, and sing (!), with their bodies, never needing words to tell a story. I feel almost mute, physically, and it really bothers me.

My social work internship for next year will be with traumatic brain injury patients. Some will have motor difficulties, speech and reading difficulties, and pain, but all will have some kind of dysfunction in the connections in their brains. Even if every distinct brain region is working fine, the communication between the areas will be muddled in one way or another, and I think that being able to see the varieties of this will be good for me. I have never been diagnosed with a TBI, even a mild one, but while the brain can be shaken up physically, it can also be shaken up emotionally, with similar results.

I took a class called Brain and Behavior a few years ago and was fascinated by the idea that you could identify specific brain areas where certain types of information are processed. There is a biological basis for the things we consider ephemeral and wispy, like emotions, and knowing more about the brain gives more weight to all of those things people have pooh poohed for years as silly and unprovable. Studying the impact of brain injuries on different areas of the brain helps us understand how much who we are, and how we behave, is physiologically caused.

The work I will, eventually, be doing at my internship, comes after the physical therapists, and occupational therapists, and speech therapists have done as much as they can to stabilize the TBI patients, but I will get a chance to observe their work, and I’m very interested in seeing the different methods people have come up with to try and retrain our bodies and brains. With one kind of injury, practicing speech patterns and walking skills can really bring you back up to close to normal, but with another injury, no matter how hard you practice, the brain connections just aren’t there and can’t retain the information. There’s some relief in the idea that you could know which goals are reachable with hard work, and which ones are just not possible.

I can watch Cricket and Butterfly walking next to one another and see clearly how their different physiques control and limit how they walk. Butterfly will never be as flexible as Cricket is, because her rib cage is too big and her legs are too short. And Cricket will never “walk like a girl” because her hips are slim and refuse to sway. Butterfly’s brain can’t begin to imagine the number of horrible dangers Cricket believes are right outside the apartment door, and Cricket’s brain cannot fathom the Zen-like calm that Butterfly feels when she hears bird song in the distance.

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See, they’re completely different.

I wish I could accept my own limitations for what they are, but I still hold onto the dream of plasticity, that my brain will change and grow over time and allow me to be something more. It’s not impossible, actually. Someday, Cricket’s brain might rewire itself inexplicably and allow her some peace.

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Wouldn’t that be wonderful?