In 2018 I was diagnosed with a T Cell Lymphoma cancer, I underwent seven rounds of chemotherapy and a STEM cell transplant. I then spent twelve months in hospital and lost the toes off my right foot, 20cm of my bowel, my ability to eat meat and seafood, my sense of smell, my sense of taste, my sense of place. Whilst all of these side effects from the cancer treatment were difficult to deal with, the worst side effect was an acquired brain injury, which is preventing me from being the father I want to be, the husband I need to be, and from being the Strategy Development Manager I really loved being.
The acquired brain injury occurred when bacteria from an infection in a wound, infiltrated my brain, causing Encephalitis, which resulted in severe brain damage, and a cognitive impairment. The damage was primarily to the memory functions of my brain, causing both long and short term memory issues. I’m now constantly forgetting things, and I find it difficult to recognise people. It also causes disorientation, best illustrated when I was released from hospital and didn’t know how to get home, which was quite disturbing.
The damaged part of the brain cannot repair itself. The brain has to learn new neural pathways around the damage. A great analogy to use is a road system. Imagine all the neural pathways in your brain as road network. The brain damage I suffered is like roadworks, or an event that prevents cars from getting through like a flood, or a landslip. You have to figure out a different way to get to where you are going. It will most likely be longer, slower and there’s a good chance you’ll get lost. But every now and then you find a shortcut, which is so cool.
I lost huge chunks of my memory. I don’t remember contracting cancer; the diagnosis; seven rounds of chemotherapy; the STEM cell transplant; my first admission in hospital where they cut off my toes and removed my intestine; I don’t remember being released; any time I spent at home; going to Accident and Emergency a dozen times because all the side effects from the cancer treatment were acting up. My first memory of my entire cancer journey is walking into the hospital for my second admission, looking down and asking the nurse and my wife what happened to my toes! At one stage I didn’t recognise my wife and son. I couldn’t remember our wedding, the honeymoon, or the birth of our son. What kind of husband and father was I!
I dealt with my long term memory loss by setting off on a mighty quest to find my memories and I wrote my autobiography https://chalksketchesonthefloor.wordpress.com/ and it was so rewarding. I reconnected with my life. I closely examined everything that was important to me i.e. people, places, ideas, capabilities. I reconnected with people from my past. I sat back and admired how I’d created my life and career. It gave me confidence that I could conquer this tough time, because it reminded me of all the other tough times that I had conquered. More importantly it gave me hope that I’d continue my amazing life after I had conquered cancer.
Writing my autobiography also reminded me of all the amazing skills my parents had taught me, which gave me the strong desire to teach them to my son, so he could carry on these great family traditions.
Word and number app games are interesting. There’s a lot of evidence which suggests that they are good therapy for healing brains. The word games helped me remember words and also problem solving as you figured out which words you could construct from letters. Sudoku is another game that’s helping me practice ‘joining the dots’ in strategy development. With sudoku you do a bunch of data collection by making notes of which numbers can go in which box. You then analyse that data and eliminate possibilities and then suddenly the answers start to appear and then BANG the answer is right in front of you. It’s exactly the same in strategy development. Gather the data, do the analysis and BANG, the strategy appears right before your eyes. I also used these games to give me confidence. They say things like, well done, amazing, unbelievable and who doesn’t like praise?! Being able to solve the puzzles quickly and easily, also gave me confidence that my brain was still working. So I’d find that playing these games when I felt like an unproductive member of society, left me feeling more confident that I’d successfully rejoin the world.
I also undertook Return to Work therapy with the Rehabilitation Team at the University of Canberra Hospital. Which helped me to understand and develop strategies for the primary issues I’d face when I returned to work, which we determined would be my memory issues and mental fatigue.
For my short term memories issues, I should make notes, set reminders, and keep my calendar up to date. These skills will continue to help me, even after my short term memories recover.
To manage my mental fatigue, I should take regular breaks i.e. every hour I should get up from my desk to get a glass of water, go to the toilet, or just a short walk to clear my head. Also when my boss asked me to do something, I should get him to both write it down and tell me verbally, as this uses different neural pathways, which makes it easier to remember.
To deal with my disorientation, as I was being driven around, I’d purposefully practice trying to remember how to get places and It took me six months to finally remember how to get home. But it made me so happy when I finally could!
After my discharge from hospital and readjusting to life at home, I was comfortable that the strategies I’d put in place to deal with my acquired brain injury would work well, and I made the decision to return to work, to the job I left before my cancer journey as a Strategy and Business Development Manager with Lockheed Martin Space Systems, with an amazing boss who supported me brilliantly during my journey and was very clear that he wanted me back. But we also acknowledged the need for flexibility as I returned to work, especially with my cognitive impairment. Before my cancer journey I had never needed, or even considered flexible working options. But suddenly flexible working practices weren’t just a nice to have, they were essential for me to get back up to speed as I returned to work. Although even if I hadn’t suffered my cognitive impairment, flexible working conditions would have helped me, because returning to work after a long absence can be difficult for everyone.
The Rehabilitation team at The Canberra Hospital had been fantastic whilst I was admitted there. They got me back in front of a computer for extended periods of time, producing work-like products before I was discharged, which helped me understand how many hours per week I could cope with. They then sat down with my boss, who welcomed me back with open arms and a flexible approach, by very kindly agreeing that I could start out working 12 hours per week over three days.
Working from home didn’t even cross my mind, because I really enjoyed going into the office to reconnect with my colleagues, talking with them to get my “head back in the game” and most importantly, sharing a coffee. I also really needed my boss’ help to get me back up to speed and he did such a great job. He did everything he could to get me back up to speed. Going into the office really helped me in all these areas.
Wanting to go into the office was also partially driven by my work ethic. The business was paying me to deliver, so I should at least turn up, I felt that I needed to be seen working. This work ethic had been instilled into me from an early age. I had started working while I was in primary school, mowing lawns for half a dozen neighbours. Then during high school I delivered newspapers and worked in the hospitality industry.
During this time my parents had rightly ensured that I understood that people were giving me their hard earned money to help them. It came with obligations and expectations. That I should turn up and do the best job that I could. I further refined this as I entered the workforce and it had been really successful for me throughout my career.
It was a job that I knew well and really loved. But I was a changed man because of my cognitive impairment. Both my boss and myself acknowledged this and we talked about it. We discussed that I was a top performer when I had left the role, that we weren’t sure if I was again, but he said that it didn’t matter if I wasn’t.
As part of my return to work plan, he had prepared a list of tasks for me to do. He had put some really good thought into these tasks. They were designed so that I could; get back up to speed with our current projects and business pursuits; reconnect with internal stakeholders; and fully understand all the changes to the market that had occurred in my absence.
I clearly understood all the tasks my boss had assigned. I had done them before, I remembered how to do them and I was confident I could do them again. But frustration set in. I was doing the tasks, but nowhere near as quickly as I knew I could do them. My productivity was down. This was because of a combination of factors.
Because of my memory issues I had to spend more time writing things down. I’d also forget things that I’d done. For example one day I mentioned to the boss that I might construct a profile of an emerging competitor in the space industry. To which he replied “you did that last month”. Sure enough, I went back and checked my files and there it was. So I found that I would need to go back over my work multiple times, which slowed me down.
I was also having difficulty organising my thoughts to solve problems, and finding the right words as I wrote something. Which also resulted in me struggling to ‘join the dots’. Joining the dots is the ability to look widely across the entire business strategy and see how different parts of the strategy can work together to create a larger opportunity. This was one of my key strengths before my cancer journey. Now the cognitive impairment I suffered prevented me from doing the wide thinking needed to join the dots.
But the worst part of my cognitive impairment is the mental fatigue I suffer. At work I’d get to a point where I know what I need to do, I know how to do it, but my brain just doesn’t work and I can’t do it. My head hurts, but not like a headache, it’s like my brain is trying to escape my ravaged body. It also results in my head being highly sensitive to the slightest noise. The only way to fix it is to rest. Find a quiet spot and practice some mindfulness. I didn’t realise it at the time, but I wasn’t taking the brain breaks that I needed to remain productive. This was driven by my work ethic, which meant that I’d feel guilty taking the brain breaks that I needed, rather than seeing them as key to better productivity. So while my work ethic had been so successful for me before my cancer journey, in my current cognitive state it was working against me. I was a changed man.
A great example of my work ethic working against me, is coffee breaks with my colleagues. Before my cancer journey I’d regularly go on them, but I didn’t have a single coffee break with a colleague when I returned to work with Lockheed. My boss did comment on this. At the time I couldn’t explain why I wasn’t taking coffee breaks with colleagues, but looking back it was because of my work ethic. I was only working 12 hours a week and my work ethic was telling me that I should be doing at least 38 hours. Before my cancer journey, my work ethic would drive me to work 40-45 hours a week. So my work ethic was telling me that taking a 20min coffee break was wasting my time, which I didn’t want to do, especially after they’d be flexible enough to allow me to only work 12 hours a week. I’d even eat lunch at my desk whilst working, because I felt guilty just sitting in the kitchen eating for 10minutes.
But it’s not just work that sets my head off. Just talking to people does it; going for a drive in the car; eating in a restaurant; flying in an airplane; building things in the backyard; noises; all sorts of things. This makes being a good husband and father terribly difficult. I’d get to Friday and my head would be buggered from work. I’d rest all day Friday, but it still affected me over the weekend, which prevented me from being the father I’d want to be and the husband I need to be. Luckily my family are very understanding. My wife knows when I need a break even before I do, and she willing gives it to me. My son will often ask me how my head is, before he asks me to play a game. This is so gratefully appreciated, but it’s still really frustrating for me because I want to do all these things. I want to be a kind loving husband and father. I just want to get out in the backyard and kick a ball, I want to take my wife to a restaurant or drinking at a bar. But I can also accept that there’s nothing I can do about it. So I’m sad, but I don’t get caught up in anger and regret.
Head movement seems to be a cause of my bad heads. So when I’m flying in a plane or driving in a car, my head is constantly being just slightly jerked around in all directions. This is also an issue when I’m building things in the backyard, because I’m constantly moving my head, side to side and up and down, as I’m lining things up. So even though I desperately want to teach my son, the skills my dad taught me, I just can’t right now.
Noise is another cause of my bad heads. It doesn’t even have to be a loud noise. When I go into the office to work, just the background noise gives me a bad head. Restaurants and bars are even worse due to the clattering of crockery, people talking all around and loud music. When I do have a bad head, just the sound of my son gently building lego makes my head explode. This also makes it difficult to go out for dinner, or to a bar. Which means I can’t be the loving husband my wife needs.
My acquired brain injury also causes vertigo. Sometimes when I stand up, my head will spin. I just need to pause briefly before I take off, so I don’t fall over. I think this partially explains the issues with cars and airplanes. My heads are always worse if I’m driving up or down a steep mountain. The endless corners also do not help. But the best example of vertigo that I have, is when I visited Leven Canyon in Tasmania. It’s a 275m high Lookout, with a see-through wire mesh base. Just walking out on the lookout sent my head severely spinning.
My other impairments also require me to use my brain more. Because of my missing toes, which cause balance issues and the nerve damage on the soles of my feet, when I’m going for a walk, my eyes scour the track looking for obstacles. I can no longer just mindlessly wander along. Because of my memory issues I have to concentrate on identifying the key bits of information I need to remember. I also need to think harder to remember things. All of this adds additional mental fatigue.
But on my bad head days I can’t just sit around all day. Sure I have to rest, but doing productive things i.e. working, housework, going for a walk, working; gives me a good feeling, which helps clear my brain, even on a bad day. In fact it gives me an even better feeling a bad day, because it’s harder to do it on those days. But it also causes fatigue, so it’s important to understand what I can and can’t do, and to limit the those activities.
Eventually my company asked me to undertake an Independent Health Assessment. They were interested in discovering how long it would take me to get back up to speed and if there were other things I could be doing to help me get back up to speed. To be honest I was very curious about this myself, so I thought I’d give it a go.
The report from the Independent Health Assessment indicated that my cognitive function was permanent and that I’d never again be able to do the wide thinking needed to develop strategies. I can guarantee you that this made my head spin! I honestly wanted to cry. I loved being a strategy guy. But I also had the humility to know that I wasn’t doing a good job, that the cognitive impairment did prevent me from developing strategies. The brain damage is also permanent, it needs to learn new neural pathways around the damage. No one knows how long that will take, or even if it will happen. I had to find a new job that didn’t need the wide thinking that strategy development required, a job that was rote and repetitive. I decided to dig back in my career to find this type of job, looking at quality assurance or delivering training courses, because they didn’t need the wide thinking I could no longer do.
I then found the most amazing new job with a mighty Australian owned software development company called 12thLevel, who have outstanding flexible working practices, that are making it so much easier for me to deal with my cognitive impairment and be more productive. Whilst I still get some bad head days, they’re nowhere near as frequent, or as bad as the head days I chronically suffered at my previous job.
When I had interviewed for the job with my new boss Andrew, I’d been very open about my cognitive impairment and how it affected my work performance. He didn’t even bat an eyelid when I told him I could only do 12 hours per week. He didn’t require me to set specific days and times to work. I could work from home whenever I wanted to. There’s only 24 employees at 12thLevel, when I first started, one was working from Singapore, another in Mexico, there’s a couple in Melbourne. Working out of the office is situation normal! So when my Occupational Therapist kindly offered to once again help me negotiate flexible working, I politely declined, because there was nothing to negotiate!
But even though I could work from home. I still wasn’t sure that I wanted to. I really enjoyed going into the office to work. I had a whole bunch of new colleagues to meet and get to know. I was also working in a new industry, so I had lots to learn. But lots of people were suggesting that working from home would help me. I also acknowledged that my working strategy at Lockheed Martin, didn’t work for my cognitive impairment. So I gave it a go.
When I did start working from home, it surprised me. I found my head wasn’t as bad after working from home. I think this is partially because I would take better brain breaks. When I had returned to work with Lockheed Martin, I felt like I had to prove that I was still capable. So I was even more determined to have a good work ethic. Which resulted in me thinking that going for a walk, or getting a coffee, even taking a lunch break, as slacking off; rather than acknowledging that it was key to better productivity. That attitude had been very successful for me in the past. But in my current cognitive state, it was a killer. I hadn’t recognised that I did this when I had returned to work at Lockheed Martin. It was only when I started working from home that it had occurred to me that I was doing this.
But I also developed new habits when I worked from home, which led me to be more productive. I’d start each day by planning out what I wanted to accomplish for that day. I’d never done that before. Then I’d review the material for the task at hand. Then I’d go for a walk. Whilst I was on my walk I’d consider my tasks, and I’d get great ideas for how I’d should do them. Every single walk. Nature clears a cloudy head. Every. Single. Time. I also found that I was more conscious of when my brain fatigue was setting in, which led to better brain breaks. All of these things result in me being less fatigued and more productive.
But even though working from home was helping me so much, I was still determined to go into the office at least once a week. I would go into the office every single day if I could. Unfortunately my cognitive impairment makes that difficult and I’m so lucky my boss allows me to work from home, which means that I’m more productive. Unfortunately going into the office for just one day still wipes me out. I think this is a combination of factors. Just talking to people causes mental fatigue. Even going on a coffee adventure talking with friends wears me out. It is also continuously noisy in an office, albeit at a low volume, but just this slightest noise affects my brain which results in fatigue. My work ethic is also so deeply engrained in me, that it continues to drive me and I do feel guilty taking the brain breaks. But I now force myself to take brain breaks, because I’m more mindful how they help me be more productive.
So whilst I had been aware of the benefits of flexible working and the need to take good brain breaks when I first returned to work. I never fully embraced them until I started working for a company that also fully embraced them. It helped me feel so much more comfortable taking the breaks that I needed.
Even though my acquired brain injury is permanent and there’s nothing the doctors can do about, I could still see benefit in exploring if the medical system could help me deal with it. So I booked in to see a Neurologist at the University of Canberra Hospital and we conducted a Neuropsych Assessment to compare against the one I’d completed when I was in hospital. The assessment showed an improvement! I was still below expected memory levels, but it was above my last assessment and I’ll take that! We then talked about exercises I could do to help with my mental fatigue issues and much of what I was already doing was helping me. Then we got to mindfulness.
During my hospital stay I’d worked with my Occupational Therapist and she had reminded me about mindfulness and I’d then used it as a key strategy to manage my brain fatigue. But as I talked through mindfulness with my Neurologist, he kindly pointed out that I could be doing it more effectively. A proper brain break doesn’t involve scrolling through social media, or other similar distractions, it’s a meditation. This realisation then helped me take better brain breaks. For me it’s about observing. Observing the wind blow the leaves. Observing the birds flying high. Observing my own thoughts and feelings. Marvelling about how the world operates so beautifully. I’ll do this sitting in a chair, or walking along and I’ll sing to myself as I do it. Which leaves me more peaceful and in tune with my thoughts. So while I’d been mindful about practicing mindfulness, I hadn’t been giving it the attention it deserved. Don’t think the irony of that isn’t lost on me 🤣
I now have to know my limits, so that I don’t push myself over the edge. I have to stop myself doing things, even if I really want to do them. A good example was when I flew down to Tasmania, straight after the borders opened during the Coronachaos. I was so looking forward to spending time with my mother who had been terribly isolated. So I was keen to spend as much time down there as I could. Unfortunately I chose to fly home two days before I got up on stage to tell my cancer story, to help The Canberra Hospital Foundation raise funds. I was so excited to this for them after they had helped me survive and thrive through my cancer journey. They also had a bunch of bands playing live music, which was cool. But it destroyed my head, which was already quite tender from the flight home. The next day was my work Christmas party which I really wanted to attend, because I’d only just joined the company and I really enjoyed working with every single workmate. But the party was in a bar, which would be very noisy. On top of flying home and getting up on stage, it would have wiped me out for at least week! So I unfortunately had to miss it and I felt so bad for missing it.
My cognitive impairment has highlighted a key lesson for me. What seems like the fast way, is not always the fast way. My work ethic was telling me that if I took breaks, then it would take me longer to finish a task. When the reality was, that I need to take breaks, to be more productive when I do work, which helps me finish something faster and better than if I hadn’t taken the breaks.
I found a great analogy for this lesson when my mother took me up to Cradle Mountain. You can no longer drive all the way to Cradle Mountain because it got too busy. You now have to park at the Visitor Centre and catch a shuttle bus for the last 20 minutes into Cradle Mountain. We were waiting in a big line to get on the bus. When we finally reached the front and stepped on the bus, the driver announced that it was standing room only. We’d been waiting a long time, some would say the fastest way to get to Cradle Mountain would be to suck it up and stand. But we stepped out and waited for the next bus. Then as we’re driving along on the next bus, we actually passed the first bus we’d got on, that was standing room only. We beat it to Cradle Mountain and we got to sit down along the way. Slowing down and waiting for the next bus got us to Cradle Mountain faster, much more comfortably.
My best advice for people suffering an acquired brain injury is that if you explain your condition and how it affects you, most people will understand and support you. Everyone suffers similar conditions, people forget things, they suffer mental fatigue, etc the cognitive impairment just exacerbates them.
Also seek help to understand your impairment, and develop strategies to combat it. Then practice these strategies regularly. I had a great team at the University of Canberra Hospital that helped me to understand and develop strategies for my cognitive impairment, but I didn’t diligently follow those strategies. I’m now much more diligent and it’s helping me enormously.