Impaired Decision Making- the inability to regard the cognitive processes which result in the selection of a belief or a course of action among several alternative possibilities; the inability to take into account all possible choices and come to a conclusion on a course of action.

The slowing of my processing speed the doctor says is happening, makes sense to me now that I know what it is. Processing information takes multiple parts of the brain working in cooperation with one another. For me, all thoughts are coming into my brain with equal importance and intensity.  My ability to filter importance and prioritize tasks is greatly reduced, so everything has equal power as it comes in.  I have trouble sometimes focusing my attention on what I think is most important. I cannot process/filter other things vying for my attention in order to determine the best course of action.  Therefore, I have trouble making decisions of even basic things.

Picking out what to wear is an example. I think about all the possibilities of the clothes, the work I will be doing, the weather, what I might need, which shirt works for whatever event I am going to, which one fits better, what color looks better on me.  It seems impossible to sort through all that, in addition to my worry I might not be ready for the unexpected.  It is hard to just pick one shirt.  It is easier for me if my wife picks it for me, even though it is tiring for her to pick something and then have me question why or if it is really the right shirt for the day. 

 It is the same with a big menu at a restaurant.  I drive servers crazy with my questions because I just cannot decide. It is embarrassing to be sitting there while the server waits for me to go through the whole menu asking questions.  Everyone with me is embarrassed, too.  Usually, my wife helps me narrow it down by pointing out things I will like. If she can get it down to two entrees I can usually pick, but sometimes it is simpler and less embarrassing to let her decide for me.  Then she can tell me what I need to order and I order it. I trust she knows what I like.  

There are some things which help me to cope with this processing issue. Driving helps me to think as long as it is a relaxing drive and there is no traffic. Listening to jazz helps calm stuff down mentally.  My reactions to these events on one day are different from the exact same stimuli on another day.  If I am fresh, it is easier to decide things; when I am tired and out of sorts, mental fatigue sets in more quickly. It is hard to be aware, and to predict when I will have trouble with a choice. It is like all of a sudden my brain cannot process. Flash anger pops up when I cannot figure out what to pick. Lately, I can tell I am giving out faster.  All of the sudden my brain just gives out.  No one can see when it happens or be aware of it since it is internal. It is internal torture to make decisions. It is part of me I can’t share with anyone even if I wanted to because it is  hidden, even from myself.  

Michelle gave me an analogy which has helped me a lot.  She said I have a piggy bank with only so many coins. I don’t know how to spend my coins, because I don’t know how much things cost me.  Learning to budget my coins is critical. In the past,  I have felt bad about not being able to complete tasks or I would feel guilty when I didn’t want to go somewhere we had planned to go.  I couldn’t see I was out of coins.  That comparison to a bank helped me emotionally. It made my issues outside of me; somehow the analogy separated me as a person, from the mental fatigue/overwhelm of my injury..  

 I struggle with self judgment, self-awareness, and self-observation.  It’s not because my character is flawed, it’s just that I have a limited resource.  I don’t like being different than everyone else, but the conversation with Michelle has helped me so much in figuring out why my decision making is always so hard. This idea of limited resources helps me to understand the troubles I have are my brain injury. 

I have to see my mental energy as currency.  It is a pile of available energy.  But it may not be enough for what may be demanded of me, so I have to work under a budget.  The problem is I need to learn to be aware of the cost of goods and conserve energy for more taxing activities. Many activities don’t have a price tag so I don’t know the cost of my expenses…until I am paying or, even worse, the cost is already spent and I have nothing left. I cannot always predict it.  

In my brain, I don’t connect to an idea and then suddenly I am done.  It is more like gradually the light is fading.  It gets dim.  It appears to those around me the light suddenly goes out, but to me it seems like it is more gradual. Michelle knows because she recognizes the signs when I am about to run out.  In those moments she can make some adjustments to our surroundings or do things for me.  She is good at it and I am grateful.  

Thinking of energy as currency is a practical and measurable way to talk about my life and what I have to deal with daily. It is hard to manage my life.  At times, this is true for anybody.  It helps me to think about it as assets and liabilities.  This separates the injury from my identity.  It separates my struggles, from who I am. 

I don’t want TBI to be who I am. That is one reason I don’t tell people about it. But, this analogy separates the injury from me, even though it is something I have to deal with and manage.  Someone who lost a leg doesn’t change who they are, but they have to adjust. While it is harder for me to see what adjustments I need to make, the realization that I am not flawed, but rather,  injured makes a huge difference in how I perceive things. It is more objective. 

The tipping point, when I use up cash, is that it leads to shut down.  If my assets are spent, I may need a quiet room for days.  It takes a long time to save up money, which is why I have to be wise on how I spend it.  I don’t have to say yes to every activity that comes my way. I can look and think “How much will this cost?” and be honest if something is too expensive.  I can save up money if I have a big event coming up.  My wife can say to me “You are spending too much money on this yard work today,” and I can understand immediately and exactly what she is talking about.  Looking at things like this has improved our communication dramatically.   

 Self-awareness is a hard thing for most people, but for brain injuries it is almost impossible. I know I keep saying that, but it is so true.  Because of this, my shutdowns have caught me unaware, and when things are getting slowly darker it is so gradual I don’t even notice it. Other times my mind has a sense of peace.  I would like to think there are sometimes maybe the currency is not diminishing, maybe I can even save some. Sometimes things feel effortless, other times I am conscious of the exertion required, which drains me. The weird thing is that sometimes they are the same things, and they have the opposite effect. 

Sometimes I sit down at the piano and I am doing it for a purpose, and it flows.  Then when someone says, ‘sit down and play,’ my mind goes blank. I cannot decide what to play, and suddenly I am stressed.  A lot of times I think what I am playing sounds stupid.  Other times it is good.  Sometimes it is interesting.  I want it to be interesting.  I feel like anybody who plays the piano can play what I can play, and that what I have is not all that special.  It feels so simple, no big deal. But lately, I don’t play at all. I just am not interested in it anymore. 

However, I know I have always carried some element of worship to the Lord which is unique to me. I can play multiple instruments.  If you can show me how an instrument is set up I can play it. I don’t think many people can do that, even if they are musical.  Of course, with piano as my main instrument there is a certain kind of ministry of peace and an ability to help people tap into it and feel it. I do admit it is a gift I have.  I don’t know how special it is, not to diminish it, but how unique is it for a broader audience beyond a worship setting?  I don’t degrade it, I just don’t know if everyone will view it as something of value. I know what I have musically is different, but I don’t know how many people it touches. 

I have other talents and gifts too, but the music is one thing I know I carry.  It has a place, but I am not always sure when people ask me to play, if it is the place for me to pour that out or not. Funny how I can play notes and understand musical scores, but I can’t tell if what I do is appropriate in the moment.  Lately, I haven’t been playing at all.  This makes my wife sad.  It makes me sad too.