NASA Technical Memorandum 104635 /

Building Satellites Is Easier

Phyllis Nimmo Marsh

June 1996

NASA Technical Memorandum 104635

Building Satellites Is Easier

Phyllis Nimmo Marsh

National Aeronautics and

Space Administration

Goddard Space Flight Center

Greenbelt, Maryland 20771

1996
This publication is available from the NASA Center for AeroSpace Information,

800 Elkridge Landing Road, Linthicum Heights, MD 21090-2934, (301) 621-0390.
CONTENTS

.,o

Forward .................................................................................................................................... ill

Introduction .............................................................................................................................. v

! Cannot Spin Gold from Straw ................................................................................................ !

Sometimes You Have To Look Straight Ahead ....................................................................... 11

This Has Gotten a Bit Out of Hand ........................................................................................ 17

Pigs and Fat Bats .................................................................................................................... 21

The Set O' the Sails ................................................................................................................ 27

When Anger Becomes a Today Question ............................................................................... 33

Everything I Did Not Know About Thyroid ........................................................................... 37

Two Steps Forward, One Step Back ....................................................................................... 43

Settling In ............................................................................................................................... 49

Going Home ........................................................................................................................... 53

O Montebello, I Sing your Praises .......................................................................................... 57

Home for Good ....................................................................................................................... 65

Re-Entry ................................................................................................................................. 69

When Is a Husband Not a Husband ........................................................................................ 75

Healing ................................................................................................................................... 85

When Bad Things Happen to People Who've Had Head Trauma .......................................... 91

Progress Hurts ....................................................................................................................... 101

No One Remembers Rocky Did Not Win the Fight ............................................................. 107

FOREWARD

Jim Marsh joined the staff of Goddard Space Flight Center (GSFC) in 1964. Serving within the

Laboratory for Terrestrial Physics, he was a prominent scientist and team leader for diverse activities

including the development of GSFC's precision orbit determination capability, utilization of satellite

altimetry to further the goals of ocean and geodetic science, and improving knowledge of the global

gravity field. Jim had a very productive career, producing over 100 publications with more than 80

being in the refereed literature.

Jim's accomplishments included application of satellite observations for measuring the size, shape,

gravitational, and tidal field of the Earth and developing models for improved orbit determination.

These investigations produced both the NASA standard and internationally recognized state-ofthe-art gravitational models used for geophysical and orbit determination purposes. Jim played a

key role in many NASA missions including those flying altimeters (GEOS-3, SEASAT, TOPEX!

Poseidon) and those used to study the properties of the solid Earth employing precision laser tracking

(LAGEOS, LAGEOS-II). By fostering international cooperation and collaboration, Jim Marsh

was instrumental in making satellite geodesy an international forum for multi-disciplinary science

having extensive ties with astrodynamics, geophysics, geology and oceanography communities.

He served as the Secretary for the Geodesy Section of the American Geophysical Union and received

numerous NASA and International Awards including the NASA Exceptional Service Medal in

1980. Jim was a Principal Investigator with the GEOS-3, SEASAT, LAGEOS, LAGEOS-II, TOPEX,

and Crustal Dynamics Projects.

Despite being held in high esteem by colleagues and friends, Jim Marsh committed suicide at home

on the morning of June 30, 1991.

This document is a narrative of Jim Marsh's struggle to overcome a medical disorder, which was

seriously complicated by a suicide attempt. It was a tragedy which involved and touched colleagues

around the world and those within the NASA/GSFC community. It is also the story of a family

rising to cope, support, and heal, a family member. It describes a journey of rehabilitation and

frustration.

This, at times, painful story contains many important messages; included is the complex

manifestations of serious head injury and trauma and the day-to-day struggle of rehabilitation.

These are important lessons for preservation and improved understanding, and the motivation for

this publication.

May 1996

Dr. David Smith

Head, Laboratory for Terrestrial Physics

NASA/Goddard Space Flight Center

111

INTRODUCTION

Building Satellites is a story about Jim Marsh's recovery from a severe head injury told by

his wife Phyllis from the moment she learned of its happening, through the ups and downs of a

lengthy rehabilitation, until his return to work and daily living. It continues on, however, and

narrates his battle with the more insidious Graves' disease. Told in the first person, Building Satellites

vividly portrays Phyllis's thoughts and feelings throughout this experience with scrupulous honesty.

This is a story worth reading for many reasons. First of all, Jim was an accomplished

scientist, respected by his colleagues both in this country and abroad. Secondly, it narrates the

many stages of his recovery from head injury with detailed, readable accuracy; it informs us as well

as inspires. Finally, Building Satellites also tells us the story of Phyllis Marsh's remarkable, creative

response to this crisis. It narrates her personal experiences as she progresses through the strange

and sometimes bizarre world of medicine and rehabilitation, guided by a few basic beliefs, which

she learned as a child in Iowa, that provided her with the strength to endure. Building Satellites

seems to reaffirm our unconscious, but settled conviction, that when confronted overnight with

adversity, we are somehow given the means for coping, supported by our basic beliefs, strengthened

by family and friends, and eventually learning to accept any outcome.

Jim Marsh was a remarkable man with whom we were privileged to work. He seemed to

welcome the challenge of his recovery, and by his example, challenged all those around him. Building

Satellites is a testimony to both his and his family's courage, an inspiring work which provides an

example of how others might learn and grow from personal crisis.

William E. O'Donnell, Ph.D.

Brian Bemis, M.A., C.C.C.-S.L.E

January 14, 1993

I CANNOT SPIN GOLD FROM STRAW

The call came in the midst of laughter.

On Wednesday, February 22, 1989, three

friends, who were also my co-workers, and I had

splurged on lunch at a nearby restaurant and

joked about the movie "No Way Out" with its

surprises. Giggling as ! opened the door to the

office, I heard over the intercom, "There is an

emergency call for Phyllis on line 5."

"Mrs. Marsh, my name is Hannah

Shafer." The emotionless voice of the stranger

provided no clue about why she was calling. "|

am a social worker at Huntington Memorial

Hospital in Pasadena, California."

"Uh, oh," I thought, "what has Jim

done?"

"Your husband has been injured and is

in surgery now," she continued. "He is in very

critical condition, and you need to make

arrangements to come as soon as possible. Two

of his coworkers, Steve Klosko and Chet

Koblinski, are here with me, and here are the

numbers where we may be reached."

"But how was he injured?" I asked

myself.

Jim, a geophysicist with NASA, used

data from artificial satellites to study the earth.

On Monday, he had left Maryland for Pasadena

to attend an international scientific conference

on this work. Jim was a leader in the project

under discussion.

The previous two weeks Jim had been

tired and depressed. His sleep patterns were

disturbed; he would fall asleep but seemed

unable to stay asleep. When he complained of

cold legs, I guessed he had a thyroid problem.

In 1970 he was prescribed radioactive iodine to

cure his overactive thyroid and was told his

thyroid might someday go low. He had made

an appointment to see a doctor but could not

get in until after he was scheduled to return from

Pasadena.

Now he was in critical condition in a

hospital three thousand miles from home.

I explained to the social worker that Jim

had two problems the doctors needed to be aware

of. For some time, he had complained of numb

legs and feet, and the previous week he felt the

numbness was spreading to his hands. I

explained his thyroid history and asked that his

thyroid be checked.

The social worker handed the phone to

Steve, and I asked how Jim had seemed at the

meetings. He said Jim contributed well on

Monday afternoon and Tuesday morning, but

something seemed to change in him on Tuesday

afternoon. Several people became concerned

because Jim was so withdrawn.

After relating to Steve my concern about

Jim's medical problems, I asked him what had

happened. He hesitated, then said, "He has been

injured in a fall."

"How?" I wanted to know.

Steve covered the phone while he asked

the social worker what to say. He answered, "It

was from a pretty great distance."

"Like from a balcony?" I asked.

"Yes."

I did not want to know more. I told Steve

I would let him know my plans, walked into the

next office, and said to my supervisor, "My

husband has been injured, and I need to go to

California."

I then paced the floor as I began a mental

list of things I needed to do.

One of my luncheon companions drove

me to the credit union at the nearby Goddard

Space Flight Center so I could get some cash.

Another one drove me home in my car and the

first one followed us. In the meantime my

supervisor made plane reservations for me to

leave for Los Angeles at 7:00 P.M.
PHYLLIS NIMMO MARSH

On the way home, I decided to call

Sylvia in Omaha. She is the wife of my brother

Ken, and we call her "our own 911." She and I

helped the family cope when Ken's twin, Keith,

was dying of melanoma in a Minneapolis

hospital. We again shared responsibilities when

my father had a stroke and my mother broke her

hip, and both were in a rehabilitation facility in

Des Moines.

"Hello, Sylvia."

"Well, Phyllis! This is a surprise." Sylvia

knows I am not inclined to pay the rates for middleof-the-week, daytime long-distance phone calls.

"Is there something wrong?"

"Well, I'm okay" I stated, "but I just got a

call from California. Jim is there at a meeting and

has been injured. He's in critical condition. I'm

packing to leave, and I need a friend."

"You want me to come?" she asked.

"If you could. He's in really critical

condition."

"Would you believe, Phyllis, I am packed

ready to leave tomorrow to go to Salt Lake City

to do research and my calendar is all clear. I

can just change my plane tickets and leave

tonight."

"Could you? I'd really appreciate it." I

did not know what I would do if she could not

come.

asked.

"Do you want me to rent a car?" she

"Yes."

"Shall we get a motel room?"

"Yes."

"Phyllis, I had a meeting scheduled for

today that was canceled. It is unusual I'm here

to get your call."

We then worked out the details. We

would ask Steve and Chet to find us a motel room

and leave the address and phone number with

the ticket agents of the airline she would be

flying in on.

Sylvia planned to rent a car at the Los

Angeles airport and drive to Pasadena in the

middle of the night. Even though she and my

brother, a retired career officer in the Air Force,

had lived and traveled many places in the United

States and Europe, she had never been to Los

Angeles and never traveled the LA freeways.

Sylvia is a person who could conquer them for

the first time under such circumstances.

She later told me that when she called

my brother, his response was, "If Phyllis calls,

you know it's serious, so go."

A different social worker from the

hospital called and said Jim had survived the

surgery. He had landed on his right hip causing

a great deal of injury there. Since there was good

brain wave activity, there did not seem to be

major trauma to his head. His heart was very

steady. The severe trauma to his body, though,

had left him in critical condition.

Then she asked, "Has your husband ever

been suicidal?"

"No," I said, "he has always been a very

stable person."

Now I was confronted with both a

medical crisis and the question of suicide. I

knew, however, I needed to make arrangements

to go to California, and I forced myself to think

of that.

Mathew, our 20-year-old son, worked

as an engineer's aide in a local laboratory and

lived at home. My friend who had driven me

home called him to relate what sketchy

information we had. When he came home, he

and I decided he would stay at home by himself.

Our daughter Melissa, a high school

junior, had gone out with friends after school,

and I did not get to see her before leaving. The

mother of her good friend told me Melissa was

welcome to stay at their home, and I knew she

would be in good hands. My neighbor came

over to wait for Melissa and explain what had

happened.

My friends drove me to Baltimore

Washington International Airport. "Jim must

still be alive," I told them as we waited. "Steve

and Chet know my flight number, and I figure

they would stop me from coming if Jim were

dead." Six and a half hours after receiving the

phone call, I boarded the plane to California.

2
BULIDING SATELLITES IS EASIER

The flight took five and a half hours.

Sitting alone in the first row of tourist class

staring at the dark sky I had no sensation of

moving. I felt like I was playing the children's

game where straight chairs are lined up in a row

and everyone pretends to be on an airplane.

Every fifteen minutes I looked at my watch and

went into the bathroom. No one questioned my

strange behavior.

For five and a half hours I did not know

whether I was a widow or a wife. I could not

comprehend my future so I concentrated on why

Jim could have done the unthinkable. Mulling

over the previous weekend and the past few

months, the only thing that made sense was that

Jim's thyroid had shut down. "This must be a

syndrome," I thought, "and they should know

about it in a good hospital."

The thought of Jim's dying was

unbearable.

As the plane landed at Los Angeles, the

pilot came on the intercom. "Ladies and

gentlemen, our gate is not ready so we will have

to wait here awhile."

There I sat, desperate, with no way to

bridge those last few yards so I could learn if I

still had a husband.

Chet and Steve met me, and my first

words were, "Is he still alive?"

"Yes."

"Then I think he can make it." I reached

out to them as I continued, "And let us remember

good things happened today also." I thought of

Sylvia being free to come.

Chet and Steve had become involved

when they returned to the hotel to see why Jim

did not arrive for the morning meeting. They

discovered an ambulance was taking him to the

hospital and followed it.

During the time I was on the flight Jim's

blood pressure could not be stabilized. Several

doctors worked over him, and the situation was

very critical. About two hours before Chet and

Steve left to meet me at the airport Jim's blood

pressure had stabilized, and they felt much more

confident.

When we arrived at Huntington

Memorial Hospital, it was almost ll:00 RM.. A

social worker escorted us to the intensive care

unit (ICU). There a resident told me the same

general information I aheady knew. He also

indicated Jim's wrist was cut and this had caused

a loss of blood. The resident began explaining

all of the machinery I would see, but I had visited

people in ICU before and knew what to expect.

"Can I just go in and touch my husband'?" 1

asked.

Only one spot on Jim's right shoulder

seemed accessible. A pin beneath his right knee

was hooked up to traction to hold his leg in place.

A tube down his windpipe delivered oxygen to

his lungs. Monitors measured his heart rate, his

blood pressure, and the oxygen in his blood, and

the accompanying machinery filled the room.

An IV administered drugs and fluids. A device

in his mouth held it open, and a stiffplastic collar

stabilized his neck because the staff had not been

able to X-ray the seventh vertebrae, and until

they did so, they could not take a chance on a

fracture. The nurse assured me Jim was

breathing on his own.

Standing there I wondered if Jim Marsh

would ever emerge fiom the prison he seemed

to be in.

Steve and Chet insisted on driving to the

airport to meet Sylvia alter dropping me off at

the Pasadena Hilton. "Tell her everything you

know," I said, "because she is here to help me

and can only do so if she has the facts." At the

airport she recognized their names and was

relieved that her introduction to California's

freeways was not going to be a late-night drive

to Pasadena in a state of shock.

Sylvia explained to Chet and Steve that

she and I had climbed a couple of mountains

together. "Phyllis will handle what has to be

handled," she told them.

Sylvia arrived at the hotel around 2:00

A.M., and we spent the night passing each other

on the way to the bathroom. If we slept at all, it

was in five-minute segments.

Her first task the next morning was to

confirm that Jim had attempted suicide. I had
PHYLLIS NIMMO MARSH

not heard a definitive statement that convinced me

suicide was the only explanation for his injuries.

When the doctor had said earlier that Jim's wrist

was cut, I thought it had been cut in the fall. Sylvia

discovered he meant that Jim had cut his wrist

before he jumped. That information created a

totally different picture.

"Thank goodness he jumped," I said, "or

he might never have been found alive."

This was our first "red dress day." We

dressed as if we were going to an officers' wives

luncheon; I wore a red wool crepe dress and Sylvia

a dusty pink ultrasuede suit. Earlier medical

situations had taught us to enhance our credibility

by dressing up. In this strange hospital in an even

stranger situation, we needed every boost we could

get. For several days afterwards, the first question

of the morning became "Is this a red dress day?",

and when we were meeting with new professionals

or wanted some specific answers, we ",always agreed

it was.

Chet and Steve helped Sylvia rent a car,

and we followed them to the hospital. The chief

trauma surgeon met us in the Intensive Care Unit

to explain the situation. Jim was very seriously

injured; they had worked mainly to stabilize his

condition in surgery. After discovering internal

bleeding they had done abdominal surgery. A

laceration on his liver and a break in one of the

blood vessels leading to his intestines caused the

bleeding but were not considered serious

complications since the doctors had operated so

quickly. A quick look around Jim's insides

indicated good health. "What a way to have a

physical!" I thought. If he stabilized enough for

further surgery within the next three weeks, his

recovery would be quicker because a pin could be

put in his leg. If they could not operate before the

three weeks, Jim would have to remain in traction

and recovery would be more prolonged. There

was serious concern about his lungs because of a

bruise to the right one.

Because of the seriousness of Jim's injuries

and because of his age, the doctor felt there was a

less than fifty percent chance that Jim would live.

If he lived, his recovery would take a very long time.

Because Jim had both cut his wrist and

jumped, experience had taught the trauma team

that he was serious about the suicide, and in

similar cases an overdose of drugs often

occurred. Therefore, they did a drug screen on

him. Of course, it came back negative. The

doctor, I'm sure, thought I was naive when I said

Jim would not have known where or how to get

drugs, but he lectured me saying that people find

out if they really want to know. I knew my

husband better than that.

Sylvia and I then had to find our way to

the Pasadena Police Station. The police had

conducted a complete investigation to make sure

there had been no foul play and would only

release Jim's belongings and money to me. But

first we had to find the station.

Chet and Steve had drawn a map for us

on how to get back to the Hilton from the

hospital. However, they live in Maryland, and

their Pasadena map did not have north in the

proper place. When we showed it to the lady at

the front desk of the hospital and asked where

the police station was, she became confused and

redrew the map on the same paper. Thus, north

was where north was supposed to be as well as

where it wasn't, and we couldn't walk outside

and find it.

Together Sylvia and I did not add up to

one, but somehow we made it to the police

station. On Arroyo Parkway we crossed

Colorado Boulevard (where the Rose Bowl

parade is held) in downtown Pasadena and kept

going for a couple of blocks, but nothing looked

like a police station. Finally when Arroyo ran

out, we saw an old building with a small parking

lot outside and discovered the sign that told us

we had arrived.

Perhaps our difficulty was not just that we

were in a state of shock and had had no sleep the

night before. Never did I dream I would have to

go to a police station, ask to be let in (there was a

security door that had to be opened before I could

go upstairs), walk up to a counter, and say, "My

husband attempted suicide yesterday, and I have

come to claim his belongings." Maybe I didn't

4
BULIDING SATELLITES IS EASIER

want to have to say the words. Arriving a little

after noon, I was told I would have to wait until

somebody got back from lunch. I started crying

and sat down. "I can't wait," I said. They must

have sensed my state of mind because shortly

somebody came with keys and gave me Jim's

suitcase, briefcase, and valuables.

Retrieving Jim's suitcase from the police

station unhinged me. I had packed it many times

for his travels. To have something so personal

land in such an impersonal place at a time when

his survival was in doubt made me want to

withdraw from people and try to sort things out

in my mind.

But I knew I had to call Mathew and

Melissa and Jim's brother and sisters. Sylvia

suggested Mathew and Melissa needed to come

if there was less than a fifty percent chance Jim

would live. So using our map with two different

norths on it, we struggled back to our hotel

somewhere north, south, east, or west of the

Pasadena Police Station.

I knew from the beginning I would be

honest in dealing with Jim's suicide attempt.

One reason was the way my family had handled

the birth of my brother Duane. Born in 1952,

he was the youngest of seven children. The

doctors labeled Duane a Mongolian idiot, a term

now outdated. Today, his condition is called

Down's syndrome.

In 1952, mentally retarded children were

hidden away. There was a totally different

atmosphere than the one that prevails today when

a man with Down's syndrome stars in a

television series.

My father was the first to tell me that

something was wrong with Duane and he would

not be coming home with Morn.

"What's wrong?" I had asked. I was

almost fourteen.

"Well," he hesitated, "he has some

feeding problems."

A few days passed before my parents

leveled with me about Duane, and I still

remember the let-down feeling I had that my

father had not been able to be truthful with me.

It parallels the scene in the movie "Rain Man"

when the character played by Tom Cruise tells

Dustin Hoffman's character (who is mentally

retarded), "I just wish they had told me about

you."

Mom and Dad still did not know how to

handle the situation. "Don't say anything about

it for now," they cautioned.

Walking past a neighbor on the way to

the grocery store one day, I was grilled. "How's

that new baby?" she asked. "I bet you are really

excited."

I felt uncomfortable and marched home.

"Mom," I demanded, "I want you to call and

tell her exactly what's wrong with Duane. I don't

know how to answer her questions, and I don't

want to lie about him."

Many years later my mother told me how

much I had helped her that day. She had always

taught us that honesty had the highest value, and

my being more uncomfortable about covering

up the situation than I was about Duane's

condition helped her open up. When she called

our neighbor, who was Mom's good friend, the

neighbor admitted she had a mentally retarded

sister in the county home she had never

mentioned. She said that when she took her

sister out to lunch, they went to a neighboring

town so no one would see them.

Our family accepted Duane as one of us.

In talking about what was previously hidden, we

were strengthened and helped many others, like

our neighbor, unload secret burdens.

The reading I had done in my adult years

and the public spectacle of the details of Richard

Nixon's involvement in the Watergate affair

coming out piecemeal and ruining his credibility

reinforced my instincts to be open.

As Sylvia and I sat in the hotel discussing

the calls we were going to make, I suddenly

realized the position I had put her in. "Sylvia,

I'm sorry. I forgot your dad committed suicide.

This must be really awful for you."

She assured me that she had accepted her

dad's death long ago and then counseled,

"Phyllis, if you are open with people, you will

5
PHYLLIS NIMMO MARSH

find those you least expect will come forward

with their own stories and will comfort you in

ways undreamed of." Her counsel echoed my

experience, and we began notifying the family.

I wanted to tell my children. Our trust

in each other comes from long years of honesty.

I spoke with Mathew, but Melissa was at a school

activity so I asked my friend and neighbor Peggy

to tell her what had happened. Peggy and her

husband agreed to help Mathew and Melissa

make plane reservations to fly to Los Angeles

the next day.

I did not have enough energy left to call

Jim's brother and two sisters, so I asked Sylvia

if she would do so. It was one of the many ways

she showed her talent for friendship that week.

She also called Jim's cousin Carol, who lives in

Ventura. Each was told Jim had cut his wrist

and jumped. We said he was in critical condition

with a less than fifty percent chance of living.

Each one of them learned that I thought Jim had

a medical problem, most likely in his thyroid.

We supplied three phone numbers where we

might be reached if anyone had further

questions. No matter how much any of them

probed later they could find nothing I had hidden.

We were interrupted in our calls by two

of Jim's colleagues delivering a basket of yellow

mums. Word had gone out that we did not want

visitors, but these two felt it was important to

speak with us.

My guilt feelings about letting Jim come

to Pasadena were just beneath my surface calm.

The previous weekend we had long talks about

his not feeling well and his disturbed sleep

patterns. I had told him all I had read about sleep.

Studies showed sleep could not be forced.

Rather than lying in bed tossing and turning, a

sleepless person should get up and read a book

until he or she feels sleepy again. Jim kept

thinking he could will himself to sleep, but it

never worked. Over the weekend, he had

listened to me and done some things to help

himself relax.

When he left on Monday, I had felt

comfortable. He was tired and feeling low, but

every person at some time has gone to work

feeling that way.

Jim's colleagues were concerned that

they had missed what was going on. One of

them had taken Jim walking the night before

because Jim was so withdrawn. Both colleagues

felt Jim had seemed tired but fine until around

Tuesday noon. They will never know how their

honest judgment freely given reinforced my

feeling that Jim had been feeling well enough

to come to California on Monday.

"There was no way anyone could have

known what Jim was going to do," I told them,

"and we cannot waste our energy feeling guilty.

We have to go forward." In my subsequent

dealings with those colleagues and others, I

always affirmed that same philosophy.

Sylvia and I returned to the hospital. The

Intensive Care Unit was a circle with the nurses'

station in the center of the configuration and

individual rooms surrounding it. This circle in a

square-shaped building left little alcoves in the

comers where families could congregate. A phone

enabled waiting family members to receive calls

from others who wanted information.

We staked out our claim to the alcove

outside Jim's room, and by doing some

occasional rearranging of the chairs, we found

it to be a comfortable place for naps, conferences

with friends, and quiet reflections. A row of

windows provided a view of the hills around

Pasadena, and I often paced back and forth both

comforted and bewildered by the unfamiliar

scenery.

It was there arrangements were made for

Mathew and Melissa to fly to California the next

day. Chet and Steve took care of the details with

our neighbors. One of Jim's colleagues charged

the tickets on his airline credit card and was later

reimbursed from a collection set up to help with

our expenses.

Sometime that afternoon a social worker

told me that when Jim woke up the next day, the

three of us would discuss what had happened and

begin to sort out the feelings that had led to his

actions.

6
BULIDING SATELLITES IS EASIER

Some thought had to be given to where I

would stay since Jim's recovery would take a

long time. Again, Chet and Steve took over. A

local university had furnished apartments it

rented out to visiting professors and researchers.

Because of the university's connection with the

scientific project Jim was involved in, I would

be able to rent one of the apartments. The

management had not planned on my being there,

but I could rent the apartments that were empty

between other planned visitors. On Thursday

afternoon, Chet and Steve told me the

arrangements had all been worked out.

That afternoon and evening Sylvia and I

visited Jim a few minutes at a time. His left leg

twitched, but he did not make any other

movement as we talked to him. We tried to speak

normally and tell him who we were and what

we were doing. The machines indicated there

had been no change for the worse.

Friday morning found us still at the

Hilton but with a little more sleep than the

previous morning. We asked ourselves if it was

a "red dress day," and we also began the routine

of asking, "What are the questions for today?"

Because the future was such a total question

mark, it was easy for me to start worrying about

how things would ever get back to normal. Such

worry would overwhelm me so much I could

not function. To survive, ! had to separate the

questions: today's questions I would work on;

tomorrow's questions I forced to the back of my

mind.

The projects for Friday were to move to

our apartment and to speak to as many of Jim's

doctors as possible. Also, I asked Chet and Steve

to arrange a meeting with two close friends,

Michel and Francois, French scientists who were

attending the meeting. After they left for France

on Friday, I would not have the chance to see

them again for a long time.

I decided I needed to be honest with the

people where I worked. On Thursday night I

called one of the friends who had driven me to

the airport and told her the truth. On Friday

morning I called her at work and asked her to

tell our supervisor everything. I wanted my

coworkers to know the full story so that when I

returned, there would be no discomfort about

the subject.

A hospital visit was always first on our

agenda. Friday morning we spoke to Jim, and

again there was no response. Obviously, we

were not going to have a discussion that day with

the social worker. It looked like he was retaining

fluid, but to our untrained eyes there was nothing

to indicate that anything else had changed.

The chief trauma surgeon confirmed our

findings. He also said Jim's thyroid had tested

normal. I accepted the information. But since I

had read the previous week in a layman's

medical guide that in a small percentage of cases

the tests of thyroid function can read normal even

when there is a problem, I knew I would insist

on more tests. In the meantime I worded nay

response to questions carefully. "Jim's thyroid

tested normal," I said.

Next came our move to the apartment.

Chet and Steve checked it out and teased us about

its elegance. With a key to the underground

parking garage, a key to the elevator, a key to an

outside security gate, and a key to the apartment,

our safety was assured. There were two bedroom

suites, each with private bath, and a large livingdining room in between. Double French doors

led out to a patio. The kitchen was fully

equipped. I called it home when I discovered

the Maytag washer and dryer--my father is a

Maytag retiree, and I went to college on a

Maytag scholarship.

Sylvia went grocery shopping, and I

stayed behind to meet Michel and Francois. The

lovely apartment added a measure of stability

to our meeting after the chaotic events of the

last three days. It was a time to speak of an

extraordinary friendship, one that reached across

the barriers of language and distance. Each of

them had visited in our home many times, and

Jim had been a welcome guest in their homes

on his many trips to France. At times we had

laughed until our sides hurt; at other times we

had shared the pain of parents dying and of
PHYLLIS NIMMO MARSH

illness striking. Now the person who had

brought us together was in critical condition

under circumstances that were inexplicable. As

we parted, we could only affirm that we were

friends. As Michel put it, "Comrades are thrust

upon you, but friends you choose!"

Later Sylvia and I returned to the ICU

to find very little change in Jim. He made no

response when we talked to him, and his body

continued to look puffy.

As we sat in our alcove, Chet and Steve

arrived bearing a bouquet of long-stemmed

flowers wrapped in plastic and decorated with a

big red bow. I called them "my Miss America

flowers" and walked around the rest of the

evening holding them as if I were walking down

the platform at Atlantic City with a crown on

my head. It is one of my fondest memories of

those early days, and I hope I understood the

meaning of the gift when I accepted it in that

manner.

After some hesitation, Chet and Steve

decided to go in to see Jim, which pleased Sylvia

and me. There were very few people I allowed

in. As I told Chet and Steve, "Jim Marsh is still

a person of dignity even if he is in a coma, and I

don't want people coming out of curiosity." It

was necessary to identify those who were

important in helping to bring Jim out of the coma

and those who were not. Sylvia came and went

frequently. Jim's Uncle Melvin lived in Ventura

and he, along with Jim's cousin Carol, would

have free access. Sylvia and I had urged Chet

and Steve to go in, but they had hesitated.

I accompanied Chet and Steve into Jim's

room and explained that sometimes comatose

people can hear even if they do not respond; 1

asked them to talk to Jim as if he could hear all

they were saying. It was hard to do, but they

did it. Afterwards, each said it was not as bad

as they had thought. Reality is often easier to

accept than what the mind can imagine.

Mathew and Melissa arrived later with

Carol. Since we were not in our alcove when

they arrived, Carol, a registered nurse, took them

in to see their father and explained all the

machinery. She shared our concern about the

swelling in Jim's body.

Before leaving for the evening, Mathew,

Melissa, and I slipped in to say goodby to Jim.

"Jim," I explained, "we are going back to our

apartment, but we will be back in the morning."

As I turned and walked to the nurses' station to

make sure they had my new phone number,

Melissa watched Jim's whole body react as if

he were reaching out to me. Overwhelmed by

seeing the first response, Melissa had to go

outside and sit down with Sylvia.

Melissa later told me she had cried on

the entire trip to California. Walking through

the airport at Dallas she had followed blindly

behind Mathew, who had become very upset

with her. After seeing Jim respond, she never

cried again because she felt her dad would be

O.K.

We returned to our apartment exhausted

but secure in the knowledge we had answered

the questions of the day. We had an apartment;

I had met with Michel and Francois before they

left for France; and Mathew and Melissa were

in Pasadena. Those were big accomplishments.

By Saturday, we almost had a routine.

"Is this a red dress day?" We decided

Saturday was not.

"What are today's questions?" On

Saturday we needed to find a place to buy some

travelers checks. Jim had almost $800 in cash

with him, and I had taken $600 out of the credit

union before leaving Washington. Together

Sylvia and I still did not add up to one, and we

did not feel safe having that much cash to lose.

Other than that, we would come and go

from the hospital. Cousin Carol and her daughter

were coming to take Mathew and Melissa on a

tour of Los Angeles. We needed to be at the

hospital to meet them.

Our alcove was like Grand Central

Station. Carol came to pick up Mathew and

Melissa. Chet and Steve came by, and Steve

drove me to an American Express office to buy

travelers checks. The phone rang constantly as

friends and relatives checked in to see how Jim
BULIDING SATELLITES IS EASIER

was doing. Doctors came out to report on Jim's

condition.

Without any big questions [or the day, I

had an opportunity to reflect on Jim's attempted

suicide. Sitting in the alcove with Chet, I said,

"If anybody can recover from this and go back

to a normal life, I think we can. Jim and I and

Mathew and Melissa have lived our lives in such

a way that I think people will support us rather

than try to get back at us for past wrongs."

I went on, "I cannot use my energy

worrying about what other people are going to

think about Jim's suicide attempt. What they

think is their problem, not mine."

Chet agreed with both statements. He

had overheard my phone conversations with

several people and knew 1 was being honest

about what had happened. Taking his cue from

this, when he went back to work, he kept

everything out in the open.

During that time of reflection, Steve told

me he felt somewhat like the people of

Hiroshima. A recent book about the aftermath

of the atomic bomb described how the people in

one small fishing village had lived the same way

for 3,000 years. Sons grew up to do just what

their fathers did and daughters became like their

mothers. After the bornb, life in the village was

never the same. Forever after, events were dated

as either before or after the bomb. Some things

in Steve's life would now be dated either before

or after February 22, 1989.

Sunday was spent coming and going

from the hospital. The lung doctor came out to

tell us that Jim's lungs were recovering, and he

felt the prognosis was good. "The problem is,"

he continued, "we don't know if we have a braindead man."

I was stunned. From the beginning the

indications were that Jim had good brain-wave

activity. How was I going to handle this

information with Mathew and Melissa watching

so closely?

My response became what I call the

Phyllis Marsh rule of survival in times of medical

crisis. "The lung doctor said the lungs were

recovering and that is good news. We should

believe him on that," I said. "However, he is

not a neurosurgeon, and he is not a specialist on

the brain. Therefore, we will not take his word

on what is going on in the brain," I reasoned.

"We will listen to the expert only in his field."

It proved to be a good rule, for shortly

the resident in neurosurgery came out. He said

the CAT scan they had just done on Jim showed

no major injury to the brain. Jim most likely

suffered a concussion or a bruise that could still

leave damage of an unknown quantity, but the

neurosurgery specialist felt there was room for

"cautious optimism."

One of the doctors said Jim had opened

his eyes in response to his name.

As we sat there waiting for the doctors,

Mathew first questioned whether the statistics

fit Jim. In landing on his pelvis and right femur

(the bone in the leg that curves and goes into the

hip socket), Jim suffered a severe break,

especially for a fifty-year-old man. "Mom, I

think Dad will do O.K.," Mathew explained. "He

has always drunk all that milk, and he has always

done a lot of walking, so his bones should be in

good shape."

I realized Mathew was right. Jim always

ordered skim milk when given a choice. He

believed in Vitamin C and for several years took

some every morning. He did not sit around on

weekends but spent his time working on cars or

cutting firewood. All this helped bone density.

Jim should be ahead of the curve for others his

age.

On Sunday it was time to say goodbye

to Chet and Steve. They would be going on to a

meeting in Colorado (which Jim had been

scheduled to attend) before going back to

Washington. I shall always cherish the note I

found tacked on the door to Jim's room. It said:

9
PHYLLIS NIMMO MARSH

Phyllis -

I stopped by to say good-bye. We take offat

12:30.

The nurse came out and said all is still stable

and that is good.

I am reminded of the line from

Rumpelstiltskin--'l weep, Jbr in my very. life,

I cannot spin gold from straw.'

It's now up to Jim--and, like always, he'll

come through.

Helve a nice day and we'll be talking to you.

It has been an honor to be in such a family

over this week.

My love to all.

Steve

10
SOMETIMES YOU HAVE TO LOOK STRAIGHT AHEAD

Each morning I gave myself a pep talk

as I reentered Jim's world. "What will I find

today?" haunted me as I rode up the hospital

elevator.

When I spoke with Bruce Marsh, Jim's

good friend who shares his last name and many

like interests but who is not related, Bruce told

me about his grandmother who lost her husband

and son within two days during the 1918 flu

epidemic. "Sometimes in life," she had said,

"you have to turn around and look straight

ahead."

"Sometimes you have to look straight

ahead," I told myself as I approached Jim's door.

Cards and letters began arriving. The

anticipation of finding them at Jim's bedside

eased my re-entry, and the messages touched me

deeply. One from a church friend read:

Dear Phyllis,

I wish I could be there to sit with you,

hold your hand and help you think of happier

times. Until that is possible I want you to know

that your pain is our pain. Our lives have been

different as we have waited for news every day.

We pray that you will sense strength

anew each day and feel that God will provide

for 3,our needs.

You have approached a curve in life's

roadway, and we pray that you will not feel alone

as you tO' to make the turn. May all your friends

help to make things easier as you and Jim travel

through this difficult time.

Melissa bought Jim a balloon that said

"You're special" and put it on his bulletin board

along with the cards. On the way home from

school the day Jim was injured, she had bought

two pieces of bubble gum, each with a prediction

in the wrapper. The first one said, "You are going

on an unexpected trip." The second one read,

"There is no end to your good luck." We put

them both up. Since the first one had come true

so spectacularly, surely, we reasoned, the second

one would too.

Jim's responses increased on Monday.

"Mr. Marsh, wiggle your toes," the nurse

ordered.

Jim could not move his right leg because

it was in traction, but his body would start to

move and after a short interval his left foot would

twitch.

"Mr. Marsh, squeeze my hand."

At first his right hand responded; the left

remained still. Again, there was a hesitation

before any movement, but the action followed

the command so there was functioning in his

brain.

Each nurse followed this routine and

entered the results in Jim's record. Each change

for the better was exciting; a change for the

worse would be cause for alarm.

The nurses gave Jim morphine before

they gave him a bath or moved him to his side

because he became very agitated in response to

the pain of being moved. A response to pain

also indicated brain wave activity.

The chief trauma doctor explained there

had been edema (or swelling) in Jim's brain and

drugs had been administered to counter it.

Sometime on Monday I was given a note

asking me to come to the business office to sign

some papers. Reality was going to set in, and

Sylvia and I contemplated the worst. It appeared

Jim would live, but his response was slow. We

knew that sometimes injuries are permanent.

11
PHYLLIS NIMMO MARSH

Even if Jim recovered he would require extensive

rehabilitation. Our concern, shared by many

friends, was that our insurance might not cover

his expenses because of the suicide question.

Sylvia and I had dealt with some of this

before when my brother Duane was placed under

what is called Title XIX to provide for his care

in a state school. And we had researched

insurance coverage of long-term nursing home

care in 1986 when my father was in a wheelchair

following a stroke and my mother fell and broke

her hip. Luckily, my parents never needed such

care.

As Sylvia and I talked, I again said I

thought this would prove to be a medical

problem and therefore my health insurance

should cover it. If not, I would probably be able

to cover the cost of the hospitalization and a stay

in a rehabilitation hospital but this would take

all our savings. If Jim remained in a coma and

required IV feedings and round-the-clock care,

I would have to seek assistance. I thought that

in seeking such assistance, I would be allowed

to keep our home and one car and half our

savings.

"Somehow, someday," I promised

myself as I faced the loss of a good part of our

life savings, "I will manage to make life good

again."

Employees of the federal government are

allowed an unlimited accumulation of sick leave.

Since beginning work in 1963, Jim had had only

one major illness, hernia surgery in 1980, and in

the course of twenty-six years he had

accumulated almost a year of sick leave. With

vacation time added, I knew his salary would

continue for almost fourteen months--a good

length of time in which to plan our future.

I waited until Tuesday and a chance to

wear my red dress before going to the business

office. As I signed the papers, the clerk asked

one question, "Did he jump deliberately?"

"I don't know how to respond to your

question;' I replied.

"When I call to verify coverage," she

said, "the insurance company may ask me that,"

"Well," I answered, "'deliberately implies

Jim knew what he was doing. If his mind was

not firing correctly, and I don't think it was

because of a medical problem, then he could not

have made a competent judgment in his actions."

I do not know if the insurance company

asked the question. Jim's medical bills were

covered.

On Tuesday morning Melissa left for

Maryland. A car picked her up at the hospital to

take her to the sidewalk check in of American

Airlines at the airport. She would change planes

in Dallas. Traveling so far did not daunt her,

and I admired her for doing something at sixteen

that would have scared me at twenty-five.

"Melissa," I counseled her, "you may

find yourself angry at Dad for the position we

are in." I was concerned that I would not be

there to help her. "Please understand that such

feelings are normal and talk it over with an

adult."

A haircut had been on my calendar in

Maryland for Thursday the 23rd. It was long

overdue, and on Tuesday the 28th it became a

today question. Sylvia booked an appointment

for us at a shop on nearby Lake Avenue, a

beautiful commercial area with specialty shops

and a Bullock's Department Store.

Sylvia's hairstylist inquired how we had

happened to come to Pasadena. Sylvia hesitated

and the stylist persisted. When Sylvia quietly

told her the events of the past week, the silence

stretched for several minutes.

"You just tell that nice lady," she finally

whispered to Sylvia, "to do whatever it takes to

get that man well. Then after he's all well, she

should just take him out and give him a good

beating."

We had many laughs over the beating we

were going to give Jim. We plotted a wet noodle

party, a reunion in Washington of Sylvia, Chet,

Steve, Jim and me and anyone else who wanted

12
BULIDING SATELLITES IS EASIER

to come to celebrate Jim's recovery by giving

him several lashes with a wet noodle because of

all he caused us.

Eventually, Jim opened his eyes when I

spoke to him. As he slowly turned his head my

way, his eyelids opened a quarter of the way. I

continued talking and gradually he stared. His

bulging eyes reminded me of the Cookie

Monster on Sesame Street. There was no

indication that he recognized who I was.

At some point one of the doctors told

me he had had a patient who was in a coma for

two weeks and still recovered. I found that very

encouraging.

As midweek came, Jim continued to

make progress. The blood pressure and heart

monitor were turned off. He was fed a blue

liquid through a tube down his throat with a

machine monitoring the rate it was administered.

The liquid's coloring was a precaution in case

he started vomiting and they needed to identify

what was coming up.

The nurse would tell Jim to squeeze her

hand, and when he made a weak response, she

would ask him to squeeze harder. His left hand

began responding though it was still weaker than

his right. He became agitated and pulled at the

tubes, so his hands were tied.

Thursday morning Mathew and I visited

Jim to tell him Mathew was leaving. Jim opened

his eyes and looked at us, his best response yet.

Jim could not talk because the breathing tube

delivering oxygen to his lungs went through his

voice box.

By Thursday, the trauma doctor was

encouraged about Jim's overall health. He felt

if we could rouse Jim more and the breathing

tube could be taken out, Jim could be moved

from ICU.

Thursday's question thus became how

to arouse Jim from the coma. We discussed what

might be happening in his body. One nurse

suggested that Jim might be ducking the world

because of what he had done; Sylvia and I agreed

this was possible. We also noticed that whenever

we mentioned his friend Bruce Marsh, Jim's

whole body reacted.

I have always believed everyone needs

some control over his situation. There was very

little Jim controlled, but if he were roused a little

he could decide who was allowed in to see him.

Taking these ideas into consideration, Sylvia and

I began a good guy-bad guy routine. She was

the bad guy.

"Jim, this is Sylvia." Sitting in the alcove

outside the room, I heard her clearly. "You are

in the hospital and you have been seriously

injured. Now, Jim, you have to listen to me. I

know you can't move, but you can open your

eyes and let us know how you are. Bruce Marsh

is coming on Friday to see you. If you don't

want him to come, that is O.K., but you are going

to have to wake up to tell us this or we are going

to let him in. Can you hear me, Jim?" Jim would

always respond in some way, either by turning

his whole body as if to reach out or by turning

his head and blinking his eyes.

After Sylvia finished, I would go in and

speak in a softer voice. "Jim, this is Phyllis.

You are fn a hospital. You have fallen. You

cannot move your right leg because it is broken

and in traction. You cannot speak because there

is a tube down your throat to deliver oxygen to

your lungs. The doctors have explained

everything that has happened, and they assure

me it can all be fixed, including your feelings. I

need you to help me make some decisions. The

hospital only lets certain people in, and I want

to know who you want to see. I have put Uncle

Melvin and Carol on the list if that is O.K. Bruce

Marsh is coming tomorrow, and I need to know

if you want to see him."

We continued all day long, and each time

the name Bruce Marsh caused the most reaction.

We felt as the day went on that Jim was rousing.

Sylvia and I expected some complex

cognitive functioning to be taking place, and no

one at the hospital counseled otherwise. At the

end of the day we were exhausted, and Sylvia

13
PHYLLIS NIMMO MARSH

remarked, "Jim Marsh in a coma can still

outsmart the two of us with all our faculties."

All during that week, and throughout my

stay in California, I received many calls from

Jim's colleagues. My journal, which I started

early that week, notes a call on Friday from

Francois in France. "Tell Jim," he said in slow

English, "life is important, and this event does

not change the love and respect we all feel

toward him." Francois' son had stayed with us

one summer, and so Francois remembered our

son and daughter as he continued, "Tell Mathew

and Melissa there is nothing wrong with their

father's mind."

Steve called to say they had had a

meeting at work and arbitrarily set October 1 as

the date Jim might return. In dividing up Jim's

work they were amazed at how many people

were required to do it. "Please understand,

Phyllis, everyone just wants Jim back. What

happened, happened," Steve told me, "and the

old Jim Marsh would forgive Jim Marsh for

doing this."

On Friday the orthopedic surgeon said

things were looking good for Jim, and surgery

on his leg was scheduled for Thursday, March

9, the first date he could get the operating room.

The surgeon spoke for the first time of Jim's

broken right cheek bone. A plastic surgeon

would be consulted on it.

Early Friday afternoon the lung specialist

removed the breathing tube. Jim's oxygen level

and blood pressure would be monitored, and if

they remained stable, the tube could be left out.

"Say hi," the doctor commanded Jim just

as I walked in.

Jim responded with a very breathy, very

hoarse, very soft, "Hiiii." He could speak, and we

had a new indication of brain function. Because a

breathing tube suppresses the voice box, hoarseness

is very common after it is taken out.

The oxygen monitor hooked up to Jim's

toe caused it to glow like E.T.'s finger. The

monitor electronically read the percentage of

oxygen in the blood. We focused on it as Jim

breathed without the tube.

Bruce Marsh arrived around 1:30. Of

course, Jim wanted to see him; we never had

any doubt about that. Jim spoke a little with

Bruce. The nurses were in and out checking the

oxygen rate. Jim squeezed Bruce's hand often.

Bruce commented afterwards, "The old

Jim is there. He's just very, very sick."

Jim tired quickly so we left to go to the

cafeteria. When we returned, I asked him if he

had had a nap and he said, "Yes." I thought that

was an encouraging sign. At least he made the

proper response. Later I learned he might have

said yes to anything.

The oxygen rate remained stable. Extra

oxygen was provided by a plastic tube under his

nose held in place by an elastic band around his

head. His E.T. toe glowed, and the feeding

machine regulated the flow of food. Jim's body

was almost on its own.

By Saturday morning, Jim asked the

nurse when he could go home. His throat was

very dry, partly because the ventilator had

irritated it but also because drugs to reduce the

swelling had dried his body out. He did not have

the strength to sip through a straw so the nurse

put ice chips in his mouth. He complained of

hunger, and he tried to scratch his itchy skin.

All this required processing in the brain.

On Saturday his nurse explained hospital

policy in attempted suicides required that when

the patient was moved to a regular room

someone had to stay with him or her twentyfour hours a day. Huntington had a service

through which we could hire sitters at $4.25 per

hour or we could provide family volunteers.

Health insurance usually does not cover this

expense. There was no way I could provide

family volunteers, but I could at least take one

shift. Thus from the time Jim was moved out of

ICU his care would cost me $68 a day out-ofpocket expense, and I would have to be at the

hospital eight hours each day. If a psychiatrist

determined the sitters were not needed, they

could be stopped. Unfortunately, Jim's

14
BULIDING SATELLITES IS EASIER

confusion was such that he needed sitters the

entire time we were in California as well as when

we returned to Baltimore.

Saturday was a day of change. Sylvia

needed to go home. I could not and did not

expect her to stay with me for the long haul.

Jim's brother David, who lives in Northern

Arizona and had called several times to check

on Jim, suggested his wife Linda could come

for a week if I needed her. I quickly accepted.

Arrangements were made for both David and

Linda to fly to California on Saturday, and they

arrived in the middle of the afternoon. Jim was

alert and recognized them.

That evening I received a phone call fi'om

someone I had never met but who cared enough

about my pain to share his own. He had attended

the conference in Pasadena and knew of Jim's

suicide attempt. He felt his experiences three

years earlier might help me understand Jim.

"Everything was going well in my life,"

he stated. "'1 have a happy home life. We have

strong religious beliefs. My job had been going

well, and I had just returned from a sabbatical."

Then, he explained, he started going into deep

depressions. Things would be fine for a couple

of weeks, and then the depression would return.

"When it returned, I would just get the

feeling that all I wanted to do was end the feeling

that came over me" he continued. His work

suffered.

His family doctor put him on one type

of medication but it did not work. Finally, he

was referred to a psychiatrist, who listened to

his story and assured him that he was not crazy.

The psychiatrist stated he had a chemical

imbalance triggered by the lack of stress. Up to

the point of the sabbatical, he had thrived on an

active, stress-filled life, and the sabbatical

changed that. The psychiatrist indicated the

resulting chemical imbalance led to a problem

in the neurotransmitters in his brain and caused

his feelings of depression.

The psychiatrist put him on medication

about ten times stronger than his regular

physician had prescribed, and at the end of four

weeks the moods lifted. After two or three

months he went off the medication altogether

and has been fine since.

He had spoken with some colleagues

about this after Jim's injury. The other

colleagues had a hard time understanding that

neither religious beliefs, mental attitude, nor selldiscipline could change this chernical imbalance.

I thought a lot about this conversation in

the weeks to come as we sought the cause of

Jim's behavior. It took a lot of courage for this

man to make that phone call to me, a stranger.

Before David left for Arizona, he spent

some time with Jim. Jim said he was sorry he

had messed himself up. David offered to help

in any way he could, but Jim responded that

Mathew would help after he got home. This

conversation led us to think Jim's mind was fine.

Sylvia left at 9:30 RM. Sunday. We had

seen airport shuttle vans around Pasadena and

called one to pick her up. She tells me I would

have survived without her that first week, but I

know differently.

15

THIS HAS GOTTEN A BIT OUT OF HAND

Monday brought progress; we left ICU.

I always reminded myself when a move occurred

that it was progress toward Jim's getting well

even though leaving the familiar tbr the unknown

was scary.

When I arrived at ICU that morning, Jim

seemed stronger. He was asking what time it

was and where he was. He did not remember

falling, so I explained the scenario again. After

going through the broken bone in his hip, the

surgery on his stomach, and the possible surgery

on his cheek, he thought a moment, and without

any emotion, said, "This has gotten a bit out of

hand."

Again, I told him the doctors had

explained everything, and it could all be fixed,

including his feelings. He was gripping Linda's

hand, and she felt him relax with my explanation.

Sitting in the cafeteria later, I started

giggling. "A bit out of hand," I thought. "If he

only knew."

Jim's lungs were still a concern. His lung

doctor did not want to send him to a regular ward

because he still needed respiratory therapy along

with close monitoring. Thus, Jim was moved to

what is called the Progressive Care Unit. Here

one nurse was in charge of three patients.

Our lung doctor, concerned that Jim

needed stimulation from the outside, insisted we

have a room with large windows looking out at

the palm trees on Pasadena Avenue.

The plastic surgeon came by to say Jim's

right cheek bone was broken. Repair would

require the placement of a wire in the bone, or

the right side of Jim's face might look sunken.

The procedure would be done immediately

following Jim's hip surgery so only one

anesthesia would be required.

Jim was talking more and told me the

left side of his mouth felt funny as well as his

right leg and hand.

In talking with the various social workers

and doctors over the preceding days, I told each

of them I thought Jim had a medical problem.

Trained to suspect denial in any suicide attempt,

they did not quite trust my judgment. They

approached the idea of calling in a psychiatrist

gently. In actuality, I would have felt the hospital

staff had been negligent if they had not called in

a psychiatrist, for he or she is trained to

distinguish illnesses that have an organic,

medical basis from those that have a

psychological one.

Dr. Suzuki, the psychiatrist called in,

arrived around 7:45 on Monday evening and

asked if we could speak. We went to a visitors

lounge in the unit, and I sat down and leaned

my head back against the wall. I was too

exhausted to do anything other than tell him

everything.

I explained about Jim's tiredness, his loss

of a sense of well-being, and his sleeplessness.

Jim had told me that sometimes he felt like he

was crawling out of a hole and just as he got to

the top he fell back in. Particularly during the

previous weekend Jim would get up tired in the

morning after tossing and turning all night, and

then things would improve in the afternoon.

The past few months had been

particularly stressful for us. Contract

negotiations at Jim's work had resulted in a

change in contractor and the disruption of many

of the researchers' lives. Jim shared his

colleagues' pain and was glad things had

smoothed out. Both of Jim's parents were dead,

and their farm had been jointly owned by him

17
PHYLLIS NIMMO MARSH

and his three siblings for four years. Events had

made a final settlement necessary, and the

negotiations among the four had been difficult.

That had been settled, though, in December. Our

son had gone through a difficult semester at the

university he was attending and decided to come

home to seek a job in the engineering field to

help him know what kind of career he wanted.

Though his decision had been painful for us, he

had just settled into a job as an engineer's aide,

and we were all pleased. Thus, it was surprising

that Jim should attempt suicide when things were

easing off.

I explained that Jim was a highly

respected geophysicist. He had received a high

award from the French Space Agency, one of

few foreigners to ever receive it, because of joint

research projects. "Many colleagues told me,"

I said, "if they made a list of people who might

commit suicide, Jim Marsh would be at the

bottom."

"Did your husband ever have any

previous episodes of depression'?" Dr. Suzuki

asked.

"In 1976 he had a similar episode, but

this recent one was worse," I said. "He

complained of stomach pains and went to a local

clinic. Because of the stomach pains, he was

referred to a specialist on digestive problems."

I went on to explain that in 1976 1 asked

the stomach doctor to do the T3 and T4 tests of

thyroid function. Following Jim's treatment for

an overactive thyroid, the thyroid tests had

always shown Jim to be in the high nonnal range.

In 1976 the tests showed the function had

dropped rapidly to low normal. I had discussed

with the doctor whether the rapid drop from high

normal to low normal could have caused the loss

of Jim's sense of well-being, but the doctor

dismissed my questions. Two years later the

Washington Post reported that this doctor had

been fired from the clinic because he had erred

in diagnosing a serious problem, but by then Jim

was feeling better. I had often wondered if I

had been right.

Dr. Suzuki asked if any family members

had ever been suicidal or on mood-elevating

drugs. There was no one.

"It is obvious," he explained, "Jim's

problem is not related to stress. His career shows

he can handle stress." I knew that. "The

symptoms you describe though are classic signs

of depression. What I think happened," he

continued, "can happen to anyone and can come

on overnight. There seems to be a chemical

imbalance in the neurotransmitters, and it is a

medical problem that needs to be diagnosed and

treated in the same way diabetes is a problem

that needs to be monitored."

I had given a lot of thought to what Jim's

colleague had told me about his own chemical

imbalance. I told Dr. Suzuki I pictured it in terms

of starting a car. A cold car often will not start

until the gas is pumped, or if it is an older model

the choke is pulled out, to get more gas in the

carburetor. If the engine gets too much gas, it is

flooded. The juice is coming from the battery

as the starter is turning, but it never quite makes

the connections to get going, and it just keeps

firing.

I pictured stress requiring certain

chemicals in the mind. With less stress, they

are not used and flood the brain. The mind is

firing but does not quite make the proper

connections because of them.

The doctor smiled at me and said,

"Actually, that is a very good analogy."

I would later joke to one of Jim's

colleagues, "If this has been brought on by a

lack of stress, then Jim in his own way has solved

the problem."

The next morning I met the

endocrinologist. He saw Jim's eyes for the first

time, and their Cookie Monster quality surprised

him. In my communications through the social

workers and other doctors I spoke of Jim's

overactive thyroid. When he went for treatment

in 1969-70, we had not been married long and I

did not go with him. I had not heard or

remembered the term Graves' disease as part of

18
BULIDING SATELLITES IS EASIER

Jim's thyroid problem. Jim's bulging eyes

enabled the doctor to recognize Jim had had

Graves' disease. I had never given much thought

to Jim's eyes because they reminded me of his

grandmother's eyes. Then I remembered she had

also had an overactive thyroid.

The endocrinologist showed me the

numbers on Jim's thyroid. The first day the tests

of thyroid function were all low, but in times of

trauma a substance is released by the body to

suppress the action of the thyroid, and so thyroid

tests of most people in these circumstances

would show low. However, when a thyroid is

low, the pituitary gland releases a substance

called thyroid stimulating hormone, TSH, to

prod the thyroid to release more of its hormone.

A high TSH level indicates a low thyroid. Jim's

TSH level was a little high.

Jim's eyes, with the diagnosis of Graves'

disease, bothered the endocrinologist and caused

him to rethink some of the statements he had

been planning to make. He was concerned

enough that he wanted to do further thyroid tests

before allowing the surgery on Thursday.

During the course of our conversation,

he asked me, "What made you think your

husband had a low thyroid'?"

Again, I mentioned the tiredness, the

sleeplessness, and the cold legs. "Those," he

said, "don't necessarily add up to low thyroid.

Usually people are cold all over."

Tuesday afternoon and evening were a

period of soggy brain. Jim's brain fired as if its

electricity had been flooded and shorted out

during the swelling. While I was at dinner, he

insisted Linda hand out papers in a meeting he

thought he was attending. Not realizing he was

sick in the hospital, he talked about orbits and

perambulations and colleagues in Australia.

Linda wrote down his words as she listened and

pretended to respond to what he was saying.

Nothing was coherent.

That evening I took a detour as I returned

from the cafeteria. My tears had begun at dinner.

I did not want to be comforted, and I did not

want to see anyone. Searching for refuge, I

discovered the hospital's small chapel. The only

light came through the stained glass windows

on two side walls, and the chapel was empty.

My whole body shook as the tears streamed

down my face. My mind went blank as if my

body had shut it oft" while my tightly coiled

nerves unwound. Several minutes passed before

I could regain my composure.

Upon returning, Linda looked at my

swollen eyes and asked gently, "Do you feel

better now.'?"

"Yes," I responded and sat down. After

that, I needed a similar detour about once a week

during our stay in Pasadena.

Steve called on Wednesday morning to

say he had sought answers from his sister who

is a clinical psychologist. She told him a suicide

attempt like this is quite common. When it

comes to a battle between chemistry and the

mind, the mind depends upon the proper

chemistry to function and chemistry often wins.

Wednesday marked the end of the second

week since Jim had been injured. He was

lethargic when I arrived that morning, but the

sitter told me he had been asking for me. At

first, I was not sure he knew who I was.

When everyone left, he talked but made

little sense. The feeding tube had been removed,

and a dietician had just been in to talk about his

nutritional needs. He told me we were in Santa

Fe and the diet center was in Northern Arizona.

"We've been here before," he declared.

A little later he asked how we were going

to solve the situation we were in. "I need to get

back to work next week," he said.

"We need to get you well first," 1

cautioned. When he asked how we would get

care back home, I told him Bruce Marsh would

help us find a rehabilitation center.

"Bruce will know how to do that," he

said. The conversation ended on a rational note.

The resident in neurosurgery came by to

examine Jim. He felt shy about asking a

geophysicist some basic questions. "Mr. Marsh,"

19
PHYLLIS NIMMO MARSH

he said, "I don't mean any disrespect, but could

you raise two fingers on your left hand for me?"

When Jim did not respond, the resident pointed

to the hand and said, "Raise two fingers, please."

Jim did. The resident felt that given his condition

neurologically, Jim could be moved back to

Maryland shortly.

If we had moved him then, an airplane

equipped with medical service would have been

required. That seemed beyond my ability to

handle.

Jim's Uncle Melvin and cousin Carol

came in to see Jim on Wednesday afternoon. Jim

stayed awake for several hours and made sense

approximately seventy-five percent of the time.

Uncle Melvin asked him, "Are the nurses good

here or are they giving you hell?"

Jim replied, "They're giving me hell."

Jim asked about other cousins who lived

in Ventura and friends of Uncle Melvin whom

Jim had met. We were encouraged because Jim

was initiating conversation.

On Thursday, I woke up saying to

myself, "Don't sweat the small things,"

something I learned from Jim. Who would have

thought orthopedic surgery would be a small

thing. Jim was scheduled to go into surgery

about 2:00 P.M., but it was 3:05 before they

rolled his bed down to the second floor. I had

explained to him that he was going to have

surgery, but I had the feeling he did not realize

what was happening.

Linda and I waited in the first floor

reception room. At 5:05 the surgeon called down

to say everything had gone fine. "Actually," he

said, "it went better than I expected." Mathew

had been right about his dad's bones!

The computer showed Jim was taken to

recovery at 5:39 so the plastic surgeon finished

his work in about 45 minutes. I never saw the

plastic surgeon then or again.

It was a couple of hours before Jim came

out of the recovery room. He had a tiny band

aid at the corner of his eye as the only indication

of the plastic surgery. Gone was the traction. A

tube coming out of the incision in the leg

collected blood and fluid common after such

surgery. He was restless and in a great deal of

pain.

I called Mathew and asked him to call

several people to say surgery was successful.

Linda called her husband and asked him to call

the family. And the calls continued to come in,

from California, New York, Maryland, and West

Virginia.

Linda and I happily turned Jim over to

Frederick that evening. Frederick, the sitter who

came each night to stay with Jim, first arrived

on Wednesday, March 5, and he was there every

night but two until Jim and I left the hospital

seven weeks later. His normal shift would have

started each evening at I1:00, but I found I was

too tired to last an entire eight-hour shift, so I

asked Frederick to come in at 10:00 P.M. He

was always there, on time, calm and cheerful.

20
PIGS AND FAT BATS

Our routine was established. We spent

the morning at the apartment making phone calls

and taking care of business.

On Friday, the day after surgery, Jim's

supervisor said he had placed Jim on sick leave,

which meant Jim's checks would continue to be

deposited in our account. That relieved one

worry.

"Do you have Jim's travel papers'?" he

asked. "I was in touch with the police within an

hour of this happening and they indicated they

had them."

"I have them all," I said. To myself I

thought, "They did not find me for two hours.

Everyone knew what happened before I did.

There was no way I could have covered it up."

He continued, "When Chet returned, he

sat down with all the branch and explained what

happened. He also indicated your attitude about

being open about the whole event. It was very

much appreciated, and I think you did a wise

thing."

Steve called with words of

encouragement. "The fun part of my job," he

explained, "is talking with Jim Marsh and getting

excited about our results." He and Chet were

willing to bring work out to the house to help

Jim make a gradual re-entry into work.

"Steve," I said, "Jim will be fully healed

if he ever reaches the point where he can laugh

about this."

Steve understood me very well. "Greek

tragedy," he said, "is based on the ultimate

human comedy that we are not in control. Once

we realize we are not in control, then we are

free to live."

My mother phoned to offer help. She

and Dad wished they could come, but my father

was in a wheelchair and the trip would have been

too much. She offered to transfer money to my

account electronically so I would not run short.

This was truly appreciated. Jim and I had lived

frugally on his salary, but in planning for

emergencies I had not considered we would be

on the West Coast unable to get to the credit

union. My parents' offer helped tide me over

until I returned to Maryland and rearranged some

accounts.

At the hospital Jim seemed calm and

fairly rational. He wanted his mouth cleaned

out.

When the orthopedic surgeon came in, I

teased him. "Did you find good bones?"

"Yes," he laughed, "it was like drilling

through a rock."

"I saved that little surprise for you!"

He indicated they would get Jim up that

day, the first time he had been in an upright

position since the injury.

Getting up meant sitting up and dangling

his legs over the side of the bed. This was

difficult, for several parts of Jim's body did not

move. In surgery on the day of injury Jim's

stomach muscles had been cut and then sown

back together. He could not move his

midsection.

His right leg, which had been in traction,

was still very painful, and he did not move it.

He was able to move his left leg even in ICU.

Because of his orthopedic injuries, there

was a metal framework over his bed, and a chain

with a triangle on the end hung down from it.

Jim could use this to help pull himself up. At

first Jim used his right hand to place his left hand

on the triangle. Gradually he learned to walk

his left hand up his right arm.

Moving Jim up in the bed required two

people. Each would put an arm under Jim's

shoulder, and on the count of three, if all went

well, Jim would pull on the triangle and push

21
PHYLLIS NIMMO MARSH

with his left leg at the same time they lifted him

up.

When the physical therapist came to get

him up, she had difficulty getting him awake

enough to cooperate fully. Trying to make

conversation with him, she asked where he was

from. "South Wales," he replied.

The trauma doctor came by to say Jim

would be moved to a regular room in a day or

two and then to the rehab section of the hospital

in about a week. "Your husband's affect seems

flat," he commented.

I thought to myself, "Well, what does

that mean?", but the doctor offered no more. It

was true Jim had little animation in his face when

he spoke. I assumed it was from being sick.

Jim's lungs continued to be monitored.

He needed extra oxygen, and every four hours a

respiratory therapist came to put medication in

the oxygen to help open up his lungs. Jim was

required to cough, which was difficult for him,

and then the mucous was suctioned up. By the

end of the week, he started coughing a little on

his own, and at times, a very thick bloody

mucous came up. Pneumonia was a big worry,

and the nurses frequently had him change

positions so the fluid in his lungs would get

shifted around.

After being awake about five hours, Jim

had just dozed off when the nurse came in at

10:00 RM. She needed to ask several questions

to see if Jim were oriented. Waking Jim up from

a sound sleep and having him make sense have

always been hard. I was sure she was going to

fail.

She spoke very gently. "Mr. Marsh, my

name is Frances. I am your nurse this evening,

and I am going to be moving you and cleaning

you up. First, I would like to turn you on your

side so your lungs won't develop any problems.

Can you give me your arm?" As she told him

each step she was taking, from taking his

temperature to checking his pulse, he gradually

woke up.

"Mr. Marsh, can you tell me where you

are from'?"

"Upper Marlboro," he replied.

"What is your wife's name?" Her voice

continued in a gentle, steady tone.

"Phyllis."

"How many kids do you have?"

"Two."

"Mr. Marsh, can you count to ten for

me?"

His voice was weak but he spoke quickly.

"One two three four five six seven eight nine

ten."

Right on all counts! Who would have

thought that hearing Jim Marsh, who has a

master's degree in physics, count to ten would

be cause for celebration? But I left feeling

encouraged.

It was not always so. Asking questions

of a patient coming out of a coma is an art. If

Jim were asleep, and the nurse came in abruptly,

shook him, and started asking questions, he

rarely got them right. Thus, his medical record

shows great discrepancies but I always felt the

differences in techniques among the nurses

accounted for much of it.

The calls continued to come in each

morning. On Saturday one colleague called to

tell me Jim was the only public servant who had

ever treated him with respect. Jim helped him

back when they both started out in satellite

geodesy research. He told me the French

community expressed to him how in the early

days it was Jim's help that had forged the trust

between the French and Americans. Several

other younger scientists felt Jim had helped them

when their careers were just starting and his

generosity had made a difference.

Other calls came from friends. One

called just to hear personally how things were

going. "Every day when I come home" he said,

"I call around to find out how Jim is."

A fund set up through our church to

handle contributions from people wanting to

22
BULIDING SATELLITES IS EASIER

help received mail from Japan, Germany, and

France as well as many places in the United

States. Jim had rarely talked about his travels.

He liked to leave his work at the work place and

enjoy the community with his family. It was a

surprise to the community to hear from such faraway places.

That morning I said goodbye to Linda,

who had guided me through a difficult week.

Jim's cousin Carol was coming to spend the

night.

That afternoon, March 11, Jim got to

brush his teeth, and he was moved to a regular

hospital room. I learned over and over progress

can be measured in many ways.

Shortly after Jim was moved, a leading

scientist in Jim's field came in. I held my breath,

for I had no idea what Jim would say.

Jim smiled at his visitor. "Charlie," he

said as they shook hands, "building satellites is

easier."

"Well said, Jim," I thought.

By Sunday, I was developing "hospital

psychosis", and cousin Carol kidnapped me. She

drove us to Glendale for a champagne brunch.

Upon our return Carol washed Jim's hair

and discovered a wound on the back of his head.

By this time, it looked infected, and Carol

cleansed it with peroxide. About two inches

wide and an inch high, it looked like a knife had

sliced through it. Jim must have hit the back of

his head as he fell. I asked the trauma doctor

about it the next day, but he did not know the

wound was there.

As I walked into his room once, Jim

asked, "Have you heard from Pop recently?"

"No, I haven't," I responded. There was

no reason to explain that his father had died in

1972.

On Sunday night my friend Marti arrived

from Maryland. We had met through our church

choir and been co-workers for over a year. She

had driven me home from work after I received

the call from the social worker notifying me of

Jim's injuries. When I told her I needed her, she

did not hesitate about coming.

On Monday, Michel called from France.

"Chet sends out telemail messages about Jim's

progress," he told me, "but I just wanted to call

to express our caring in a more personal way."

"I'm well taken care of, Michel." I tried

to find a way to express to him all that was being

done. "In American history when the pioneers

going west met hostile forces, the pioneers

circled their wagons for protection. I told Jim

all of his friends had circled the wagons around

us, and the wagons were all filled with love."

"I see," he said.

On Monday, I spoke with Dr. Suzuki, the

psychiatrist. He had told Jim on Saturday that

Jim had cut his wrist and jumped out the window

of his motel room. Jim found it hard to believe

he could have done such a thing. Dr. Suzuki

questioned him again on Monday, but Jim could

not remember anything about the cause of his

injuries.

Jim's confusion seemed to have a lot of

other people confused.

I told Dr. Suzuki my rule of survival--I

was only going to listen to each expert in his

field. Several people had again commented

about Jim's low affect (or lack of expression in

his face) as if this were something to be

concerned about.

"Dr. Suzuki, you are the expert in

emotions so when it comes to that I am going to

listen to you."

"That's a good rule," he responded, "but

Jim's emotions may be part of the neurology,

and I will have to work with the neurologist to

determine what is going on."

An admissions process is required before

someone enters a rehabilitation facility. In order

for insurance to cover rehabilitation, certain

criteria have to be met. At least three hours of

therapy a day must be needed. The patient must

be making progress or it must be shown that

therapy will result in increased function.

23
PHYLLIS NIMMO MARSH

Jim obviously needed physical therapy.

He could not move his midsection or his right

leg. He could not turn over or get to an upright

position on his own, let alone begin to walk.

He had obvious speech problems. Many

times he did not make sense. Even when he did

make sense, he used more complicated speech

patterns than he normally would have used. For

instance, he might have said, "Never enumerate

your fowl before the end of the gestation period"

instead of "Don't count your chickens before

they hatch". Speech therapy would address this

problem and others.

He could not dress himself. That was

partly a physical problem, but it was also a

cognitive problem although I did not realize it

at the time. An occupational therapist would

help him in this.

The evaluations needed for Jim to enter

the rehabilitation program began on Monday.

I spoke with the social worker about all

of the drugs Jim had been given since he entered

the hospital. Jim never took medicine other than

Tylenol for the headaches he had experienced

over the past year. He also rarely drank alcohol.

His body would have no tolerance for drugs.

After the first surgery, he had been given strong

antibiotics, valium to calm him down, morphine

for pain, and diuretics to get rid of the swelling.

Then the second surgery had come two weeks

later with more anesthesia and more pain killer.

The social worker indicated that different

people metabolize drugs at different rates.

Someone who is very active, a jogger perhaps,

might metabolize a drug in forty-eight hours,

whereas an eighty-year-old might have it in his

body for two weeks. It seemed to me Jim's body

could have an overload of drugs if that were the

case.

On Monday afternoon Jim took a nap

and seemed very relaxed. His nurse awakened

him with much difficulty to clean him up. By

then the pain in his leg was extreme, and she

gave him a shot of Demerol.

Within forty-five minutes Jim's affect

had raised. He rattled the triangle above his head

and rambled on about pigs and fat bats. I called

the nurse and she turned the lights on. She asked

Jim if he knew who I was, and he said, "No."

She pointed at me, but his small red eyes stared

at the triangle. When he focused on me, he

wiggled his eyebrows like Groucho Marx and

said, "That's my wilE, Phyllis. That's nay blonde

wile, Phyllis."

When the nurse turned out the lights, Jim

started in. He was concerned about paying

$15,000 for wire for a building under

construction. Marti recognized the hallucination

and talked him through it.

"Come on, let's get this show on the road,

or it will be noon before we get started," Jim

ordered. While rattling the triangle, he almost

sat up. "We've got to get this vertical structure

up. Now, Phyllis, get going there or we'll never

get done."

I had heard that tone of command often.

Thinking he wanted me to leave and that my

absence would help, I walked outside to the hall.

"Now, where does she think she is going?

We've got to get this building going. It's getting

late, and it'll soon be dark here. What's keeping

her'?"

At one point he picked up his catheter

tube and said, "Here's some wire we can use."

Marti responded quickly. "J ira, that wire

has been used. Don't you think it would be better

to get something new."

"You're right," he said and tossed it aside

before he had done any damage. "It's getting

dark now. We better wind this up before too

long."

Marti pointed out later that within the

hallucination Jim's mind had followed a logical

sequence. He had gone through two days work

starting each morning and closing down each

evening. Although his rattling around and

restlessness exhausted him, in his agitation he

showed more of his old personality.

24
BULIDING SATELLITES IS EASIER

Several things might have contributed to

the hallucination. Since it started within a short

time of the Demerol, the drug was the obvious

culprit. I remember that following Jim's hernia

surgery in 1980, he had been in "la la land"

following a shot of Demerol for pain.

Jim's mind was very stimulated that day

because of all the testing for admission to the

rehab unit. Dr. Suzuki had also started Jim on a

very low dosage of Tofranil, an anti-depressant.

On Tuesday afternoon around 3:00 the

physical therapist came again. Following that,

Jim was in agreat deal of pain and got ashot of

Demerol. Off he went to sleep, only to be

awakened by the speech therapist. But he was

in "la la land" again and could not respond to

the questions.

When the therapist left, he started giving

me orders to do something about "the bear at

the end of bed." I could not figure out what he

wanted me to do. He then began a monologue

that ranged far and wide, as if the memory

portion of his brain were the wheel of fortune

spinning round and round, touching at one place

only to spin again and stop at another totally

unconnected place. He talked of getting in touch

with his grade school principal. His cousin

Kenny in West Virginia was spoken of in the

same sentence as the company that had won the

contract in his office. On and on his monologue

went, from money to Uncle Melvin, from

Australia to church.

His nurse for the evening heard me

express my concern about the medication. In

checking his records, she told me that in place

of the Demerol, he could have an equal amount

of Tylenol with codeine in tablet form if it were

given every three hours. "You have the right to

refuse the Demerol if you choose," she advised.

I chose to do so. The consequences of Demerol

outweighed its advantages.

At 1:30 RM. on Wednesday, March 15,

three weeks after his injury, Jim was dismissed

from the hospital and admitted to the rehab unit.

25

THE SET O'THE SAILS

One ship sails east

another west

With tile selfsame winds

that blow.

'Tis the set o' the sails

and not the gales

Which determines

the way they go.

This bit of wisdom comes from a cross

stitch sampler I worked before I had children.

It hangs in the bathroom Mathew and Melissa

use so they may read it every day if they so

choose. Its simple message speaks a profound

truth.

My prairie ancestors, who were farming

in Iowa before the Civil War, never commanded

ships at sea, so they did not pass on to me any

knowledge of actually setting sails. However,

they faced tornadoes and blizzards as they went

about establishing a home in the new world.

My ancestors survived, and their

descendants thrive, because they knew a

satisfactory life depended upon "the set o' the

sails" inside them more than the winds of change

on the outside.

Sometime in my mid-twenties I

discussed with my sister-in-law Margaret,

widow of my brother Keith, the idea of being a

survivor. Some people suffer great tragedies and

losses and still retain a sense of self and a caring

attitude toward others, while other people are

embittered and defeated by a minor loss. We

questioned whether we were survivors or

defeatists and pronounced ourselves survivors.

That pronouncement haunted me in the

early days of Jim's illness. How does a survivor

sail through pain, tiredness, anger, and

loneliness?

Religion and prayer were never topics

for discussion when I met with Jim's colleagues

in the scientific community. As satellite

geodesists, they focused on what can be

measured rather than the why of the universe or

the unknown forces of faith. As the days passed

and I received letters from Jim's colleagues, I

began sensing that in the face of such an

inexplicable happening as Jim's illness even the

scientists were searching.

Early on I received a letter from a

colleague in the academic community that said:

"The terrible ordeal that you and Jim and your

family are going through is impossible to

comprehend. However, it is encouraging that

Jim continues to improve. I know that I am just

one of Jim's many friends who are thinking of

you both and praying for Jim's complete

recovery."

That short statement touched me deeply,

first because it was honestly meant, and

secondly, because it said it all. The situation

was beyond comprehension, he was thinking of

us, and the only thing to be done was to search

for meaning and help outside ourselves. He did

not define what he meant by praying.

Tiredness overwhelmed me in the first

weeks of Jim's illness--tiredness that left me

unable to think of anything more than what had

to be done that hour. I was too tired to pray in

whatever form that might be. I felt that an allknowing God would understand that I was too

tired to pray. After all, I had not complained!

In quiet moments, though, my mind

searched for a deeper understanding, one that

might elude the scientific or realistic mindset. I

thought often of the people who were praying

27
PHYLLIS NIMMO MARSH

for us. In one of those quiet moments I

remembered a conversation I had many years

ago with a devout lady who belonged to the

Methodist Church we attended. She was sharing

some things a person could do for someone who

was seriously ill. "You could lend that person

your faith," she stated. It had seemed an odd

idea to me, and I had pondered over it for years.

I re-examined it several times in those

early days in Pasadena. I lacked the energy to

focus on subjects as deep as faith, meaning,

prayer, ultimate reality, purpose. So I decided

to borrow someone's faith.

I chose (yes, chose) to borrow the faith

of an optimist.

This optimist was a co-worker of mine,

Walter. The previous September I attended the

ceremony during which he was ordained a

deacon in the Catholic Church. His sense of

humor enlivened the office, and his constant,

quiet statements of faith interspersed with his

laughter were genuine. He knew God was

compassionate. I knew Walter would be praying

and an all-caring God would understand I did

not have the energy to create my own. I would

just second what Walter was praying. By

choosing Waiter's faith, I was choosing to

believe that life could still be good.

As the weeks went on, we received many

letters stating "our church held you up in prayer."

The prayers came from California, Maryland,

Poland, France, and all places in between. These

expressions of caring touched me deeply.

Moving to rehab meant moving to a

different part of the hospital. The facility had

thirty-two patients; some were stroke patients,

some had severe injuries from car accidents, and

some were elderly women having knee surgery.

Check-in went well. A nurse asked Jim

questions about his belongings and his injuries.

He answered correctly except that he told her

he was in western Maryland.

After Jim was settled, Marti and I

decided to follow up on prodding from my sisterin-law Sylvia that we do a Medline search in

the library at the hospital on the medical problem

Dr. Suzuki had described. I was not up to

concentrating on the project, but Marti

volunteered to help.

We first asked the social worker the

terminology we would need. In checking the

medical records, she said Dr. Suzuki had labeled

Jim's illness a "major depressive episode with

psychotic features." She told us to start with

that and also the term neurotransmitters.

Medline is a computer program that

searches through the medical literature and prints

out a list of articles in various journals on a topic.

We discovered that the library at Huntington did

not have the Medline program. Marti was told

the Pasadena Public Library had Medline, but

unfortunately, Medline had been down for

several days because of a water main break at

the National Institutes of Health in Bethesda,

Maryland, where the computer is located.

The librarian directed Marti to a guide

to medical journals similar to the Reader's Guide

to Periodical Literature. She found several

listings of articles linking neurotransmitters with

depression and psychotic illnesses; however, she

did not get a chance to pull any of the articles.

Dr. Suzuki inquired about my research

when he next saw me. "Doctor," I leaned my

head against the wall in the hall as we were

talking, "I am a lhirly well-informed person. I

read a lot of articles in the papers and magazines

about medical problems. If what has happened

to Jim is so common, why haven't I read about

it?"

"Because," he responded, "when it

happens, people go home and don't talk about

it."

"Well, then," I told him, "our ability to

overcome this is going to depend on educating

people about it."

He agreed. "Remember, you have

nothing to be ashamed of. Jim had a biochemical

imbalance. It is best to talk about it."

28
BUDDINGSATELLITESIS EASIER

The first few days at rehab were

unbearable.

Jim was required to dress each day and

sit in a wheelchair as long as possible. Marti

and I shopped for sweat clothes for him to wear

as the soft fabric would be as comfortable as

anything on his leg.

Physical therapy began with range of

motion exercises. Lying immobile had

weakened Jim's muscles, and a series of

exercises done in bed moved each of the major

muscle groups.

To get Jim up, the nurses used a lift. A

canvas pad was placed under him. Hooks on

the end of a chain were attached to the four

corners of the pad. A hoist then lifted him up

and placed him in a wheelchair.

Jim was feisty. When I walked in one

day, the nurses wanted to speak to me about what

was happening. "Aren't you forgetting

something'?" Jim yelled.

The nurses said, "What'?"

"Me."

He was uncooperative during therapy

sessions. One aide beckoned me aside to urge

me to calm him down. "They send patients home

if they are uncooperative," she warned.

Marti stayed in the room while a speech

therapist worked with Jim. He could repeat the

sounds the therapist asked him to, but he could

not remember longer sentences to repeat back.

The therapist gave him three words, and then

said she was going to go on to something else

but would ask him later what the words were.

He remembered the first word, but then gave

longer, more complicated words for the other

two.

In response to questions, he said he was

born in Orange County, California, and had gone

to a Greek-American junior high school and a

French-American high school. The therapist did

not know if these answers were correct. Jim was

born in Ventura, California, but his parents moved

to West Virginia when he was three. He grew up

on a farm and attended the local public schools.

Letters and cards arrived each day. One

I received during the early days in rehab read:

March 6, 1989

Dear Jim,

How delighted I am that you are

readi,g this letter/ We all look forward to your

return to Washington, so we can express our

happiness at your recovery in person.

There is one thi, g I want you to know

above all. That is, your legion of.friends and

colleagues sttpport you to the hilt. In your career

you have set THE sta,dard,/br generosity,

fairness, kind, ess, amt respo,sibilio'. It is our

time m)w to retur, the favor. I, DIV OWll case,

without your support and tmderstanding back

at the beginnitt£,, lily career wouhl be fitr less

tttatt it is toehtv. Aml it was also your example

of many years ago when we worked closely

together that made me realize how important it

ix to cooperate a,d be generous with colleagues ....

What I am to,ing to say here is t/tat vott

are very highly regarded and hehl in deep

affection by myself and ma,y. ma, v others, and

your recent tragic eve, t has not changed any @'

that. When you get back to Washington, we look

Jorward to seeing you, helping yott and vottr

family in a,y way we can, a,d worki,g

professiomd& with you in whatever capaci O, you

choose.

So get off yoar butt and come home/

The truth is when I received this letter

Jim was incapable of reading it. Either I was

measuring progress in inches that were being

taken to mean miles or I was guilty of a coverup of the seriousness of Jim's injuries. Perhaps

all of us were naive when it came to

understanding comas.

That letter was meant to encourage Jim

in his recovery, and it also came at a time when

I needed to be reminded in every way possible

29
PHYLLIS NIMMO MARSH

that the person in that hospital bed speaking in

strange ways was really a caring, thoughtful

human being. At a time when Jim could not

speak to me himself to tell me this battle was

worth it, his friends spoke to me for him.

Usually I read the cards to Jim, but one

day 1decided, for my peace of mind, to see if he

could read. There were three cards that day, one

fiom relatives named Hilda and Oscar in West

Virginia, one from a colleague named Clyde

Goad in Ohio, and one from a high school friend

named Ed Schupbach. These were not names

that could be made up. I opened each card,

handed it to Jim, and asked who had sent it. He

named them all, and I relaxed a bit.

Two days alter Jim went to rehab, the

physical therapist had him standing between the

parallel bars. The doctor did not want him to

bear full weight on his broken bone, so his arms

supported him.

By this time, though, Jim was not eating.

He could barely swallow. Talking hurt, and his

method of communication became a thumbs up

signal lk)r yes, thumbs down tk)r no, and a shake

of the hand if he did not know.

Since Jim was still on oxygen, the lung

doctor came by and checked Jim's throat. He

had developed a common infection that occurs

when too many antibiotics kill off certain good

germs that protect the body from this infection.

Medication was prescribed.

Dr. Suzuki spoke with me about Jim's

confusion. To me, he was far better the night

before the surgery than he had been any time

since. Dr. Suzuki told me no concussion had

shown up on the CAT scan so that was not the

problem. He indicated Jim's confusion might

clear up, but at that point no one could say.

He also told me he had taken Jim off the

anti-depressant. Because of Jim's hallucinations

and confusion, he did not feel Jim needed any

drugs to make his mind more active.

By the weekend Jim was a wild man. It

was necessary to get him up more each day in

order to strengthen him, but he did not feel good.

With his throat too sore for swallowing, he had

eaten very little for several days, and I am sure

his blood sugar was out of balance.

Sitting in his wheelchair, he looked like

a man whose head had been cut off and placed

in his hands. Something was wrong, probably

neurologically, so his head seemed to hang down

on a floppy chain. He could easily raise it when

prompted, but it soon slipped back down.

The nurses kept him up a little longer

each day, but he cussed them when he wanted

to go to bed.

On Saturday morning, my friend Marti

left on the airport shuttle to go back to Maryland.

I told her later she had helped me survive the

roughest week.

Jim's brother David and his family

arrived on Saturday afternoon. Jim recognized

them but was too uncomfortable to enjoy the

visit. He pounded his head and said it hurt. He

rattled Ihe triangle and generally was very

restless.

The visitors left for dinner, and I finally

got Jim to down some ice cream and a little water

belbre taking a nap. This was his first food in a

couple of days and had a cahning effect on him.

When his brother came back, Jim started

giving him orders about adjusting the bar over

his bed. "Move that," Jim said.

David would point to one side of the bar.

"Is this what you mean? It seems to be O.K. to

rile."

"No," Jim would say. "Move it. You

know get it out of there."

David kept trying to find out what Jim

wanted adjt, stcd, but nothing seemed to work.

After about fen minutes, Jim finally managed to

communicate that he wanted the framework out

of the way so he could get out of bed. We tried

to explain why hc could not.

That evening, rny sister-in-law

Margaret arrived from St. Paul. She is the widow

of my brother Kcith. Margaret is the only one

of rny five sisters-in-law I knew before my

brothers started dating them. Her hometown is

3O
BULIDING SATELLITES IS EASIER

thirty miles from mine, but we both played the

French horn in high school and we met at band

festivals.

Sunday morning Margaret and I spent a

leisurely time enjoying the California sunshine

on our patio. I rented a cal the entire time I was

in Pasadena, but I preferred having someone else

drive so we stopped by the rental agency and I

added Margaret as the drivel.

Her introduction to the headless Jim

Marsh was brutal. We arrived at the hospital

around 12:30. His nurse for the day wanted to

keep him up until 1:00. When we walked in, he

yelled at me. "There's Phyllis. Phyllis, 1 want

you to get me back to bed. They won't listen to

me." His eyes bulged out of a gaunt tklce.

I tried to get him to stay up long enough

to eat. Because of his throat problem, he was

still on soft food. The generic brown meat and

green vegetables were not appetizing. Sitting

outside on the patio, he took a bite and tapped a

rhythm on his bowl with his spoon. He ate a

little ice cream and sipped some water so his

throat seemed to be clearing up gradually. At

12:45 his nurse gave in and put him to bed.

The afternoon was spent with my

rubbing his head or washing his hair with a

special shampoo that is poured on, rubbed in,

and then dried. It is an unsatisfactory way of

washing hail, and after three and a half weeks

without a good shampoo Jim's scalp itched.

Afterwards, I combed his hair. I felt any kind of

stimulation would be good, and that touching

his head would stimulate the nerves there.

His speech pattern remained disturbed.

"Use more static," he ordered while I combed

his hair. It was a while before I figured out he

meant to scratch harder.

The word "bear" became a catchall tk_r

any noun. "Give me one of those bears" might

mean to hand him a Kleenex.

"Margaret, would you adjust those bears

down there" meant he wanted the heel protector

readjusted.

As we sat there, he kept asking lk_r water

to rinse his mouth out, and if I reminded him,

he would swallow a bit.

He ate a ripe banana I bought in the

cafeteria. After he devoured some custard, the

nurse ordered ice cream. After he ate nearly all

of this and drank some water, I was beginning

to feel the crisis was ending.

Margaret's introduction had been

difficult, but the day ended on an upbeat note.

Jim looked up and said, "Why there's a clock

and it is quarter to eight." And it was.

By Monday it was obvious Jim had

seriously disturbed sleep patterns. Each evening,

we told Frederick, his sitter, that Jim had been

awake a long time and should sleep through the

night, but he never seemed to sleep longer than

three hours. Frederick would spend the night

trying to cahn Jim down.

Jim had gone through four hours of

therapy on Monday morning and was again

getting feisty. The nurses continued to ask him

questions to see if he knew who and where he

was. Finally, he turned to his sitter for that

morning and said, "O.K. You tell me. What is

my name? Where am I from? How many

children do I have?"

When I arrived on Monday, he was

slouched in his wheelchair. As I pushed him

around, he said, "Phyllis, I feel just awful." It

was the same expression and tone of voice he

had used prior to coming to Pasadena and back

in 1976 when I thought his thyroid had gone low.

"Jim, I know you feel awful." I tried to

soothe him. "The doctor seems to think your

feelings are caused by a chemical imbalance,

and we will have to find the medication to change

them."

After some pain medication and a short

nap--not nearly long enough for someone who

had had only three hours of sleep the night

before--he became agitated. He played with

the TV button, continually changing channels.

His speech became very mixed up, and he

31
PHYLLIS NIMMO MARSH

constantly made a circle with his index finger.

It had been a stimulating day, including a visit

by his brother David.

The nurse gave him a sleeping pill,

hoping it would help him sleep through the night.

It had no effect. He started yelling in the night,

and the nurses had to tie him down to keep him

in bed. He did not cooperate during his therapy

sessions the next morning.

I worried that Jim could not continue

with therapy if he was unable to sleep. While

he dozed off and on all day, he could not stay

asleep, the same sleep pattern he exhibited before

coming to Pasadena.

I called Dr. Suzuki to express my

concern. He replied that the rehab doctor could

order a sleeping pill for Jim. There were still

severe cognitive problems, and he did not want

to start any anti-depressants until the extent of

the problems was discovered. A psychologist

was testing Jim regularly to determine what the

problems were.

Then, almost as an afterthought, he said,

"The endocrinologist decided your husband is

slightly hypothyroid and is starting him on

Synthroid. That should make him feel better."

"Indeed," I thought, "perhaps this

housewife knew what she was talking about."

That afternoon Jim pointed to his left leg

and said something about a warm water wash.

Upon examination, I discovered the urine bag

had leaked out and the bedclothes were wet.

"That's getting closer," I thought.

On Wednesday, four weeks from injury,

I received a call from Jim's supervisor. He asked

me if I thought Jim would eventually return to

work. I responded, "Nothing indicates that he

cannot fully recover, but nobody knows for sure."

I never found a better way to answer that

big question. I always asked the doctors if they

knew anything that would limit Jim's recovery.

No doctor told me Jim could not get well, but

no doctor guaranteed things would be fine either.

Thus, I talked with friends about the gray period

we had to go through.

I did not go into great detail about Jim's

confusion, not because I was denying it, but

because I felt Jim had a certain right to privacy.

Progress that day was marked by Jim's

using the urinal after the catheter was taken out.

His brain recognized a problem and directed his

body to solve it.

Margaret and I set keeping Jim awake

from supper time until 10:00 P.M. as our goal

for that evening. Then maybe he could sleep all

night. It took some planning. We armed

ourselves with a Sony Walkman, nail clippers,

and Vitamin E oil.

He was king for the evening. His stitches

had come out that afternoon, and his nurse

wheeled him in to take a shower for the first

time in four weeks. He grumbled when he could

not stay longer. We trimmed his nails, we

combed his hair, we played his favorite music,

we rubbed oil onto his dry skin, we reminisced,

and at 9:00 P.M. he fell asleep.

Two days after Jim started on thyroid

medication, he had a good night's sleep. The

next day he completed all his therapies. His

physical therapist had encouraged him to take

some steps hanging on to the parallel bars, but

he had been unable to. The fourth day after

starting on Synthroid, he not only took a step

but walked the length of the bars. Everyone

watching gave him a thumbs up sign for

encouragement. His nurse gave him two Tylenol

#3 (which has codeine in it) and he fell asleep

for two hours.

He stopped twirling his finger. His

speech improved, although when he wanted his

pillow fixed, he said, "Would you please do

something with this footprint?" and he asked

where his "clothes" were, meaning his blankets.

He did not complain of feeling cold, and there

were fewer bears.

32
WHEN ANGER BECOMES A TODAY QUESTION

Every Wednesday the therapists, nurses,

and doctor in the rehab unit reviewed each

patient's progress and set goals. A social worker

assigned to the case attended and reported back

to the family and patient. After the first meeting

about Jim, I did not get a chance to talk with

Maria, our social worker, until Thursday

afternoon.

Each time I approached Maria or any

other professional who was working with Jim I

yearned to hear everything was going to be fine

in the long run. As professionals, they could

not assure that and could only tell me how far

Jim had progressed. Understanding there would

never be a way to overcome that difference

between hope and reality because they only

become one at the end of the long recovery

process, if at all, did not quell my yearning.

"All the therapists and nurses noted an

improvement in Jim when he was put on thyroid

medication," Maria began.

She spoke of head trauma, a new term

for me. She said Jim's cognitive abilities were

rnildly to moderately impaired. His judgment

of safety was very impaired, and he could not

be left alone because he might try to get out of

bed and could break his leg if he did. In IQ

testing by the psychologist, Jim's IQ tested at

70. In fourteen questions of common

knowledge, such as "Where is London?," Jim

could answer only six. His speech patterns were

disturbed, and when asked a question he could

not answer, he resorted to confabulation, or using

language from his work situation that had no

meaning in the context of the moment.

The team felt Jim would be strong

enough to fly to Maryland by commercial

airliner in three to four weeks. He would have

to transfer to an acute rehab facility for another

two to three months of therapy and then might

go to a convalescent home. Perhaps, following

that process, he could go back to using

computers or be trained in a new field. It was

too early to predict the longterm prognosis.

Afterwards Dr. Suzuki came by, and I

asked him about head trauma. He explained that

when the head is hit, the brain, which is encased

in fluid, bounces around. That caused the edema

or swelling Jim had. Nothing specific may show

up on a CAT scan when this happens, but it can

cause serious damage. A month is a short time

in the recovery process for head trauma.

From several sources, I had learned the

brain heals well for at least a year. After that it

continues to heal but at a slower rate. This

recovery was going to take a long time.

To be told my husband had an IQ of 70

felt a little like coasting down a two-mile hill on a

bicycle and being swept off the seat by an

unexpected branch. It stopped me short, it took

my breath away, and it unleashed anger so powerful

I wanted to destroy the thing that did it.

I had experienced every emotion since

getting that call; I had cried, I had laughed, I

had cared, I had mothered, I had reached out for

help, I had been supported. Equally important,

anger had nibbled away at me. At times it

surfaced only to be denied. Too many other

questions came before it.

That day I could no longer suppress my

anger. My husband evoked images of my

mentally retarded brother, and no one could tell

me Jim would be O.K. down the road. If I was

going to spend the rest of my life introducing

this man as my husband, I needed to know how

I was going to handle my emotions.

First, I had to acknowledge the anger I

had begun to feel long before February 22, 1989,

and which I had been trying to resolve.

33
PHYLLIS NIMMO MARSH

Once upon a time I had a really good

marriage. Several years ago I read in Ann

Landers or Dear Abby that if all marriages were

rated, five out of twenty would be truly good

and harmonious, five would be intolerable, and

the other ten would be so-so, an equal mixture

of good and bad. I had rated my marriage in the

truly good category and felt blessed.

Jim and I were married in 1966,

and up until 1982, we relied closely on each other

tbr emotional support. At some time during each

day, it was necessary to each of us to sit down

and share emotionally the events of the day. That

had changed in recent years, and the change

began in 1982, the summer we brought Jim's

mother home from the rehabilitation facility she

had been in because of disabilities caused by a

brain tumor.

My mother-in-law appreciated my care.

She was not the reason for the disturbance. But

the burden we shouldered, taking care of

someone with a life-threatening disease and

seeing that the family farm was maintained, cut

into the time Jim and I had together. I always

blamed myself for not insisting Jim and I do

more together during that time.

After that summer Jim's mother spent

eleven months in California with her sister before

we brought her back to Maryland to a nursing

home for the last five months of her life. Jim

and Mathew continued to drive three hundred

miles to West Virginia to maintain her property.

In the meantime, Jim traveled more that year

than any other. We were apart at [east one-fourth

of the time. Many times when his mother was

in the nursing home, I was the only one she had

to visit her.

It seemed after that Jim's energy went into

his job, into going to West Virginia to take care of

the farm, and into working on old cars with our

son. In 1988 Jim went to Paris in May, Helsinki in

July, Florida in September, and the Netherlands in

December. When he came home, he preferred to

listen to the radio and fall asleep on the sofa on

Saturday nights rather than go out.

I spent many hours alone. Jim objected

when I wanted to volunteer my time somewhere.

When I talked about my loneliness, he told me I

was lucky I did not have to go out each day to

work.

When I first mentioned getting a job, Jim

suggested we would be further ahead if, instead

of going to work, I took over the management

of our savings and investments. I took his

suggestion seriously and spent many hours in

the library researching financial planning. He

supported all the changes I recommended.

However, in no way did our resources match

those of the Rockefellers of this world, and

managing them did not give me the challenge

of a full-time job.

In order to keep my mind active, I solved

many New York Times crossword puzzles. I

played complicated games of solitaire. I read

ten books a month and crocheted many afghans.

Jim seemed to think I preferred these pastimes;

1 knew I did them to accommodate him so he

was free to travel and take care of his family

farm. I reached the point where I felt I would

scream if I had to spend another day this way. I

was angry I was not supposed to want or need

what Jim had.

I finally decided I could not continue,

and I was going to do for myself what I had done

for everyone else; I was going to encourage

myself to be all I could be.

I found a part-time job as a proofreader.

Though it was an excellent reentry job while

Mathew and Melissa were still home, there was

no room for advancement.

With our children reaching college age,

1 wanted to use my education in a career job.

Each Sunday I studied the Washington Post

employment section looking for something that

enticed me. I had sent my resume asking to be

considered for an administrative assistant's job.

In September 1988 I began a course of

study at our local community college that could

have led to my becoming a CPA. The program

excited me because it was tailored for people

34
BULIDING SATELLITES IS EASIER

who already had bachelor's degrees. I could take

all the necessary courses at this college so near

my home. My first course was a cinch and

piqued my interest in following through. While

I was flying to Pasadena, I should have been in

my accounting class getting back my first exam

of the new semester.

Excited about making a contribution to

the world and tired of being lonely, I felt my

future beckoning.

Now I was faced with a husband who

could not be left alone. His recovery would take

several months in a hospital and then follow-up

therapy as an outpatient. Someone would have

to be available to drive him.

No one I knew witnessed the battle

between my anger and my soul. Margaret and I

went separately to the cafeteria each night so

the other could stay with Jim. Them, after my

talk with Maria, with no one to distract me and

no other problem to confront me, I had to

acknowledge and release my rage.

"I have taken care of everyone else. It is

my turn to experience the world," one half of

me said.

"Yes, you're right," the other half

responded.

"Jim Marsh was not concerned about me

when I had to stay home while he went

everywhere. He told me I was lucky I didn't

have to go out into the world. Why should I be

concerned about him'?" My body was on

automatic pilot as it shoveled in the food.

"You're right, Phyllis," I answered

myself. "He wasn't concerned about your

loneliness when he was on top of the world. He

thought being lonely was stupid."

"Well, then why should I worry about

being with him?" My anger was like a relentless

prosecutor persuading a jury to pronounce Jim

guilty.

"Phyllis, you have every right to feel

angry," | soothed myself. "The job, the farm,

the old cars, and everything else came first."

That was the first step in resolution. I accepted

the anger. The prosecutor was looking out for

my interests. "But look behind you, Phyllis. If

you walk out, who is going to take your place?"

"Well, there is no one in Jim's family

who can take over to see that he gets to the

doctor. I guess the responsibility would fall on

Mathew and Melissa--he is their father." Even

in anger I could be honest.

"Can you do this to your kids?" My

conscience was looking out for me also. "What

would they think of their mother if she walked

out on their father when he was down?"

The prosecutor had no answer for that

one.

"No." Somewhere within me I resolved

this. "I can't. I can't walk out on somebody who

is down. I can't walk out on my kids. There is

no one but me who can do this. Besides, I once

had a truly good maniage, and someday I would

like to have a chance to find it again." Luckily I

had not choked on the food.

"But how am I going to survive if I have

to spend another summer doing crossword

puzzles and playing solitaire'? If I have to do

that driving, I am not going to be able to have a

job. I don't think I can do that again."

Something inside of me demanded totally

honesty. "Jim Marsh shot all my goodwill on

spending time alone on himself, his family farm,

his old cars, and everything else."

"That is a difficult question." A long time

ago I had learned we have to accept that

sometimes life can be unfair.

"What if Jim Marsh never gets better?"

I demanded to know. "What if I am faced with

a lifetime of taking care of him and never being

able to leave him alone? I don't want to be a

lonely, bitter old woman. I will probably eat

myself to death and then where will Jim be."

Somewhere deep inside me a rational

voice came back. "Phyllis, calm down. You

won't know for at least a year whether Jim will

get better. You won't know whether you have

lost anything until then, and maybe not even

then."

35
PHYLLIS NIMMO MARSH

"I don't want people to say, 'There goes

Phyllis Marsh whose husband jumped out of a

window and ended up brain damaged.' I want

to be known as someone who used her mind to

make the world a better place in some way." That

prosecutor could be brutal. "I worked hard to

get this education; why waste it baby sitting for

someone?"

"O.K., Phyllis. It's time for some plain

talk." Perhaps I was hearing my mother's voice

inside my head. "You may have to face all that

you are worried about, but you are not going to

know for at least a year."

That was true. "At the end of the year,"

the voice continued, "you will have to take stock

of what you have lost, whatever that is going to

be. Then you will have to grieve--grieve as hard

and as honestly as possible for all you have lost,

whatever that is. If Jim requires constant care,

then you will have to arrange for that. If that

means adult day care programs, that's what it

means." Indeed!

"You are going to have to work

crossword puzzles and play solitaire and spend

a lot of time alone this summer because there is

no one but you to see that Jim gets the care he

needs. Yes, you will have to postpone your

career, but not forever--just for a year or so." I

could feel the anger receding.

"But what if Jim Marsh does not do the

therapy program.'? He's never liked having others

manage his life. He thinks therapists are stupid."

My prosecutor/friend still cared.

My soul responded. "If Jim Marsh does

not do his therapy, that will define and limit Jim

Marsh, but it does not have to define and limit

Phyllis Marsh. Only Phyllis Marsh, by the

choices she makes, can do that."

"But what about this bitterness?" I asked

myself. "I don't want to pass on to Mathew and

Melissa that life is so bitter. I want them to know

that life can be good."

The answer came from somewhere

within. "Phyllis," I promised myself, "at the end

of the year you can grieve for whatever you have

lost. And at the end of that process, there can be

joy and beauty in your life if you choose to

recognize them. Remember, only you can define

what your life is going to be."

By then I was finishing my frozen

banana yogurt.

Looking back, I realize the understanding

I reached during that mealtime made survival

possible. In a situation in which I had little

control, I took control of the only thing I could--

my attitude. When the going got rough, I

reminded myself my bargain depended only

upon me.

When Jim refused at times to do his

therapy, he could not manipulate me. I reminded

myself it would be Jim Marsh whose life was

limited if he did not cooperate. Consequently, I

take no credit for the hard work which Jim

eventually did in order to recover. He did it for

himself.

I knew enough about myself to know I

would spend that year seeking the most up-todate knowledge about Jim's illness and injuries.

I was not walking out on Jim Marsh.

I did not walk out on Phyllis Marsh

either.

36
EVERYTHING I DID NOT KNOW ABOUT THYROID

That Friday we met Virginia De Jesus,

our new daytime sitter, who soon had Jim figured

out. She pushed him all around the hospital for

entertainment and encouraged him to do his

exercises. The first day he fired her twice, but

then thanked her for her help when she left. She

said Jim had gotten all but one of the speech

therapist's questions right.

That day Jim turned himself on to his

side. It required effort to reach over, pull on the

bars and bend his right leg. Progress visited us

again.

As we left that evening, though, he asked

me to take his socks off. "They're too tight

around the interstate," he said.

I missed my children. Melissa's spring

vacation provided an opportunity for her to visit.

On Easter Sunday she flew into Burbank, and

Margaret and I braved the freeways to meet her.

When Melissa walked into his room,

Margaret saw Jim smile for the first time.

"Melissa, don't spend all your time here," he

said. "Old Dad is not going to be in here lbrever,

and you should get out and see some of

California."

That afternoon when he was in pain, he

wanted a pain pill but in asking for it said, "Give

me cold pain water." Later, after a rest, he talked

on the phone with his brother and was able to

tell him about Melissa's arrival and how Mathew

was planning to fly out and go home with us.

That Easter Sunday, at Dr. Suzuki's

suggestion I began speaking with Jim about what

had brought us to this place. First, I told him of

the many calls and cards we had received. His

eyes filled with tears as I went through the many

kindnesses.

"Jim, I understand you were not feeling

well on Tuesday afternoon and evening.

Sometime in the middle of the night you cut your

wrist and then jumped out the window causing

your injuries." He just looked at me. I could

not tell if he comprehended, if he remembered,

or if he were ducking the issue. At least, I had

the event in the open.

Our days settled into routine. Our

second floor apartment looked out onto South

Wilson Street. The balcony caught the morning

sun. If we looked to our right, palm trees and

stucco roofs told us we were in California. If

we looked to our left, a white frame house and a

treeshaded street reminded us of the Midwest.

Our mornings were usually filled with

phone calls. Some took care of business. The

idea of moving Jim back on a government plane

was explored with his supervisor. It finally

seemed too difficult to arrange, so I made a

decision to keep Jim at Huntington until he was

able to fly by commercial airliner. I asked for

first class tickets since first class seats recline

more. Jim's floppy head required that. His right

leg was still painful, and the incision down the

side would be better protected in the wider first

class seats.

I began searching for a rehabilitation

facility near our home. In looking down the long

road to recovery, I wanted the best, but I also

wanted the facility to be convenient for certain

people to visit Jim because they could stimulate

his mind in ways therapists could not.

I thought first of the world-renowned

Johns Hopkins University Medical School in

Baltimore; it is within driving distance of our

home. Bruce Marsh lives in Baltimore, and I

felt Jim would be able to talk with him about

this experience in ways he could not talk with

anyone else. If Jim were nearby, Bruce would

have an easier time getting to see him.

I asked Bruce to contact Johns Hopkins

to see what kind of rehabilitation facility they

37
PHYLLIS NIMMO MARSH

had. Bruce first gave me the name of the

psychiatric facility there, but Dr. Suzuki said Jim

did not need that kind of care. Bruce went back

for further information and found that Johns

Hopkins did not have the kind of rehabilitation

facility Jim would need. The staff at Johns

Hopkins referred us to Montebello

Rehabilitation Hospital, which is connected with

the University of Maryland Medical School, and

to another hospital in Baltimore.

Our social worker Maria, who arranged

for our transfer, suggested I find at least three

facilities because ifI chose only one, a bed might

not be available when I needed it. The rehab

doctor at Huntington suggested a facility in

Washington for our third choice, and Maria

began the process of seeking admission to all

three.

Virginia, Jim's sitter, gave us a report

each day about his progress. On Monday, she

reported a good day. Everyone had commented

on how much better he was doing. He had been

mixed up only once, after the psychologist did

cognitive testing.

That afternoon his last physical therapy

session was from 4:00 to 4:30. Margaret,

Melissa, and I were waiting for him in his room.

The therapist asked Jim to wheel himself back

to his room to see if he knew the way. This

required coming out the therapy room, turning

right down the hall, going to the second door,

and turning right into his room. He made it down

the hall, but turned left into the room across the

way. The patient there was an older man with

his own cognitive problems. Jim wheeled

himself in, looked at a man he had never seen

before, and said in a voice we heard across the

hall, "Hi, there, John. How ya doing, you old

fart?"

That night when Bob, the nurse who

had taken care of him many nights, brought his

tray, Jim turned to me and said, "I don't know

who that man is. He is really nice. I see him at

the hardware store all the time and I write him

little notes."

Jim and I talked that evening about what

had happened. He told me how awful he had

felt Tuesday night at the meetings. I told him

that we needed to find out why he had felt that

way and that the doctors were willing to work

with us to do so.

On Wednesday, Melissa and I took a oneday vacation to Mexico. A tour bus picked us

up at the Pasadena Hilton at 9:00 A.M. After

changing buses in downtown Hollywood, we

spent the afternoon shopping in Tijuana. We

expected to be back around 7:00, but because of

several mixups our bus did not arrive back at

the Hilton until 10:30. That was the only day in

nine weeks I did not go to the hospital.

Melissa's visit sped by. On her last

evening she and I left the hospital for dinner.

We discussed the ways our lives had changed.

"Morn, I think I've grown up a lot," she

said. I could only agree. She had become

responsible for herself at a time when her parents

could not be there, and when Jim and I returned,

we could not make her, nor did we want to, into

a child again. At sixteen she had flown across

country by herself, taken on the responsibility

of a car, continued getting straight A's in school,

and lived with a family who enjoyed her so much

they still tell me they miss her. She had spent a

week in California, and other than our day in

Tijuana, most of it had been spent in a hospital

visiting a father with severe cognitive deficits. I

never heard a word of complaint from her.

It is no wonder I missed her.

Chet called me the next week. "I coach

my son's team" he began, "and the other coach

is a doctor doing graduate studies in

endocrinology."

Chet mentioned to the doctor that Jim

had complained of numb legs for several years

as well as feeling low and depressed, particularly

the two weeks before going to Pasadena.

The doctor had replied, "When the legs,

feet, and hands go numb, that can be a subtle

indication of a thyroid that stops working"

38
BULIDING SATELLITES IS EASIER

I was stunned. Never had I connected

numb legs with the thyroid. In 1982 Jim went to

our family doctor to find out why his legs were

numb at times. He was sent to a neurologist,

who had tests done in which electrical impulses

are sent through the muscles. The tests showed

a problem, but the neurologist could not

determine why. "It will either get better or

worse," he had told Jim. "If it gets worse, we

will have to do further studies." Jim had not

complained of the numbness getting much worse

until the week before his trip to Pasadena, when

he told me it was spreading to his hand.

Chet went on to tell the doctor that Jim

had had radioactive iodine therapy for an

overactive thyroid in 1970.

The doctor winced and said, "We now

know that the thyroid almost always stops

working after that therapy."

Chet spoke of Jim's attempted suicide.

"That is entirely in keeping with a thyroid that

shuts down," the doctor responded.

I now had several points of information

1 wanted to know more about. Jim had had

Graves' disease; he was given radioactive iodine

to treat it; he was now called hypothyroid

(meaning low thyroid); and it had been suggested

that the numbness he had felt offand on for seven

years could be connected with a thyroid problem.

The library at Huntington Hospital

beckoned. Libraries have been an important part

of my life. In Newton, Iowa, where I grew up,

we had a Carnegie Free Public Library run by a

member of the Maytag family. To me it was the

most interesting place in Newton, and the books

I checked out transported me far beyond the

cornfields that surrounded my town.

At Grinnell College, I learned more

about the research process. In a freshman health

class in the spring of 1956, I was required to

write a research paper on a topic of interest. I

chose to write about my brother Duane.

Searching the periodicals and health books I

found many theories about the causes of

Mongoloidism. A popular theory said an illness

in the mother during the first three months of

pregnancy might cause the problem. Since my

mother had a serious case of flu early in her

pregnancy, that theory seemed reasonable. I got

an A on my paper.

The main value of that paper came to

me ten years later when two medical students

mentioned in casual conversation that the

medical field now knew Mongoloidism was

caused by an extra chromosome present at

conception. The most up-to-date information

of 1956 was disproved by a discovery in the early

1960s. From then on, I did my research with a

bit of skepticism about the finality of any

statement, and I always tried to get the most

recent statements on any subject.

I also learned that terms change for now

Duane is referred to as having Down's syndrome.

Margaret and I went to the hospital early

one afternoon to see what we could find out

about the thyroid. We started with a book on

endocrinology with a full chapter on

hypothyroidism.

The computer data now suggests that

hypothyroidism occurs within a year after

therapy in from 12 to 90 percent of patients

treated for Graves' disease. That surprised me.

Up to 90 percent have hypothyroidism within a

year, and Jim's was not diagnosed until eighteen

years after his treatment. This surely placed him

in a rare position.

One of the reasons for the variation in

frequency of hypothyroidism suggested by the

current data was the use of antithyroid drug

therapy prior to treatment with iodine. Reading

that, I recalled that when Jim first went to the

doctor in 1969 for his overactive thyroid, he was

given a drug which inhibited the thyroid gland

from producing its hormone but did not cure the

overactive thyroid. Jim was told he could stay

on the drug for a while but that he would have

to go off of it for six weeks before he swallowed

the radioactive iodine.

Jim got the prescription filled for this

drug, propylthiouracil, at the pharmacy at the

39
PHYLLIS NIMMO MARSH

clinic where he went. After several months, he

went back for a follow-up appointment with the

doctor, and the doctor became very upset that

the pharmacist had continued filling the

prescription. Remembering how upset the

doctor had been, I wondered if this incident had

influenced the course of Jim's disease.

The book went on to state that following

the first year after iodine therapy,

hypothyroidism continues to develop, probably

indefinitely until all of the population at risk has

developed the disorder.

When hypothyroidism develops long

after radioactive iodine therapy, this

hypothyroidism is preceded by a long period of

subclinical hypothyroidism. I thought back to

the preceding years when it seemed that Jim

often ran out of gas on Saturday night and did

not want to expend the energy to go anywhere.

Reading on I discovered a paragraph

entitled "Transient Hypothyroidism." Following

radioactive iodine treatment for an overactive

thyroid, a period of hypothyroidism often

develops. During the time the thyroid is

overactive, the pituitary gland cuts back on the

production of thyroid stimulating hormone

(TSH) because of the excess secretion of the

thyroid gland. Following therapy, parts of the

thyroid gland that are overactive are destroyed,

and the production of thyroid hormone gradually

decreases. When production reaches subnormal

levels, the pituitary gland must then start to

secrete TSH, which may take some time since

the production of TSH has been suppressed

during Graves' disease. Thus, production of

thyroid hormone may remain low for a long time.

Reading this I thought back to the period

in 1976 when Jim's thyroid hormone had dropped

to the low normal level and he was feeling very

like he did prior to coming to California. I had

argued with the doctor, who was a specialist in

stomach problems, because I thought Jim had a

problem, and I had been told I did not know what

I was talking about. Now I knew I had been

right back then, and I knew that most of Jim's

symptoms before his trip to Pasadena had been

caused by the thyroid.

Thyroid hormone affects every organ in

the body, and therefore symptoms of

hypothyroidism can be many. Puffiness around

the face is a characteristic appearance of

someone with hypothyroidism. A picture of a

patient suffering with hypothyroidism reminded

me that on occasion in the preceding year I had

sat at the dinner table and thought that Jim

looked very fat around the jaws. At other times

he did not. Both Steve and Chet had mentioned

to the social worker the same fullness in Jim's

face even though he had not put on weight.

The nervous system is affected by the

thyroid hormone, and low hormone causes

tiredness, lethargy, fatigue, and depression. A

person suffering from lack of hormone may

become physically clumsy. I recalled that in

recent months Jim often stumbled when he got

up from a chair and took his first steps. His

movement reminded me of someone who has

arthritis and for whom those first steps might be

painful. However, when I asked if he hurt, he

told me no.

Muscle cramps are common in

hypothyroidism. I remembered how often in the

preceding months Jim had wakened and told me

that the calves of his legs ached and felt cold.

Headaches may be prominent

complaints in hypothyroidism. Headaches--I

had fbrgotten to mention those to any one. Over

the past year, Jim had had a series of unexplained

headaches. Tylenol had not helped, and we could

never find a trigger tor them.

The gastrointestinal system is affected.

I read that the tongue is often enlarged and

remembered that before coming to Pasadena Jim

had stuck his tongue out to show me it was sore.

In 1976 when I thought he had a low

thyroid, he had complained of stomach pains.

During the months belbre his trip to Pasadena

he often complained that what I cooked upset

his stomach. One night it was the beef, one night

the chicken. After a while I tuned out the

4O
BULIDING SATELLITES IS EASIER

complaints because it seemed everything

bothered him. Now I read that hypothyroidism

caused gastric problems.

Sleep can be disturbed in

hypothyroidism. A patient may need much more

sleep but also may have insomnia and sleep

apnea. Each time I thought Jim's thyroid was

low, one of his symptoms was the inability to

stay asleep. I would note him falling asleep but

waking up, sometimes in a minute or two,

sometimes in fifteen minutes or so.

The final section on hypothyroidism

talked about lab tests. The most common tests

for hypothyroidism are called tests of T3 and

T4. I did not understand all of the technical terms

about these tests, but two things stood out. The

first was that serum T4 concentrations need not

be below the range of normal in the presence of

significant hypothyroidism. The second was that

in 20 to 30 percent of patients with overt

hypothyroidism the tests show normal serum T3

concentrations. I remembered that first day

when the trauma doctor told me Jim's thyroid

tested normal, and I had told myself further

testing was needed.

I acknowledged that in 1976 when the

doctor did these two tests, it was possible the

data base was not large enough for him to know

these facts. And I will never know if a test for

thyroid stimulating hormone was done then.

The test for TSH, thyroid stimulating

hormone, thus became very significant in

diagnosing Jim's thyroid problem. Even then,

his TSH level was above normal but not

significantly high.

My research caused me to rethink how I

had handled this event. I remembered back to

what the endocrinologist had asked me. "What

made you think he had low thyroid?" was the

question I remembered.

"He was cold, tired, and depressed," I

had answered.

Because the question was asked in that

way, I was ,'equired to be knowledgeable about

thyroid, and there was a whole lot I did not know.

What if the doctor had said, "Tell me about your

husband's physical self." Would I have been able

to remember the headaches, stomach problems,

and muscle cramps. What if the doctor had

asked, "Does he have headaches? Have you

noticed any changes in his movements? Has he

put on weight?"

I realized then that for all the tests, the

medicines, and the new surgical treatments,

diagnosis still depends a great deal on

communication and how questions are phrased.

In all fairness, the endocrinologist never

had the opportunity to question Jim directly, to

note his physical features prior to injury, to watch

Jim walk, and to check such things as his

reflexes. All this would have made his job easier.

Looking back on the preceding year, I

asked myself how we could have missed all those

symptoms and not known that something was

drastically wrong. I was comforted by a

statement I read that the recognition of

hypothyroidism n-my be difficult because of its

insidious onset and slow progression. Jim's

condition had been coming on gradually for

seven years if the numbness in his legs was the

first sign of the problem. Each development was

such a minute change from the previous one that

it raised no alarm. Only in looking back did the

full picture become evident to me.

The book I was reading was copyrighted

in 1989. The library also had a copy of the same

book copyrighted in 1979. I noted one significant

change. In 1979, the data showed most thyroids

fail following radioactive iodine therapy. By

1989, the data was more complete, and the

statement was made that hypothyroidism is a

nearly inevitable consequence of iodine therapy.

In 1970, Jim had been told only that the thyroid

might fail.

The lessons of my research paper on my

brother Duane came back to haunt me. The most

up-to-date information in 1970 had changed by

1979 and again by 1989.

41
PHYLLIS NIMMO MARSH

One other line in my research jumped

out. It cautioned that the metabolism of many

drugs is prolonged in hypothyroid patients and

care should be exercised when anesthetic,

analgesic, or sedative drugs are given. Jim had

gone for a month after his injury taking all those

drugs before starting thyroid hormone.

I had dated the decline in my marriage

to the summer we had cared for Jim's mother.

Probably that date corresponded to the time

when Jim's thyroid started its decline. Perhaps

I had attributed the problem to the wrong cause.

42
TWO STEPS FORWARD, ONE STEP BACK

Then the setback came.

The second week in April several of

Jim's colleagues were due back in Pasadena for

another conference and wanted to see Jim. I

wanted Jim to be coherent when they came by,

and I felt he needed to make contact with people

before then. It took some finagling, but I

arranged for him to receive phone calls each

evening. His days were taken up with therapy.

Exhausted from therapy, he needed a nap.

Following that was dinner. It was seven o'clock

before he was free to talk, which meant it was

ten o'clock for his friends on the East Coast.

I asked Bruce Marsh to be the first to

call. When I arrived at the hospital the day of

the planned call, Jim was convinced he was

going to die. Gas pains rumbled through his

stomach. Even in the midst of his agony, though,

he seemed better, for he told me he wanted to

live and was afraid of dying. He said he

appreciated my being there and would not have

made it without me.

When I told him Bruce was going to call,

Jim started an imaginary conversation. "Oh,

Bruce," he moaned, "I feel awful. I don't think

I'm going to make it. If I don't, I want you to

know it's been nice to know you."

When I reminded him that Bruce had not

called yet, he said, "I know. I'm just practicing."

Jim's sister and her husband called just

at the time I was expecting the call from Bruce.

I let Jim talk to them, and his voice was so low

and lethargic they did not know how to handle

the conversation. After all the good reports I

had been sending, they were shocked. I tried to

explain he was sick.

When Bruce called, Jim perked up.

Bruce asked Jim how to set the bearings on his

Model A Ford, and Jim responded in accurate

detail. However, when Bruce asked about the

weather, Jim said, "It's about zero outside here,

and I think its supposed to snow."

Bruce was still ecstatic and told me, "The

old Jim is still there."

Jim's stomach agony increased. I asked

him if he wanted to listen to music. "Yes," he

responded, "play some of that stink music so

this gas will go away." Such statements always

caught Margaret and me by surprise, and we had

to stifle laughter.

"Please," he said, "get the nurse to punch

a hole in my stomach to let out this gas."

"Jim," I tried to be calm, "we can't do

that."

"Yes, you can. Just get herto drill a hole.

Don't give me any guff about it. She can do it."

When the lab technician came in to take

a blood test to determine what the problem was,

he gave her the warmest welcome she had

probably ever received. "Oh, thank you for

coining!" Unfortunately, doing a blood test did

nothing for letting out the gas.

Nothing showed up in the lab or stool

tests as to the problem. He started on antidiarrhea medicine which helped slow it down.

He started giving orders to the people

around him, calling his roommate "crude" and

telling him to turn off the television. "Hey, be

quiet over there," he yelled to the nurses talking

to his roommate.

At one point, Margaret asked him if he

had pain, and he commented, "I don't have any

area of concentrated pain. I just hurt all over."

That was a pretty complex word pattern.

Jim tried to tell me he was being

sabotaged by the Russians and that was why he

was in the hospital. Dr. Suzuki told me intestinal

upsets often make people think they are being

poisoned so Jim's reaction was typical.

43
PHYLLIS NIMMO MARSH

I spoke with Dr. Suzuki about Jim's

thyroid problem but did not have an opportunity

to relate all I had read. I was just too tired. Since

the endocrinologist stated Jim's thyroid tested

slightly low, Dr. Suzuki did not feel that was the

major cause of his depression. Therefore, he

was going to start Jim on an anti-depressant.

This was good news in a way because he had

stated he would not start Jim on any medication

until his cognitive functions improved.

The medication (Norpramine) takes two

weeks on a dosage of 100 mg per day before any

benefits are noticed. Jim was started on 10 mg

per day. If he tolerated that, the dosage would

be increased gradually.

His diarrhea continued two days before

easing. Jim had two good days of therapy, and

one afternoon he was still sitting in his

wheelchair when I arrived at 3:00 P.M. Virginia,

his sitter, had taken him for a ride all around the

gardens at the hospital, which he had enjoyed.

Jim started receiving surprise visitors.

Colleagues from back east were in town, and

several stopped by to see him. Jim weighed forty

pounds less than what he had prior to his injury

so I am sure he looked very frail to them.

I began to learn more about the speech

therapies. The therapists always invited me to

sit in on Jim's sessions, but I chose not to for

many reasons. First, most of them took place in

the morning and early afternoon. Since I had to

be at the hospital the entire evening, I needed

the morning for myself. Secondly, I felt Jim

would rely on me too much if I were there. I

wanted to make sure he did the therapy. I wish

now I had learned more about the process.

When the therapists first started working

with Jim, they asked him a series of questions

that could be answered yes or no, e.g., "Is a

handkerchief smaller than a pillow case?"

After that they moved on to more

complex processes. As Jim became more aware,

he read the questions himself. The first words

were in fairly large letters. From questions, they

went on to paragraphs and then to gradually

smaller print to help his eyes focus. All the time

he was in Huntington, he continued to make

good progress in the speech therapy part of his

program.

The diarrhea, though, still erupted. Bob

was his nurse one night when it was particularly

bad. Jim and everything around him needed

cleaning. Fontella, who was working in another

section, had been particularly helpful and nice

during our stay. She came in to help Bob clean

up. Bob left to go get new sheets while Fontella

waited.

Jim tore in to her. "Look at her standing

there. She's just lazy and stupid. Why doesn't she

help get this mess cleaned up?" His outburst

surprised and hurt Margaret and me as much as it

did Fontella. This was not the Jim Marsh we knew.

Later he said, "I'm just no good and

useless." I wondered then if he were mad at

himself.

In physical therapy he had graduated to

using a walker and could walk halfway across

the physical therapy room, but he seemed

agitated and confused at other times. One day

when I arrived, hc pointed to some balloons tied

to the end of his bed. "When I looked up at the

ceiling," he said, "those balloons were peeing.

Why don't you take them down?"

After stifling my laugh, I realized one

was hanging down and leaking air. "Taking a

leak" is sometimes used to mean peeing and so

maybe he was not as far off as I thought.

Jim became more aware of his feelings.

One day he asked what would happen if he did not

want to go back to work. "That decision will have

to be made down the road," I responded. "The

therapy will help your mind, and things will be

better when you can move around. Then we will

decide the future."

He expressed concern that he would end

up a bum on the street and that Mathew and Melissa

would not understand.

"We are not going to desert you, and

Mathew and Melissa will understand" I reassured

him.

44
BULIDING SATELLITES IS EASIER

Michel arrived from France on Saturday,

April 8. I left them alone for half an hour.

Michel did not intend to speak of work, but Jim

kept bringing up the subject. Michel told me

later he was impressed with the details Jim

interspersed in their conversation, details Michel

had forgotten. There was no confusion. This

conversation was the most encouraging sign so

far that Jim's mind might eventually be O.K.

When I joined them, Jim appeared to let

down, as if the effort had been difficult. His

speech became confused, and he talked about

my cooking dinner for Michel.

The next day his diarrhea returned. It

was Sunday, and there was no therapy. We

arrived at the hospital at 3:00 P.M. to find Jim

still in bed and not dressed. His cousin Carol

was with us, and I asked her to get Jim dressed

because several of his colleagues were waiting

to see him. She noticed blood in his diarrhea.

Visiting with colleagues he was lethargic and

very, very thirsty.

Two days later, I began hearing

complaints that he had fallen asleep on the mat

during therapy. Virginia and the therapists told

me he seemed drugged.

When I arrived, he said, "Phyllis, they

are drugging me so I won't give them any guff."

I was concerned and asked the social

worker if I could refuse the anti-depressant. She

said I could but suggested I talk with the doctor.

When Dr. Suzuki came in, he agreed Jim

seemed drugged and canceled the prescription.

Jim was receiving 40 mg per day of the

Norpramine, far less than the 100 mg for two

weeks needed before any change in his moods

could be noted.

When I mentioned to Dr. Suzuki that Jim

seemed more aware, he gave Jim a series of

questions to check his orientation. Jim got all

of them right.

On Wednesday, April 12, Maria, our

social worker, told me National Rehabilitation

Hospital in Washington would accept Jim as a

patient. Washington was not my first choice,

but I wanted to go home. Living in Pasadena

was costing me almost $1000 a week by the time

I paid $37 a night for my apartment, $33 a day

for the rental car, and $74 a day for the sitters. I

was ready to get back to my world. Jim and I

discussed the situation and agreed we would go

to Washington.

That evening Jim's supervisor and two

other colleagues came to visit. I told them we

would be leaving the following week for

Washington.

The first naemory Jim had of his stay at

Huntington was this visit from his supervisor.

It happened seven weeks from the day of his

injury and marked the end of what is called his

post-traumatic amnesia, a condition quite

common in head trauma patients. The date is

significant because post-traumatic amnesia that

lasts twenty-four hours indicates a serious head

injury; anything over one week in duration is

considered very serious.

The next day Margaret dropped me off

at the hospital so I could make further

arrangements for us to leave. I walked in to

disaster; Jim was delirious with a temperature

of 102 degrees.

The doctor who headed the rehabilitation

unit talked with me about his concerns. Jim's

blood and stool tests had come up negative. He

suggested calling in a gastroenterologist, and I

quickly agreed.

Never have I seen nurses work as hard

as Jim's did during the next few days. The

diarrhea persisted. Everything on the bed would

have to be changed only to have the same thing

occur within a half hour.

Jim was too weak to go to therapy. Again

he said, "Phyllis, they are trying to kill me here."

The gastroenterologist was concerned

that Jim's mother had suffered from ulcerative

colitis for many years. Although it would have

been unusual for Jim to develop the condition

suddenly at this point in his life, it was possible,

and therefore the doctor wanted to do a

colonoscopy.

45
PHYLLIS NIMMO MARSH

After the gastroenterologist examined

Jim, he said, "The record says something about

your husband being exposed to radiation in the

work place."

"Huh," I responded. "I've never said

that."

When the resident in gastroenterology

came by, he said, "The record says something

about your husband being exposed to radiation."

Again, I denied it, and wondered where

that idea could be coming from. When I asked

the head nurse, she said she had also read that.

"But it isn't so," I said.

One of the doctors who had seen Jim in

ICU had written up a medical history based on

the information I had given the social worker.

He stated Jim had been exposed to radiation in

his work place.

Then I realized how true to life the game

is where one person whispers a phrase to the

person next to him, who then whispers it to the

next person, and so on through several people

until the phrase comes back totally changed.

I had spoken of radioactive iodine

treatment to the social worker who called. She

passed the information to the doctors treating

Jim. One doctor, who never spoke to me about

Jim's medical history, entered into Jim's record

that Jim had been "exposed to radiation."

Because Jim's occupation was listed as

geophysicist, no one questioned the truth of this

statement. It made me wonder what else could

be in error in Jim's medical history.

Margaret left for home on Thursday

evening, the day alter Jim's supervisor visited.

She had stayed three and a half weeks, and Jim

had no memory of her being there. It is another

way we date the length of his post-traumatic

amnesia.

I had recovered enough to stay alone.

The colonoscopy took approximately

forty-five minutes with Jim sedated. The results

showed colitis, an inflammation of the colon. The

lab tests were inconclusive as to whether it was

ulcerative colitis or a non-specific inflammation,

perhaps caused by a reaction to all the drugs. Either

way he would be started on prednisone (a steroid)

and asulfadine. He could go back on regular food

but with low fiber.

In follow-up studies on Jim's thyroid, the

endocrinologist found Jim's TSH level was still

slightly elevated after taking thyroid medication

for a month, so his dosage of Synthroid was

upped slightly. The doctor indicated Jim

essentially had a non-operating thyroid and

would have to remain on medication for the rest

of his life.

I asked the doctor if it was rare for Jim

to still have thyroid activity eighteen years after

taking the iodine. He responded, "Jim is in the

statistical minority of less than one percent."

When I told him Jim had taken the

propylthiouracil longer than he was supposed

to, the doctor agreed that this could have caused

Jim's thyroid to respond differently.

Dr. Suzuki wanted to start Jim on an antidepressant, but I feared Jim's super-sensitive

digestive tract would object. I was not convinced

Jim needed it anyway. "Doctor," I told him,

"prednisone is going to make Jim feel better.

They are going to up his thyroid medication,

which is going to make Jim feel better. The antidepressant is not going to take effect before we

get to Maryland next week. Why take a chance

on upsetting his digestive tract? Let's wait until

we get back to Maryland to start it." He agreed.

While I Ielt Jim's problems were caused

by thyroid, no doctor said that, and I did not

want to take total responsibility for Jim's

diagnosis. I felt if he showed up in Maryland

on antidepressants, the doctors there would rely

on the diagnosis at Huntington. I wanted their

independent judgment. I vowed to myself that

for safety's sake I would listen to the experts in

Maryland. If they decided Jim needed antidepressants, I would agree.

As Jim's diarrhea was brought under

control, we looked forward to our return to

Maryland. Montebello Rehabilitation Hospital

in Baltimore sent word they would accept Jim

46
BULIDING SATELLITES IS EASIER

for treatment. Now I had a choice. Baltimore

had been my first choice because I felt Bruce

Marsh would help Jim recover. Montebello was

connected with the University of Maryland

Medical School, and I had always heard that

facilities connected with medical schools are in

the forefront of new techniques.

Something within me urged me to go to

Montebello. At times in my life, I have had ESP,

and I have learned to heed these feelings no

matter how many times I have been told they

are stupid. I had the feeling that in the long run

something at Montebello would make me glad i

had chosen it.

Preparations went forward for our flight

across country. The only non-stop flight from

Los Angeles to Baltimore left around noon and

arrived in Baltimore at 8:00 P.M. Montebello

arranged for us to be admitted that evening.

Cousin Carol would drive us to the airport, and

our neighbor, whose car has a front seat that

reclines, would meet us in Baltimore.

Jim had not been outside the hospital

since his injury, and I was concerned about

overstimulation on the trip. We started sitting

outside the front entrance of the hospital. Cars

zooined by on Pasadena Avenue, and some came

up to the entrance to drop passengers off. One

evening I pushed Jim's wheelchair around the

outside of the hospital stopping in the parking

lot to show him my car.

Great discussions took place about the

physical problems we might encounter on the

flight. The staff at Huntington wanted the trip

to go smoothly. Since Jim could not walk

without a walker, going to the bathroom on the

plane might be difficult. Some suggested the

use of a condom catheter and adult diapers. "I'll

handle what has to be handled," I told them.

The nurses decided among themselves

that Jim would probably be O.K. in the long run.

I knew they were not experts, but they had seen

a lot of rehabilitation and I appreciated their

judgment.

Dr. Suzuki came to say goodby. I

appreciated the way he had always shown

concern for me as well as for Jim. He told me

he and the neuropsychologist had determined

Jim would be safe traveling with me. They lbund

no overt indications Jim was suicidal.

Then he added, "Mrs. Marsh, I think the

long-term prognosis for your husband is

probably going to be good. He has come a long

way in a short time, he had a high IQ prior to his

injury, and he has a strong family support system.

All those contribute to a good recovery."

His encouragement stuck with me for a

long time.

Two days before we left, I walked in to

Jim's room and for the first time thought, "He

looks healthy." Jim told me that day he felt like

his head was much clearer. A cousin came to

visit that night, and we had a good conversation

with no mix-ups in words.

April 26, 1989, arrived--nine weeks to

the day I left Maryland. All I had accumulated

had been shipped ahead. Our bags were packed.

Jim and I said goodby and departed with

tranquilizers, pain killers, motion-sickness pills,

urinal, an extra change of clothing, and the

determination that nothing was going to stop us

from going home. "Remember," I steeled myself

as we said goodby to the security of Huntington,

"no airline is going to inconvenience three

hundred passengers and land a super jet short of

its destination because of a little diarrhea. If

you make it to the plane, you will have help with

any problems."

47

SETTLING IN

At the airport we were met by a travel

agency representative who aided us because we

had two first class tickets and needed wheelchair

assistance. She took us into a VIP lounge to

wait. Our flight was delayed slightly. Jim rode

in the wheelchair to the door of the plane and

by grabbing walls and seats walked to his

assigned place.

The day was clear, and flying out over

the ocean before turning back toward land, we

enjoyed a spectacular view of the California

coastline. Our royal first class treatment, from

hot towels for our hands to wine lists and a meal

served in three courses, helped us forget Jim's

illness.

Touchdown came at 9:30 P.M. We were

both too exhausted to celebrate. Jim visited with

our neighbor while Mathew and ! searched for

his bags, and then Bruce Marsh guided us across

Baltimore to Montebello Rehabilitation

Hospital, where the guard was expecting us.

Montebello was built by the state of

Maryland in 1957 as a chronic disease hospital.

The dark brown tile floor and turned-out lights

cast a dreary mood over its antiquated decor. An

early heat wave had hit long before the air

conditioning was turned on for the summer. The

four-bed room where Jim was placed had

patients in an earlier stage of head trauma, and

a sign above one bed stated in big letters, "Patient

subject to seizures." I felt as if I had gone

backward in time to the 1950s. The one bright

spot was Joy, the nurse in charge, who seemed

caring and competent.

"I'll be O.K.," Jim said, and with much

trepidation I left. After nine weeks, I yearned

for my own home and my own bed.

Mathew took off work the next day to

drive me back to get Jim settled in. He had been

moved across the hall to a room with patients

near the end of their stay. A surprise awaited

us, for in the next bed was a prisoner of the State

of Maryland. He had round-the-clock armed

guards, and every eight hours there was a shift

change that included a transfer of guns and

manacles.

Several things impressed me. Jim was

assigned a primary nurse who was responsible

for his care. That seemed logical. He had had

difficulty keeping the nurses straight in

California.

The therapy program was designed so

Jim would have a set schedule for the whole

week, much like going to work. He would have

one physical therapist, one occupational

therapist, and one speech therapist and would

get to know them.

He would be given a journal with his

schedule written on the cover. After each

session the therapist would write in the journal

what had been accomplished so Jim could have

a written record of his progress.

These were small changes, but for a

confused mind they could have significant

impact.

Still concerned about my choice,

exhausted from everything, and suffering

cultural shock coming from Pasadena, I asked

the doctor when I met him, "Did I come to the

right place?"

He responded, "You have come to the

best place in the state of Maryland and one of

the best in the nation for what you need."

When the psychiatrist came to talk with

Jim, I asked her the same question. "Yes," she

responded, "this may not be as fancy as you are

used to, but this is where you should be."

That afternoon the comments of the Xray technicians who had heard someone was

coming in from California should have

49
PHYLLIS NIMMO MARSH

comforted me. They assumed that we were

California residents and I had brought Jim across

country for the therapy program at Montebello.

Their pride in Montebello's program told them

such a move was logical.

But as Mathew and I stood in line at

Wendy's for supper that evening, I started

giggling and could not stop. "Mathew," I said,

shaking my head, "how did we get here?" I

thought of the armed guards sitting next to Jim's

bed. "Who would have dreamt we would end

up in a situation like this?" Mathew had no

answers.

My friend Marti had cautioned me that

the flight across country would lead to setbacks.

"Don't tell me that," I had wanted to say. Of

course, she was being a friend.

That first weekend many friends came

to encourage Jim. They would speak, and their

words seemed to go through him. Nothing of

Jim came back. One colleague felt he did not

recognize her. There was no way to explain that

he had been doing so much better in California.

At first a rehabilitation hospital seems

depressing. Bruce Marsh's introduction at night

was probably more so, but he did some research

and found out the same thing the doctor had told

lIle.

Montebello is dedicated to helping

people who need retraining in how to live

because of an injury or illness that has caused a

loss of function. Its head trauma unit deals

exclusively with people who have suffered head

injuries that can totally change them.

On the first floor of Montebello were a

spinal cord injury unit and a multiple trauma

unit. On other floors were stroke and orthopedic

units. Approximately every third person was in

a wheelchair. Even the wheelchairs were unique,

for some were rigged with traction units, some

were motor powered, and others were designed

to accommodate a wide range of orthotics.

Jim's unit had a sign above the entry that

proclaimed, "Head Trauma Unit---#1 in the State

of Maryland." 1 objected to the sign. I did not

want Jim's colleagues to read it. Why did I need

to advertise his head injury?

The unit is self-contained. The nurses'

station is just inside the entrance; the dining

room is across the hall and the patients' rooms

are located on either side. At the end of the hall

are rooms for physical, speech, and occupational

therapy.

Dr. Drubach, who was Jim's primary

physician and directed the program, is a

neuropsychiatrist. He is both a neurologist and

a psychiatrist with a specialty in rehabilitation

of head-injured people.

The head trauma unit is connected with

the University of Maryland Medical School

Shock Trauma Unit, which is world renowned.

Dr. Drubach had many years of experience with

the Shock Trauma Unit.

A neuropsychologist with specialized

training in the interrelationships between the

brain and behavior worked full time on the unit.

He tested the cognitive functions of a patient's

brain to determine the way it had been changed

by the trauma it had sustained. Using the results

of those tests, an individual program of

rehabilitation tbr each patient was planned.

A social worker, whose office was near

the therapy rooms, worked full time with the

patients and their families to plan for discharge

and the future.

Barbara, the nurse assigned as Jim's case

manager, called me regularly to discuss Jim's

progress. In one of her first calls she asked mc

when Jim liked to shower or bathe. I explained

that each morning he shaved, showered, and

dressed before eating. "I will put that down for

his schedule," she responded. It was such a small

thing, but what better way to bring Jim back to

his regular living patterns than having him

actually do them.

There is no therapy program on

weekends at Montebello. As soon as a patient

is able, he goes home on Saturday and returns

Sunday. That first weekend Jim and I basked in

the sunshine on an outside patio enjoying the

5O
BULIDING SATELLITES IS EASIER

pink azaleas. There I discovered the brown

highlights in his hair. Several times in the

previous three or four years I had told Jim his

hair was changing color--to a dull black. Its

healthy vibrant glow six weeks after he started

thyroid medication was another clue that Jim's

thyroid had been low for a long time.

All the next week the therapists evaluated

Jim's progress and planned a program of

rehabilitation. Jim was uncooperative. One

afternoon I found him standing next to the

nurses' station phone insisting the next phone

call was going to be from his congressman

getting him out of there. All day he had told the

nurses and therapists on the floor that Dan

Quayle's office was interested in his progress,

and Dan Quayle's office would be calling.

One of the nurses took me aside to explain

that Jim had tried to sign himself out of Montebello.

Since the hospital cannot keep someone against

his will, members of the staff had held a hearing to

determine Jim's competency to sign himself out.

The heming determined he was not competent to

do so. He had no idea where he was; a sitter was

still assigned full time to keep him from wandering

off.

Jim objected to the walker. The

orthopedist had stated Jim was not yet ready to

bear his full weight on his broken bone, so his

arms bore part of the weight with the help of the

walker. That day Jim carried the walker down

the hall, saying, "See, I don't need this." His

therapist took it away, and he was confined to

his wheelchair.

It was a complicated scene. The nurses

began educating me about changes in personality

and behavior that accompany head trauma.

Confabulation is defined by the Maryland Head

Injury Foundation as the elicitation of imaginary

things and events to fill in for lapses in memory;

it is not lying, but an attempt to make sense of

poor memory. Patients usually do not realize

they are confabulating.

The staff did not know for sure that Jim

was confabulating. They knew he was a highly

respected geophysicist with NASA and were not

certain if Dan Quayle's office might call. His

nurse, Barbara, finally said, "Dan Quayle is not

my boss." I informed them Dan Quayle had

never heard of us.

Another change in behavior caused by

head trauma is called perseveration, which is the

repetition of speech or an activity. A patient who

has suffered head trauma may have difficulty

changing topics.

Jim could not turn off the idea he knew

Dan Quayle. The problem was complicated

further because Jim had done some studies in

assertiveness, and many times used what is

called "the broken record technique" to

accomplish certain goals. In that technique, a

person keeps repeating the goal until others are

forced to respond. That day I had a hard time

distinguishing between perseveration and "the

broken record technique."

Jim's agitation disrupted his healing. A

tranquilizer was prescribed to calm him down,

but it also made him less responsive to visitors.

Bruce began coming in almost daily for

a few minutes. Jim smiled when he entered but

contributed little to their conversation. Bruce

would talk about his woods in Maine, where we

had visited the previous summer, or he would

ask Jim questions about Model A Fords. Jim

would seem to listen, and so Bruce kept talking

even if Jim made no comments. At no time did

Jim laugh, and this bothered me, for he had had

a delightful sense of humor.

On Monday, a week and a half after Jim

arrived at Montebello, I took the day off from

the 124-mile round trip to visit him and attended

a sports banquet with Melissa. Mathew spent

the evening with his dad in my place. Jim did

not eat his supper because of pains in his

stomach. Mathew was concerned when he left,

but Joy was Jim's nurse for the night and Mathew

had confidence in her.

At 11:00 P.M. I called Joy. A doctor had

checked Jim several times, and they were not

certain what was going on. She explained that

51
PHYLLIS NIMMO MARSH

+

since Montebello had no X-ray or lab technicians

on duty at night, if an emergency developed,

patients were sent by ambulance to a nearby

hospital.

At 2:30 A.M. the doctor called to say

Jim's stomach pains had gotten worse, and they

were transferring him by ambulance to the

University of Maryland Hospital for evaluation.

Mathew, expecting the call, insisted we leave

immediately.

The University of Maryland Hospital, in

the south end of Baltimore, has an armed guard

in the emergency room in the middle of the night

to keep the homeless from overwhelming it. A

few people were waiting there when we arrived,

some who would fall asleep and end up on the

floor, only to be poked and awakened by the

guard and told to sit up.

Since Montebello had not called 911 but

a private ambulance service which was slower

to respond, we arrived at the hospital well ahead

of Jim.

Jim stayed in the emergency room all day

for the doctors were puzzled by his condition.

He had no bowel sounds, which showed a

disturbance in the digestive tract. Diagnosis was

complicated by the prednisone he was taking for

the colitis. Prednisone, an anti-inflammatory

drug, can mask several things, including an ulcer.

When Mathew and I returned from

lunch, we found a very disturbed Jim. Left

unattended, he had tried to get out of bed and

could have broken his leg. Because there was

no one to stay with him and because he could

not be trusted to stay in bed, the staff had tied

his hands down. This had agitated him, and he

had gotten out of the bindings. They then tied

him down by running a binding around his body

as well as his hands. When we arrived, he was

frantic, and the doctor asked us to stay with him

so he could be untied.

After deciding Jim had an obstruction

in the digestive tract, the doctors admitted him

to a room on the eleventh floor. Though the

hospital frightened me at first because we had

no primary doctor, it proved to be excellent. The

system assigned each patient a team of doctors.

At least one member of that team was on the

floor at any given time to answer questions and

direct treatment. Each team had a small number

of patients, and I felt I could always get an

answer.

The doctors determined Jim had an

impaction in the bowel, and they treated it

aggressively with enemas. Jim felt he was being

assaulted, and he was, but the treatment worked

quickly.

Two days later Jim returned to

Montebello. His first words to Barbara were,

"I'm glad to be back."

When we returned, the prisoner was

gone. "Our luck has changed" I thought. At no

time had I felt uncomfortable with the guards

there; they had spent time talking with Jim. The

prisoner, because of his injury, had not spoken

much and had not been a problem. But the

situation had been just too far removed from our

life to aid in Jim's recovery.

52
GOING HOME

I was glad to be home. Mathew had

taken good care of things in our absence. My

own car was like a friend, and when it developed

a problem in the universal joints and the master

cylinder in the brakes, Mathew fixed it.

A cardinal took up residence outside my

bedroom. A boom followed by the sound of

wings scratching on the screen awakened me

each morning as he bombed my window and

then tried to stay in the air.

Sitting in the sunshine on the patio at

Montcbello watching the birds, I told Jim about

my feathered alarm clock. "In California," he

responded, "the gypsies believe it is good luck

if a bird tries to get into your house."

My first thought was, "I think I have

heard other tales that it is bad luck for a bird to

try to get in." I knew Jim's mind was not very

reliable for information.

My next thought was, "Phyllis, accept

his response and take the bird as your symbol of

good luck," and on that beautiful May day I

did. Then, when the boom came, I told myself,

"Yes, Mr. Cardinal, some day I'm going to have

some good luck."

This incident hooked into something my

mother had taught me long ago. "The sun will

shine again," she always said when times were

bad. It was understood bad times would come

again also, but we would have our fair share of

good ones along the way. My bird helped me

keep my sense that all things come to an end,

even illness.

As things settled down, I made an

appointment to see my dentist. One of my teeth

had cracked three weeks before I left Pasadena.

Since my departure date had been so uncertain,

I had not been able to have it capped there.

When I related what I was dealing with,

my dentist responded, "Very often in times of

stress people grind their teeth at night, and they

may not be aware of it." His words proved

prophetic, for in the following months I had four

teeth capped. Eventually, all four probably

would have needed to be capped but not in the

same year. This was one of the hidden costs of

Jim's head trauma.

In fairness to my employers, I needed to

let them know ifI were going to return to work.

My tournament bridge experiences provide the

best analogy for why I decided not to return. In

bridge, before the first card is played, a winner

plans the entire game. Since that first card often

determines the final outcome, there is only one

chance to play it right.

If I had felt Jim would never return to

work, I would have found a career job. it would

have been in Jim's best interest as well as mine

to do so. The professionals gave me no

assurance Jim would return to work so that was

a concern.

But now 1 had my chance to play the

cards, and I decided I wanted, for my sake as

much as Jim's, to gamble for a return to what

we had prior to his injury. I wanted Jim back in

his job and his hobbies so I could be free to

pursue mine. The best chance we had to do that

was for me to make Jim's therapy my major

concern. Jim did not need to worry about

whether I felt it was important for him to go to

therapy during the time he was working so hard

at getting well. He did not need the worry of

wondering whether someone would be available

to drive him.

One of Jim's colleagues likened me to

Florence Nightingale for taking care of Jim. I

could not explain that I was willing to spend nay

total energy for one year on Jim's recovery so I

would not have to spend part of my energy on it

for the rest of my life.

53
PHYLLIS NIMMO MARSH

In bridge terms, my decision to go for

Jim's return to work was the equivalent of

bidding a game in four spades with a hand the

experts would have passed. In quitting my job I

was losing the first trick in order to control the

final ones, and I was betting that my playing the

hand would make the difference in bringing

home the contract.

Our next goal was to bring Jim home for

a weekend visit, what Montebello calls a

functional therapeutic visit or FTV. Such visits

help reorient someone who has suffered a head

injury by bringing him back to familiar

surroundings. They also help identify deficits

that often do not show up in a hospital setting.

Jim needed to be evaluated before the

staff could be assured he and our family could

handle a home visit. A family conference was

required; one had been scheduled and then

postponed because of Jim's stay in the hospital.

Our conference took place Thursday,

May 18, and was attended by the doctor, Jim's

three main therapists, the neuropsychologist, a

nurse, and a psychiatric nurse sitting in for the

psychiatrist. Again, hope and reality were in

conflict. Mathew attended with Jim and me, and

we hoped for encouragement about the future.

Each staff member reported on Jim's

status. First, the doctor was concerned about

Jim's uncooperativeness. He said, "Time is

running out for Mr. Marsh. We are passing the

three month mark, and he needs to really work

in the next few months or a window of

opportunity is passing."

I had questions. "Doctor, physiologically

what is happening in Jim's brain? Is there still

swelling?"

There was no answer to my question.

"Mrs. Marsh," the doctor continued, "your

husband is on two stress hormones right now."

Confused by this, I asked, "What do you

mean by stress hormones?"

"Prednisone is a steroid and a stress

hormone. Also, thyroid hormone is considered

a stress hormone. When your body is under

stress, your thyroid secretes more of its hormone

because your body requires it. For example,

thyroid increases the body's metabolism rate.

Some of your husband's behavior may be related

to this."

Therein, I finally found my answer to

what had happened. The numbness in Jim's legs

had begun when Jim was dealing with the stress

of his mother's brain tumor. Over the years his

thyroid had continued to slow down. The

previous fall had been very stressful with the

problems at work, the settlement of his parents'

estate, and Mathew's decision to come home

from college. At a time when Jim's body

required more thyroid hormone, his thyroid was

less and less able to produce it, causing a

biochemical imbalance in his body.

The weekend before Jim went to

Pasadena we spent a lot of time talking. I have

always been a calming and soothing influence

on Jim, and over that weekend he became cahner

and probably required less thyroid. Thus he

seemed better when he left that Monday. The

stress of the meeting, though, had called for more

thyroid, and his body could not produce it.

When I had spoken of the problems

being solved, we assumed the resulting lack of

stress had brought on a biochemical imbalance.

We never considered what the stress had required

of Jim's body in the first place.

Our conference continued with the

therapists very clinical in their assessment of Jim.

"Jim walked around the unit one time

without stopping. He still cannot walk in a

straight line because of balance problems. We

are working to get him to push off with his toes."

This from the physical therapist.

"We are still working on movement in

Jim's shoulders because there are some he

cannot make," the occupational therapist

reported. "He reached level seven in a computer

game that we played, and he was able to work

for twenty-five minutes without stopping."

Mathew and I pushed for a home visit

that weekend. "I think it would be beneficial

54
BULIDINGSATELLITESIS EASIER

for Jim to go home. He is not going to be truly

oriented until he gets back into familiar

surroundings. This weekend Melissa is going

to the prom, and I think it would help Jim to be

there to see her leave." I had my own broken

record.

Again I was told, "Mrs. Marsh, we are

concerned about your husband's safety. We need

to be assured he will not do something compulsive.

Remember he jumped out a window, and we do

not want anything like that to happen again."

After being confronted with this

statement several times, Jim decided to take

action. "Just a minute," he said. "I did not jump.

There was a scaffolding that fell."

There was a collective gasp followed by

silence, and l was the one who answered. "No,

Jim," l laid my hand on his leg as I spoke, "You

jumped."

Finally the professionals recognized that

I was not denying the suicide attempt. Their

training teaches them that most people deny

suicide; they had not realized that they were

denying the possibility that I might accept what

had happened.

As to Jim's safety in my care over the

weekend, I explained, "I am fifty years old. Jim

is the fourth family member I have had in

rehabilitation. I took care of my mother-in-law

after she had a brain tumor. I was involved in

caring for my lather following a stroke and my

mother following hip surgery, l think I have

enough experience to handle this weekend, and

I have always been able to cahn Jim down."

Jim showed flashes of his executive

ability that day. Following what he considered

negative comments about his physical therapy,

he said, "Why don't you tell them the good

things I did? I rode the bicycle ten times

yesterday." I felt he was right.

The next day I arrived early at

Montebello to go to bat for a home visit. A final

decision could not be made until the psychiatrist

cleared Jim. She was waiting at the nurse's desk

for me.

"Mrs. Marsh, I find no evidence of

depression in your husband, and I find no

evidence he is suicidal." I agreed.

At no time during Jim's stay at

Montebello had the staff suggested that he

needed antidepressants. The thyroid medication

and his continued recovery from the head injury

were all he needed.

"My concern, Mrs. Marsh," she

continued, "is that he is very impulsive because

of the head trauma."

We talked about the safety factors

involved, and I convinced her that Mathew,

Melissa, and I could handle them.

"Then I feel your husband is ready for a

home visit tomorrow," she concluded.

The only special instructions I received

for the home visit were to be aware that people

who suffer head trauma are prone to seizures.

Jim had not had any, but I needed to be aware of

the possibility. In the event of a seizure, the only

thing I could do was make sure he could not fall

where he might hurt himself. Then I was to

notify the doctor so medication could be started

to prevent them.

Saturday, May 20, was a warm, sunny

day. We left Montebello at 9:00A.M. As I drove

us down Route 3, Jim started commenting,

"There's where you turn to go to Ted's. There's

where Melissa went to volleyball." What

beautiful therapy the drive through familiar

surroundings was.

Mathew and a friend were waiting to

help Jim into the house, but using a walker he

made it up the steps on his own. It had taken

three months, but we had triumphed over the

events of February 22.

In the afternoon Jim and I rode with

Melissa to pick up a flower for her date for the

prom. We needed to make some other stops,

and Jim was concerned the flower might wilt.

When I explained to my sister-in-law Jim had

figured that out, I know she thought I was stupid.

A geophysicist should be able to know that a

flower might wilt in a hot car, but by then I knew

55
PHYLLIS NIMMO MARSH

that a person who has suffered head trauma has

difficulty in perceiving a problem that might

arise and devising a solution to it. Jim's ability

to look ahead to solve the problem encouraged

me.

Several neighbors stopped by for a visit.

I stayed close by Jim because I feared that his

disinhibition would cause problems. Jim had

exhibited his disinhibition in California when

he called a nurse waiting to help him lazy and

stupid. He had made many derogatory remarks

at Montebello; some of the staff wondered if he

had always been so difficult to get along with.

The problem was caused by his head injury; his

brain registered negative thoughts but had lost

its ability to inhibit them from being spoken.

I did not want our friends hurt by his

disinhibition, but since it was the result of his

injury, there was no way I could guard against

it. Luckily, he did not exhibit any of this

behavior that weekend.

Melissa's date arrived in a black tux with

a tie and cummerbund that matched the raspberry

sherbet color of the prom dress I had made for

her in the three weeks I had been home from

Pasadena. Since Jim always took the pictures,

we bought film for his camera and gave him the

,job of recording the occasion. It was another

cognitive test, and he scored an A+.

Mathew and I were afraid Jim would

balk at going back to Montebeilo, but Jim made

no fuss. He told me later it seemed normal to

him to be at Montebello. He was not aware

enough to question it.

Several things improved after his FFV.

The staffdetermined Jim could function without

a sitter. An aide would still accompany him to

the shower each morning, mainly because his

balance was sometimes a problem. Otherwise,

he was required to show up on his own at the

proper times for therapy.

Bruce Marsh continued to come by each

day. He noticed more of Jim was coming back

at him in their conversations, and gradually there

was more expression in Jim's face.

!

Jim and I discovered the cafeteria at

Montebello, and each night we went out to

dinner there.

One afternoon Jim said, "Phyllis, I was

trying to recall the trips that we took. Do you

rernember when we drove through Maine?" We

reminisced about each of the trips we had taken

in our twenty-three years of marriage.

The next night, he started, "Phyllis, I was

trying to recall all the trips to Europe I made.

Do you remember when I went to Grenoble?"

We tried to recall all the European trips, but I

had difficulty because I had not gone on any of

those. The next night we listed his ancestors.

One evening, we did mine.

It seemed like we were turning on lights

in the memory part of Jim's brain, and he was

becoming a participant in conversations rather

than a spectator.

56
O MONTEBELLO, I SING YOUR PRAISES

Jim took control of his life on Monday,

June 5, 1989. During his third home visit, he

had read all the get well cards he had received.

By this time they numbered over a hundred,

many containing very kind, encouraging

messages. "This isn't a dream is it?" he

commented as he emerged from the bedroom

where I had piled the things from Pasadena.

"No," I responded, "it isn't."

That Monday a psychologist tested Jim's

cognitive processes. The testing took most of

the morning, with the doctor asking Jim several

times if he were getting too tired.

The first entry in Jim's journal in his own

handwriting is: "4:30 Tues June 6, 1989, meeting

w/Dr. Kelly, Re: Test results." Jim made the

appointment and on Monday afternoon asked

me to be there.

Jim wrote his own notes during the

meeting. Dr. Kelly was very encouraging about

Jim's progress. Most things had improved,

including his attention span, his control of

behavior, his walking, and his balance. There

was still much room for progress in

concentration and memory of details. No

cognitive function was missing, and in the

problem-solving portion of the test Jim did as

well as the average fifty-year-old. While all this

was encouraging, it indicated the need for further

therapy because Jim, prior to injury, had been

functioning at a much higher level. Part of the

problem was the speed with which his brain

transmitted messages. This transmission is

slower following any head injury but continues

to improve long after other healing has stopped.

Questions arose about the types of

therapy Jim should be doing. He had never

enjoyed word games, computer games, or

puzzles. A good part of therapy involves those

things because they stimulate brain pathways.

After listening to Dr. Kelly, I asked about finding

other things Jim might do.

"No," said Jim, "these people are the

experts, and I'm going to do what they tell me."

From then on, he kept his own notes in

his journal and would have the therapist sign his

or her name. He became so cooperative that

when his speech therapist decided she no longer

had any program for him, he asked for further

physical therapy. He is probably the only head

trauma patient at Montebello who ever asked

for more therapy, and the staff decided to grant

his request.

As Jim continued to progress and we got

to know the staff better, their education and

training in head trauma became more evident.

Educating me was part of their program. I asked

for all the reading material they could give me

on cognitive therapy.

I longed for a book by someone who had

survived what I was going through. I wanted to

know somebody had been as mixed up as Jim

was in California and still returned to a normal

life. I wanted to know what it took for recovery.

But the staff at Montebello had no such book.

In reading the guidebook put out by the

Maryland Head Injury Foundation, I discovered

Jim's progress had been very typical.

One of the ways to document recovery

from a coma is to use the Rancho Los Amigos

levels of cognitive functioning scale. Originally

developed by the professional staff at the Rancho

Los Amigos Hospital in Downey, California, the

scale was the result of a major federally funded

research project and is used by professionals to

communicate consistently with other health care

professionals about a patient.

57
PHYLLIS NIMMO MARSH

The levels of response are:

Level I: No response

The patient appears to be in a deep sleep

and does not respond to voice, sounds,

light, or touch.

Level II: Generalized response

The patient begins to move around;

however, those movements are not for a

specific purpose and are not consistent.

Level III: Localized response

The patient begins to move his or her

eyes to look at specific people or objects.

At times the patient may turn his or her

head in the direction of a sound or a

voice. Simple directions (such as

"wiggle your toes") may be followed.

The patient is becoming more aware of

his or her body and discomfort and may

try to pull at tubes.

Level IV: Confused-agitated

The patient is agitated and confused

about where he or she is and what is

happening. The patient may be very

restless, verbally abusive, and/or

aggressive and may cry out. Agitation

results from the patient's inability to

understand everything that is going on.

The pat.lent may talk but generally the

information does not make sense.

Level V: Confused, inappropriate

nonagitated

The patient is confused and may not

make sense when talking. The patient

does not know where he or she is or what

is happening. The patient is less agitated

but may become agitated at times for a

specific reason. Memory of some things

from before the accident may return but

not of recent things since the accident.

The patient is able to follow simple

directions most of the time.

Level VI: Confused-appropriate

The patient is now making more sense

when talking. Simple daily activities

(such as brushing teeth) can be

accomplished but with help in knowing

what to do and when to do it. It may be

hard to learn new things, and

remembering recent events is still

difficult.

Level VII: Automatic-appropriate

The patient makes sense and can do

many daily activities without help. For

safety purposes, the patient needs to be

watched at all times. The patient still

may have some difficulty remembering

things that were said or done that day or

recently and may have problems thinking

things out, solving everyday problems,

and judging situations. The patient may

not realize that any problems exist.

Level VIII: Purposeful and appropriate

The patient is now independent with

daily activities and learns new things.

Abilities include remembering recent

events, thinking things out, and solving

problems. The patient may still have

some mild difficulties but is more

independent in finding solutions.

The exciting thing about finding the scale

was discovering that Jim had already been

through most of the stages in a relatively short

time. Knowing from the beginning all the stages

he had to go through would have been helpful

so I could have recognized them as being normal.

As I read the literature on head trauma, I

wondered how I could have been so naive. In

the movies, someone gets knocked out, makes

no response for a long time, and then

miraculously wakes up and is O.K. I now know

that happens only in "reel" life.

I tried to push the term head trauma out

of my mind. That sign above the door, "Head

Trauma Unit---#1 in Maryland" still bothered

me so I always took the back way into Jim's

unit. My natural instincts, though, pushed me

to find out everything I could about the problem.

1 came to understand that a head injury

is like no other injury to the body because every

58
BULIDING SATELLITES IS EASIER

breath, every motion, every idea, every feeling

and every sensory perception at some point

requires a signal in the brain. If the pathway in

the brain which that signal must traverse is

interrupted by injury or a chemical imbalance,

it comes out wrong.

I finally came to view the brain as a

master computer, although infinitely more

complex than any devised by man, and in using

that simile, I came to understand the difficulties

Jim and I faced in his recovery.

Just sitting in a chair requires my mind's

computer to be operating. Is my head held up

straight'? A signal is constantly telling my brain

the answer to that question. That signal in Jim's

brain had been disturbed and resulted in what 1

had called "thc headless Jim Marsh." This had

since healed.

Who does this hand in my lap belong

to? That may seem like a crazy question, but

knowing what a hand is and recognizing it as

my own arc two separate functions in my brain.

If one of thcm is injured, such as in a stroke,

there can be problems. It is said that when

President Wilson had his strokc, he woke up and

wondered whose leg was in his bcd. It was his

own.

Who am i? Where am I? What day is

it'? My brain knows and must hold this

information somewhere in storage ready for me

to call upon it while I am sitting in that chair. It

is a separate function of the brain to retrieve that

information, and sometimes the brain gets fouled

up doing it.

I began to understand there are programs

in a brain for transferring information to longterm memory and for calling information up

from the same long-term memory. To do that,

the brain has to have some way to organize that

information.

The brain has a program for holding bits

of information in what is called working

memory. Some of us can hold a great many bits

of information in working memory to use while

we are making decisions. As a bridge player, I

could remember most of the fifty-two cards as

they were played. Head trauma can limit the

number of things a brain can hold in working

memory.

I learned there are hundreds of functions

in a brain, and any one of them can be disturbed

in head trauma.

As I came to learn more about the brain,

I realized that many times differences in people

are related to a difference in the computer in their

brains. I know people whose brains have

excellent "Spell Check" programs and others

who lack that option. Our son has a super-speed

math coprocessor in his brain. Mine came with

good long-term storage of what people tell me

about themselves, but a loose wire in the section

directing me to say the word I mean. I came to

understand that every brain is damaged in some

way. Certain parts in each one are prone to

real functions.

In a head injury, a person's central

processing unit has been damaged. Unlike a

computer, the processor cannot be taken out and

rephiced with a new one nor can an extra unit be

wired up to add processing power. Any fixing

tip must come about as part of the natural healing

process or by manipulating the input to the brain

so as to stimulate lost abilities or to cause the

brain to forge new pathways. If none of that

works, then some compensatory techniques can

be learned to the help the brain function.

According to the Maryland Head Injury

Foundation, "for all patients surviving 6 hours

or more of coma, over half will return to school,

jobs, and independent living by 1 year after

injury, although many will have some residual

cognitive problems." Reading that in the early

stages of Jim's recovery made me shudder. If

just over half return to jobs, that leaves a large

percentage who do not.

The literature kept repeating that the

prognosis for a child with a head injury is

considerably better than that for an adult.

After my study, the therapy programs

took on greater importance. In any head trauma

59
PHYLLIS NIMMO MARSH

unit the programs are basically divided into three

types: physical, occupational, and speech.

Jim needed physical therapy because of

the injury to his leg and the general loss of

muscle tone from inactivity. His head injury left

some problems with balance, gait, and range of

motion.

Occupational therapy is more concerned

with everyday living techniques that get

disturbed by head trauma. For example, doing

things in the proper sequence can be a problem

if a person's central processing unit has been

disturbed by head trauma. The preparation of a

meal involves sequential tasks, so an

occupational therapist might help a patient

prepare a meal. Other functions that might be

disturbed following head trauma are the ability

to write a check, read a road map, or go

shopping. Luckily, Jim's ability to function in

these ways was not seriously disturbed. In a

life skills test he scored in the 98th percentile.

Because movement of the hands and

arms are very necessary in life skills, the

occupational therapist is concerned with that

range of motion. Jim did not have certain

movements in his arms and shoulders, so each

day he worked improving them.

The occupational therapy program also

worked in some ways with attention span

problems and memory. Several computer games

were used for these. One day his therapist gave

Jim several multiplication problems to solve. I

was thrilled to find Jim could still do them;

however, the therapist was concerned his

attention span was so short.

Speech therapy deals with more than the

sounds we use to communicate. The formation

of speech involves organizing our thoughts,

finding the right word for what we want to say,

and voicing it correctly. It also involves the

receiving of speech, processing the information

received, and transferring that to long-term

memory. All these things get disturbed in head

trauma.

It was obvious in California that Jim's

speech processing function was disturbed when

he called everything a "bear." Other speech

functions were impaired, but it took me longer

to recognize that.

Rehabilitation is hard work, particularly

rehabilitation from head trauma. Jim's body had

suffered a major physical trauma and he had been

through two surgeries. In addition, one of the

side effects of head trauma is mental fatigue

because the brain requires more energy to

function following trauma. In the early days,

someone suffering from head trauma wants to

sleep a lot. Yet the theory behind rehabilitation

is that pushing the body and mind a little more

each day will strengthen them and help them

recover.

The program at Montebello was intense.

An example of Jim's journal for a day reads:

6/27/89 9:00 - 10:00 O.T.

(Occupational Therapy)

!. Exercised arms (range of motion)

2. Cornputer game - logic

6/27/89 10:00- 10:30 P.T.

(Physical Therapy)

I. On back - knee exercises

2. Back arches and lifted legs

3. Knee exercises over wedge

6/27/89 11:00- I 1:30- Speech

Discussion of test results:

Analogies - good

Deductive reasoning - good

Missing premises - weaker

Scientific brain - coming back

Analyzing info - good

Time frame - needs improvement

Sequencing - bad

Overall - very good

Several were in the 98 %tile

6O
BULIDING SATELLITES IS EASIER

6/27/89 11:30 - 12:00 Cognitive group

1. create bulletin board - brain injuries

6/27/89 - l:00 - 1:30 Speech canceled

6/27/89 - 1:30 - 2:00 O.T.

1. Written paper test

2. Logic computer game

(up to 7)

6/27/89 2:00 - 3:00 P.T.

1. Wall exercises no wt.

2. Crossed steps then rotated

3. Trampoline

4. Leg muscles w/wts on stomach

5. Kicked ball

6. Walking - push off- not on heels

6/27/89 4:00 - 4:30 Psycho-social group

1. Discussed Thurs. outing

It is no wonder that in the late afternoon

I usually found Jim asleep in his bed.

During a weekend visit home in June,

Jim discovered the police report from Pasadena.

My sister-in-law Sylvia, who is a genealogist

and believes in keeping complete records on

every event, urged me to get a copy of the report

before I left California. She told me I did not

need to read it and offered to put it in her lock

box in a sealed envelope if I wanted her to.

I made a second trek to the Pasadena

Police Station the week before I left Pasadena.

Maria, my social worker there, suggested that if

I wanted to read the report I bring it in so I would

have someone to talk to about it. I decided I

would put it in an envelope and take it home.

At home, when I knew my friend Peggy

would be nearby if I got upset, I read it. I should

not have worried. In my job for a firm that does

background investigations for federal job

applicants, I had seen many police reports and

understood their language.

The report cited the time and place, the

condition of the room, and the reasons why no

foul play was suspected. The investigating

officer had interviewed the maintenance man

who had found Jim and two others. There was

no doubt Jim cut his wrist and jumped.

I had stashed many of the things from

Pasadena in a box in our bedroom until I had a

chance to sort through them. There,

unbeknownst to me, Jim found the report.

His memory of the event was blank, but

the police report left no room for questioning.

"I guess I really did it, didn't I?" he asked.

"Yes," I responded, "there is no doubt

about it."

At times, it was hard for Jim to speak

openly about his suicide attempt if people asked,

but from then on he could not deny the events

were as I had told him from the beginning. That

realization was important in terms of recovery

because it takes mental energy to deny

something--mental energy which Jim could

direct toward getting well.

In June Jim's colleagues sensed his

recovery and became excited about the prospect

of his return to work. One colleague called to

see if he could come for lunch. I insisted he

check with Barbara, Jim's nurse, before doing

so. I did not want Jim overly tired. Barbara

thought lunch was an excellent idea and made

arrangements for it. The idea caught on with

other colleagues, and Jim's weekly business

luncheons added a creative and enjoyable

dimension to his rehabilitation as well as a return

to normalcy.

As the month of June progressed the staff

at Montebello increased Jim's independence in

little ways. When he could bear full weight on

his leg, the wheelchair was taken away. After

the physical therapist was convinced his balance

was fine, the walker was taken away.

Each morning Jim was given the tray

with his medicine, and he set out his proper

dosage--one thyroid pill and two asulfadine

tablets for his colitis. Barbara checked before

he took them.

He became concerned about my

traveling 124 miles round trip to visit. "You

61
PHYLLIS NIMMO MARSH

don't need to come every day," he insisted. "I'll

be fine." Some weeks I took him back on Sunday

evening, and since I could stay Friday evenings

with Bruce and Judy Marsh and get an early start

on Saturday, I would not return to Montebello

until Friday. Should he happen to run out of

clean clothes during the week, there was a

washer and dryer on the unit he could use. Once

he even did.

The final measure of his independence

came in late June. When Jim went to bed at

night, the sides of his bed had been pulled up,

and he was given a urinal to use. That stopped

when he was deemed capable of making a trek

down the hall at 4:00 A.M.

Like anyone who has dealt with a longterm hospitalization, we longed to go home.

Montebello originally scheduled a release date

of August 3, much too far away for our liking.

Dr. Kelly, the neuropsychologist, told us

that as long as each of the therapies reported

work yet to be done and progress being made,

the staff recommended staying in the hospital.

His remaining in the hospital then was both

encouraging and discouraging--encouraging

because Jim was continuing to make progress

and the therapists thought they could help,

discouraging because we wanted him back to

normal. Finally we were given a release date of

July 18, and follow-up therapy had to be pursued.

As I learned about the cognitive

disturbances caused by head trauma, I realized

Jim's return to work must be a very controlled

process if he were to succeed. I came to respect

the healing process as our ally but only if we

followed its timetable and its idiosyncrasies.

"Jim, you are going to have to listen to

me when you go back to work," I lectured him.

"If you go back to work and try to work on

everything at once, you might get several phone

calls in a morning on totally different subjects.

You have difficulty switching gears and recalling

the right information, and you could make a lot

of mistakes. Too many wrong answers and

people are going to distrust you."

"Phyllis, you have gotten me this far so

I will do what you tell me," he responded.

"You need to take the simplest project

you are involved in, review it completely, and

find out what has happened on it this year. After

you are comfortable with that, you can take the

next easiest one," 1 explained.

After realizing his return to work must

be well structured, 1 was thrilled to learn there

were vocational rehabilitation therapists trained

to guide us in the process. I told Jim we would

borrow money to pay for this service if our health

insurance did not cover it.

In recent years new community

programs have begun providing therapy and

guidance for victims of head trauma who are

released fiom rehabilitation hospitals but need

further therapy to return to work or independent

living. For many years such people went home

and stopped recovering.

One such program had started near our

home, and 1 visited the facility full of

appreciation lot the lifeline they were extending.

The program was housed in a private home that

had been converted into living facilities for eight

clients. It also accepted day patients. The

beautiful woodland setting soothed me as I drove

up.

The director spent some time talking

with me. As I explained my hopes for Jim and

how I had already told Jim the way I felt he

should return to work, the director jokingly

offered me a job as a vocational counselor.

"What does your husband do?" he

asked.

"He's a high level geophysicist," I

responded.

"Well, it's doubtful he will return to such

a high level following an injury," he counseled.

There were many reasons why I chose

to go elsewhere, one being that most of the

clients in this facility were much younger than

Jim was, but the director's comments were my

most lasting impression. He had been involved

in head trauma rehabilitation for about twenty62
BULIDING SATELLITES IS EASIER

five years and had seen many clients who did

not return to previous levels of accomplishments.

I know he was trying to help me be realistic, but

his comments sent me into despair lot several

days.

"Am I wrong," I asked myself, "to think

Jim will go back to his job? Remember, the

director is an expert in the field and should know

what he is talking about."

Finally, the corollary to the Phyllis

Marsh rule of survival took over. "Remember,

he has never examined Jim or seen Jim's records.

He does not know you or your strengths," I told

myself. "Therefore, he cannot predict what will

happen to Jim. Listen to the expert in his field

but only after he has examined Jim and knows

you."

While working through my despair, I

was introduced by the social worker at

Montebello to Community Rehabilitation

Services of Annapolis. Diane, their

representative who introduced me to the

program, spoke with pride about the staff and

clients. She offered us help but did not promise

recovery. More importantly, at no time did she

talk of limits. That was all I could ask of any

program and arranged for Jim to enter it.

I look back on the final days at

Montebello with fondness. Many of Jim's

colleagues were taking him out to lunch or

visiting him in the evening. Everyone was

excited at his progress. It was interesting to me

that friends and colleagues talked to Jim about

their bouts with depression thinking Jim would

be able to help them. They did not realize I was

the one who was open about his suicide attempt

at a time when Jim was in a coma.

Old patterns emerged. Some came to

reassure Jim and tell him that they wanted him

back but then quickly started talking about their

own problems because in the past Jim had been

the listener.

Jim realized his mind was not back to

normal, and he sometimes worried about the

visitors running tests on him. "Don't worry," I

counseled him. "Everyone is running a test on

your long-term memory and that was not

affected by the injury. You will pass all their

tests."

One colleague called me after a long

phone conversation with Jim about the work they

were doing. "He understood everything! I have

no doubt Jim will be back to work, and that is

really exciting news for all of us."

I rejoiced in his judgment but responded,

"Just remember there is still a clinical question

about whether Jim can return." How could I

explain Jim might not remember the

conversation the next day.

By this time I accepted Jim's head injury.

I entered his unit the front way and appreciated

the sign that read "Head Trauma Unit---#1 in

Maryland". I could name and thereby

acknowledge the problem we had to solve, and

I rejoiced I had chosen Montebello.

Saying goodby was a happy-sad event.

We were relieved when Dr. Drubach kept Jim

on as a patient. We had someone to call in an

emergency.

Many of the nurses hugged Jim. He had

become a model patient, working harder than

almost anybody they had seen, and his success

was what their careers were all about.

63

HOMEFORGOOD

Jim's coming home required

adjustments. By mid-July I was taking him back

on Sunday evening, visiting him for a couple of

hours on Wednesday, and returning Saturday

morning to pick him up for the weekend. The

rest of the time I was free to read, to clean house,

to shop, to watch TV or whatever. For five

months I had made all decisions concerning our

household. Now there would be one more

person whose feelings had to be respected.

Jim had five days of rest at home before

he was scheduled to begin his therapy in

Annapolis--five days to walk around the yard,

look at all his tools, and take lots of naps.

"Look, Jim," I lectured, "the worst thing

you can do is go home and sit. To recover you

need the stimulation of people. You need to push

yourself." He was willing to listen, and we went

out to eat one evening and visited friends.

On the following Monday we drove the

thirty-one miles to Annapolis to the offices of

Community Rehab. Dr. Jeanne Fryer, program

director for Community Rehab, helped pioneer

the concept of community rehabilitation

programs for people with head trauma and is

well known in the field. Her open friendly

manner eased Jim's entry.

Dr. Fryer introduced us to Brian Bemis,

the speech therapist who had come to

Community Rehab the week before from the

Shock Trauma Unit at the University of

Maryland Hospital and would be Jim's case

manager.

"Tell me a little about yourself," he said

to Jim. "What do you notice that is different?"

Jim had difficulty organizing his

thoughts. At one point he turned to me and said,

"You tell him."

"No," I responded, "he wants to hear

what you have to say, and then he will ask me."

In running that evaluation, Brian was

listening for many things that still needed

working on following head trauma.

"Here is what I notice," he said. "First, I

hear a bit of slowness in your speech. Do you

notice that'?"

Jim nodded in response.

"Secondly, as I watch you, I don't see a

whole lot of expression in your face. I think

that has probably been changed by the injury. I

am also hearing some difficulty in organizing

your thoughts so they come out right. Do you

know what I mean?"

Jim nodded in response.

"All of these are things I can help you

with, and they are all very common following

head trauma." Brian's manner was very

supportive of Jim and the problems he was

experiencing. "As you get stronger and after

we have worked on these problems, we will look

at your work situation and see if we can help

with that. Also, at some time, I might try some

stressing situations to see how you might handle

them because managing stress is often a

problem."

Next, we met with the occupational

therapist. Jim needed less of this kind of therapy,

but the staff decided there were some decisionmaking skills they could begin with.

The physical therapist did not meet with

us that first day.

Jim's program for therapy was set up for

Monday, Tuesday, and Thursday mornings from

9:00 to 12:00. Since Jim did not drive, I would

chauffeur him.

I had not realized while Jim was at

Montebello that his being able to walk down the

hall to therapy and then walk back to take a nap

had saved so much on his energy level. Nor did

I realize how much energy it takes just to live in

65
PHYLLIS NIMMO MARSH

your home. Now he taxed himself further,

getting up in the morning, getting dressed, riding

thirty miles to Annapolis in morning traffic,

going through three hours of intense cognitive

and physical therapy, stopping somewhere for

lunch, and coming back home. Usually, Jim

would fall asleep in the car or take a nap

immediately upon our return home.

The fatigue presented itself in many

ways. "Phyllis," he told me, "[ don't have any

interest in anything. What am I going to do about

that?"

"Jim," I suggested, as did a therapist later

on, "that will come. I think you are going to

have to pretend an interest in something at first

and let it hook into you."

"But I'm not that kind of person," he

responded.

Our car developed a strange noise. Since

it first occurred when we placed a tractor part in

the trunk, I thought it probably came from

something knocking in the trunk, but it was still

there when we unloaded the part.

"Mathew needs to look at this. It sounds

like it's coming from the motor," Jim said.

Mathew was free when we were away.

He slept in on Sunday mornings while we were

at church, and then was gone when we got home.

"Damn that Mathew," Jim said. "He

doesn't care."

Mathew promised to drive the car one

Sunday afternoon, but on our way to church the

noise stopped. Coming home we drove down

Route 301 running the car at high speed since

we usually heard the sound above forty miles

per hour. We could not find the noise.

At home I told Mathew the noise had

stopped. "Why isn't Mathew going to take the

car out? Doesn't he care?" Jim demanded.

I did not answer. I wondered how

Mathew was supposed to find out what was

causing a phantom noise. Later, by moving

things around in the trunk, I discovered the noise

was caused by a tire-changing tool that rattled

against the floor of the trunk when it got shifted

to certain positions. My husband, who had

rebuilt entire cars, had been stymied by the

sound.

Mathew bore the biggest burden for

Jim's fatigue. Whatever Mathew did, Jim felt

he should have done the opposite. If Mathew

turned left, he should have turned right, and if

he had turned right, I felt Jim would have said

he should have turned left.

A typical episode occurred when the

hook on the spring in our garage door broke.

Jim wanted Mathew to add a new hook to the

old spring. Mathew felt that after twelve years

of use metal fatigue had caused the spring to

break.

Jim blew up at being challenged oil the

issue. "Don't give me any guffon it," he yelled.

"Let's just fix it."

"It's dangerous, Dad," Mathew

responded. "It could break anytime again. Call

and find where you can get a new one, and I'll

put it on."

"That's too expensive," said Jim. "If you

don't want to help me, I'll fix it myself." He

really was not capable of doing so.

After several phone calls, I located a

source for the spring, and Jim and I, both

exhausted, went to pick it up.

"This is really unnecessary," Jim said on

the way. "If Mathew would just listen, we could

have fixed it, but he won't, dammit." I felt

Mathew was right.

After putting the new spring on, Mathew

adjusted the one on the other side of the door to

match. Shortly, we heard a loud clang from the

garage, and the door would not go up. The

opposite old spring had snapped.

"Goddam that Mathew. He won't listen

to anything," Jim shouted. "He tightened that

spring too much. I told him what to do, but he

thinks he knows everything. Goddam him."

Listening and watching Jim try to express his

anger was a little like watching a movie in which

the reel is moving too slowly. His fist touched

rather than hit the table, his words were a whine.

66
BULIDING SATELLITES IS EASIER

Mathew listened to himself being cussed

and left hurt and angry.

Several things were out of kilter. Jim

could only concentrate on the spring. He had

no energy to focus on the safety factor nor did

he have the cognitive ability to hold the safety

factor in his working memory as a consideration

when he solved the problem. He was unable to

recognize that Mathew was concerned about

him. Only later he realized the way in which

Mathew had adjusted the spring had had nothing

to do with the other one breaking. He felt no

responsibility for Mathew's feelings.

I spent the night on the sofa in tears. My

husband could not handle an everyday problem.

The authority and care Jim Marsh used to have

were nonexistent in the impaired man pounding

his fist on our dining room table. Mathew had

looked after us and now felt unappreciated and

deeply hurt. I was afraid he would move out in

anger and miss the opportunity to finish college.

Mathew and I talked the next morning.

"Mom, I could have been killed when that spring

broke, and Dad didn't even care."

"I know, Mathew, and that is why what

we are dealing with is so awful." I could not

keep back the tears nor did I try. "Mathew,

whatever you decide," I counseled, "please keep

on going to college. Your future is still important

to me, and I hope you will get your degree. I'll

try to help in any way possible."

"Morn," he responded, "my first priority

is to go to college. I am not thinking of dropping

out, but I can't study if I am going to be put

down and yelled at all the time."

"I know, Mathew."

"But, Mom," the tears welled in his eyes

as he spoke, "ifI move out, then you won't have

anybody to help you around here."

"Well, Mathew, I'll get along somehow."

Mathew confronted his bottom line like

I had confronted mine when I had the

conversation with myself about my anger. We

both agreed college was his priority, and there

was no reason to postpone it.

He decided to stay, and we discussed the

way in which Jim's fatigue led to problems. By

Friday night, we could depend on Jim's being

so tired he would blow up at Mathew, and

Mathew, with my support, started planning to

be away Friday evening as much as possible.

By the time Jim rested up over a weekend, things

were tolerable until the lk_llowing one.

The ride over to Community Rehab each

morning was a good gauge of Jim's fatigue. On

Monday we would talk about the people we had

seen on the weekend or what we were going to

do about our new roof. By Tuesday, half of the

trip would be taken up by Jim's complaining that

Mathew wouldn't listen, was going to throw his

life away, and did not care about anybody but

himself. By Thursday, the entire trip would be

a tirade against young people.

"Jim," I would say, "I think you are

tired."

clearly

"No, I'm not. I just see things more

than you do."

"Jim, Mathew is twenty years old, and it

is time for him to get out and experience the

world. Remember, when you were in a coma,

he came through. All our friends told me how

helpful he was when they called about

information. He came to Montebello to see you

so I could have a break, and he kept our cars

fixed."

"Well, I just don't see it."

At that point in Jim's recovery, one of

his cognitive problems was putting things in

long-term memory, particularly verbal messages.

It was probably impossible for Jim to upgrade

his computer and store in his memory the things

I told him that Mathew had done and call them

back up when a judgment was needed. His

fatigue only complicated the process. And we

as a family had to cope.

The fatigue problem was a major

concern for Rick, the physical therapist at

Community Rehab. He felt that many programs

dealt with the cognitive problems following head

trauma and went to great pains to identify the

67
PHYLLIS NIMMO MARSH

areas that needed working on while forgetting

that fatigue alone can cause overwhelming

difficulties.

He started Jim on a program of exercises

to develop the muscles weakened by the injury

and in early August started taking Jim to a health

and fitness club in Annapolis. There Jim was

introduced to Nautilus machines specifically

designed to work different muscle groups as well

as build up physical stamina. Twice a week Jim

would spend over an hour going through the

program under Rick's guidance. It included

riding a stationary bicycle for aerobic fitness as

well as using the Nautilus machines. I could

see the progress Jim made in physical stamina,

and Jim could feel himself getting stronger.

Jim later told me that at first it seemed

like he was carrying a two-hundred-pound

weight on his shoulder when he tried to walk

around. As he progressed through Rick's

program, he felt as if he was throwing offbricks.

If exercise increases an uninjured

person's ability to think, it certainly should have

the same function in a person suffering head

trauma. Jim's improvement while going through

Rick's program affirmed that.

After dropping Jim off at Community

Rehab each day, I needed something to do.

Annapolis is a beautiful city in many ways. The

gleaming white yachts and tall sailboat masts in

the harbor hint at faraway places and weekend

getaways in protected coves. Specialty shops

on the main street carry unique but expensive

home furnishings and gifts. The local mall is a

popular place for professionals to shop for career

clothes.

All that seemed far removed from the

world of head trauma. Listening to two silkbloused matrons discuss whether to purchase a

wedgewood blue or dusty rose flowerembroidered towel set while I hesitated buying

a summer blouse at half off the sale price, I

wondered if the color of our bathroom towels

would ever matter again.

Seeking refuge, I found the public

library. There, in a room with ceiling-high

windows framing a shaded nook, I made my own

world among the magazines and books and

managed to survive one more step toward

recovery.

68
RE-ENTRY

On the way to Annapolis in mid-August,

Jim said, "I keep forgetting to tell Brian

something. He gave me a test the other day, and

he said he was going to give me three words

that he would ask me later to see if I remembered

them. He never asked me what they were."

"What were they?" I asked.

"They're easy to remember--rose,

hamburger, and sweater."

"Well, be sure to tell him because I think

he'll be surprised," I said.

Brian was excited. "I have no doubt now

that Jim will return to work."

Why would remembering rose,

hamburger, and sweater be so significant for a

man who used to be invited to present papers on

satellite geodesy at international meetings? It

signaled the return of several cognitive functions.

First, it showed Jim's ability to process

verbal information. All of us get our inlbrmation

either verbally or visually. These are two

different processes in our brain. Secondly, when

the brain receives such information, the brain

holds it in what the psychologists refer to as

working memory long enough for the brain to

act upon it. Then the brain transfers to longterm memory the information it wants to keep.

Head trauma causes disruption of this process.

Jim showed the ability to receive

inlk)rmation verbally, hold it in working memory,

as well as transfer it to long-term memory. If

Jim returned to work, he would be able to sit in

a meeting, take part in the discussion by holding

information in his working memory, and then

incorporate what was going on into the store of

information in his mind.

None of this had anything to do with his

ability to understand scientific calculations or

remember the work he had done in the past. At

stake was his ability to contribute new work to the

scientific field.

By late August it was time for Jim to start

the process of returning to work. Brian guided

us each step of the way. In order for him to

understand what Jim would encounter on his

return, Brian suggested meeting in Jim's office.

Brian also suggested it would be helpful if one

of Jim's colleagues could act as a mentor to help

identify problem areas. Jim and I readily

proposed Chet.

Jim first returned to work on a Friday

afternoon in late August. Jim, Brian, and Chet

spent some time in Jim's office talking about

his return. Then we went to a conference room

where Jim's colleagues had a reception for him.

Jim stood at one end of the room, looking rested

and healthy, more so than many of his colleagues

who attended. He stood the entire time to show

how much stamina he had. Across the room,

Chet chatted with Brian, who watched Jim to

see if any problems developed.

It was a celebration!

For the two hours or so we were there,

Jim seemed a healthy man. Many colleagues

and supervisors came to welcome him back. But

those two hours taxed him to the limit. It still

took a great deal of energy for his brain to

operate, and had he tried to do more, he would

have made significant errors.

Brian's plan for Jim's re-entry was

simple yet profound. He suggested Jim select a

research project he could have some input in.

Jim would lecture Brian on the content of the

project as part of his therapy, and then a meeting

would be set up for Jim to take part in the

discussion while Brian watched.

The project selected was a research paper

written by a graduate student at the University

69
PHYLLIS NIMMO MARSH

of Colorado. Jim had helped arrange a research

grant for the student and was involved in guiding

the research. The student needed to make a

decision about further projects.

Jim lectured Brian during four different

sessions. The lectures had a more important

function than just imparting information to

Brian. Following head trauma, organizing

information to present to others is impaired.

Sometimes too much information is included;

at other times, a head trauma victim may have

difficulty identifying the main point. Giving

speeches was a big part of Jim's job, and if these

cognitive functions had been impaired, there

would have to be therapy to improve them.

It is also difficult for head trauma victims

to switch to another subject and remember to

come back to the first one. Brian asked questions

to get Jim off the track to see if he could get

back on.

A luncheon meeting was scheduled at

our house for the group, consisting of Brian, Jim,

Chet, the graduate student, and another coworker. Jim would not be overtired from

traveling and would be in familiar surroundings

for the meeting.

Group discussions present a different set

of problems for someone who has had head

trauma. Dealing one on one with another person

is easy because we can concentrate on one thing.

In a group discussion, there is more stimulation.

Sometimes more than one person is talking.

Each member of the group has his own agenda

we have to pick up on. Sometimes one person

goes off on a tangent that disrupts the flow of

information. For a victim of head trauma, the

extra energy required for processing all that

information is exhausting. If the process of

keeping bits of information in working memory

has been impaired in the trauma, a meeting can

be overwhelming.

The meeting went very well. Brian felt

Jim had been a very active participant and

contributed well to the overall project.

The next phase of his return to work

needed to be planned.

Dr. Drubach, the neuropsychiatrist who

was Jim's primary doctor, emphasized, "Stress,

but don't overstress." Each new step should

forge new boundaries in his recovery but not go

so far as to overwhelm the healing process.

"When you start;' he counseled us, "work

only a few minutes a day, and then gradually

increase it."

A meeting at our house required one

level of stamina, a day at the office would require

a different one. In September Jim was not ready

to go in to work because he was still going three

days a week to Annapolis for therapy. Starting

back to work then consisted of catching up on

all the mail that had come into the office in the

previous six months and speaking by phone with

many of his colleagues.

Since life cannot be all work and

rehabilitation, we continued reaching out to our

friends and looked for some recreation. We

attended church, and one Saturday night went

to a wedding in Baltimore. Colleagues invited

us for dinner.

One family adopted us as members. At

a crab least with them in August the question of

prayer came up. I told the people around me a

therapist had suggested a study be done to

determine the factors that led to Jim's remarkable

recovery. One of the young men immediately

said, "Prayer. They wouldn't count prayer,

would they?"

The question nagged me. Did prayer

make a difference?

I admit to certain difficulties in

understanding prayer. The problems I dealt with

at times seemed impossible. My geophysicist

husband sometimes reminded me of my Down's

syndrome brother. Was it possible an allpowerful God was waiting for some kind of

prayer before deciding whether to heal Jim or

leave me with a second Duane? What if I could

not find enough people to pray? If I were going

70
BULIDING SATELLITES IS EASIER

to have to go through this situation, I wanted a

God who knew what He or She was planning

from the very beginning!

All I resolved as an answer was that Jim

had a lot of prayers offered for him, and the

expression of caring implicit in those prayers

had touched us deeply.

In the meantime, Community Rehab in

Annapolis brought Dr. William E. O'Donnell on

staff. He is a clinical neuropsychologist and

continues doing research into brain healing as

well as working with clients. He wanted to do

some neuropsychological tests on Jim to

determine the extent of his progress and to map

where further therapy should be done.

The tests took six hours to complete,

three hours on two different mornings. I told

Jim just the fact he was able to last for six hours

said a lot about the extent of his healing. Many

head trauma victims would have walked out in

a huff much earlier. Dr. O'Donnell later agreed

with my conclusion.

Part of the test was a standard IQ test

called the Wechsler Adult Intelligence Scale -

Revised. Eleven different components measure

such things as vocabulary, arithmetic, picture

completion, and object assembly, and produce

a number based upon how well Jim did

compared to what is considered the general

population. That number is called an IQ score.

In March Jim had scored 70 on the tests

given to him in California. In June at Montebello

he had scored 103. In September, Jim scored a

verbal IQ of 135 and a performance IQ of 107.

Once again, the slowness of his cognitive

processing, though it had improved since June,

brought his score down on the performance part

of the test. His overall IQ based on this test was

scored at 126.

"Jim, don't worry about IQ," I told him.

"The school places kids with IQs of 130 in the

talented and gifted classes, and yours is almost

that already. Besides, the literature on head

trauma says that speed of processing continues

improving long after other healing has stopped

so that is still going to get better." I rejoiced in

this report because it was a major boost to my

feeling that Jim would be fine in the long run.

Dr. O'Donnell also did tests of memory

functioning--both verbal and visual--and again

Jim scored in the above average to excellent

range. Clearly, a lot of healing had taken place.

However, there were problem areas that

needed working on. Jim's performance in

inductive reasoning or "concept formation

requiring hypothesis testing and formulation"

was poor. He seemed to draw a blank as he

attempted this test.

Tests that required longer attention and

concentration presented some difficulty, but this

is common following head trauma. A test of

Jim's ability to shift between two conceptual

domains (letters vs. numbers) proved difficult

for him, primarily because of the slowness of

his cognitive processing. Tests of his ability to

devise strategies for problem resolution also

showed some impairment, again because of

slowness and the need for attention and

concentration that is injured in head trauma.

Projective and personality tests showed

Jim had a clear appreciation for the nature and

extent of his cognitive difficulties. This was an

important component of his continuing work

toward recovery.

There were no signs of any psychiatric

or organic personality disorders, and there were

no suicidal tendencies.

Dr. O'Donnell was very encouraging.

"Remember," he said, "we are very early in the

healing process for head trauma. The healing

will continue for a long time."

He went on to explain that many of the

problem areas were in what is called "the higher

level" mental functions. In head trauma, these

functions are usually the last to return. He told

us of a client who had suffered a severe head

injury in his late teens. "His sense of humor,

which is a really high level mental function,

came back after seven years. That means his

brain was still healing then.

71
PHYLLIS NIMMO MARSH

"You have healed much more rapidly

than could have been expected from the

seriousness of your injury," he said to Jim. "That

fact makes prospects for your long-term recovery

very encouraging."

I would hear these words from Dr.

O' Donnell many times, and they became my life

support. "Remember;' I would tell myself, "Dr.

O'Donnell says the healing will continue for a

long time. What is happening today may

improve as Jim's healing continues."

When Steve returned from Pasadena in

February and sat down with Jim's colleagues to

plan for Jim's return, he set October 1 as the

target date. October 1 came, and Jim still was

not ready for return full time. Lack of stamina

was one problem. Driving was another.

During September, Jim had returned to

the office on occasion for meetings with out-oftown scientists and his supervisor. Some days

he rode in with Mathew, and I picked him up in

early afternoon. I was ready to toss my

chauffeur's hat.

The State of Maryland requires that

anyone who has been unconscious tbr any length

of time, even momentarily, for whatever reason,

must notify the Medical Advisory Board of the

Motor Vehicle Administration. An evaluation

is then done by the board to determine whether

that person can retain his or her license.

When Jim left Montebello, we forwarded

a letter to the board, and Dr. Drubach provided

a medical statement to them. Jim eventually had

to appear before the board for a final evaluation

as to whether he could retain his license.

Before he could return to driving, it was

recomrnended that Jim undergo a driving

evaluation by someone specifically certified by

the State of Maryland to test driving function

following injury. We felt this was important

because we recognized that if Jim were in an

accident, even if it were not his fault, the other

party might claim Jim was at fault because of

his head injury. An evaluation would provide

us legal protection.

Driving involves a whole set of cognitive

functions that can be impaired by trauma. A

big one is depth perception. We need to know

as we drive along whether we are ten feet or ten

yards from the car in front of us.

Sometimes people with head trauma

cannot look at a situation and recognize that

something is out of place. If a tire rolls out on

the road in front of us, a complex process tells

us to avoid it, and head trauma can disrupt that

process.

People who have suffered head trauma

also have slowed reflexes partly because the

speed of cognitive processing is slowed.

Jim had already returned to mowing the

lawn using our riding lawn mower, and there

was no evidence he was having any difficulty

judging turns or distances. None of the tests at

Community Rehab indicated he would

encounter difficulties in driving. It was time for

an evaluation.

On October 10, John Arthur of the

Maryland Rehabilitation Center in Baltimore

conducted the three-hour evaluation. Mr. Arthur

teaches driver education at the rehabilitation

center to people with all kinds of injuries to

enable them to return to independent living.

For reflex testing, Jim sat in front of a

machine with a red and green light. On the floor

was a brake pedal. The light stayed green for

varying lengths of time and then turned red. The

machine registered the time elapsed between the

change to red and Jim's hitting the brake. An

average of twenty-five times determined his final

score. He did well.

Mr. Arthur also did an eye exam to

determine Jim's peripheral vision and depth

perception.

An occupational therapist then gave Jim

a series of tests requiring interpretation of what

was happening in a sequence of pictures.

72
...... BULID!N_G SATELLITES IS EASIE R .....................

Experience has shown that difficulties on these

tests lead to difficulties in driving. Jim did well.

Finally Jim drove Mr. Arthur through

Baltimore on a twelve-mile test designed to

cover almost every driving situation--heavy

traffic, residential areas, stop signs and stop

lights, entrance and exit on to a freeway. The

test took forty-five minutes, and Jim did well.

With proof in hand of his ability to drive,

Jim could now take the final step toward

independence--he could get in the car and go

somewhere whenever he chose. How much we

had taken that freedom for granted before he was

injured. With Jim's driving to work, I was free

to spend the day doing what I wanted. How

much I loved that freedom!

Jim's return to work still had to be

gradual. He could function well for a short time,

but because his cognitive processing took so

much energy, he tired quickly.

In mid-October, he went off full-time

sick leave and started going to work three days

a week. He continued therapy at Annapolis on

Thursdays and had Tuesdays free to rest.

Jim felt awkward about returning to

work. "I look normal, and they are going to think

I'm faking it when I can't do everything I did

before," he said. "I know I'm not fully healed."

The expectations and knowledge of his

supervisors and co-workers then became an

important part of Jim's rehabilitation. Statistics

show that younger workers are more successful

at reentering the work place following head

trauma than older ones. Some of the statistics

suggest this difference may be because

employers are more willing to make allowances

for the difficulties encountered in the return of

younger workers because they have a longer

potential in the work place.

If Jim were involved in a conversation

about work that involved several people, he

could follow along and contribute well for a short

time, and then fatigue would take over.

A common problem following head

trauma is called initiation, one of the higher level

functions in the brain that psychologists call

"executive functions." A person with head

trauma might know how to get up, get dressed,

fix breakfast, and go to work. However, if the

initiation function has been disturbed, that

person might not be able to start the process.

Jim showed some problems with

initiation when he first returned to work and a

lot of problems with stamina. There were

possibilities that colleagues, who were used to

Jim's contributing actively, might think Jim was

uninterested in the work. Without an

understanding of head trauma, they might think

Jim would never be the same. In that case, they

might ignore and exclude him. Since his ability

to initiate contact had been injured, he would

have great difficulty overcoming their exclusion.

Education in head trauma provided the

solution. By this time, I had perceived that some

of Jim's colleagues felt I was protecting him. I

was, but I knew what was going on. I could

have gone to Jim's colleagues and quoted Dr.

O'Donnell about his healing continuing for

years, but that would have looked like I was still

protecting Jim and not accomplished any

purpose.

I wanted at least one person at work to

know from an expert what was going on so that

when conversations among colleagues centered

on Jim, that person would be able to say,

"Remember, the healing will continue for a long

time. Jim can still be O.K."

Again, I thought of Chet, who had been

so good in the months just past. I pushed for a

meeting between Chet and Dr. O'Donnell. Jim

also wanted to include Dr. Jeanne Fryer.

After studying cognitive processing for

eight months, I pictured the meeting at

Community Rehab in Annapolis that day in

terms of the brain power present in one small

room. Chet has a doctorate in oceanography,

both Dr. O'Donnell and Dr. Fryer are

73
PHYLLIS NIMMO MARSH

neuropsychologists, and Jim is a geophysicist.

I knew such power could solve any problem.

Jim told me he began the meeting by

saying, "Tell it like it is. If I have problems,

let's hear about it."

In several different ways, Dr. O'Donnell

and Dr. Fryer said, "Initiation is a common

problem following head trauma."

After several repetitions of this idea, a

light went on in Chet's mind. "We thought Jim

wasn't interested," he said.

Dr. O'Donnell counseled Chet on head

trauma. "Healing continues for a long time. We

are still very early in the process, and Jim has

made good recovery. I think he will do well in

the long run."

We never told Chet what we expected

him to do with his knowledge. It was his to use

as he saw fit. However, some of his colleagues

said to me on occasion afterward, "I understand

this is going to take a long time." That

understanding and expectation on the part of his

colleagues played an important part in Jim's

recovery.

In his battle with fatigue Jim's arsenal

had one secret weapon. Jim had the ability to

drop off to sleep for short periods of time and

wake up refreshed, something I find impossible.

Returning from the cafeteria at work he began

shutting off the phone, locking the door, and

putting his head down on his desk for thirty

minutes. Dr. O'Donnell dubbed them "power

naps." They saved his afternoons.

Jim and I hoped he would be able to

return to work full time in December, but fatigue

was like an enemy submarine, circling, alert,

torpedoes loaded.

?4
WHEN IS A HUSBAND NOT A HUSBAND?

In late fall some of Jim's colleagues gave

a dinner in celebration of his recovery. The

evening ended with a surprise. "I propose a toast

to the good luck Jim and Phyllis have shared

this year," one colleague began. "It may sound

funny that I speak of good luck, but I think you

have had lots of good luck compared to what

might have been." All of us at the table nodded

in agreement.

"In searching for a gift to celebrate that

good luck," he continued, "we thought of the

oriental philosophers who took the bird as their

symbol of good luck. There were many reasons

for this, but one of them was the bird is able to

soar above danger when it comes."

My cardinal banging into my bedroom

window had reminded me many times over the

summer that good luck in my life was possible.

Jim's colleague could not know how appropriate

a symbol he had chosen.

As he handed me a small package, he

continued, "We are giving you this bird, which

came from a market in Beijing, in the hope that

you will touch it each day to remind you of your

good luck both this year and yet to come."

In the following days, good luck birds

puzzled me. "What difference did they make?"

I kept asking, knowing the birds themselves did

not cause good luck but sensing they contributed

in some way. Over and over, just as I thought I

had captured the answer in my mind, luck's

unseen, untouchable, indescribable something

twisted from my consciousness.

Then it dawned on me. The birds

provided the concreteness I needed. I could

focus on them, as I could not on the idea, to

reinforce my belief that good luck or good times

were possible in the face of tragedy. Believing

good times were possible did make a difference.

That belief accompanied me as I sought up-todate medical care. That belief prodded me to

find solutions to the problems of Jim's re-entry

into the work force. Sometimes that positive,

forward-looking mindset was the only thing that

got me through a difficult situation.

Despair is the absence of that belief. Had

I chosen to believe I would fail, I would have

failed.

This led me back to the question of

prayer. Did prayer make a difference? Is not

prayer the affirmation that an all-knowing, allpowerful force (named God) designed a world

where support, knowledge, love and healing

(other names for good luck, perhaps) exist along

side disease, ignorance, hate, and injury? Is not

prayer a reinforcement of the belief that healing

can follow injury, that wholeness can replace

fracture, and that a better tomorrow is possible

no matter how painful today is'? Is not prayer

something concrete to reinforce some elusive

truths?

Prayer is a turning away from despair

and that made a difference. Our community of

friends who affirmed life through prayer

bolstered us in our time of need.

My family called in November and

December to ask how Jim was. "He's doing

well," 1 responded, "but he's not yet back." It

was difficult to explain how Jim could have

returned to driving and going to work three days

a week and still not be healed. My response

was the same in January, "He still has a way to

go."

Going to work each day is not the same

as working. Each evening Jim shared his day

with me, and at first I was struck by the number

of extraneous tasks he had done. He attended

seminars he saw advertised. He sent a memo

concerning the phone directory he found hard

to read. He took in a magazine article about

75
PHYLLIS NIMMO MARSH

thyroid problems and spent the morning handing

out several copies. I listened for some mention

of working on research. He resented my

questioning him about it. Then, intermittently,

I began hearing about personnel problems he

worked on or discussions of future research.

His old personality began asserting itself

when he talked about his return with his

colleagues. "I'm not coming back t00 percent,"

he told them. "I've just had a sabbatical where

I learned a whole new field--neuropsychology--

and I'm coming back 110 percent. I've had six

hours of tests now, and I can prove I'm O.K.

Furthermore, I've learned how to run all these

covert psychological tests on everyone, and

some people have passed them and some have

not."

His colleagues squirmed at the

suggestion he was studying them. He really was

not, but the understanding he now had of

cognitive processing helped him analyze

situations in new ways.

At an all-day meeting on a satellite

project, he observed the scientists concentrating

for three hours without a break. At lunch the

conversation focused on the same research. Two

more hours of intense discussion followed. As

the meeting broke up at 3:00 P.M., these

distinguished scientists could not establish a time

for the next meeting. One would be agreed upon,

and then someone would remember he or she

could not be there. Jim realized their minds,

exhausted from such long immersion in one

subject, could not switch gears to call out of

long-term memory the information needed to

make a decision.

As Jim became more involved in his

work, he realized he did not wish to return to

the same role he had before. The day-to-day

research could be left to younger scientists. He

felt his role should be that of facilitator and

leader. Dr. O'Donnell at Community Rehab

encouraged him in this.

Home was the place where the

submarine of Jim's injury fired its torpedoes.

In explaining what happens when

someone with head trauma gets tired, Dr.

O'Donnell used the analogy of the tired twoyear-old who gets cranky. If the most contented

toddler is taken shopping, lugged in and out of

a car all day, and misses his nap, no one can get

along with him. The stimulation and the lack of

rest combine to overwhelm his cognitive

functions, and the child lacks the ability to gain

control over his emotions.

By the time Jim returned home from

driving to work, taking part in scientific

discussions, talking on the phone, and catching

up with what had gone on during his absence,

his brain could handle nothing more. Some

evenings he plopped on the sofa after dinner and

fell asleep. Those were the good times.

"You goddam son-of-bitch, I'll show

you," Jim would yell as he banged the side of

his stereo system when it stopped working

periodically.

"Goddam it, you son-of-a-bitch,

goddam," Jim would yell from the basement.

Perhaps he had dropped a wrench or forgotten

where he had put a screwdriver.

Sometimes his stream of cusswords was

directed toward our neighbor's farm. That

neighbor could win the Olympics in cussing, but

Jim had never felt the need to answer back in

kind.

Monday might be fine, but by Friday all

his reserves were depleted. One Friday he tried

putting Trac II blades on an Atra Plus razor,

which is similar but slightly different. Head

trauma injures the ability to look at other

solutions when the first one does not work.

"Goddam, son-of-abitch. You goddam son-ofa-bitch. Goddam it, you son-of-a-bitch," he

yelled at the razor. I came in and explained the

problem. It was 6:00 A.M., and for Mathew and

Melissa his outburst was their alarm clock.

At times there seemed to be little

emotion behind the cussing. He called me to

look at the used hood he had bought for his old

tractor. "This really looks nice, doesn't it," he

76
BULIDING SATELLITES IS EASIER

asked. Then with no change of expression or

warning he yelled, "Goddam, son-of-a-bitch,"

and continued in a normal voice, "that wire is

loose."

Jim's progress then became measured in

terms of one less goddam or son-of-a-bitch, or

one more day between outbursts.

On December 11 Jim went to the

orthopedic surgeon. Waiting in one of the

examining rooms, Jim shared with me the

encouraging calls he had received that morning

at work from his colleagues around the world.

We realized he had not been forgotten during

his long absence.

The doctor spent a lot of time with us

going over Jim's X-rays and commenting that

Jim's bones were healing unusually well for

those of a fifty-year-old man. "I think you are

younger than your wife says you are," he teased.

Life felt good. I asked Jim to stop at

the Safeway on the way home as a snowstorm

was predicted, and I needed to get some milk

and bread in case we could not get out for a

while. Jim remained in the car, and my errand

took longer than I expected because others

shared my concerns about the weather.

Walking out, I heard the dueling horns.

The first horn was located in the first row to the

left very near the door. After it beeped a couple

of times, the other horn echoed from the end of

the first row on the right, near where Jim was

parked.

Walking to the car, I prayed, "Please.

Not Jim. Please, not Jim," but my fears were

realized.

In the car he gloated. "See. That kid is

going wild in that other car. I answered him

and then I didn't, so he really started beeping. I

had him going so much."

"Jim. Let's just leave, please. That kid

looked like he was about six years old."

"So. I showed him. He couldn't figure

out what was happening."

This geophysicist believed he was a big

man because he could outsmart a six-year-old.

"How," I wondered, "will he ever be able to deal

on a level with other scientists when he acts like

this?"

That evening at supper, he bragged to

Melissa about how he had really had the kid

going. "Dad," she said, "you need to grow up."

Melissa's words were as accurate as the

most knowledgeable neuropsychologist could

have used. One effect of head trauma is that the

victim often seems younger and exhibits

behavior common to him or her at an earlier age.

In the movie "Big" a thirteen-year-old

boy goes to the carnival and finds a magic

machine called Zoltar. The boy wishes to

impress a girl so he asks Zoltar to make him

bigger. The next morning the thirteen-year-old

awakens in a thirty-year-old body. The comedy

and truth in the film are based upon the

incongruities between the two. At times living

with Jim was like being thrust in the middle of

the movie "Big"---except our lives were not a

comedy and the difficulties were not going to

be resolved in two hours.

In December, every conversation we had

with Jim hooked into his long-term memory at

a point where the knowledge of his ancestors

was stored.

For example, I told him of a conversation

with my mother about how much easier word

processing is than typing. My mother had

replied, "Yes, everything is easier but somehow

we don't have as much time as we used to. What

do you suppose happened?"

I thought it was an interesting topic to

pursue. Jim's response was, "Yes, John Wesley

used to go to town every Saturday, and all along

the way he would take the time to stop and speak

to people and find out what was going on in the

world." Jim then told me in great detail about

John Wesley Marsh, his great-grandfather who

died in 1922.

When news of the end of a miner's strike

was in the paper, Jim commented, "I believe

Little Grandpap was a miner, wasn't he." Little

Grandpap died in 1956.

77
PHYLLIS NIMMO MARSH

Jim related minute details of events from

his childhood. In the early sixties his father's

sister came from California to visit. When it

was time to take her to the bus, his father was

late in feeding the cattle and did not change his

clothes. They visited an uncle on the way to the

bus station. This was unimportant detail, but in

Jim's telling it was as if it had happened

yesterday.

His behavior changed as he adopted the

persona of those farmer ancestors from McAdoo

Ridge, West Virginia. He insisted we buy him

suspenders to wear. "They hold my pants up,"

he said, even though with the weight he had put

back on, his pants were too tight in the waist to

fall down, and the suspenders, with nothing

pulling down on them, usually came off. He

wore plaid shirts, longunderwear, and old pants.

He smoked a pipe, and for four days he did not

take a shower.

Bruce Marsh came to visit over

Christmas and commented, "Jim seems older

somehow."

One of his ancestors could imitate the

sounds of a pack of dogs chasing a fox. First

would come the sounds of dogs barking from

far off, then his ancestor would get louder and

more intense as he pretended the group passed

in front of him, and then the sounds would taper

off as the dogs went off into the woods.

During this period of imitating his

ancestors, most of whom he had only heard

about during his childhood, Jim started agitating

the dogs in our neighborhood. He would go

outside and bark for five to ten minutes. He was

happiest when the dogs in the neighborhood

barked back.

Several times he told me how as a child

he had walked past a dog at his great-uncle's

house and the dog had suddenly lunged at him.

The event had scared him.

When my thoughts were broken by the

sound of Jim's barking, all I could think was, "I

did not marry a barking dog." And then, as on

several occasions in the recovery process, it

occurred to me that some things might have been

easier had Jim died.

I was surprised that his emotions were

ruled by the point at which he locked into his

long-term memory. Intellectually, he knew he

was Mathew and Melissa's father, but when he

acted like his ancestors, he seemed to lack the

feelings of being their father. His disinterest

made them feel rejected. He unplugged the

phone in our bedroom when he went to bed

because he did not want to be bothered by the

outside world. He forgot that Mathew and

Melissa were out, and if they ran into trouble,

they needed to be able to reach us. After Mathew

tried unsuccessfully to reach us one night, I

learned to check for a dial tone just before I got

into bed.

It would have been easy to nag Jim all

the time about his behavior, but the mechanisms

in his mind that would enable him to work on

the problem were already taxed to the point of

exhaustion by his return to work. I hoped the

healing process would correct the situation. It

was intolerable, though, to have everything in

life relate to those old codgers. In their time,

they probably did as well as any one, but they

had not lived in the world I was dealing with.

After much deliberation, I told Mathew

and Melissa we would follow the theory behind

therapy and try to strengthen the pathways in

his mind that led to more recent events. Thus,

when he started remembering the past, we would

change the subject rather than get angry. We

would mention our trip to Arizona in 1985 or a

fishing trip when the bluefish were abundant in

the Chesapeake. It was my theory, perhaps more

my hope, that if we stimulated his recent

memory, his behavior would match more recent

times.

If he would not stop talking about his

ancestors, I started talking about one of mine,

and he changed the subject.

78
BULIDING SATELLITES IS EASIER

I later came to understand what was

happening in Jim's mind when I read a book

entitled The Man Who Mistook His Wife for a

Hat by Dr. Oliver Sacks. He told of a seventyyear-old woman who was orphaned in Ireland

before she was five and brought to this country

to be raised by relatives. She had no memory of

her parents. Following a stroke, she kept hearing

a lullaby in her mind and began to feel as if she

were in her mother's arms. The realization she

was remembering her mother's singing

comforted her. The stroke had occurred in that

part of her brain where that memory was stored

and caused it to become prominent. As her brain

healed, she stopped hearing the lullaby.

Once a month Brian scheduled a

conference at Community Rehab for Jim and me

to meet with the therapists and discuss Jim's

progress and whether we needed to continue

therapy. I asked Melissa to attend one of the

meetings so she could know what was

happening.

"We are still very early in the healing

process," Dr. O'Donnell told her. "Your dad is

still going to get a lot better."

One Saturday, when the cussing and the

barking got to me, all I could do was repeat, "I

refuse to give up. We are going to make it

through this."

It was Melissa who soothed me.

"Remember, Morn," she said, "Dr. O'Donnell

says Dad is still going to get better."

Progress, and healing, then came to be

measured by fewer stories of long-ago ancestors

and longer periods of time between the dogs

barking.

Jim's head trauma manifested itself in

quiet conversations at the dinner table.

Organizing thoughts and expressing them in

logical sequence are difficult for anyone but for

someone with head trauma these tasks can, at

times, be impossible.

A typical exchange started out by Jim

saying, "Bob is sending his daughter to France

for spring vacation."

"Oh. That sounds interesting. How old

is his daughter?"

"I think she's a junior in high school."

He then added, "The trip costs $1,500."

"I'm not sure a high school student could

get that much out of the trip," I answered.

"Yes," he started in, "you know how they

talk all the time. They would be talking with

each other rather than looking. Their attention

span is about fifteen minutes so they wouldn't

be interested in doing anything. It's just purely

a case of the tail wagging the dog rather than

the dog wagging the tail."

I was shaking my head by this time.

"Jim, I haven't the slightest idea of how that

applies to what you are talking about."

"WelL," he said, "the dog usually wags

his tail, but if something is wrong, then it is the

tail wagging the dog."

"But what does that have to do with

sending a child to Europe?"

"Well," he said, "I think those trips are

just a bunch of businessmen trying to make a

buck out of someone. People just have too much

money to spend. Parents don't spend any time

with their kids so they bribe them with a trip to

Europe. Kids know that and so manipulate their

parents."

"Jim, I don't think that applies to all

parents and why they send their kids on a trip."

"I didn't say it was true of all parents.

You are putting words in my mouth," he

responded.

At no time did I feel we were

communicating with each other on the benefits

of travel for high school students. True

conversation requires focusing clearly on the

topic rather than regurgitating cliches, and Jim's

mind now called up the latter.

At times, Jim pontificated. He knew

exactly what the world was all about and

delighted in telling me.

My neighbor and I went to visit some

model homes in the neighborhood. "Jim, Peggy

and I really enjoyed that. The first house was

79
PHYLLIS NIMMO MARSH

very traditional, but the second one was weird.

It had a Roman motif with marble busts and pink

and white striped wallpaper."

He answered, "You know people buying

those homes can't afford them. People don't

know what's important. Both parents are going

to have to work, and the kids are going to grow

up thinking they have a right to everything.

People don't know what its like to really have

to work to make a living."

I stopped sharing my thoughts with him.

But decisions had to be made because

life was continuing, and many of them I made

on my own. Melissa needed to find a college.

Most applications had to be in by February 1,

many of them before that for scholarship

consideration. As Melissa began her search, Jim

showed no interest.

"Melissa," I told her, "in the long run,

when Dad is healed, he will care."

Adding extraneous detail to a story is

common for someone with head trauma. If Jim

were trying to explain about a car his co-worker

was selling, in December his story might have

gone like this: "Well, to make a long story short,

Ken is from Missouri. He graduated from a

teacher's college out there in the early seventies,

and then went on to get a master's degree in math

from Iowa State. He didn't know where he

wanted to work so went to California for a while

before he came back here. He is a friend of John

Smith, whom I met working for Data Tech back

in 1978. John asked me if Ken might get on at

Goddard so I interviewed him and brought him

on board. At any rate, he has this 1989 Buick

and so he doesn't need his 1979 Plymouth and

wants to sell it."

It seemed like his mind loaded

everything it knew about a subject into his

working memory, and then could not sort out

what details were needed to answer the question

of the moment.

After several such encounters, I called

up Brian, the speech therapist at Community

Rehab, and explained what I was up against.

"Phyllis, those are things I can help with," he

reassured me. Jim still needed therapy.

Dealing with Jim's thought processes

one-on-one at home was difficult enough. I did

not worry too much about his thought processes

at work because Dr. O'Donnell had said that

overlearned processes come back more quickly

following head trauma. Jim's work fell in that

category, and he was always more rested when

he went to work.

In life, though, we interact with many

people beyond our work and home, and we often

express opinions that cause others to judge us.

For the most part, I did not worry when I was

among friends that Jim's processes were fuzzy.

They knew and respected him from before. A

visit from our pastor, though, was different.

Assigned to our church in July, she had spent

the summer and fall getting established. By late

November and early December she was trying

to complete her visits to the homes of all the

church members so she would get to know them.

"How do you get to know someone who is

healing from head trauma?" I wondered.

Under the leadership of one of the young

couples in our church, our members became

interested in the homeless problem in our county.

The church started preparing a meal for a nearby

shelter, and one Sunday a month several hundred

sandwiches were prepared and taken to

downtown Washington for distribution to the

homeless there.

Homelessness is a complicated issue.

Intelligent people who have studied it from all

angles do not have the answers. Someone with

head trauma, though, can think he knows the

answers. Cliches such as "I don't think we

should just give people food because people

don't appreciate anything unless they have to

work for it" replace serious study of the

underlying causes. Jim was prepared to offer

his lecture to the pastor on how the problem

should be solved--a problem he had never

studied.

8O
BULIDING SATELLITES IS EASIER

I wrestled a long time with how I should

handle that visit. We liked her, and I asked

myself what I owed her in terms of preparation

for the visit. If she came expecting a thoughtful

scientist and Jim came on too strongly, I

wondered if she would understand. I wondered

how I would handle my own feelings watching

Jim express cliches and think they were

knowledge.

I considered calling to tell her about head

trauma, but somehow I held back. Finding the

energy to reveal my concerns to someone new

was difficult. I knew I was not responsible for

Jim's behavior, and I objected to taking that first

step toward what seemed to be an apology for

it. Besides, if Jim were going to live in the world,

he needed to learn his ideas would be questioned

and find ways to handle it. At no time did I

consider confronting Jim about the ways his

cliches on homelessness were limited. His

energy needed to be focused on work, and I

realized I could correct him only a limited

number of times before he would resent it. The

problem of homelessness did not need to be

solved by us at this time.

Several things helped make the visit a

pleasant one. For many reasons it kept getting

postponed. When the pastor came in midJanuary, Jim's thought processes had improved.

He did not tire as quickly or pontificate as much.

In the meantime, a good friend became interested

in helping the homeless and shared quiet

conversations with Jim about the complexities

of it. On this issue Jim listened to his friend

more than he would have to me. Our pastor had

met many people who disagreed on positions

taken by the church and responded without

difficulty to Jim's comments.

Looking back, I am glad I never took that

first step toward accepting responsibility for

Jim's behavior. Somehow, I think doing so

would have been too easy, and I might have taken

that responsibility again and then again. I am

willing to educate people about head trauma, but

recovery in the long run meant Jim was

responsible for his own behavior.

Jim had difficulty keeping track of where

he placed items. Our cognitive processing

should hold in working memory the fact that we

have just picked up an item. Many things might

disrupt that process, including distractions or

stress. For head trauma victims, the problem is

that the process may only work sporadically.

Jim called to me one Saturday, "Phyllis,

do you know where the nozzle to the hose is? I

can't find it anywhere."

"I'm sure I put it on your workbench

yesterday," I responded.

"Well, it's not there. Goddam it, why

can't anything ever be put back in its place?

Goddam."

Alter retracing my steps from the day

before, I was sure I had placed the nozzle on his

workbench. In trying to understand what might

have happened, I theorized he had picked the

nozzle up, and because it looked like a pair of

pliers, put it in one of the drawers. I began

checking all of them to see if I could find it.

Five minutes later Jim came into the

basement. "Phyllis, I found the nozzle."

"Good," I said. "Where was it?"

"Well," he said, "I could have not told

you, but I decided to be honest. It was in my

pocket."

It takes a lot of cognitive energy to be

cussed at, to be blamed for misplacing something

that you know you have not, to live with someone

who has difficulty communicating, to remember

you are reaching for a long-term goal of healing,

to remember these changes were caused by an

injury, and to remember that anger would only

exacerbate the situation. Holding all those ideas

in working memory while figuring out a

response took all the brain power I had at times.

Sometimes I was too tired to succeed and did

the only thing I knew to do--I ate chocolate chip

ice cream. I knew eating did not solve a thing,

but I had no energy to work out a different

solution.

81
PHYLLIS NIMMO MARSH

To my credit, I never put Jim down by

saying, "You have the head injury, not me."

Luckily, I never used my struggles as an

excuse to spend money on myself. From the

time Mathew was born, I have been the family

bill payer. Jim never worried that I would

overspend or forget to pay the bills. I had often

heard of women who are suddenly widowed and

cannot comprehend their finances. In our family,

Jim would have had the difficulty if something

happened to me.

That system was an asset during Jim's

recovery. He did not squander his energy

worrying about money, and we did not have to

work through our fuzzy communication system

to arrive at any compromises on spending. He

trusted me, and I came through.

As healing progressed, Jim began

playing his extensive collection of records and

became interested in making a tape for Brian of

the songs that expressed Jim's views of life. He

gave a lot of thought to the selection, and after

that enjoyed his music again.

In January Jim learned of a 1956 Ford

pickup truck that might be for sale. For years

he had wanted a 1955, 1956, or 1957 model.

He and Mathew went to look at the track on a

Saturday. "Let's just look," Jim said. "I won't

work on it for a while so we can leave it there

until spring." But someone who suffers from

head trauma has difficulty getting off a subject.

It's as if once an idea is brought into working

memory, the mechanism for sending it back to

long-term memory fails.

Jim paid for the truck on Monday and

that evening began to talk about getting it home

the following weekend.

Mathew became concerned. "Morn," he

said, "I've already planned something for

Saturday. That truck hasn't been moved for a

while, and Dad might have trouble on the way

home. If he wanted it, why didn't we just get it

last Saturday?"

Jim would not be deterred. "I am going

on Saturday no matter what anybody says." We

were reassured when a friend agreed to ride with

him and help if a problem developed.

That Saturday several people from Jim's

work were coming to our house for a potluck

dinner. A friend was bringing a powerful

telescope so we could view Venus. Jim needed

to conserve his energy for the party.

Jim left around eight in the morning and

arrived back home, luckily with no problems, at

around two in the afternoon. Instead of resting,

he started tinkering on the truck and only came

up to change his clothes after some guests arrived

at six. After the party, Jim went to the garage

and continued tinkering until 12:30 A.M. Three

times I went down to urge him to quit.

When I awoke at 5:30 A.M., Jim was

already in the garage. That day he quit only to

eat and go to church. As the days progressed I

lost track of the number of times Jim polished

his truck. He washed it and put a coat of wax on

by hand. He bought a cleaning compound and

abrasive and tried that on it. He went over it

again when he bought a new polisher. Each time,

I was called upon to admire it. The fenders and

bumpers were dented beyond repair, but the hood

and top began to look like they were in a

showroom. I realized the truck would have been

new the year Jim graduated from high school,

the time in life when boys are most interested in

new cars.

Jim started going into work four days a

week in January, a concern to us and his doctors

because we felt he might not have the stamina.

Squandering his energy on polishing his truck

every night endangered his heavier work

schedule. When he cussed because of fatigue

from work, I understood, but when he cussed

because of fatigue from polishing the truck, I

felt abused.

At breakfast I finally laid it on the line.

"Jim, you are going to have to listen to me." My

five years of school teaching experience showed

in every word. "Your most important goal right

now is going back to work. If you continue using

your energy on that truck, you are going to start

82
BULIDING SATELLITES IS EASIER

making significant errors either at work or

driving and cause yourself harm. That truck can

wait."

After he left for work, I called Dr.

O'Donnell at Community Rehab for

reinforcements. "Jim has forgotten he needs to

watch his fatigue," I complained. "Can you work

with him on that?" Dr. O'Donnell assured me

he would.

Because this was the only thing I had

jumped on him about, Jim listened.

Many times Jim's colleagues or our

friends told me, "You really have been very lucky

and have a lot to be thankful for."

At first I responded quickly, "Yes, I do."

As Jim's recovery continued, I found myself

pausing longer and longer before I could answer.

I had seen enough head trauma victims to know

Jim was recovering well ahead of the norm.

However, there were also many things I was

angry about, and reminding myself to be

thankful did nothing for that anger. Finally, I

realized our minds are designed to store all

feelings, angry and thankful ones, and one

feeling does not erase the other.

"Yes, I do have much to be thankful for,"

I agreed. In my mind I always added, "And,

yes, I have a lot to be angry at." Acknowledging

the anger released some of its potency.

In understanding my anger, I finally

faced my loneliness. My sister-in-law Sylvia

put it best. After I explained the changes in Jim,

she remarked, "You really miss Jim, don't you?"

Yes, I did.

I missed him at the dinner table. I missed

being able to talk with him about ideas and

feelings and people. The person with all these

fuzzy thinking patterns was not the Jim I took

to the airport on February 20, 1989.

I missed hugging him. Who wants to

hug a barking dog?

I missed him as we sat in church. I used

to go places with Jim and feel a sense of pride

that he was my partner. Now I waited for

torpedoes to hit.

I felt alone as we listened to the therapists

talk about Jim's injury. "Jim and I were equal

in intelligence before, and we still had to work

at decisions," I grieved. "l haven't had head

trauma. How will I feel if he remains impaired?"

l felt alone when I listened to wives

complain about their husbands. "At least you

can argue with him," I thought.

I was lonely when we went to bed at

night. Physical feelings toward another person

are grounded in the mutual sharing, closeness,

respect, pride, and humor of the present, not in

the memory of what used to be.

I had no interest in cleaning house. I

went to the Safeway every day because I could

not decide until mid-afternoon what I would

cook for dinner. | fixed the same quick meals

week after week. "I'm depressed," I realized,

and then felt better when I read a study done of

the wives of Israeli soldiers who had suffered

head injuries. A survey taken three months, six

months, and twelve months post-injury showed

a significant level of depression in the wives. "I

know why," I thought.

I reflected on the first time I faced

loneliness in my life. After college, I taught

school in Elgin, Illinois. In my fourth year of

teaching, nay roommate got married, and I

decided to live alone. I had grown up in a large

family, lived in a college dorm, and finally shared

an apartment with a roommate; living alone in a

town three hundred miles from my family was a

shock. When I left work on Friday, no one cared

what I was doing until I returned on Monday.

After recognizing my loneliness, I finally

accepted responsibility for it and conquered it

by playing bridge, volunteering at the local

hospital, and working at the library on my

teaching units.

"Maybe," I now told myself, "I should

be thankful I learned to face down loneliness in

a less complicated setting. It was hard enough

back then. What would it have done to me now."

83

HEALING

Jim celebrated his fifty-first birthday in

a special way. The French Space Agency

scheduled the launch of a satellite, called Spot

2, sometime in December. The launch was

delayed until early January and then delayed

again. Speaking with Michel, Jim joked,

"Maybe Spot 2 can be launched on my birthday."

As the countdown continued, the launch was

scheduled for January 21st, Jim's big day.

The French launch their satellites from

French Guyana off the coast of South America

in a time zone similar to ours. The scheduled

launch time on Sunday morning passed with no

call from Michel. "Oh, well," Jim and I told

each other, "we still have all day."

At 10:00 RM., the phone rang. "Happy

Birthday, Jim." Michel was as excited as we

were. "I just received word that Spot 2 was

launched a half hour ago and everything is

working fine."

In early February Jim was asked to give

a presentation to his co-workers about the Spot

2 satellite. The project would tax his ability to

organize his thoughts, respond properly to

questions, come back to the topic at hand if he

got sidetracked, and remain interested.

The day after the presentation Jim

suggested I call one of his colleagues in order to

get some feedback in case there were problems

he needed to work on. That I could call someone

I had never met and discuss with her specific

problems caused by head trauma and how Jim

was handling them illustrates how Jim's coworkers as well as his therapists had become

our partners in his healing process. Jim asked

her to be honest with me.

"Technically, Jim was very good," she

said. "If he did not know the answer to a

question, he said so. Those he did not know the

answer to nobody expected him to know."

"What about his organization?" I asked.

"He stayed on the topic very well," she

responded. "Somebody scooped him about the

satellite being launched on his birthday, but Jim

responded in such a way as to make it his story

without repeating what the other person said."

"Did you notice any fatigue?" I asked.

"No. I finished speaking to him around

noon, and he seemed fine then. That's a real

improvement. Last fall, I felt he could only talk

for about ten minutes on something before his

mind wandered. Now, I feel he talks until the

conversation comes to a normal end."

"Initiation can be a problem following

head trauma. Do you notice any difference in

Jim'?" I probed.

She hesitated a little on that one. "Last

fall everyone felt Jim was not interested in the

work. I heard people comment that physically

he looked fine and he sounded fine, but he wasn't

involved. But he did an excellent job in

preparing for this presentation and even brought

in information he had gotten from the French."

She continued, "I am not sure if there is

a hesitancy in Jim. Always before when I went

to him with a new idea, he would think about it

before responding. There is a hesitancy now,

but there was hesitancy before, and maybe it is

the same."

After I explained that Dr. O'Donnell

said healing would continue for several years,

she said, "l have noticed so much improvement

each time I see Jim that I really think he will be

fine in the long run."

"This event," she continued, "changed

us all. I went to the synagoguc and prayed in

front of the Torah for Jim's recovery, l have

never told Jil-n that because we arc of different

religions, and I did not know how he would take

it. I am so glad he is back."

85
PHYLLIS NIMMO MARSH .............................................

Tears welled in Jim's eyes when I told

him about this conversation.

Working four days a week was going

well, and Jim and I began to go places for fun.

Again, fatigue was waiting for us.

One Friday, I met Jim at work at 3:00

P.M. so we could go to a music store that had a

large selection of folk music records. A collegeage couple came in while we were browsing.

The boy was small, pimply, slightly unkempt.

The girl was probably his first love interest. They

sought a specific "in" tape'Pete Kennedy at

the Birchmere. As they were going down the

tapes and reading titles, the boy said, "The

Greatest Hits of Burl Ives. That must be a small

tape." The girl giggled at his sophistication.

A couple of minutes later, Jim erupted

as I walked up to him. "Did you hear what that

kid said? Burl Des' Greatest Hits."

"Jim, not so loud," I said.

"No. I'm going to tell him. Who does

that young punk think he is? Burl Ives was

around many years before he was born." He

meant for his voice to carry across the room.

"Jim, you do not have to make an issue

of it. Shhhh." 1 nudged him on the leg and he

was quiet. Embarrassed, I walked away.

No store owner was going to let someone

pick a fight over different tastes in music. The

kid was speaking only to his date not to Jim,

and because of his fatigue Jim missed a lot of

clues that should have told him there were other

ways of looking at the situation. Jim's

disinhibition could have led to an unpleasant

confrontation.

It took me a while to cahn down, and on

the way home I grieved for both of us. Going

out with Jim made me very apprehensive about

getting into difficult situations. Once we might

have been able to reminisce about our own early

dates and chuckle over the boy's bravado, but

his brain injury robbed us of that closeness.

I realized that four days a week at work

was all Jim was ready for if by Friday afternoon

he showed this much evidence of fatigue.

As healing progressed, Jim's language

clued me in to his new phase. We were at a

store one evening when I asked him what time

it was. "Two hairs past a freckle," he said.

I had not heard that phrase since college.

When the news was finished one day, he

said, "They're rioting in Africa, they're starving

in Spain. There's hurricanes in Florida and Texas

needs rain." Looking out the window, he said,

"Spring has sprung, the grass is riz, I wonder

where the birdies is." Both were sophisticated

comments when we were in our early twenties.

In conversation, Jim told old college

jokes as if he had heard them last week. In sexual

innuendoes, he referred to his pecker. Gone were

the suspenders. He renewed his interest in radios

and began acquiring gadgets. One evening I

realized he was listening to the local police

channels, something he had not been able to do

before. When I questioned him, he bragged,

"See, I fooled you. George and I went to Virginia

this afternoon and bought this. You thought I

went to work, didn't you? All I have to do is

take this little plastic card, and I can get

anything."

In the car he became very aggressive.

When a car pulled out in front of me, he yelled,

"Doesn't your horn work? Don't let them get

away with that." The horn in his Monarch was

rather quiet, and he spent a Saturday replacing

it. He reminded me of Mathew, who often told

me I drove like an old fogey.

Then the fires began. When we first moved

to the country, we burned our trash because there

was no pick up in our area, but in 1983 Mathew

had been badly burned in West Virginia when the

gasoline he and Jim put on a pile of leaves to help

it burn exploded. After that Jim and Mathew had

great appreciation for the destructive power of fire,

and we got rid of the burn barrel.

Jim was a packrat and had some old wood,

car parts, and junk behind our garage. He began

cleaning the area out, and one day I saw thick black

smoke darkening the sky. Jim had turned an oil

drum into a burn barrel.

86
BULIDING SATELLITES IS EASIER

On a windy day in February Jim came

home early. Busy in the house I did not notice

the flames until they rose ten feet above the

barrel. When a gust of wind came, fire brushed

the spruce trees ringing our yard as well as the

gas tank area of the 1967 Plymouth Barracuda

Mathew had bought. Scared that anyone would

build such a large fire, particularly on a day when

the wind was gusting so strongly that the flames

could be twisted anywhere, I ran to the garage.

"Jim, you have to put that out!" I yelled to make

myself heard above the wind. "If there are any

gas fumes in that tank, it could explode and you

could kill us all. This is too dangerous."

Jim's eyes gleamed with excitement, but

he put the fire out. That night at a concert I

could not enjoy the performance. Jim's pretense

of anger at me for yelling at him and of

contriteness at his foolishness could not mask

the far away, contented look in his eyes as if he

had found an inner release of energy that was

satisfying.

When I called Dr. O'Donnell to ask his

advice, he was away on an emergency. The next

week he was gone again, and I never found an

explanation for Jim's behavior.

For several weeks I felt like I was

watching a small child. When Jim was home, I

monitored the garage area because he was unable

to let go of his fascination with the fires.

In March during Jim's college phase,

we visited the farm in West Virginia for the first

time since his head injury. Getting ready

illustrated many of the residual problems of head

trauma. Jim waited until the last minute to buy

the lumber we were going to need to fix a garage;

he worked on making lists of things to do but

never got around to purchasing the universal

joints Mathew needed to put in the truck before

we drove it. Jim hardly slept the night before

we left.

Jim's emotions matched his mental age,

and I felt my worst nightmare was coming true.

Jim's mother and father had run a truck farm. I

remember them as two of the hardest working

people I have ever known, and I have fond

memories of good times. From the first time I

went to the farm, though, I remember troubled

family relationships concerning the farm and the

way in which Jim and his brother and sisters

related to it. There was anger because some took

advantage of the farm; when work needed to be

done, it was difficult for them to sit down and

figure out a plan of action. At times some

members of the family stopped speaking to

others. Jim's father died in 1972; his mother

died in 1984. Jim and I had spent a lot of energy

since then working through those relationships

while remaining friends with his family. The

previous fall the farm had been divided in a way

that all four siblings felt comfortable with.

Now it seemed that all the

understandings Jim and I had worked so hard to

achieve concerning his family had been wiped

out in Jim's mind. During that first visit Jim

became so angry because he felt someone

slighted him that he was not going to speak. At

one point, while Jim was operating a chain saw,

his anger overwhelmed him so completely that

he became a danger to himself by swinging the

saw wildly. Mathew threatened to take the saw

away if Jim did not cahn down.

I knew I did not have the interest or the

energy to work through those relationships

again, and after that weekend I found myself

wondering, "If Jim's emotions are lied into his

college days, and we did not meet until after he

was out of graduate school, would he really miss

me if I left?"

At breakfast one Saturday Jim was

telling me how he almost joined the Coast Guard

shortly before he graduated from high school. I

could tell the memory was vivid, but I also felt

Jim was rested enough that I could discuss the

implications of such memories with him.

"Jim, in the book The Man Who Mistook

His Wife for a Hat the doctor explains about a

lady who has a stroke and hears her mother

singing lullabies, something that happened over

sixty-five years earlier. Sometimes I hear you

87
PHYLLIS NIMMO MARSH

explain something that happened long ago as if

it happened yesterday. I think your head injury

has affected your long-term memory in the same

way the lady's memory was affected by her

stroke. Do you know what I'm talking about?"

He stared at me before he answered. "I

knew my memories were very vivid, but I didn't

know they were related to head trauma."

"Last fall was very hard," I explained,

"because everything we did you related back to

years ago."

That made him angry. "Why didn't you

tell me this then? It's like having a dirty face. If I

had dirt on my face, you would tell me to wash it."

"Because," I explained, "there were so

many issues to deal with. I could have been on

you all the time, but that would have been

counterproductive. I felt getting you back to

work was more important, and I felt as you got

involved in work, your more recent memories

would come back."

As we discussed this, I suggested he

might want to tape his memories. Then when

he retired in a few years, when he might not be

able to recall them as well, he could use the tapes

to write a book.

He later discussed this phenomenon with

Dr. O'Donnell. "Many people seem younger

following head trauma because of this," he told

Jim. "The healing process goes much quicker,

though, than growing through it did. It is not

like you have to live through your whole life

before you are healed."

After that Jim monitored the number of

stories about his ancestors he told us and realized

we became bored if he continued too long.

Sitting at traffic lights I often thought

about Jim's roommate at Montebello. He was a

mechanical engineer. His many visitors

indicated he was well liked. While on a business

trip to Philadelphia, he waited in a left turn lane

with his turn signal on. The next thing he knew

he was in the hospital. An oncoming car had

crashed into his leaving him with a severe head

injury.

"What if that happened to me?" I

wondered. "What would I be like if my longterm memory were activated?"

The martyr in me also caused me to ask,

"Would Jim Marsh have bothered to learn as

much about head trauma if I had been the one

injured?"

At other times I asked myself, "What

would it be like if Jim's memory locked into the

times when our marriage was good'?"

There were no answers to my questions,

but asking them helped me get over a rough time.

In March, Melissa made her college

decision. She had fallen in love with Loyola

College, located in a beautiful old section of

Baltimore near where Bruce Marsh lives, when

we visited the campus the previous fall. I liked

the school's Jesuit philosophy of educating the

whole person.

"Melissa, this is the kind of education I

had at Grinnell. I would not have been able to

handle this past year without it. It's worth every

effort," I had told her, "so go for it. But please

remember that after what this past year has cost,

you will have to get a scholarship for us to afl'ord

your tuition and other expenses."

On a visit to see Bruce in March, we

drove Jim around the Loyola campus. We

showed him lhe catalog, and he studied the

backgrounds of lhe faculty. The number of

doctoral degrees impressed him. When the letter

offering Melissa a Presidential Scholarship

covering a big portion of the tuition came, Jim

was ecstatic. The father who showed no interest

in Melissa in the fall had healed to the point of

being her strongest supporter. As his colleagues

called from around the country and the world,

he shared his pride with them. "Go for it,

Melissa," his actions said. "You're worth it."

In early spring Jim and his co-workers

moved to a new building. Three years earlier

Jim and I had purchased a blue plaid wool carpet

for his office, but he had never installed it

because moving the furniture would have been

too difficult.

88
BULIDING SATELLITES IS EASIER

"Jim," I suggested, "since they are going

to move all your furniture, why don't you put

down the carpet before they put everything into

your new office'?"

The carpet just fit. That first day Jim

told me, "Phyllis, you cannot believe how much

difference the carpet makes in the noise level."

The cinder block walls and tiled floor

had provided no cushion for sound. When Jim's

mind had to block out the sound bouncing

around in his office, he quickly became fatigued.

Now that energy could be focused on work.

There was also energy left when he came

home.

By this time, his suicide attempt was

almost forgotten. Many people had come

forward with their own tales of difficult times.

One colleague told Jim she had a fliend who

committed suicide and it was later determined

she had a thyroid problern. I learned of one

colleague who, upon hearing of Jim and his

thyroid history, asked his son in medical school

if that could have caused the problem. After

doing some research, the son called back and

said yes. The truth will always be supported.

Jim and I were talking about his injury

one day when I commented, "Jim, aren't you

glad you don't have to worry about what people

know? If you had to worry each time you met

someone if he knew about your jumping, it

would take so much mental energy you wouldn't

be able to function."

"You're right," he answered. The truth

had set him free.

The extent of Jim's healing could be

measured by a meeting he attended in n-rid-April.

Jim headed a team of scientists who were to give

a presentation at the Naval Observatory on a

proposed new satellite. He planned his

wardrobe, wanting a new tie, shirt, and shoes to

go with his pinstriped suit. To get to the meeting

he had to drive across downtown D.C. during

morning rush hour--a trip of over an hour. He

participated in meetings all day and made the

presentation, answering several technical

questions. Then he drove home during evening

rush hour.

In cognitive terms the energy

requirement for his brain to process all that was

equivalent to the electricity needed by the power

company in the Washington area during a 102

degree day in July. Jim had no brownouts.

About that tirne, Mathew complained to

me, "Morn, Dad is beginning to treat me like

I'm a kid who doesn't know anything. He was

listening to me for a while, but now he treats me

like he did three or four years ago."

I paused before I answered. "Mathew,

this is going to sound funny, but in a way that is

good news."

"Huh?" he responded.

"Remember how at Christmas time all

he talked about were those old guys in West

Virginia and he acted like them? It was as if he

had no feelings of being a father. That was part

of the head trauma."

Mathew nodded slowly in response.

"Then as his brain healed, he acted like

a college kid."

He nodded again.

"Well, Mathew, if he is now acting like

he did three or four years ago, it shows that

healing is still going on. At least he must now

have feelings of being a father."

Mathew understood what I was saying.

"But, Morn, I'm not going back to what I was

three or tkmr years ago. I know what I'm talking

about many times that Dad does not give me

credit for."

"I'm not telling you to go back. I'm

proud of your knowledge, but just understand

that part of what we are going through is still

his brain healing."

It seemed like each new step in healing

involved new complexities in Jim's mind. At

the beginning, it was necessary for him to be

aware of who and where he was. Then his

movement and speech patterns were worked on

followed by more complex tasks such as balance

and organizing thought processes. By the end

89
PHYLLIS NIMMO MARSH

of April we were at the point in healing the

psychologists refer to as the executive functions

of the mind--those functions that monitor or

manage all the processes in the mind.

In late April, Jim could not find his comb.

He started searching through his pants pockets.

"I wish I could remember where I put things,"

he said.

"Jim," I responded, "I want to

congratulate you for not cussing. I appreciate

it."

One night I heard three loud bangs.

When I found Jim sitting at the stereo, he laughed

and said, "I didn't cuss."

When he told me that situations at work

upset him, he said, "I could have really blown

my stack, but I didn't."

"Good for you. You are learning," 1

responded.

Thus his mind was able to manage

information about a problem, its cause, and his

response options, and to control his choice of

action.

By late April he began planning for a

visit from a group of French scientists. The

itinerary included sightseeing for one of the

wives and a group dinner at a well-known

Maryland inn. His colleagues were surprised at

how quickly he acted to firm up the details of

the visit. In terms of initiation, one of the highest

level executive functions, Jim was showing his

old abilities.

In mid-May, Dr. O'Donnell conducted

some neuropsychological evaluations to chart

the extent of Jim's healing and to determine if

he needed more therapy.

On the way to Annapolis to meet with

Dr. O'Donnell about these tests, Jim said to me,

"Phyllis, I have so many things I want to do this

summer, I don't think I'm going to have time to

go to work."

I smiled at these words. "Do you

remember last summer, Jim, when you told me

• ¢_,,

you had no interest in anything.

He could not remember that

conversation. Now he wanted to learn more

about his shortwave radio, research his ancestors,

fix up our farm property, visit friends, and many

other things.

Dr. O'Donnell was very encouraging

about the tests. On the Wechsler Adult

Intelligence Scale - Revised, Jim scored a verbal

IQ of 142, with a performance score of 122, and

a full scale IQ of 137. That was an eleven-point

overall gain since his last evaluation in

September.

The greatest area of improvement was

on the Category Test, which is a measure of

inductive reasoning. In September, he scored

in the bottom four percent of people taking the

test. In May he scored in the top one percent.

Dr. O'Donnell felt such a great

improvement indicated Jim's ability to problemsolve had been suspended rather than lost

because of his head trauma and natural healing

in his brain had restored it.

Dr. O'Donnell's summary reads:

"These findings are quite encouraging.

Improvement is found in all areas of cognitive

functioning with the most important

improvement being observed on tests of

reasoning and problem-solving ability. Jim is

more alert and aware of the environment and

his social sensitivity has greatly improved. He

continues to evidence mild visual perceptual

difficulty, mild verbal learning difficulty, and his

speed of cognitive functioning is still slower than

pretrauma levels. However, no test score is

below average and additional improvement can

be expected."

90
WHEN BAD THINGS HAPPEN TO PEOPLE WHO'VE HAD HEAD

TRAUMA

Before Jim stopped going to Community

Rehab in Annapolis in late June 1990, Dr.

O'Donnell and Brian counseled both of us

repeatedly that someone who has had a head

injury will always tire more quickly than he or

she would have prior to the injury and that stress

will be harder to handle. It was therefore

important to pay careful attention to stress and

fatigue levels because too much of either could

cause the brain to malfunction.

In late June the orthopedic surgeon

removed the pin in Jim's hip. The bone had

healed well, and there was the possibility the

pin would cause arthritis oz" injury to the hip

socket if it were left in. Jim chose to have general

anesthesia during the operation, which lasted

twice as long as the scheduled forty-five minutes

because the bone had healed so well around the

screws holding the pin the doctor had difficulty

removing them.

After the anesthesia, Jim's stories

stretched so long I lost the point before he

finished. He had difficulty mastering the use of

crutches because he could not keep the process

in his working memory. The same thing

happened with the cane. The anesthesia had

brought back earlier manifestations of his head

injury.

A week after Jim's surgery Mathew was

driving to the beach when a passing car crossed

in front of him. Mathew swerved to the left to

avoid it, but his little finger was caught when

the rear view mirror where his hand was resting

scraped a construction barricade. The doctor

woke us at 6:00 A.M. to discuss surgery.

Once again I went to a strange hospital

in an emergency. Jim hobbled down the hall of

the hospital on crutches to see Mathew.

When Jim had an allergic reaction to the

stitches used to sew up his fourteen-inch

incision, I had to cleanse and bandage it daily

for a month to prevent a bone infection. I had to

do the same for Mathew's hand.

In August Mathew collided with a deer

on a rain-slickened road and damaged the front

end of the almost-new Escort he had purchased

that spring.

In early September, after we waited

eighteen months for everyone ahead of us to be

taken care of, the well drillers arrived. My

shallow well had caused me much grief in the

dry years, and I rejoiced that I was going to join

the twentieth century with a new deep well.

Two hours after the drilling started, a

malfunction in one of the safety features allowed

the shaft to be bent. "In eighteen years this has

never happened to me before," the operator

explained. They drove away with no promise

of how soon they could get the part fixed. I was

beginning to feel my life was the personification

of "anything that can go wrong, will."

A late heat wave hit in September, the

kind that hovers close over the area and drains

everyone of all energy. The air conditioning in

Jim's car had broken, and as he left work the

temperature inside it would have been well over

a hundred. Driving home took him

approximately forty minutes.

The people who share the small blacktop

road that leads to our driveway had been using

their farm as a depot for their tractor trailer rigs,

something not allowed under the zoning

regulations for the area. Many times as they

pulled out they ran across the edge of our yard

leaving deep ridges.

When Jim discovered the new ridges that

humid night, he swore in the direction of the

neighbors' house in as loud and uninhibited a

voice as he would use yelling at a Super Bowl

game. He painted a cardboard sign saying "No

91
PHYLLIS NIMMO MARSH

More Trucks" and stuck it in the yard. Still not

satisfied and unable, because of his head injury

combined with heat and exhaustion, to talk out

the problem, he built a barricade along the road

using tire rims and metal pipe. Just like John

Henry, the steeldriving man in the folk song, he

pounded four pipes deep in the ground--a

danger to anything that hit them, including us if

we had to swerve to miss a car. His brain was

broadcasting anger, but no messages got back

in to tell him to question the wisdom of his

actions.

I was exhausted as well as embarrassed.

Usually when I reached the point where I could

no longer take his actions, I withdrew and

released the tension by crying as I had done

many times since my visits to the hospital chapel

in Pasadena. That evening though I needed to

act before Jim built something impossible to tear

down and before his anger and exhaustion

caused us harm.

There are many ways to say stop and

many ways to say the pressure is unbearable,

but what came out when I faced him was, "Jim,

this has to stop." When he continued pounding

as if he had not heard, I said, "Jim, would you

like a divorce?" and walked back to the house.

Jim did not respond. The next morning

I explained, "Jim, I am going to take those things

down. The county people will be coming to

inspect our well, and I don't want to be cited for

an obstruction in the road."

Again he did not answer. I spent the

morning digging the barricade out, causing my

shoulders and arms to ache for several days.

Our well was finished a week later.

In the fall Jim continued working full

time. Melissa went off to Loyola and had the

usual joys and traumas of adjusting to the first

year in college while Mathew continued working

as an engineer's aide at Goddard and attended

college part time.

The French scientific community

planned a celebration to commemorate the

twenty-year anniversary of their involvement in

satellite geodesy to be held in February at the

Academy of Sciences in Paris. The French

Space Agency offered to pay for both Jim and

me to attend. In a visit to Washington in

November, Michel told us, "We asked what

foreigners we should invite, and the unanimous

answer was Jim and Phyllis Marsh."

We planned to go on to Toulouse on

February 22, 1991, the second anniversary of

Jim's head injury. Our invitation was a testimony

to Jim's strength of character and an

acknowledgment that his contributions to joint

French-American cooperation were still that

highly respected. Everyone felt he had recovered

enough to make the trip.

When I called Dr. O'Donnell to share

the news of our trip, I said, "It is almost a fairytale ending that on the two-year anniversary of

Jim's injury, we will be in France."

He agreed. Many times the extent to which

a head injury has healed at the two-year mark is a

good indication of the extent of full recovery.

Our Christmas celebration was full of

excitement for our planned trip. Melissa

enjoyed buying us sweaters and travel items, and

she commented, "'This is the best Christmas

we've ever had."

On January 3, the flu struck Jim and me,

and back in Iowa my lather entered the hospital

with a high fever. We felt fine one day only to

have no energy the next. I was unable to travel to

Iowa.

On Wednesday, January 15, after being

unable to reach my mother to tell her I was

finally well enough to come, I turned on the news

and caught the earliest broadcast of the bombing

raids in Iraq.

My father was much worse, and the next

night my sister-in-law Sylvia called to say I

should come as soon as possible.

Jim supported me in every way. "Go,"

he said, "go tomorrow morning." Because of

increased airport security, we had to be at the

airport an hour earlier than usual. We got up at

3:00 A.M. so I could catch my flight.

92
BULIDING SATELLITES IS EASIER

When my father died four days later, Jim

arranged for Mathew and Melissa to come later

in the week and then flew to Iowa that afternoon.

All during his visit he let each member of my

family know he cared about them.

But in many ways we were still dealing

with his head trauma. The bombing raids

continuing each day over Iraq fascinated him.

He woke up in the middle of the night and

listened on his Sony Walkman.

In my parents' 1910-vintage home with

an open staircase and lots of wood, sound

bounces around. Thirty people can make a lot

of noise, and Jinl's mind could not process that

comfortably. The executive function that allows

the brain to turn off too much stimulation so

sleep can cotne still did not work well in Jim's

mind, and he had difficulty sleeping.

Two of my brothers took me aside to

express their concern that Jim was not the same

as he used to be. "He seems hyper," they said.

Explaining that the last functions to

return are those that monitor the mind, I said,

"There is still a lot of healing that can take place."

I worried, though, about how Jim would handle

the stimulation of a trip to Europe.

By the time we returned to Washington,

the State Department would not allow

government personnel to travel overseas because

of the terrorist threat intensified by the war in

the Middle East, and our trip was canceled.

Our money situation bothered me. A

home equity loan had covered our new roof and

well and the hidden expenses of Jim's injury. If

Jim had to retire early because of his injury, our

savings would have to see us through a long

retirement, and I did not want to touch them now.

Our credit had reached a limit that I feared to

cross.

I had also become a recluse. While I

spoke by phone with several friends, I did not

feel free to spend money going out. I needed

more interaction with people.

It was time for me to return to work.

There was an opening at my former job, and

February 11was set as the day for my return.

Saturday, February 9, was a clear sunny

day, warm enough to stay outside with just a

sweater. Around noon Mathew's friend Carl

came by to visit just as Jim was leaving the house

to run errands. Carl's parents were dead, and he

lived alone in his parents' home. He and I sat at

the dining room table discussing the beautiful

weather and the animals in our neighbor's fields.

Shortly, two brothers, Brent and Chris, came and

all three went down to the garage to see Mathew.

Brent, Carl, and Mathew had been friends since

junior high and had spent many hours working

on cars in our garage. When Brent, Chris, and

Carl left to run an errand, they asked Mathew to

go with them.

"No," he said, "I want to work on my

Barracuda."

About an hour later I heard an emergency

vehicle go by our house and stop a short distance

down the road. Shortly after, Jim returned and

said, "Phyllis, I have just seen the most awful

sight. A car ran into a tree, and there are three

young people dead. I'm sure Mathew and

Melissa will know who they are."

When Mathew came up, Jim asked,

"Mathew, do you know anyone who drives a car

that would have "GT'" on the rear bumper. A

car smashed into a tree up the road, and that is

the only way I could tell what kind it was."

Without answering Mathew ran to his

truck to go find out. Returning shortly, his face

drained of color, he said, "What can I say, Morn.

It's them.'"

"It's who?" I asked.

"Brent, Chris, and Carl. They're dead,

and I can't bring them back."

None of us could speak and we walked

away from each other. Later that evening,

driving home from the Safeway, I screamed,

"No, this can't be," but my cry did not help.

93
PHYLLIS NIMMO MARSH

The death of three well-liked young men

stunned the community. Immediately calls went

out to colleges up and down the East Coast as

friends reached out. Melissa called us from

Baltimore to ask about the accident before we

recovered enough to call her.

In church the next day, ! could not stop

the tears.

I was unable to start work on Monday.

The volunteer fire department placed

three wooden crosses in front of the tree, and

flowers, cards, and balloons soon adorned them.

Car after car stopped. Everyone wanted to pay

tribute and to seek some understanding of how

such an event could have happened.

There was standing room only at the

funerals. On Valentine's Day, the day Jim and I

had been scheduled to leave for France, with

flowers and mourners surrounding us, we

watched a heart-shaped balloon sway above

Chris's casket as the high school principal

remembered the two brothers.

Processing this event, with all its anger,

grief, and bewilderment, taxed everyone's brain,

but for Jim, processing it through an injured

brain, it was overwhelming.

"I am so angry, Phyllis," Jim told me, "I

don't think I will ever get over it." He looked

for anyone and anything to blame it on. "The

insurance companies are at fault," he said. "They

should not insure those fast cars."

"People are always speeding down our

road. Why don't the police patrol it?" he

complained.

Focusing anger in personal situations had

never been easy for Jim, and I did not know how

to help him in this one. If I suggested other ways

of looking at things, he felt I was arguing with

him.

I was angry, too. "Why couldn't Brent,

Chris, and Carl have a full life?" I wondered.

"If such a thing were going to happen,"

I asked, "why did it have to hit so close?" Carl

had come by to ease his loneliness and had left

his car in our driveway. Its presence reinforced

our sense of loss as we returned from the funeral

homes.

Before the accident, the phone rang five

or six times a night with young people calling

Mathew. Brent and Carl dropped by often, and

their energy and spark lightened my feeling of

loneliness. Now the house was silent.

Jim had not recognized Brent, Chris, and

Carl or Brent's car. A scene so smashed that

three familiar people are unrecognizable would

remain etched in anyone's memory. Because

releasing what was in his working memory was

still harder for Jim, the picture seemed to be

seared in his brain. Jim returned day after day

to the tree. Our neighbors said they often found

him standing across the road staring at it. He

relived the approach the car would have taken

and drove it slowly trying to understand.

His going and returning from work

required passing the tree adorned with new notes

and flowers each day.

The ground war in Iraq started. Once

again there was round-the-clock news, and Jim

tuned in during every waking moment. Unable

to shut off all the stimulation, he began losing

sleep.

I knew I could not sit at home alone all

day and cry, and I was still worried about our

money situation. I decided to go back to work.

The call from Pasadena had come on the

Wednesday after President's Day in 1989, and

by coincidence the day I felt my life was in order

enough to go back to work was the Wednesday

after President's Day i'n 1991.

"What a privilege;' I thought as I dressed

that morning, "to be free to go to work."

In order to spare me a lot of questions

about him, Jim suggested he accompany me and

thank the people who had remembered us during

the two years.

As I walked around the office saying hello,

many colleagues asked, "How's your husband?"

"He's right behind me" I responded and

introduced Jim. He smiled and shook hands with

each of them.

94
BULIDING SATELLITES IS EASIER

Afterwards, many came to tell me how

strong and healthy Jim looked. "It's a miracle,

isn't it?" they said.

Since my office was very near Goddard

Space Flight Center where Jim worked, we rode

together that first day. After work, Jim invited

me out to dinner.

"Phyllis," he began as | was finishing my

coffee, "I want you to meet someone. After I

left you, I didn't go to work today."

To show his concern Jim had wanted to

give Mathew something to look forward to and

offered to make the down payment on a new

truck. While I understood the concern behind

Jim's suggestion, I felt that if Mathew were

going to invest in car payments over five years,

he should take his time deciding what he wanted

and how he was going to pay for it. My advice

to Jim had been, "Everything l have read, Jim,

says not to rush into decisions too quickly

following a traumatic event. People often regret

things decided too quickly." To myself, I had

said, "Where does Jim think the money will

come from?"

"I know you told me not to rush into

anything," he said as we left the restaurant, "but

I went looking for trucks today. I want you to

meet the manager of the Ford dealership. He's

a really nice guy."

The next day as I was concentrating on

learning a new phase of my job, I was called to

the front desk for a visitor. Jim was waiting.

"Mathew and I have this truck we want you to

look at."

I thought Jim had gone to work.

I'm sure the Ford dealership thought if

they gave a young man a new truck to drive for

the day, he would buy it. Mathew, though, had

learned many bargaining techniques over the

years, and when the dealership did not meet his

price that day, he walked away from it.

"Mom," he asked me that evening, "do

you really have the money for the down

payment?"

"Well, Mathew," I replied, "it would help

if we could wait a couple of months."

"That's O.K., Morn, because I need to

pay off my charge card before I make new car

payments. I'll wait."

Jim, however, became hooked on buying

a new truck. "Phyllis," he said, "our cars are

getting old, and we make enough money that

we should be able to drive better ones."

Since I drove a 1975 Mercury and Jim's

was a 1979, I could not argue about our cars being

old. However, both of them had been rebuilt by

Mathew and were in good shape.

During Jim's recovery, I had made the

financial decisions and sheltered Jim from

money problems so he could concentrate his

energies on returning to work. Now he could

not understand that we needed my salary to catch

up on paying the bills before we went into debt

for a new car.

"You did a good job while I was sick,

Phyllis," he told me when I did not immediately

agree to the purchase, "but you don't understand

that with our total income, we can afford more."

Those first weeks I sat at work and

wondered where Jim was. Sometimes he

stopped by Mathew's office to invite him to go

look at new trucks. Sometimes when I came

home, Jim would have coffee waiting and be

dressed in old clothes. Several times as I passed

the three crosses in front of the tree and

remembered our loss, I looked ahead and saw

heavy smoke coming from our yard. Jim had

built another fire. The former highly disciplined

geophysicist could not concentrate on his .job.

We had not worked our way back to the

physical closeness we had in our marriage prior

to his injury, and at a time when I wanted (and

probably Jim did, too) to hold tight to someone

strong, we went to bed each night and turned

our backs to each other.

When the gulf war ended, Jim started

listening to his police radio. The crime-ridden

95
PHYLLIS NIMMO MARSH

areas in D.C. always had shootings, robberies,

and chases, and if he woke in the night, the radio

was like a magnet drawing him. Stimulated by

the excitement, he could not go back to sleep.

His stories begin stretching on and on.

Mathew could listen only so long, and then he

would ask, "What's the point, Dad?"

Finally, Jim was sleeping only a couple

of hours a night.

When Jim had spent too much time

polishing his 1956 Ford truck the previous year,

he listened when I complained because I had

not tried to change too much of his behavior. A

year later, faced with a much greater challenge,

I found that too many problems had been faced

for him to listen willingly. When I questioned

things now, he turned our discussions into power

struggles to show me he was independent.

Finally, his sleeplessness was keeping

me from my rest, and I decided l had to save

myself before I could help him.

"Jim," I explained, "I can't be up all

night listening to the radio and music. I need to

keep working, and I need my sleep to do it."

After that, when I went to bed I closed

the door to the family room where he sat

listening to his radio and music and slept on the

sofa.

Jim began looking at Model A ads in the

newspaper. At Christmas time we had

laughingly made a pact that if he found a Model

A Ford truck for $500, he could buy it. I knew

he would never find one at that price.

When his friend Bruce found the parts

for a Model A truck for $500, Jim bought them.

They did not add up to a complete truck since

there was no engine or cab, but Jim thought I

should live up to my bargain.

Two weeks later Bruce found the parts

to complete the truck for $700, and Jim could

not pass up the deal. When I explained that our

cash was so depleted I was waiting to get our

tax refund before I got the septic system fixed,

Jim said, "Can I use the rest of it for the truck'?"

"Why can't he see," I asked myself, "that

if he can buy the parts only after the tax refund

comes, we can't afford them?" That payday, in

order to have some money in case of an

emergency, I put my check in a separate savings

account without telling Jim. In twenty-five years

of marriage I had never felt the need to do such

a thing.

In the face of Brent's, Chris's and Carl's

lives being cut so short, Jim seemed to be in a

hurry to buy everything he wanted in case the

same thing happened to him. For him long-term

planning had lost all meaning.

As his sleeplessness continued, Jim

began talking about being touched by the hand

of God. One morning he presented me with a

list he had written in the middle of the night of

twenty-four things that had happened which he

felt showed he had extraordinary powers of

mental perception. Included were beginning a

conversation in a restaurant with the man at the

next table who had had an interesting early life

in Norway and guessing at another restaurant

that the man sharing our table worked in a

classified defense job because of the way he

responded to our casual conversation about what

we did. These were enjoyable encounters, but

Jim's sleep deprivation colored them brilliant in

his mind.

He also announced, "Phyllis, I'm not

going to church any more. The minister did not

introduce Michel when I asked her to last fall,

and I think she's biased against men."

His comment came as a surprise since

he had been highly vocal in his support of her.

In my depression and tiredness it did not

occur to me to reach out for help. My brother

remembers a time when we lived on our

grandparents' farm, and Dad had begun working

at the Maytag company. When a blizzard came,

Dad put on a heavy coat and walked three miles

to a nearby town to catch the bus to the factory

because he could not afford to miss a day of

work. I was walking through my own personal

96
BULIDING SATELLITES IS EASIER

blizzard, and in my struggle, Jim's strange

behavior did not seem much different from the

barking dog episodes of the previous year. "This

too will pass," I thought.

In mid-March Jim started coming to bed

rather than staying in the family room, and the

time he slept each night gradually lengthened.

At dinner one evening, he announced, "Phyllis,

I am going to stop listening to the radio. Once I

get started, I can't get it out of my mind, and

that's not good."

Together, we agreed to purchase a new

truck, and he and Mathew studied the books to

find what he wanted. "How soon can we afford

to start payments?" he asked me. The first week

in May was our target date. In the meantime

Mathew spent his money rebuilding his

Barracuda and decided not to buy a new truck.

When Melissa came home from college

in mid-May, she and Jim talked a lot about her

future and a job for the summer. He helped her

prepare a resume and encouraged her to take an

entry-level secretarial position in a company

with many scientific projects because of the

future the job promised.

At dinner with one of his colleagues, Jim

laughed as he told about calling the fellow

patient in Pasadena an old fart and insisting in

Montebello he knew Dan Quayle. He had found

the humor in this difficult situation.

Twice during May, Mathew, Melissa, Jim

and I had dinner at home, and it felt like old

times.

Dr. O'Donnell said on many occasions

there is now proof the brain continues healing

for at least three to five years following an injury.

At the end of a little more than two years we

had done well and looked forward to a lot more

healing.

In late May I had a long talk with the

colleague who had sent the letter about Jim's

contribution to space geodesy, the letter that had

meant so much to me in Pasadena.

"Phyllis, you can quote me on this," he

said. "The soul of the old Jim Marsh is still

there, but the new Jim Marsh is more

introspective, and to tell the truth, I think I like

the new Jim Marsh better."

I asked him if he felt there were changes

in Jim in the workplace.

His response was, "Yes, there are

changes, but remember, Phyllis, our entire work

place has changed. We are older now, and some

things don't seem quite as important. Some of

us have talked, and we all agree that Jim has

fully recovered. We haven't found any deficits.

As a matter of fact, I think Jim really has come

back 110 percent because of the new

understanding that he has. Jim probably has

more enthusiasm than some of us who have

become burned out."

But his head trauma changed more than

Jim.

Rip Van Winkle lives in our folklore as

the man who hiked into the mountains and slept

for twenty years. When he went to sleep, he

was under the rule of King George of England.

When he awoke, George Washington was

president. At the end of the story the author,

Washington Irving, hinted that something other

than sleep might have caused Rip's problem:

"Some always pretended to doubt the reality of

it, and insisted that Rip had been out of his

head .... "

Head trauma is a Rip Van Winkle

experience. While Jim labored at recovery, his

family and the world changed, partly as a result

of coping with his injury. In addition, change

came because life goes on and in two years

growth occurs. Mathew and Melissa had

become young adults and that freed me to pursue

a career and interests of my own.

The other changes were more subtle, and

Jim's head injury hindered his ability to

comprehend them.

With no warning I had been forced to

travel three thousand miles from my support

system and deal in rapid succession with a

medical crisis, a suicide attempt, and head

97
PHYLLIS NIMMO MARSH

trauma. I had decided to talk about Jim's suicide

attempt, and I had arranged for Jim to have leg

surgery he did not remember having. I had not

been able to discuss my experiences with the

person who usually shared in all my decisions.

I had survived long months without the

companionship and closeness that is the basis

for any strong marriage.

I had gained new understanding and

respect for my broad knowledge, my analytical

skills in judging medical situations, and my

psychological health, all of which had been keys

to our survival and recovery.

Very few people knew me well enough

to give me good odds on recovering the way we

did. During the long months of 1989, I

remember saying to people who knew me well,

"The numbers on Jim are good. To be this far

along at this stage indicates he will probably be

O.K. in the long run."

In the silence that always followed I

could almost hear the voices inside their heads

shouting, "Phyllis doesn't know people never

recover from head trauma. How can I tell her

not to get her hopes up?"

There was no way to convince them l

was listening closely to the experts when I said

Jim would do well.

Earlier in my life I had set a long-term

goal and succeeded in reaching it. I started

kindergarten in a rural one-room school a mile

and a half from home. My three older brothers

and I walked to and from school over rolling

Iowa hills in all kinds of weather. Because I

was the only kindergarten student, the teacher

included me in lessons with the two first-graders.

The next summer we moved to town, and I was

placed in second grade. As a result I graduated

from high school at sixteen.

College was my impossible dream, for I

had no money. The Maytag Company

Foundation awarded me a full-tuition

scholarship to the college of my choice, and

Grinnell College came recruiting, offering me a

work program to earn money for room and

board.

For twenty hours a week, I was the word

processor in the admissions office typing letters

to prospective students. I took a full course load.

During summers I worked in law offices and at

Maytags. By my junior year I showed signs of

stress in disturbed sleeping patterns and an

inability to relax, but nothing was going to stop

me. I had a good time, I made many friends, I

got good grades; I look back on college as a

positive experience, and I got my B.A. at the

age of twenty. The same determination and

focus were there throughout Jim's recovery.

After Jim's injury, with all the study I

did to understand the way in which the mind

functions, I feel I earned a college degree in

cognitive therapy. In the same way that sixteenyear-old had been changed by four years of

college, I was changed by the advanced course

in living required of me.

In many subtle ways I responded

differently. When approaching a traffic light that

had just changed to yellow and facing the

decision to either step on the gas to make it

through the intersection on the yellow light or

step on the brakes to make sure I had not run a

red light, I stepped on the gas. The pre-1989

Phyllis Marsh would have stepped on the brakes.

When the caulking in the shower

Mathew and Melissa use needed repairing, the

pre-1989 Phyllis Marsh would have asked Jim

to fix it and listened to the lectures about how

teenagers use too much water taking showers.

The new Phyllis asked the man at the hardware

store what to use and tackled the job herself.

The pre-1989 Phyllis Marsh was angry

at being home alone so much. Now I understood

in new ways that life is really time available for

use, and staying home alone to accommodate

others is applying the brakes while time runs

out. I would decide how to use my time.

My interests changed.

98
BULIDING SATELLITES IS EASIER

Prior to Jim's injury, he had a long list

of interests, including his work, old cars, antique

guns, music, genealogy, his farm. He had several

dislikes--cards, games, TV, shopping. Learning

more about my interests was not a priority for

him.

Prior to Jim's injury, I enjoyed spending

time with him in the pursuit of his interests and

accommodating my family. As intellectual

pursuits, I liked reading on every topic,

crossword puzzles, solitaire. I never really

thought about my dislikes.

Jim's injury had not changed his

interests. My dealing with Jim's injury and being

forced to forego my interests while he was ill

changed mine. I wanted to play tournament

bridge again. My social studies background and

experience as a legislative aide on Capitol Hill

in Washington during the 1960s were the result

of a deeply held interest in making a contribution

to social welfare, and I wanted to become

involved again. I wanted to attend plays, travel

to Europe, go to the beach, meet new people,

enjoy our children as adults. I was bored with

old cars, antique guns, and farms. My feelings

were not a rejection of Jim, although to him they

may have seemed like they were.

I shared my feelings about the difficulties

I faced with a friend who has a doctorate in

educational psychology and is a professional in

the mental health field.

"I have felt for a long time that Jim not

only had to recover, he had to grow." I explained.

"I am not the same person. I cannot go back to

living the way I did before and that will take

adjustment on Jim's part."

My friend's response was encouraging.

"It has been my experience in dealing with other

couples going through such a change that in the

long run, if the marriage lasts, and I have no

reason to think that yours won't, it is both a

liberating and exhilarating change. For both

people to drink from full cups adds so much

more to life."

Our recovery may have seemed like a

miracle to some. When people said as much to

me, I may have nodded in agreement, but I

always said to myself, "Miracles sure take a lot

of work."

Over the years Jim often said to me, "In

science things are binary. They are either black

or white. One plus one always equals two, and

that's the way I like it. In liberal arts, Phyllis,

you are always trying to say that one plus one

might equal one and a half or three depending

on a lot of different things."

When I began this journey, I thought

head injuries were binary. Whether Jim

recovered or not was black and white. Recovery

depended upon the severity of the injury that had

occurred and the health care he received in the

immediate aftermath. The future would reveal

the extent of his injury.

Experience had taught me the severity

of the injury was only one factor. There is a

binary (or black/white) quality to such injuries,

for some leave permanent damage that cannot

be repaired. But when I look back, many small

things, many as long as a year or more after the

injury and some as minor as a carpet on the floor,

tallied up to recovery.

A major factor was merely not giving

up.

Brian Bemis, Jim's speech therapist at

Community Rehab in Annapolis, said it best.

Jim teased him about things being binary.

"In my work, Brian, one plus one always equals

two. I like it that way. This liberal arts notion

that one plus one can sometimes equal one-half

and sometimes equal four is hard for a scientist

to deal with."

Brian thought for a moment. "Maybe I

like it better my way," he responded as he smiled

at Jim, "because sometimes we can make one

plus one add up to ten."

99

PROGRESS HURTS

Current statistics indicate there are

2,000,000 head injuries each year, a staggering

number.

In late spring Jim and I received notice

of a newsletter begun by someone who had a

head injury and suffered many losses because

of it. She decided to reach out and help others

by starting a forum for sharing experiences.

The ad for the newsletter stated, "Of

those 2,000,000, eighty percent will lose their

jobs, their homes, their savings, their family, and

their friends." Jim and I did not know if the

statistic was correct, but it was easy to believe

because the changes in Jim from the head injury

had been so difficult to handle.

When I read the statistic, I accepted it as

a compliment that we had succeeded in doing

what few people could do. Jim worried he would

become one of the 80 percent.

In late May NASA provided Jim a new

laptop computer, and I became aware of a new

stage of healing as I watched Jim become

familiar with its features. Before his injury, Jim

had used a Macintosh computer at work for

memos and graphics. After the injury he did

computer games during therapy but had never

tried to use one in his work.

The first night he brought the computer

home he could not make it work. Finally, he

questioned whether the programs to make it run

had been entered correctly. The next day the

technician checked it out and agreed they were

wrong. The problem was corrected.

The next time Jim brought his new

computer home he worked a long time figuring

out how to make it print and do the things word

processing is supposed to do, such as delete

sentences and correct spelling. Since a computer

can only do exactly what you tell it, the user has

to be very precise, a difficult task following head

injury and a problem for Jim during recovery.

Jim puzzled over the commands that had once

been so familiar and stuck with it, another

difficulty for head injured people, until he

mastered it.

Over Memorial Day weekend Jim and a

friend went to the farm in West Virginia to leave

a truck we were being given to use on the farm.

When he returned, Jim told me he felt tired.

When Mathew returned from a twoweek trip, he took me aside and said, "Morn,

something is wrong with Dad. He's beginning

to act like he did before he went to Pasadena.

He just stands around and looks at me."

When Jim and I discussed how he was

feeling, he again complained he was tired. I

suggested he get his thyroid tested to see if his

body was absorbing the medication properly. All

the tests came back O.K.

Jim had been promoted to the position

of staff scientist within his division, and plans

were going forward for new offices with new

carpeting. Over the years Jim had encouraged

young scientists to enter the field, and he would

be continuing these efforts on a staff level.

Since returning to work, Jim had done

well in relating to his colleagues and working

on "people problems" he encountered, but he

had never started working on math or science

problems. In early June I began hearing

concerns about how to get some math work done.

The complaints of feeling tired

continued. They came at a bad time for me

because menstrual problems resulting in heavy

bleeding in early June had left me both tired and

concerned that I had a medical problem.

101
PHYLLIS NIMMO MARSH

The new healing that opened Jim's mind

for more precise thinking and an interest in

solving math and science problems also opened

his mind to an awareness of his past behavior

and of the changes in his thinking.

"Phyllis," he asked me one day, "why

did I think I was so smart when I went to Virginia

that day and bought that radio? Anyone could

have done that. Why didn't I talk it over with

you first like we always did?"

In mid-June he went to church again,

apologetic to the minister. "I got all bent out of

shape by that accident," he explained, "and I'm

sorry." That day his affect, or the amount of

animation in his face, had brightened almost to

what it was prior to his injury.

As the awareness continued, he worried

more. "Phyllis, do you remember when we went

to West Virginia last year, and you sat in the car

all day while I mowed the fields? Then when I

wanted to work late and you wanted to come

home, I got mad and didn't speak to you all the

way home. What made me treat you that way?"

I had difficulty answering Jim's

questions. I knew the head injury caused him to

behave in those strange ways, but I was afraid

in saying that to Jim he would only worry more

about how out of control his life was because of

his injured brain.

As Jim's mind began registering and

judging the behavior the head injury had caused,

he became more tired. Depression often occurs

in this stage of healing from a head injury

because as the brain begins new monitoring of

its functions, there is a new awareness of the

losses caused by the injury.

Jim's blood pressure had been borderline

high at times, and he stopped by the health unit

at work to have it checked two or three times in

June. It registered high enough to cause us

concern that he should be on blood pressure

medicine.

Working back into the math and science

was causing Jim difficulties. He wanted to do

more but seemed unsure about how to direct the

programmers and to provide the leadership he

remembered providing before.

On Father's Day Melissa and I gave Jim

cards at dinner. Mathew had spent the night with

some friends and had not come home for Sunday

dinner. Jim worried that the way he had treated

Mathew had turned Mathew away. In the

afternoon, Mathew called and asked to speak to

him.

"I just want to wish you happy Father's

Day, Dad," he said.

That night Jim took Mathew aside and

said, "Mathew, it really meant a lot to me that

you called. I realize I haven't been myself, and

I' m sorry." Tears came to Jim's eyes as he spoke.

"You don't need to thank me or

apologize," Mathew responded. "I wanted to

call because you're worth it."

On Wednesday of the following week,

we had a message on our answering machine

from the husband of Jim's sister. "I am calling,"

he said, "to let you know that Diane is in very

serious condition." She had been battling breast

cancer for over seven years. As it metastasized

to her bones and brain, she fought back with

surgery, radiation, and chemotherapy but now

her kidneys had failed. On Friday she died at

the age of forty-seven.

We waited a day before leaving for the

funeral, a day of reflection for Jim. "Poor

Diane," he said. "I remember the day she was

born."

Jim did not say much more that day

about his sister. 1 remember that the death of

my brother had brought back many feelings from

my childhood--of happy times, of vulnerable

times, and of times when all dreams of the future

seemed possible--and I can only imagine that

Jim was thinking that day of his parents and the

hopes and dreams of his family. If that was so,

these reflections came at a time in Jim's healing

when he was very vulnerable.

Jim and I drove to West Virginia in our

new Ford Ranger. About half an hour after we

left, he said, "Phyllis, you are going to have to

102
BULIDING SATELLITES IS EASIER

drive because I'm too tired and I'm not very

alert." Driving for the next six hours exhausted

me.

Diane was the first cousin among eighteen

to die. Growing up the cousins had spent most

holidays and Sundays together at their

grandparents' home. Many came to the funeral.

As Jim was growing up, his family had

struggled to provide a living on a small farm.

There was little money, and there were several

hardships, such as his father's heart attack at the

age of fifty. His parents were very hard workers

and proud of their heritage. Jim's early dreams

were of accomplishing things in the world

outside the farm that would be a source of pride

to his family. When he went back to his sister's

funeral, seeing many family members for the

first time since his attempted suicide, the reality

of his present situation was so far from his

dreams he felt he had failed.

Jim compared himself to his family.

"Walt has done so well. He seems to have a lot

of good ideas and really gets things done," he

told me.

When new feelings come back following

head injury, they come back stronger until the

brain learns to monitor them. Jim's brain was

overwhelmed by these new feelings and did not

recognize the good feelings he could have had

of his accomplishments.

Each of his family told Jim how much

he or she cared, but his responses remained

subdued.

Coming back, I again had to drive the

whole way because Jim was too tired and felt

unable to cope. All the way Jim talked about

how everyone was so much better than he was.

The head injury, which made it harder for Jim

to change subjects, probably made it harder for

him to stop judging himself.

I first felt anger. "How can this be?" I

asked myself. "After all I've done, why do I

have to be hit with more?" I did not know where

I would find the reserve of energy to deal with

this.

When Mathew returned, he took me

aside. "Mona," he lectured, "you need to take

Dad to the doctor. He is not acting right, and he

might do something to himself like he did in

Pasadena."

I realized Mathew was right.

The Motor Vehicle Administration

required that Jim have one final medical

examination before clearing his driving record.

He had already made an appointment to see Dr.

Gray in Baltimore to meet this requirement. Dr.

Gray now worked at the Head Trauma Unit at

Montebello and had seen Jim several times in

follow-up appointments.

"Jim," I said, "let me drive you on

Thursday to Baltimore. We need to be honest

with Dr. Gray about what is happening and see

if there is some medication that can help you."

My established rule of survival was to

listen to the expert in the field who knows us.

Dr. Gray satisfied that rule on both counts. I

also told Jim to call Dr. O'Donneli and make an

appointment to see him. Dr. O'Donnell agreed

to meet with Jim the day after Jim saw Dr. Gray.

I dropped Jim off at Goddard and picked

him up for both appointments so I could go on

to work and know he had no transportation to

go anywhere.

Several times during the trips he said,

"Maybe I can retire on disability."

"I am not sure anyone would certify you

as being disabled," I responded, unable to hear

in his words the deep concern he had for the

future and unable to suddenly give up my hopes

for a return to normalcy.

At Dr. Gray's office, I accompanied Jim

to the examining room to make sure we told Dr.

Gray everything we had been dealing with.

Dr. Gray questioned Jim extensively

about his feelings and whether Jim had any

feelings of suicide. Jim hedged a little on his

answers, but Dr. Gray probed further. "Have

you considered how you might do this?" he

asked. At that point I left the room because I

wanted Jim to answer honestly and felt he would

103
PHYLLIS NIMMO MARSH

do so more easily if I were not there. I did not

hear his answer.

Before prescribing medication, Dr. Gray

sent Jim for blood tests and an EKG, which

showed a slight abnormality in Jim's heart beat.

There are two classes of antidepressants, and the kind Dr. Gray wanted to

put Jim on in order to help him sleep should not

be used when the EKG reads as Jim's did unless

a cardiologist clears it. Therefore, Dr. Gray

prescribed Prozac, which would not have the

same sedative effects.

"Some people have claimed that Prozac

causes suicidal tendencies," Dr. Gray told us.

"I have never found that in my work. It has been

one of the most successful anti-depressants for

the patients I have treated."

"However," he cautioned us, "if you

begin feeling suicidal, remember you can go to

any emergency room and tell them how you are

feeling and they will provide care [or you."

His final words were, "You will be able

to recover from this. I have had many patients

who have felt this way and gotten better. It just

takes time. The medicine will not take effect

for at least a couple of weeks. Be sure to call if

you have any problems."

Dr. O'Donnell met with Jim for about

an hour late on Friday afternoon. I left them

alone, but afterwards Dr. O'Donnell told me he

had first given Jim some cognitive tests to see if

there had been any new injury or problem. Jim

scored about where he did the previous year.

"I told Jim," Dr. O'Donnell said to me,

"that as hard as it is to understand, some of these

feelings he is having are signs of recovery. I

had a patient whose father died and the patient

said he understood his father's death, but he had

no feelings about it. The fact that Jim feels some

of these things is a good sign."

He went on to say, "Many times at this

point in recovery there are feelings of depression

as a person realizes there are changes in the

brain. But I told Jim he could recover and to

factor in time to let things heal."

We were provided with several

emergency numbers we could call if we needed

help.

The division staff at Jim's work had

scheduled a planning retreat to begin Sunday

evening in Virginia. Jim looked forward to

taking his position on the staff, but because of

his depression and feelings of vulnerability, I

was apprehensive about his going. My wish that

I had told him to cancel going to the meeting in

Pasadena reinforced my instinct that he should

not go to this one.

On Saturday morning, I told him, "Jim,

I really don't think you should go. You are not

feeling well, and monitoring a new medication

is a legitimate reason for not going out of town.

The staff will understand. There will be other

times you can go."

He became further upset that he was not

up to going.

The weather had turned very hot and

humid. Normally Jim spent time on Saturday

working in the garage or yard, but he had no

energy for it in the heat. He began putting in

our window air conditioners, all the while

repeating, "Are you sure we should put these

in? Somebody could just push them in and get

in the house."

Melissa and I both told him, "Don't

worry about it. If anybody wants to get in, they

are not going to worry about a heavy air

conditioner. They are just going to break a

window."

I asked him to go for a ride with me, but

he did not want to leave the house. "You go,"

he said.

"No, I'll just stay here," I answered.

"You're not going to leave me alone in

the house, are you'?" he asked.

"No, I'm not," I responded.

The look on his face said he knew ! was

afraid he might do something to himself.

There were several guns in the basement

under double lock so they would not be stolen.

As a precaution, I moved the keys so Jim could

104
BULIDING SATELLITES IS EASIER

not find them, forgetting one gun that was hidden

upstairs.

As the day progressed, Jim became more

agitated. "Why did we buy that truck?" he asked.

"We can't afford it. We're just going to end up

bums on the street."

I tried to soothe him. "Jim, we have lived

frugally. We still have our savings, and you have

a good retirement coming. We are not going to

go broke." My message did not register in his

mind.

"l bet you are really sorry you ever met

me," he told me.

My mouth fell open. "How could you

think that'?" I asked. Not sure of what to say, I

continued, "Just look at the two beautiful

children you and I raised together."

"Phyllis, remember, you asked me for a

divorce. I have never tk)rgotten the night you

said that."

I had no response. We had never

discussed what I had said when I had been

pushed to the breaking point. His mentioning it

at this point startled me. I could not deny saying

it, but to tell him I had said it because of the

difficulties encountered in dealing with his head

injury would only have emphasized his injuries

and the odd behaviors it had caused when his

worry about those very things was

overwhehning to him.

"Remember that article said that 80

percent of the people with head injuries lose

everything," he told me.

Jim always had difficulty handling

feelings of a perceived failure on his part. I

remember a time when my parents were visiting

us, and I drove them in Jim's car to see my

cousin. As we were leaving to come home, the

muffler tell to the ground, and I had to call Jim

to pick us up. My parents took the attitude that

something like that could happen to anybody,

but Jim was embarrassed. "I don't usually let

things like this happen," he had told them.

There was no program in his brain for

handling such feelings of failure prior to his head

injury, and consequently, there was none there

to call upon to handle the feelings of failure he

was experiencing now. As a person who likes

things to be binary, either good or bad, he judged

himself bad.

When we went to bed that evening, we

left the newly installed window air conditioner

running. The unfamiliar hum disturbed my

sleep, but the oppressive heat would have

disturbed it even more. The sound disturbed Jim

as well.

As we went to bed, I wanted to hug Jim

and tell him that things would improve, but my

sense of estrangemcnt was too great. 1 dropped

off to sleep and awoke when Jim got up around

12:30A.M. to go out into the living room.

"i don't want him to have to face the

night alone," I thought, so I got up to visit with

him. First, though I had to go to the bathroom.

Passing by the bedroom window, I saw car lights

on our back road and waited for the car to pull

into our driveway to be assured that Mathew was

coming home before I walked on into the

bathroom.

While there, 1 heard the shot with which

Jiln ended his life.

IO5

NO ONE REMEMBERS ROCKY DID NOT WIN THE FIGHT

At Jim's funeral, we celebrated the good

life Jim had rather than mourn the shortness of

it. One of his supervisors talked of Jim's

considerable accomplishments in the field of

satellite geodesy. Steve Klosko, who helped me

so much in Pasadena, shared experiences fiom

eighteen years of working with Jim, and my

brother Kenneth talked of happy family times.

When the minister asked if others wished

to share any memories, several people spoke.

At the luncheon at our church following

the service, several people said to me, "You have

to remember this about Jim," and then recalled

a particularly meaningful experience. Others

said, "I dreaded coming today, but I feel so much

better now. I will really miss Jim." As I went

around the room, I felt an openness and warmth

among the people there.

When I spoke to Steve about the positive

feelings that were there, he commented, in

reference to the movie about the fighter, "No

one remembers Rocky did not win the fight."

In the following days many people told

me how much Jim had helped them, particularly

in the last six months of his life.

The parents of the two brothers who were

killed in the car accident did not know Jim prior

to the car accident, and thus did not know Jim

prior to his head injury. Jim had visited with

them at the tree several times and planted flowers

in front of the crosses. "He was the kindest,

most thoughtful man," they told me over and

over.

Our minister said, "I really liked Jim. I

know I did not know him as he was before he

was injured, but I often think of things he said

to me about friendship."

A sympathy card from a colleague said,

"Over the last year Jim has been a constant

source of support for me at Goddard, and I have

always appreciated his guidance and words of

wisdom."

These comments gave me new respect

for Jim and the tremendous effort he had put

forth in trying to overcome his injury. I came to

realize in new ways that Jim had still been a

person of great worth who could reach out and

help others, even though he was not the same

person I knew before. In coping with all the

changes in my life since his head injury, I had

been too wounded to understand some of the

very positive things others were seeing.

Two and a half years after Jim's injury

the healing process was not complete in either

Jim or me. We had coine so far in our struggle,

farther than anyone could have expected or

predicted, but there was still injury--in Jim's

brain, in each of our souls, and in our marriage

relationship.

As Mathew, Melissa, and I mourned for

Jim, we talked often of the events of the past,

events both before and after Jim's head injury.

In sorting through those memories, we realized

the depth of the love that was the basis for our

family, and we healed.

Within that healing, though, I will always

wonder what would have happened in our lives

and our marriage had Jim had time to heal with

US.

107




Form Approved REPORT DOCUMENTATION PAGE ouBNoo7o4-o188

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1. AGENCY USE ONLY (Leave blank) 2. REPORT DATE

June 1996

4. TITLE AND SUBTITLE

Building Satellites Is Easier

6. AUTHOR(S)

Phyllis Marsh

7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES)

Goddard Space Flight Center

Greenbelt, Maryland 20771

9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES)

NASA Aeronautics and Space Administration

Washington, D.C. 20546-0001

3. REPORT TYPE AND DATES COVERED

Technical Memorandum

5. FUNDING NUMBERS

Code 920

8. PERFORMING ORGANIZATION

REPORT NUMBER

96B(X)082

10. SPONSORING/MONITORING

AGENCY REPORT NUMBER

TM- 104635

11. SUPPLEMENTARY NOTES

Phyllis Marsh is the wife of the late Jim Marsh, Laboratory for Terrestrial Physics, NASA/GSFC.

12a. DISTRIBUTION/AVAILABILITY STATEMENT 12b. DISTRIBUTION CODE

Unclassi ficd-Unlim ited

Subjcct Category: 46

Report available from the NASA Center for AeroSpace lnlormation,

800 Elkridg, e Landin_ Road, Linthicum Heights, MD 21090; (301) 621-0390.

13. ABSTRACT (Maximum 200 words)

Building Satellites is a story about Jim Marsh's recovery from a sevcre head injury told by his wife Phyllis from the

moment she learned of its happening, through the ups and downs of a lengthy rehabilitation, until his return to work and daily

living. It continues on, however, and narrates his battle with the more insidious Graves' disease. Told in the first person,

B,ihting Satellite,s vividly portrays Phyllis's thoughts and feelings throughout this experience with scrupulous honesty.

This is a story worth reading for many reasons. First of all, Jim was an accomplished scientist, respected by his

colleagues both in this country and abroad. Secondly, it narratcs the many stages of his recovery from head injury with detailed,

readable accuracy: it intorms us as well as inspires. Finally, Bttildittg Satt41i/es also tells us the story of Phyllis Marsh's remarkable,

creative response to this crisis. It narrates her personal experiences as she progresses through the strange and sometimes bizarre

world of medicine and rehabilitation, guided by a few basic beliefs, which she learned as a child in Iowa, that provided her with

the strength to cndu,'c. Buihting Satellites seems to reaffirm our unconscious, but settled conviction, that when confronted

overnight with adversity, wc are somehow given the means [or coping, supported by our basic beliefs, strengthened by family

and friends, and eventually learning to accept any outcome.

14. SUBJECT TERMS

geophysics, head trauma, suicide

17. SECURITY CLASSIFICATION 18.SECURITY CLASSIRCATION

OF REPORT OF THIS PAGE

Unclassified Unclassified

NSN 7540-01-280-5500

19. SECURITY CLASSIRCATION

OF ABSTRACT

Unclassified

15. NUMBER OF PAGES

107

16. PRICE CODE

20. LIMITATION OF ABSTRACT

Unlimited

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