TBI: not all wounds are visible

TBI: Not all wounds are visible

December 1, 2014 2 Comments

As an Army wife, I’ve had to learn about Traumatic Brain Injury (TBI). If your soldier doesn’t have one, you probably know of a soldier that suffers from it. It comes in many different shapes and sizes and can affect all families, marriages, and soldiers separately. Although not all TBI’s come from the military, it is where many of them happen. There are two different types of TBI; mild and severe. Roughly 80% of documented cases of TBI are categorized as mild to moderate and the other 20% is categorized as severe.

TBI: Not all wounds are visible. There is a lot of crossover of symptoms of TBI and Post Traumatic Stress Disorder (PTSD). Usually how it works is it starts with a stressor. A stressor can be an RPG to a Humvee for example or a buddy getting fatally wounded in front of you and passes away. That can cause PTSD and a TBI at the same time but for very different reasons. The Icahn School of Medicine at Mount Sinai says it very well:“A major class of cognitive abilities that may be affected by TBI is referred to as executive functions- the complex processing of large amounts of intricate information that we need to function creatively, competently and independently as beings in a complex world. Thus, after injury, individuals with TBI may be unable to function well in their social roles because difficulty in planning ahead, in keeping track of time, in coordinating complex events, in making decisions based on broad input, in adapting to changes in life, and otherwise “being the executive” in one’s own life.”  Read the rest of the article here.

Now here is how I interpret that; a TBI basically affects every aspect of our soldier’s life in one way or another. It can be verbal, memory based, physically such as digestive, coordination, stress management etc. The degree of the effects depends on the person, the injury and wherein the recovery process they are.

Here is another great article by Xavier A. Figueroa, Ph.D., and James K. Wright, MD, Col (Ret.), USAF that explains the differences between PTSD and TBI. This article gets down and dirty to the nitty gritty of the science behind what separates the two.

Some of the more common neurological or neuropsychological symptoms of a TBI are fatigued easily, dizziness, apathy or lack of spontaneity (and a lack of ability to handle it), sleeping issues (difficulty falling or staying asleep), regular headaches, anxiety, depressive or effective liability (random and rapid mood swings). Are you seeing this in your spouse?

Here is a list in the article above that shows the more common day-to-day symptoms of TBI’s:
“Although at least some of the current symptoms listed above are required for a diagnosis of mTBI, the National Institute of Neurological Disease and Stroke (NINDS) has compiled a list of commonly occurring symptoms associated with a TBI:


  1. Feeling Dizzy
  2. Loss of Balance
  3. Poor coordination, clumsy


  1. Headaches
  2. Nausea
  3. Vision problems
  4. Sensitivity to light
  5. Hearing difficulty
  6. Sensitivity to noise
  7. Numbness or tingling on part of my body
  8. Change in taste and/or smell
  9. Loss of appetite or increased appetite


  1. Poor concentration, can’t pay attention, easily distracted
  2. Forgetfulness, can’t remember things
  3. Difficulty making decisions
  4. Slowed thinking
  5. Fatigue, loss of energy, getting tired easily


  1. Difficulty falling or staying asleep
  2. Feeling anxious or tense
  3. Feeling depressed or sad
  4. Irritability, easily annoyed
  5. Poor frustration tolerance.”

One thing to remember about TBI’s is that they don’t “get better”, they only improve and you learn to adapt. Your soldier will never be the way he once was. You don’t need to tell him that, he already knows. He’s already spent many sleepless nights thinking of what used to be. He knows that he won’t be capable of the same things physically and mentally. YOU need to be aware and SENSITIVE of that. This isn’t a Jekyll and Hyde thing; this is a “now I get to see a different side of my husband” thing.


TBI’s can be caused by a variety of reasons. Being an army wife, we all know that PTSD & TBI’s can and do happen. My husband has a mild TBI. It’s not debilitating physically. He walks fine, talks fine, and by looking at him you would never know. Why? Because it’s a traumatic BRAIN injury; not a bodily injury. Back in 2003 he went to ranger school and got heat exhaustion then had a heat stroke. He had very short notice to go from Alaska to Georgia in August! As native Alaskans, it takes us a while to get accustomed to hot, humid weather. The day after he got there he had a rigorous PT test.  It’s ranger school so I’ll leave it up to your imagination on how hard those schools are. The dehydration and depletion electrolytes started the first day. This means tunnel vision, imbalance, etc. Also on the first day, during the tunnel vision and imbalance, he cut himself within an inch of his femoral artery. He didn’t have any idea that he cut himself until he saw blood on his knife. On his long run, during the PT test, he started getting heat stroke. He had a speech impairment, a seizure and ended up in the medical tent. At that point, his core temperature was 105. His brain was literally cooking. His muscles were locking up due to the low electrolytes and severe dehydration.

From the med tent, he was in the ICU for 3 days and the hospital for a week. For those first few days, we didn’t know if he was going to make it. Thankfully he came out the other side of that just fine save for one issue; severe short-term memory loss.

I’m not talking about the “oh man I forgot to check everything off the honey-do list” type of memory loss, I’m talking about the “oh man, I forgot deadlines, government paperwork, passwords to critical websites, important career critical phone calls” Type of memory loss at times.

His memory loss has greatly affected our relationship. He forgets important conversations about life-altering decisions he/we have made. We can have the same conversations two and three times a day because he simply doesn’t remember the short term. He can ask me a question four times in the course of 30 minutes because he doesn’t remember my answers. This makes my husband a “list person”. There are lists all over my house. There are lists of lists around my house. What this means for our marriage is that I think and remember for myself and for our son and for my husband also. I have to remember little trivial things that he tells me and file them away for “he might need this later”. One thing that really helps with that, so I’m not tasked to remember enough for 3 people, is to send him emails. I recap the day’s events if we’ve had meetings or talked about really important things. I also recap tomorrow’s to-do’s and schedules often as well.

Is this frustrating at times? Yes! It’s more frustrating when I haven’t spent time with the Lord; when I don’t have that attitude check of grace and compassion. That’s the big secret to being that supportive source for your husband. The Lord will wash you in His grace when asked so you can treat your spouse like Christ treats us. Each day is a challenge; each day teaches me more about patience than I ever wanted to learn. It also shows me a new way to love my husband, even when I’m not looking for a new way. Especially in those moments of tension. Imagine having an argument/discussion with someone and 20 minutes into it, they start over because they don’t remember what’s already been said. Yeah… that’s happened on a few occasions. Is it frustrating? Absolutely. Does it drive me insane? More than I care to admit. But that’s life with a TBI. I get the opportunity to gently and calmly explain things a different way (the second time around) to see if they’ll stick. We get to make sure that we resolve things completely. It’s like getting a “do-over” when you didn’t say something right the first time. There are many mornings that I wake up, after an argument the evening before, still angry/frustrated/upset about the situation. You know what it gets me? Absolutely nothing. My sweet husband doesn’t remember any of the details more often than not. I have to remember to forgive and let go. {Insert Idina Menzel’s rendition of “Let it go” here}. Sometimes you aren’t going to get your way. That doesn’t happen in any marriage 100% of the time regardless of military, contractor, TBI or not.

Compromise doesn’t work that way! Sometimes things aren’t going to get resolved the way you think they should, and that’s ok too. Things look different on the other side of a TBI. Sometimes things just get left hanging out there because he doesn’t remember what the issue was. I have to learn to accept that. If it’s not a life-shattering issue; I just have to let it go. There are very few conversations that are worth re-hashing the next day when it still lingers in your mind. Let’s face it, ladies, we can have those conversations in the shower later if we need closure (because we all do that regardless of the outcome of the argument!). Why bring it up again when we all know that we’re going explain it in our favor. At best we are going to make him feel terrible for the argument and make it sound like it was all his fault. Is your relationship worth that so you can feel like you won?
This isn’t always what being a supportive spouse of a soldier with TBI looks like. Your soldier might have a very short fuse in public, so you might need to be the calming voice in his ear, even when you’re upset too (especially when you’re upset). He might have trouble sleeping, so you might need to research alternative medicines (like essential oils) to help him fall asleep easier and relax. He might have any number/combination of the symptoms listed above that you can step beside him and be that true helpmate to him. Again, what you have to remember is that there is no “getting better”, that person doesn’t exist anymore; there is recovery into a new life. It’s ok to mourn the loss of that person that you knew so well. That’s normal. That’s expected and even needed.

Just remember that your soldier is mourning for that lost person as well. Your attitude will make or break the situation, however. Remember when you were dating each other? The excitement, the newness, the adventure of getting to know each other. That’s what you need to re-initiate. Go on dates once a week and get to know each other again, talk about what’s changed and how you’re going to handle that. Most importantly, just be together in your new relationship. He is still your soldier, remind him of that often.





Nila Rhoades


  1. Reply

    Jeremy Heid

    December 2, 2014

    Great work Nila! What a good read.

  2. Reply

    Nila Rhoades

    December 2, 2014

    thank you so much!