FROM THE NEST | Issue 11

He never lost a patient. He just couldn't remember their names.

ROB'S CORNER

My job was simple.

Make the dead, undead. If they couldn't breathe, breathe for them. Go into chaos and be the most competent person in the room. That was it. That was the whole job, and I was exceptional at it.

The charts were someone else's problem.

That is what I told myself, and I believed it completely. I was the one pulling people back from the edge. The paperwork, the documentation, the medication logs, those were administrative details. There were people for that. I had lives to save.

Except that is not why I was passing off the charts.

I know that now. What I know now is that by the time a patient's care was complete, the information was already gone. The medications I had ordered, the sequence of what happened, the face of the person I had just saved. Filed, closed, erased. My brain had moved on because it had no other option. So I used my position to hand the work to someone else, and nobody pushed back because of who I was, and I told myself their silence proved I was right.

Eventually the people covering for me got tired of covering for me. Eventually the institution saw what I could not see about myself. They told me I was a vicarious liability. They were not wrong.

I want to be clear about something. I was not in denial. Denial is a choice. What I had was not a choice. The part of my brain responsible for recognizing that something was wrong was the part that was wrong. It had lost the ability to send a signal it was no longer capable of sending.

I do not say this to excuse anything. I say it because if someone you love is doing this right now, telling you they are fine, making excuses, using their position or their personality to cover gaps you can clearly see, it is worth understanding what might actually be happening inside their brain.

-- Rob

HEATHER'S TRANSLATION

A few days ago I sat in a room with a disabled combat veteran and his brother, who is also his caregiver. The veteran had been blown up more than once. His brother had never seen combat. He spent his career in white collar executive work, and somehow ended up here, doing this, the same way I did.

The four of us talked for a long time.

At some point Rob started describing what it felt like from the inside. The gaps he did not know were gaps. The explanations that made complete sense to him and made no sense to anyone watching. The absolute certainty that he was the most capable person in the room even as the room quietly reorganized itself around his blind spots.

The veteran across from him went very still. Then he looked at his brother. It was not a long look. But it had weight. It was the look of two people who had just heard their own story come out of someone else's mouth.

Rob said afterward that it felt good to finally talk with someone willing to name what is actually happening. Because he sees it constantly in the military community. Men and women who are clearly struggling and completely unable to see it. Not unwilling. Unable.

That distinction is the whole thing.

THE MEDICAL FACT

Anosognosia is a neurological condition in which a person is genuinely unaware of their own illness or deficits. It occurs when the brain regions responsible for self-monitoring, primarily the prefrontal cortex and areas of the right hemisphere, have been damaged by injury or disease. The person is not choosing to be blind to what you see. Their brain has lost the structural capacity to accurately report its own condition.

Research published in Neuropsychological Rehabilitation estimates that anosognosia affects approximately 40 percent of people with traumatic brain injury and up to 81 percent of people with Alzheimer's disease. In veterans with blast-related TBI, high-functioning individuals often develop sophisticated compensatory behaviors that mask the deficit entirely, until the system around them collapses.

Confronting someone with anosognosia directly rarely works and can damage the relationship and the care dynamic. Treatment approaches that work with this reality, rather than against it, show significantly better outcomes.

WANT TO GO DEEPER?

If this landed somewhere close to home, these resources are here when you are ready.

​What Is Anosognosia: When Brain Injury Affects Self-Awareness​

​Anosognosia in Brain Injury: Neurological Mechanisms, Symptoms, and Clinical Insight​

​Caregiver Support at Robbins Nest Alliance​

​Guides, Printables, and Tools for Caregivers​

​Browse the RNA Shop​

Robbins Nest Alliance provides free, peer-reviewed caregiver education across neurological conditions. If someone in your life needs this, forward it. That is how we grow.

robbinsnestalliance.com