Lazy, Hypochondriac Old Brain Anyway!

I'm not sure how much I shared with you about my Independent Evaluation, so I'm just going to hit the highlights and then tell you about the results that came in the mail yesterday: 

1. The Doctor preforming my Independent Evaluation only talked to me for about five minutes.
2. He made a show of being personable for a moment, but then he developed a patronizing tone and asked me about four questions, and those were very leading questions. For example, when he asked me what symptoms I was still "claiming" to have, and when I started by saying, "I've improved a lot, but --" he cut me off before I could really tell him what lingering problems I'm actually still having. It was as if "I've improved a lot" was all he really wanted to hear.
3. He glanced over the shoulder of his testing guy to skim whatever notes they had on file for me and said he remembered me and something about my not having a significant injury at all. This troubles me because I have records from Urgent Care,the ER, my neuropsychologist, my primary care physician at the time, and the entire staff at the brian rehabilitation center. Surely all these people, who have certainly seen me more frequently and gotten to know me quite well, all these people can't all be wrong?
4. Another thing that Dr IME said that bothered me was that I'd had pre-existing anxiety, and that "people like me" can sometimes make something out to be a much bigger deal than it actually was, that "people like me" exaggerate their symptoms when they're "shaken up." I resent the implication that I'm just overreacting because I've got some kind of a mental issue instead of a very real physical injury that is temporarily holding me back. Even he in his earlier report had had to admit that I was experiencing some difficulties. Did he make that up? It is offensive and bigoted to use my past experiences and counseling as excuses not to help me get my life back in the wake of my car accident. That I went to counseling for anxiety in the past was a healthy decision on my part -- It eliminated the problem. That shouldn't be used against me now. 
5. I started to tell Dr IME that I can't spell as well as I used to be able to do, but he interrupted me and said that I had had high scores in spelling when I took the last test with him, over a year ago. I didn't care for the way he blew off my concerns and didn't let me finish my sentence, or even to tell him anything more. I had to take that spelling test again this time with his assistant, and it was pretty easy, but you must understand that I taught eighth grade spelling. I was an English Major and I read a lot. I had and have a huge vocabulary -- and that now when I'm writing I often stare at a word and no longer have any clear idea if it is correct or not. I'm glad that I passed his test, but that doesn't mean I can go back to teaching kids to spell. My ability to think on my feet is gone, and I could never keep track of an entire classroom of kids with the attention span I have now.
6. Dr. IME wasn't interested in getting to know me or in finding the truth about what's been going on. He got the information he wanted and he walked out without asking me if I had anything more to say. I know I should have been more assertive, but that's hard to do when someone is making unfair assumptions about you. It's very intimidating.
7. When they (whoever they are) sent me the letter telling me the date and time to be there for this IME, the note said that I could expect to be there for between four and eight hours, and to bring a snack. It took about three hours. I get kind of competitive about those tests, even though the only thing I'm actually competing against is how my brain was just after the accident -- because really it's what my brain was before the accident that I want to see again. I did the best job that I could do, and the result was that somewhere toward the end when I was doing the one with the shapes and colors on the computer screen, I was starting to have a really hard time keeping my eyes open and my head up. That's neuro-fatigue, which is one of my major problems, and I don't think Dr IME could see whether or not I have that problem when he was only there for five minutes, and I don't know if the guy testing me knew to look for it or not.
8. I guess my frustration with the doctor besides his unprofessional attitude is that he didn't seem to be testing me for any of the types of things that are actually still difficult for me. Spelling isn't such a big deal. We have spell correct these days.I can't teach the subject anymore if I mix up words like "Chores" and "Choirs" a lot now, because I wouldn't be able to tell on the spot or in the spur of the moment how to spell any given word. Or maybe one day I can. I spent $100,000 on a teaching degree -- I was two classes away from getting my Master's Degree. I resent that this stranger would accuse me of faking or psychosomatically exaggerating the seriousness of my problem. Why would I do that? I'm not getting any kind of settlement for what happened to me, and if I could go back to work full time I wouldn't need therapy or any money. I spent all that time and all that money on that career because I loved teaching English and I couldn't imagine doing anything else with my life. It's killing me that I can't teach anymore. It's discouraging, but I'm doing the very best I can to follow through on all my therapy so that I can hopefully one day still go back to teaching full time. That's what I want. That's the goal. 
9. What about balancing my check book or keeping my things organized and where I can find them? What about being able to cook without accidentally putting in too much of one ingredient, or burning something, because I get distracted and lose track of what I'm doing? How will I do at paying my bills? How can I find a place to live on my income with the few short hours I can work before I'm too fatigued to keep enough hours to pay rent? How can I drive when I'm so easily distracted? I'm waiting on the answers that the IME doctor either could not test, or did not to test, and all the while I'm aware that when people think of brain injury they are never picturing a woman like me who can still write beautiful, well-reasoned arguments and works as an office assistant. They don't realize all the little things that turn into big things.They aren't looking very closely because they don't know what it is that they're looking for. Well I can tell you, one of the things that they can look for is whether or not a shape and color test on a monitor should be exhausting after only three hours. Dr IME didn't stick around to see that. Are there tests that he could do that would test fatigue? Does he have tests about abstract reasoning or decision-making? Are there tests of how memory is affected when I do different mental tasks for different periods of time? Can he test how well I am organized at home, or how I stay on task and successfully complete tasks around the house when I'm distracted? It seems to me like a lot of my problems involve things that there are no standardized tests for, but I'm not a neuropsychologist and I  hope that I'm wrong, or that the insurance company can take into consideration what my family is seeing and what my therapists see.

Before this happened to me, I would never have realized that a person with a high IQ could be in a car accident, suffer a brain injury, and then only have some small part of their brain damaged in such a way that they can still walk and talk as they always had.I always kind of assumed that brain damage meant the entire brain. I wouldn't understand how a person with an IQ of 145 could possibly also struggle with every day decisions, understanding conversations, recalling things in the right order, and various other little changes that only those who know me could notice are missing -- or everyone who talks to me, when I happen to be overtired.  My boyfriend met me after the accident, and it's nice because he doesn't miss how I used to be, doesn't know how I used to be. But even he can see that mental exercise tires me out, and that when I'm overtired I stop thinking clearly, stop remembering words that I'm trying to get out, and start saying things that I didn't intend to say, like chairs instead of choirs. But then that's brain injury -- It makes sense. The part of my brain that's injured makes logical reasoning difficult for me, especially if I'm trying to solve something mathematical in my head, or faced with something new that I don't know how to approach. But the part of my brain that is not injured is still well above average, and gets ideas on a page faster and more clearly than most people. So I'm very fortunate in that, so I've been using that part of my brain, using my strengths, to explain to Mr Insurance Adjuster why I believe I still need to complete my therapy despite Dr IME's assumptions. I can only tell him the truth and hope that he is willing to see it proven.

The results of the Independent Examination were mailed to me by the Insurance Adjuster who sounds like a stuffy-nosed high school kid. What he wrote serves as sort of a cover letter for IME Report from the Dark Side. In it, the insurance adjuster states that my doctor's nemesis has determined that I should be completely done with brain therapy by the end of the year. He advises that I "should continue with my 'psychotherapy' at Community Mental Health for the same time period. However, any further treatment beyond two months" would likely be related to my "pre-existing conditions of both anxiety and depression."

Mr Insurance Adjuster advises that I share this report with all of my doctors and therapists, so that they can form rebuttals to these statements "if they happen to disagree with the medical opinion of Dr IME."

Oh, it only gets better from here.

First of all, in his opening summary of my case, Dr IME states that I am "well acquainted" with him, having previously seen him for all of five minutes almost two years ago.

I guess the extra five minutes he spent on me this time really clinched the deal. 

He points out that I was released on the same day of my accident and eventually referred to the neuropsychologist for testing and follow-up treatment. Once again, Dr IME stated that my doctor's "claim that there were two collisions and therefore two TBI's within that one accident" are merely guesswork, because there's no way my doctor could know that without having been on the scene at the time of the accident. 

This is bullshit, because it's right in my police report that I was hit by two different vehicles, which Dr IME would know if he'd bothered to do any research, or to remember my own description of the accident. He says that I probably suffered a little bit of amnesia for about two hours following the accident, and then went home with a mild injury to my brain. 

Dr IME details my doctor's recent observational evaluations of me from the TBI Group, particularly the time that my brother-in-law came in with me and we talked about all the issues I was having at home in relation to my TBI -- and then said that, according to his findings, these claims are not valid. Previously when he tested me, Dr IME says, I "had a full-scale IQ of 117 (87th Percentile)" placing my "overall intellectual abilities at the high-average range." This, he says, even exceeds his "premorbid baseline estimates," which just means how smart he imagines I might have been before the accident. Thank you very much for that vote of confidence, Doctor. I really appreciate it.

Continuing further, he says that I'm solidly average in almost all aspects, if mildly depressed, including executive functioning. He mentions that I taught reading for thirteen years, and I have no idea why he thinks that. I wish he'd asked me about it in person. It must have been from something I said the last time, because he certainly didn't ask me anything about my past this go-round. He notes that I was "well-kept and dressed appropriately," that my "conversational speech was spontaneous, fluent, and articulate." I did not appear to be depressed or anxious, and my "mood and demeanor were quite pleasant."

I wish his had been a little more pleasant.

The IME test results say that I've got a Verbal IQ of 120 (within the 97th Percentile), that my perceptional reasoning index is 105 (within the 63rd Percentile), which places my "overall intellectual abilities within the average range." 

Of note was the fact that in my auditory, attention and concentration, I show "a sizable drop from previous test results," in that my Working Memory Index score was only in the 13th Percentile. He says that previously I scored higher than that, and in the low average range for mental arithmetic. 

Test Break Downs:

1. Verbal Intelligence: For detecting similarities, I scored at the range of a thirteen year old, in the 81st percentile, and in Verbal Comprehension of Information Processed I scored at fourteen, in the 91st Percentile.
2. I Perceptional Reasoning, I scored in the 84th Percentile, too, and in Matrix Reasoning I scored... A nine. Thirty-seventh Percentile.
3. My Working Memory was at an 8, the 25th percentile, and my Arithmetic's age-scaled score was 6, in the ninth percentile.
4. My Processing Speed was that of an 11yr old, in the 63rd Percentile, and for "coding" I got a ten, in the 50th Percentile. 
5. I got a high average in "fund" knowledge and abstract verbal reasoning, which basically corroborates my own doctor's recent findings that so long as I'm drawing from previous, predictable, information, I am very smart.  
6. I was high average in spatial perception and average performance in nonverbal reasoning and visual-motor processing speed. 
7. Mental arithmetic tested at the mild range of impairment "indicating the only isolated area of difficulty. Otherwise, intellectual test scores are solidly normal and often well above average, particularly areas of verbal concept formation." 
8. My memory is in the 45th Percentile, 
9. Visual memory's in the 84th percentile, resulting in a Delayed Memory Index of 108 (70th Percentile), which places my overall memory and new learning capacity at the high-average range." Yay! Hence my job success. :-)
10. He claims my fine moter is "fine" (LOL), which directly goes against the findings of my own doctor, the doctor who administered my original neurological testing, and my current Occupational Therapist. And besides all this, the man only spoke with and observed me for five minutes. His young intern did the testing.
11. Then he had me do a "set of academic achievement tests. I scored at a twelfth grade level in reading and spelling, and an 8th grade level in math (25th Percentile).

Oh, how the mighty have fallen!

Kidding.

I never was very good with math, and it involves an area of reasoning that is now damaged, to boot. 

Now, as my boyfriend, being a social security disability attorney, pointed out, is that I can't score in the high average for verbal intelligence and then have a 15 Point drop in Perceptual Reasoning unless I've got an actual brain injury, just as my other doctors and therapists have said. 

I can't process verbal information within the 91st Percentile and then score only in the 77th Percentile in spelling. For one thing, verbal intelligence isn't in the same part of the brain as spelling. Spelling involves sequencing, which takes place in the temporal lobe and, based on all my symptoms, my temporal lobe is damaged. Last week my doctor told me that, by his recent tests, expressing things verbally is easy for me, aloud or in writing, too, but that I don't remember what is said to me out loud in the correct sequence, and that it's this that is adversely affecting my communication with close friends and family members.

Going back to the IME report, the doctor does recommend that I should continue keeping a written daily schedule in a planner, but that otherwise the "subjective complaints voiced not only by [me], but [by my] healthcare professionals, seem to be more within the realm of attentional. I (the independent evaluator) would recommend continuing with the use of structured daily schedules, daily to-do lists, and other strategies to help her organize and centralize information." 

Duh.

The only test given to me regarding executive functioning was the "Trails Test," which is the same old dot-to-dot test that I scored badly on the first and second time I took it. It involved alternate attention in connecting some numbered and lettered dots in order -- from "1" to "A" and then from "2" to "B," and so forth. I've done that same test five times in the past year and a half. I now know exactly where to look. Hardly watching what I was doing with the pencil they provided, I was explaining that to the intern as I did it. All that made it into Dr IME's report was that I scored at a high average in that test as well.

But what the doctor did to me that I find most offensive of all is that, just as I had feared, he used my previous depression and anxiety as marks against me to confirm his findings. Thankfully it could not be denied that I "approached the test items in an open and honest manner," but his head-shrink test revealed that I have "The 'classic' Conversion V' often observed with individuals who do show a preoccupation with physical malfunctioning and a propensity to convert psychological and emotional distress into physical and medical complaints. They are often observed by others to be somewhat dependent.They do show little limited insight as it relates to the behavioral and psychological dynamics." 

All that said, he also found that my depression has had a "slight improvement" since the last time I took his test. 

He claims that I reported "moderate" problems with concentration and fatigue and mild problems with irritability," but that's from the last time I took the test, when I was still having difficulty even expressing myself discernibly, let alone relating well to my environment or anyone else who happened to be in it. 

Then he wrote that "I then administered two tasks of symptom exaggeration or dissimulation."

The man didn't administer shit -- All he did was asked me his four or five very leading questions about my current symptoms, interrupted me after I said I have improved and then tried to tell him what problems I was still having, and then he cut me off completely and walked out of the room. His aide administered the tests, and  I never saw him again, that day or since.

On the bright side, his head shrink test indicated "no objective evidence of feigning psychiatric or neurological disability," and that's in my favor. 

In conclusion, the IME Doctor gives his recommendations, which are as follows:

1. Because I (he means me!) have only "very slight residual effects related to initial traumatic brain injury, which I (Dr IME) would categorize as being mild to moderate in nature. She is showing a very good recovery." 
2. "There was also some exacerbation of her pre-existing history of depression and anxiety, and as such, I do believe that she does require perhaps two more months of rehabilitation with the Brain Rehabilitation Center to achieve maximum medical improvement."
3. "Otherwise, I believe she will be then rapidly approaching her premorbid baseline level of functioning, which unfortunately included pre-existing history of both depression and anxiety. She is an appropriate candidate to continue with her psychotherapy at the Counseling Center."
4. "I believe in two months she will be achieve maximum medical improvement and the counseling will then be related solely to her pre-existing conditions."
5. "I see no need for household services or attendant care."
6. "I believe Ms Hockin is capable of driving independently."
7. "I do believe she requires some degree of offset as it relates to her disability, wage loss replacement as she is not yet capable of completing full-time employment."
8. "However, I do believe there would be an advantage towards assignment of a vocational rehabilitation specialist to perhaps pursue in a more aggressive fashion, direct job placement as I believe she is capable of returning to full employment capacity in the next two months."

Meanwhile,the brain rehab has me waiting on Disability through the Social Security Administration, because none of them feel I would ever be able to preform full-time work again.

Even my optimistic neuropsychologist seems to be leaning toward my finding something else to do part-time within the realm of work that is already familiar to me -- just not teaching in a classroom full of students. He feels all too quickly I'd see the error of assuming that possibility. I still can't stop thinking that someday, some way...

It's confusing to be told that I'll be completely recovered in two months when in fact that's exactly what I want to hear -- especially since it just isn't true.

Basically what the IME Doctor is saying is (If I'm reading this correctly): "You're fine. Get over it, suck it up, get off your ass and get back to work!"

If I am fast approaching the full extent of my capacity for recovery, then I should be happy, right? He's put me into a position where I can't protest his findings without sounding like a hypochondriac who is too lazy to use Spell Check.

All I want is to teach, live in my own home, and be able to pay all my bills on time.

The IME Doctor seems to be saying that there's absolutely nothing stopping me from doing that within the next couple of months.

I hope he turns out to be right.

I think.

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