Pain trickled its way around my head. It pooled behind my left ear and crept over to above my right eyebrow. I tried to envision what my brain looked like. An underwhelming MRI hadn’t helped. Twenty minutes vibrating in an eight-foot tall magnet and nothing but grey shadows on film. I swallowed, trying to imagine the fleshy pink mass throbbing gently against a clutching belt of pressure. My concussion: an abstruse and ubiquitous presence in its 11th week of occupation. My ears popped.
Name. Address. Insurance information. Dr. H’s paperwork was as tedious as the other two doctors I’d seen, and I filled it out begrudgingly. What was she supposed to do anyway, my mother, as she watched her son decline into a weak and reclusive state, but bring me to more doctors? It gave us both, at least temporarily, a surge of optimism. Cautious optimism. Years spent caring for my withering grandmother were having an adverse effect on Mom. Mainly a deep mistrust of doctors had settled in. Initially opposed, I was beginning to share her sentiment. Each optimistic appointment brought a nasty aftermath. First frustration, then sadness, now resignation.
Dr. H called me into his office.
My legs were dangling off of his examination table and I was bored, licking my teeth when he walked in.
“Swarthmore!” A pleasant surprise. “Great school. What do you study there?” I answered. He asked me why I was here. I began my story as I had twice before. I had become businesslike about it, polished, but he cut me off.
“How do you knowyou’ve had a concussion?”
“Well, I’ve been depressed, I’ve had headaches, sensitivity to light, noise…” Cut off again.
“Did you pass out?”
“No, but…” and again.
“So you do you know you’ve had a concussion. How do you know those are the symptoms?”
His eyes were challenging, he knew I was smart but we both knew who was two steps ahead. The conversation was fierce. I studied his wispy grey hair, a full head of it combed neatly to the left. He watched my face fervently, studying my every move. His two Ivy League degrees glared back at me.
He asked me if I had any heroes. I had no immediate answer. I stumbled, embarrassed. “Your dad? You have to have a hero; everyone has heroes. There’s no one you admire? No one you model your life after? Is your dad a hero?” His delivery was firm. “That’s how life works you outlive and outperform the heroes you strive to be like, everyone has a hero.”
What did I know? Something inside of me didn’t want to answer the question. Hero seemed like a strong word but he was so insistent. How could I not have one? A man so accomplished, so sharp had lived by this doctrine, and here I was, on his examination table, with nothing to say. I could have declared one right there but I lacked the courage. I was on the verge of tears.
“Where does motivation come from?” He asked in a more gentle tone. While we were speaking, he conducted his neurological exam. He had carefully observed the movement of my eyes, hands, feet, and facial muscles – all normal. He inquired into one final thing: my secondary gain mechanism.
Dr. H explained that, despite extensive research, the neurological community still doesn’t know exactly where motivation comes from. It might be the frontal lobe, but he wasn’t sure. However, he was sure that concussions are very difficult to recover from, and in most cases (like mine), prolonged symptoms reach a point of negligibility. If I could shake my secondary gain mechanism, he explained, I would revitalize my motivation and, eventually, those symptoms would trickle away for good. Patients tend to subconsciously hold on to their symptoms, actually creating a circumstance where they benefit from being injured. In most of the cases he had seen it was some sort of lawsuit and subsequent impending lump sum of cash that motivated the patient to hold on.
In my case, it was unclear if this is what was going on and I brainstormed about it in on the ride home…nothing. My injury obviously had adverse and preventative physical effects, but my recovery had been normal thus far. While striving towards that last 10%, Dr. H requested my vigilance. The mysterious forces of the secondary gain mechanism had the potential to creep in.
As Swatties, we’re up against negative voices in our heads when it comes to identifying our motivations because our most valuable asset, intellect, is useless in this cause. We can’t intellectualize these maddeningly complex, fundamentally personal puzzles. We just can’t, but this does not mean there is nothing to be done.
A good friend of mine, Bob Bennett has also been suffering from concussion like symptoms, but his have gone on for 11 years, not 11 weeks. “You know that little voice you sometimes hear in the back of your head? In my opinion it is the voice of instinct talking to you.”
He echoed Dr. H. More careful attention internal conversations.
Bob continued, “There’s instinct, and there’s this truly f*****d up thing called your mind.”
The mind, as I understand it, tries to mess with our instincts. I believe there’s a natural, unobstructed course of action that we can take to achieve what we want to achieve, but our mind gets the way. Take youth, for example. As young people we have the world at our fingertips, but we’re blinded by the paralyzing effects of choice. As we age we become more set in our ways and our options dwindle. We have conversations with ourselves: some good and some bad, either driving us towards or leading us astray from our instincts.
A mantra in my family is “the mind is a dangerous neighborhood,” but 11 weeks of contemplation have left me many times with no other place to go. Dr. H and Bob realize what very few people can. Our internal conversations are, after all, just thoughts and ideas and like all other thoughts and ideas they can be listened to or ignored – it’s our choice. I think our motivation lies somewhere behind these choices.
Uncertain days lie ahead of many of us, including myself at home and my former ’12-ers in the flux of impending graduation. Motivations steeped in curiosity and passion may cede to the necessities of money, or maybe not. Regardless of the possible tumult in our futures, I repeat to you what Dr. H told me, “It’s time to start listening to those good voices.”