Mon February 10, 2014
For Military Couples, It's A Long Recovery 'When We Get Home'
Originally published on Tue February 11, 2014 8:24 am
Kayla Williams and Brian McGough met in Iraq in 2003, when they were serving in the 101st Airborne Division. She was an Arabic linguist; he was a staff sergeant who had earned a Bronze Star. In October of that year, at a time when they were becoming close but not yet seeing each other, McGough was on a bus in a military convoy when an IED went off, blowing out the front door and window.
"Essentially a piece of shrapnel went through the back of my head, burrowed the skull from the back of my head past my ear, out through where my eye is, and while doing this it also ripped some brain matter out," McGough tells Fresh Air's Terry Gross.
He was left with physical and cognitive problems he's still recovering from, as well as post-traumatic stress disorder. He has experienced periods of depression, paranoia and rage.
Williams and McGough started seeing each other early in his recovery, after they had returned to the U.S. They've stayed together in spite of the obstacles, including the rages that he directed at her. They married in 2005, just days before she went on a book tour to promote her memoir, Love My Rifle More Than You, about being a young woman in the Army serving in Iraq. Now she has a new memoir about her relationship with her husband, Plenty of Time When We Get Home: Love and Recovery in the Aftermath of War.
On how McGough's injury changed his behavior
Williams: He wasn't paying his bills. He would get notices that his electricity was about to be shut off or his water was about to be shut off because when he would get a paycheck he would spend it all within three or four days. The executive functioning part of his brain had been damaged, and so he would just buy a new computer, buy rounds of beers for everybody at the bar, and his entire paycheck would be gone within days.
He was a staff sergeant — he was a leader who was used to planning and executing multiday missions, supporting multiple troops in a combat zone — so for him to go from being able to handle that level of responsibility to suddenly not being able to even pay his own bills, I knew something was wrong.
Somebody who had lived in his house while he was gone had moved out and turned the electricity off but not unloaded the refrigerator, and the refrigerator was full of rotten, molding food and Brian just ignored it. He just left the refrigerator closed and didn't do anything about it. There was a family of mice living in the refrigerator. Little clues like that, [and] I'm like, "Wow, something is seriously wrong that he's letting things like this go and not handling them."
On choosing to stay together
Williams: At the very beginning I think I didn't understand. And then I fell in love with him, and by the time I started to understand what it really meant, I was already pretty deeply in. But there were a lot of times that I contemplated running away from it. I realized way later that I was doing things to bind myself to him to make it harder to run away if I got freaked out, or scared, and wanted to leave. So getting married and then buying a house together, these were things that I was doing to make it harder to run away when things got hard — because there were some really hard times, but I had this faith that we would be able to pull through, and I just kept convincing myself that he would get better. I didn't have any evidence on which to hang that hope, but through luck or perseverance or some combination of things, that did turn out to be the case.
On being aware of the changes
McGough: I went from [being] kind of a very, very high-functioning individual to a high-functioning individual. A lot of people see me and [would] be like, "Oh, I could never tell you had a brain injury." But I know. I know what I used to be like. I know how I used to be able to pick things up, learn something new and stick with it and be able to master it quickly. I don't have that ability now. ... I have to read things a few times to kind of remember them. But at the same time, I just started reading again, probably two years ago. For a long time, I couldn't read. It sounds kind of silly but ... I would read a chapter and be like, "What did I just read? What just happened?"
On going into "code black"
Williams: If he knew it was coming, he would say "code black" and just not talk to me for a few days until it would pass. But there were other times when things did get bad. I could always tell that it was going to get ugly when first he would switch from drinking just beer to drinking hard liquor, doing shots. That was an indicator that things might go bad. The clue always was when his face would just flatten. It was like the shades being pulled. He would go from having a more expressive face to just complete coldness and he would say, "You don't understand. You'll never understand." And that was when I knew some switch had flipped in his head and he had crossed over into a level of rage or something that he couldn't control anymore.
We had had a lot of terrible arguments when he was in these "code black" moments, and I'd say the very, very worst incident was ... I had locked myself in the bedroom and he was throwing himself at the door. And I thought, "I just — I can't go on like this. I can't imagine trying to live the rest of my life not knowing when this moment will happen." Not knowing if it's going to be safe. Thinking I can't have children because I don't know if one of these rages will happen. And I decided that rather than go on, I would rather be dead, and I asked him to kill me. And he put a gun to my head and pulled the trigger. It was not loaded, and he threw the gun away and called me crazy, and I left. And that night was the lowest point in our relationship, and it ended up being the turning point in our relationship.
On living with PTSD
McGough: You have to kind of get in the frame of mind that in my mind — and I can't control this, and I have to kind of fight with this every day — every small, slight or minor transgression is amplified by anywhere from like 10 to 20. So for instance, if you cut me off in traffic, that is almost like if somebody were to ram their car into you. That's how my brain responds to things — it amps things up. So when I was put in that situation, my brain kind of took over and just went to work in a way that shouldn't have happened. There was alcohol involved and a lot of emotions, and something we're very fortunate that nothing bad happened, nothing worse happened, and it worked out the way it did. ...
In times of crisis I'm great. ... My preferred state is the "Oh my God crisis."
Williams: It's a classic PTSD response in a lot of ways. ... A lot of what we think of as symptoms of PTSD are adaptive in a combat zone. So being hypervigilant, extremely alert to your surroundings, always monitoring your environment for potential threats and being prepared to respond with immediate violence if necessary if you perceive a threat — those are adaptive ways to be in a combat zone. Those traits keep you alive in a combat zone, and it's normal for anyone coming home to take awhile to wind that down. ...
I still feel my heart rate increase if I see trash on the side of the road because there's a little piece of my brain that thinks it could be an IED. But for the vast majority of people, those fairly normal symptoms fade within three to six months after coming home. But for people like Brian with pretty severe PTSD, that fading of those symptoms doesn't happen, and those normal ways to behave or think or be in a combat zone carry over into civilian settings where they're actively counterproductive.
TERRY GROSS, HOST:
This is FRESH AIR. I'm Terry Gross. My guests have had to work hard to keep their marriage together. Kayla Williams and Brian McGough are veterans of the Iraq war. They've each dealt with post-traumatic stress disorder. He's still recovering from a brain injury he sustained in October 2003, just after returning to Mosul after a mid-tour leave.
He was on a bus in a convoy headed back to his base when an IED went off on the right side of the bus, and a rocket-propelled grenade missed the bus by inches. His brain was penetrated by shrapnel. It left him with physical and cognitive problems he's still recovering from, as well as periods of depression, rage and paranoia.
Williams and McGough met in Iraq before the injury, while they were serving in the 101st Airborne. But they didn't start seeing each other until returning home to the States. They married in 2005, just days before her book tour promoting her memoir "Love My Rifle More than You," which was about being a young woman in the Army, serving in Iraq.
Kayla Williams has written a new memoir about her relationship with her husband. It's called "Plenty of Time When We Get Home: Love and Recovery in the Aftermath of War."
Kayla Williams, Brian McGough, welcome to FRESH AIR. This is a very kind of dramatic, difficult place to start, but I think it's the right place to start. I'd like you to describe what happened to Brian. Brian, do you want to describe what you know of what happened when you were injured?
BRIAN MCGOUGH: Sure. We were riding on a bus back from the airport in Mosul, Iraq, and an IED went off next to the bus. I took shrapnel to the back of my head. It went through the front. I was medivac-ed to Baghdad, where they did surgery on me, and then I was medivac-ed to Germany, where I started my recovery. And from there, I went to Walter Reed and spent two years there recovering from my injury.
GROSS: And when the shrapnel penetrated your head - so it went from the back and existed from the front - actually, some of it didn't exit. Some of it was, like, stuck in your skull. Did you have any idea of the - of how profound the injury was at that time, at that moment?
MCGOUGH: No, not at all. In fact, I thought that I had just hit my head. Like, if you ever have hit head when a car hits a bump, I felt that's what happened, and people were actually telling me to calm down and take it easy. It wasn't until probably I woke up in Germany that I realized that something was really, really kind of wrong.
GROSS: And, Kayla, how did you find out what happened?
KAYLA WILLIAMS: For once, I was down off the mountain that I had been spending a lot of time on, and one of the staff sergeants in my unit was...
GROSS: This is in Iraq. You were still in the military.
WILLIAMS: Yes. Yeah, absolutely. And a staff sergeant in my unit was also injured on the same convoy that Brian was injured on. And so I knew that he had been hurt, and we washed blood out of his gear so we could give it back to him clean. And then I bumped into Brian's platoon sergeant, and he said, oh, Williams, I know you really liked McGough, and he's been hurt pretty badly. It doesn't look like he's going to make it. So I'm really sorry to have to tell you that.
And it was about three days that they said they didn't know if he was going to survive.
GROSS: What was the status of your relationship then? How well did you know each other?
WILLIAMS: We didn't know each other very well. We had met on the side of a mountain, kind of teased each other, joked around. The military can be kind of a rough place. It's not very tender. We couldn't go out on any dates. But I knew I was interested in him and attracted to him. And one night, I had confessed to him that I really wanted to get to know him better, and he said there's plenty of time for that when we come home.
MCGOUGH: I was playing hard to get.
GROSS: And I should say, that's where the title of your book "Plenty of Time When We Get Home" comes from.
GROSS: So Kayla, when you returned to the States and say Brian again, how did he seem changed from his injuries?
WILLIAMS: When I first got back from Iraq and saw Brian again, he - I didn't notice or recognize the changes, and it was also this honeymoon period where he was so happy to still be alive that things seemed to be going pretty well. And we just - we just hung out, spent a lot of time together. I was still so discombobulated by returning, that I didn't really understand what was going on, either, and I didn't have to go to work. I was on block leave.
So we both would just sit around and get drunk and hang out and have fun. It wasn't until I had to go back on duty and show up and do PT every morning at 6:30 and work all day and then come home that I started to really realize how badly things were going for him and recognize how things were falling apart when I had a structure to go back to and he didn't.
GROSS: And at that point, how could you see that he had changed? What kind of, like, cognitive or physical problems did you notice that he was having?
WILLIAMS: He wasn't paying his bills. He would get notices that his electricity was about to be shut off, or his water was about to be shut off, because when he would get a paycheck, he would spend it all within three or four days. He - the executive functioning portion of his brain had been damaged, and so he would just - he would just buy a new computer and buy rounds of beers for everybody at the bar, and his entire paycheck would be gone within days.
And he was a staff sergeant. He was a leader who was used to planning and executing multi-day missions, supporting multiple troops in a combat zone. So for him to go from being able to handle that level of responsibility to suddenly not being able to even pay his own bills, I knew something was wrong.
Somebody who had lived in his house while he was gone had moved out and turned the electricity off, but not unloaded the refrigerator, and the refrigerator was full of rotten, molding food, and Brian just ignored it. He just left the refrigerator closed, and just didn't do anything about it. There was a family of mice living in the refrigerator.
And little clues like that that I'm, like, wow, something is seriously wrong that he's just letting things like this go and not handling them. And the headaches I knew were really bad, but I also came to see that he wasn't just staying up all night because it was fun to party, but because he had severe insomnia and that his drinking was not just to have fun, but because he was trying to what I later learned was self-medicate.
GROSS: Brian, Kayla recognized that you were having serious problems in organizing things, in taking care of your responsibilities, that you had severe insomnia, that you were drinking too much. Did you realize that at the time?
MCGOUGH: I'm not necessarily sure that I realized it at the time. I would say I wasn't probably being very introspective at the time. It was easier for me to not do things and to kind of have people care for me than it was to do things on my own. So I was in a place where it was easy for me to do that, too. I was - you know, I was the guy that got hurt. So, of course, everybody wanted to do a little bit to help me. So it was kind of easy to not have to do things.
But I really wasn't thinking about it as, you know, any change. I was just dealing with things as they came. And I knew I couldn't sleep, but if I - you know, if I drank enough, eventually, I would fall asleep.
GROSS: To help us understand the extent of the brain injury that you had, would one of you describe what actually happened in your brain, physically?
MCGOUGH: Sure. I can go ahead and talk about what the doctor told us. So, essentially, a piece of shrapnel went through the back of my head, burrowed the skull from the back of my head past my ear, out through where my eye is. And while doing this, it also kind of ripped some brain matter out. I mean, as it causes kind of a vacuum as it goes through, it rips some brain matter out. So it definitely tore some dura in my brain, and there was some brain matter. I think there's probably some pictures in the book, if anyone wants to see them.
WILLIAMS: The publisher would not include them, because they were too graphic, but I did put them on the book's Facebook page if you want to see a picture of Brian's brain. But also either a piece of the shrapnel or a piece of skull dislodged by the shrapnel severed an artery inside the skull. And so although immediately after the injury he was walking and talking and doing OK, at the same time he was bleeding out inside his skull, into his brain.
And by the time he got to the neurosurgeon, he was starting to crash. And if he hadn't gotten on that operating table pretty much right then, he definitely would've died. Talking to the neurosurgeon was amazing to learn the extent of it. I mean I knew how badly he'd been injured, but I didn't truly know, and the fact that the neurosurgeon had photos was totally astonishing to me. And just seeing it visually was shocking, even though I thought I knew how badly he'd been hurt.
GROSS: So you didn't see the physical - you didn't see the images of what happened in his brain until recently, but you had seen some of the ways that he'd changed, including the insomnia, the drinking, really terrible mood swings, and the bad mood swings were really bad. You...
WILLIAMS: And some of it I couldn't untangle what was physiological or cognitive and what was psychological. So he also developed pretty severe post-traumatic stress disorder, or PTSD, and those - the brain injury and the PTSD and the depression are all kind of tangled up together and really difficult to unwind. So if you have insomnia because you have PTSD, not sleeping impairs your cognitive function.
And if you have more impaired cognitive function and you realize you can't do what you used to be able to do, it's really depressing and affects your mood, and then you behave worse, and it affects your relationships, and that makes you angrier. And so it was like every bad thing fed on every other bad thing in this downward spiral that just was extraordinarily difficult to eventually pull out of.
GROSS: And add to that that you didn't really know each other very well. So you probably also didn't know, like, what is like the deepest part of his character and what is a symptom of trauma.
WILLIAMS: Right. My friends thought I was crazy.
GROSS: Crazy for...
GROSS: With him?
WILLIAMS: Yes. People ask me all the time.
GROSS: Did you ask yourself that, if you wanted to continue a relationship with him, knowing that his injuries might cause permanent cognitive and physical deficits, knowing that some of those problems included, you know, dangerous mood swings, where he became a danger to you and maybe to himself?
WILLIAMS: At the very beginning I think I didn't understand, and then I fell in love with him. And by the time I started to understand what it really meant, I was already pretty deeply in. But there were a lot of times that I contemplated running away from it. I realized way later that I was doing things to bind myself to him, to make it harder to run away if I got freaked out or scared and wanted to leave.
So getting married and then buying a house together, these were things that I was doing to make it harder to run away when things got hard because there were some really hard times. But I had this faith that we would be able to pull through, and I just kept convincing myself that he would get better. I didn't have any evidence on which to hang that hope, but through luck or perseverance or some combination of things, that did turn out to be the case.
But it was rough and very, very rough road to get to where we are today.
GROSS: Where are you today? Brian, where are you today in terms of your recovery, in terms of getting back some of the physical and cognitive losses that you suffered after the brain injury?
MCGOUGH: I would say I'm doing pretty well. I definitely didn't have a lot of the cognitive losses that some other people do when they have TBIs, and I'm very lucky for that. I went from a kind of very, very high-functioning individual to a high-functioning individual. So that's - a lot of people will see me and be like, oh, I could never tell you had a brain injury. But I know. I know what I used to be like. I know how I used to be able to pick things up, you know, learn something new and stick with it and be able to kind of master it quickly, and I don't have that ability now.
I'm in school. I think I do better than some of the students there, but it's hard. It's - I have to read things a few times to kind of remember them. But at the same time I just started reading again probably two years ago. For a long time I just, I couldn't read. I mean that sounds kind of silly, but I could read, I just would read a chapter and be, like, what did I just read, what just happened?
You know, and I don't really know why it happened. I'm not a doctor. So I can't say, like, oh, you were able to read because of this, but it just happened. And through it all I've just been very lucky and fortunate that I'm doing well. And you know, I realize that every day, although that doesn't mean I don't have bad days. I do realize that, and I'm very lucky for it.
GROSS: And what made you decide to go to college? How old are you now?
MCGOUGH: I'm 37.
WILLIAMS: I think you're 38.
MCGOUGH: Thirty-eight. I'm in my late 30s.
MCGOUGH: Yeah, I tried to go back to school almost two or three years after I got hurt, I'd say.
WILLIAMS: No, more than that.
MCGOUGH: Three or four years after - a few years after I got hurt. And it just didn't work for me. And that kind of was something that frustrated me. And as my GI Bill ran out, started to run out, I decided that, you know, I want to learn new things. I can write pretty well, but I want to know the right way to do it. I can, you know, give speeches, but I want to learn the right way to do it. I kind of would like to finish that experience.
And I have the opportunity because of the, you know, gracious post-9/11 GI Bill that we have, and to not use it would be kind of silly. And I was at a place where I started to comprehend things better. I was able to read. I was working a job where I was doing a lot of mind work and doing well. So I figured why not.
GROSS: If you're just joining us, my guests are Kayla Williams and Brian McGough. And she's written a memoir called "Plenty of Time When We Get Home: Love and Recovery in the Aftermath of War." And it's about coming home after her tour of duty in Iraq and becoming more deeply involved with Brian McGough. They were both in the 101st Airborne Division in Iraq. And he suffered a really terrible brain injury there.
So this book is about his recovery and what it's been like for both of them during those years. So let's take a short break here, and then we'll talk some more. This is FRESH AIR.
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GROSS: If you're just joining us, my guests are Kayla Williams and Brian McGough. They were both in the 101st Airborne Division in Iraq, which is where they met. He suffered a terrible brain injury, from which he's still recovering. And her memoir, "Plenty of Time When We Get Home," is about their relationship, how they got married, they have two children now, and what it's been like for him to recover from this terrible injury when the symptoms have included severe headaches and mood swings and paranoia and things that are very trying on a relationship.
Kayla, my impression is that you were so busy trying to help Brian with his recovery that there were times when you didn't tend to your own needs, didn't think about yourself having things like post-traumatic stress, and thinking that he was the one who was injured. So, like, you shouldn't be having any problems.
WILLIAMS: That's definitely true. I think in some ways I tried to stay busy specifically so that I couldn't think about my own problems or be too introspective. I wanted to stay as busy as possible. That was my coping mechanism. But once he started to do better, I began to realize that I wasn't adjusting very well to that and that I needed to spend some time working on my own issues if we were going to be able to take our relationship to the next level.
I was really kind of astonished at how hard it was for me to accept that he was improving. I'd taken control of so many aspects of our lives, and for me to start to give some of that up and trust him to heal and to be able to play a bigger role in our lives, it was hard for me, and it took some real effort and some therapy of my own to cope with some of my own issues and let our relationship change.
GROSS: One of those issues that came up in your therapy is that you were diagnosed with obsessive-compulsive disorder, which you say was actually considered a real, like, talent, a real gift in the military because you could organize things so well. And it was only when you got home that you realized that this could be a problem too.
What were some of the manifestations of that that were problematic at home?
WILLIAMS: I've annoyed every roommate I've ever had because I really like everything to be in exactly a particular place. I like all the canned goods to be facing in the same direction, organized by type of food, just little things like that that seem like they're not a big deal. But when you're trying to share a living space with somebody who doesn't want to live that way, apparently people can find that really annoying.
WILLIAMS: I don't understand why, since clearly my way is the right way, but...
WILLIAMS: But yeah, so - and my friends - actually, I was just talking to a friend of mine the other day who read the book and said I was so worried about you having children. I didn't know how you'd be able to have toddlers with that mindset, with being so controlling about your space. She's like, and you've done so well with your kids. I didn't know until I read your book that you had therapy and that that's one of the ways you've been able to tolerate having kids. I thought that was kind of funny.
GROSS: Is that true?
WILLIAMS: It helped.
GROSS: That therapy helped you through the chaos of having children?
WILLIAMS: Oh, I was done with therapy by then, but I think it had helped me to let go of some of my need to control things and to kind of recognize that I was going too far and to take a step back and unwind and realize where it was not helpful. I was really lucky. I had a therapist who wasn't all mushy and touchy-feely and was able to break things down for me in a way that I could understand, and say like, look, if this is negatively impacting your life, it's problematic, and you need to work on it and resolve it.
And being able to let go of some of these things was probably helpful. And now I think I'm actually reasonably relaxed compared to a lot of my other mom friends. The other day I posted a picture on Facebook of our living room after the kids played for a while, and it was this complete catastrophe. And several of my friends posted, like, I started hyperventilating just looking at that photo. And I'm like, yeah, I'm actually able to just let it go.
GROSS: Kayla Williams and Brian McGough will be back in the second half of the show. Kayla Williams' new memoir about their marriage is called "Plenty of Time When We Get Home: Love and Recovery in the Aftermath of War." I'm Terry Gross and this is FRESH AIR.
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GROSS: This is FRESH AIR. I'm Terry Gross back with Kayla Williams and Brian McGough, a married couple who met in 2003 while they were serving in the Army in Iraq. Just before their relationship got serious, he was nearly killed in an IED explosion. Shrapnel penetrated his head, leaving him with a brain injury. The resulting physical and cognitive problems weren't adequately treated - neither was the posttraumatic stress disorder that both McGough and Williams suffered from.
Kayla Williams has written a new memoir about their marriage called "Plenty of Time When We Get Home: Love and Recovery in the Aftermath of War." She's also the author of a previous memoir about being young and female in the Army.
This might be a little bit difficult to talk about, but Kayla, one of the things you write about in your memoir, "Plenty of Time When We Get Home," is about your husband Brian's mood swings - which would sometimes turn violent, violent against you. And I want you to describe an example of that, something that he started calling Code Black because you asked him like, give me some warning that this is coming on if you could feel it coming on. And so he would say Code Black.
GROSS: Give us an example of that.
WILLIAMS: Yeah. If he knew it was coming he would say Code Black and just not talk to me for a few days until it would pass. But there were other times when things did get bad. And I could always tell that it was going to get ugly when first he would switch from drinking just beer to drinking hard liquor, doing shots, that was an indicator that things might go bad. And then the clue always was when his face would just flatten. It was like the shades being pulled. He would go from having a more expressive face to just complete coldness. And he would say: You don't understand, you'll never understand. And that was when I knew that some switch had flipped in his head and he had crossed over into a level of rage or something that he couldn't control anymore.
And it had, we had had a lot of terrible arguments when he was in these Code Black moments. And I'd say the very, very worst incident when was once it happened and I - for some reason I snapped and thought I can't live like this anymore, I'd locked myself in the bedroom and he was throwing himself at the door and I thought I just, I can't go on like this. I can't imagine trying to live the rest of my life not knowing when this moment will happen, not knowing if it's going to be safe, thinking I can't have children because I don't know if one of these rages will happen. And I decided that rather than go on, I would rather be dead and I got, I asked him to kill me. And he put a gun to my head and pulled the trigger and it was not loaded. And he threw the gun away and called me crazy and I left. And that, that night was the lowest point in our relationship and it ended up being the turning point in our relationship because the next day I fell rock climbing with a friend, trying to stay, trying to stay focused and have some social interaction and pretend my wife wasn't horrible. I fell and broke my ankle and ended up in a cast and was helpeless and was totally dependent on Brian. And that change changed the dynamic in our relationship, put him in a position of being able to care for me, put me in a position of needing to rely on him. And that started a shift in how we interacted with each other and enabled him to really begin the healing process that has gotten to where it is today. That...
GROSS: Let me take a step back.
GROSS: I want to get back to when you asked your husband to kill you, to take his gun and pull the trigger, and he took his gun and pulled the trigger but the gun wasn't loaded. Brian, when you did that, when you complied with what she asked you and took the gun and put it to her head and then pulled the trigger, did you know it wasn't loaded?
MCGOUGH: Yes. But it still, it still is a stupid move, not one that I would recommend to anyone.
GROSS: Why did you go that far?
MCGOUGH: You have to kind of get in the frame of mind that in my mind - and I can't control this and I have to kind of fight with this every day - every small, slight or minor transgression is amplified by anywhere from like 10 to 20. So for instance, if you cut me off in traffic, that is almost like if somebody were to ram into your car to you. That's how - that's how my brain responds to things, it amps things up. So when I was put in that situation, my, you know, my brain kind of took over and just went to work in a way that shouldn't have happened, and there was, you know, alcohol involved and a lot of emotions, and you know, it was something we're very fortunate that nothing bad happened, nothing worse happened, and you know, it worked out the way it did, but very lucky for both of us.
GROSS: Can I ask you a horrible question? If the gun was loaded, would you have put it to her head and pulled the trigger?
GROSS: So that sense of amplification that you're burning amplifies things, you know, and like a slight becomes this like huge threat, do you attribute that to the brain injury, do you attribute that to the drinking that you were going, to posttraumatic stress, all of the above?
MCGOUGH: Yes, I mean all of the above. I was definitely was drinking way too much. Still something I struggle with, and it's not something that somebody with a TBI should be doing. Everyone tells me that all the time and, you know, one of these days it'll sink in. But it's a little bit of everything and I haven't been able to find somebody that couldn't figure out, you know, it's X percentage of this, Y percentage of that and a little bit of this. But it's something that I deal with on a, you know, daily basis and it makes things very hard for me because if I email somebody and they don't, you know, respond back almost immediately, my brain goes into a mode of: What did I do? What's wrong? What's going on? And it just keeps going and going and going until it gets to a point where it becomes an issue.
It also kind of meshes with the PTSD mindset that I have - not everyone has, but I have - that in times of crisis I'm great, I'm perfect. That is my preferred state, is the oh my god crisis.
WILLIAMS: It's a kind of classic PTSD response in a lot of ways. I've come to think of it, and some of the people have described it to me as a lot of what we think of as symptoms of PTSD are adaptive in a combat zone. So being hyper-vigilant, extremely alert to your surroundings, always monitoring your environment for potential threats and being prepared to respond with immediate violence if necessary if you perceive a threat - those are adaptive ways to be in a combat zone. Those traits keep you alive in a combat zone and it's normal for anyone coming home to take a while to wind that down.
So I was very reactive to cars cutting me off in traffic when I first got home for a long time. I still feel my heart rate increase if I see trash on the side of the road because there's a little piece of my brain that thinks it could be an IED. But for the vast majority of people, those fairly normal symptoms fade within three to six months after coming home. But for people like Brian with pretty severe PTSD, that fading of those symptoms doesn't happen and those normal ways to behave or think or be in a combat zone carry over into civilian settings where they're actively counterproductive.
GROSS: My guests are Kayla Williams and Brian McGough. Williams has written a new book about their marriage called "Plenty of Time When We Get Home." More after a break. This is FRESH AIR.
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GROSS: My guests are Kayla Williams and Brian McGough. Williams has written a new memoir about their marriage called "Plenty of Time When We Get Home: Love and Recovery in the Aftermath of War." They met in Iraq when they were serving in the Army. He was injured by an IED and sustained a serious brain injury.
I thinking that since you both had PTSD - yours, Kayla, was probably less so than Brian's, since he was actually injured by an IED in Iraq and nearly killed - that your PTSD might have been like an echo chamber. You know, that if you were both hyper-reactive to things and he hyper-reacts to something in a negative way, then Kayla, you could hyper-react to his negative reaction, which could make him more hyper-reactive to you and you more hyper-reactive to him. I mean did you feel like that kind of thing was happening?
WILLIAMS: Yeah. I felt like the fact that we were both combat vets could either help us or hurt us, depending on the given situation. So it could help when, for example, if we were, if we went to Wal-Mart and I would suddenly freak out and I just couldn't be there anymore and had to leave right away, he never questioned it; he just understood and say, OK, and we would just walk out. And that level of understanding was really comforting and helpful and to not feel like somebody was looking at me like I was crazy. But yes, the fact that we could both respond overly aggressively to perceived threats was not helpful if we would start to have what should have been a very minor disagreement. And sometimes I wonder if, you know, if at least one of us had been a civilian, maybe we would've gotten therapy or something a little sooner. At least one of us would have been willing to break sooner and say like, no, we need to get a professional involved to help us cope with some of these symptoms.
GROSS: Well, didn't take a while before people really understood what traumatic brain injury was, even the medical profession?
GROSS: Didn't that happen a little bit after you had your injury?
WILLIAMS: Yes. And for both me and for Brian, I think an important part of our eventual healing and our recovery process was advocating to improve those services. When we started to get better and were able to take care of ourselves, we both started to speak out publicly and advocate to improve the systems and services available to others veterans, and that new form of service helped us get better, helped us find meaning in what we had gone through by trying to make things better for others.
GROSS: Brian, you had said earlier that your best state is at crisis mode, that's where you perform the best and feel most comfortable. Do you think that had something to do with why you were a career person in the military?
MCGOUGH: No. I mean I was never that way before getting hurt, so I don't know if maybe it was PTSD or TBI.
GROSS: Oh, oh, I see. OK.
MCGOUGH: It was something that has only been probably since, you know, after I got back. And a little bit going into Iraq fresh out of Afghanistan, I think I was OK with it, but it was just that, I mean that pace that if everything is going wrong, I'm good, I can deal with it. Like that's just my kind of tranquil Zen mode.
WILLIAMS: I think your brain gets used to this like flood of adrenaline when you're in combat and when it goes away everything feels weird and you're kind of waiting for it. And a lot of vets when they come home, they like drive like fast cars or go rock climbing or get in fights. They like seek out situations where they get that adrenaline rush. And then later, when Brian ended up joining the fire department, I think it was the same thing - like seeking a quasi-safe or at least like socially appropriate way to get the adrenaline surge...
GROSS: A productive way.
WILLIAMS: Right. A way - yes - a way that you can serve but get that surge of adrenaline that, like be in a crisis setting where things feel normal again. And in the fire department it's with a bunch of other people in a structured environment that's like pseudo-military almost.
GROSS: You're the parents of two young children now. And Brian, you had said earlier that crisis mode, since your injury, like crisis mode is where you feel like you perform the best and feel most relaxed. I think young children could keep you in a pretty fairly constant state...
GROSS: ...of crisis mode. And I'm wondering what the experience for you has been like being a father during this period of ongoing recovery from the IED explosion that left you with traumatic brain injury and all the posttraumatic stress that accompanied that.
MCGOUGH: Sure. So it's kind of important to keep in mind that I've been a father for quite a while, a daughter born in 1998, so I came into this new fatherhood with a little bit of experience.
GROSS: I should say, that was with your first marriage, before you and Kayla were together.
MCGOUGH: Exactly. So I had a little bit of experience. There are difficult times but it's easy for me to kind of separate that, you know, they're kids and they're kids and, you know, they don't - I've never had an issue with him pushing me over the edge or anything. They're trying but they're no more trying than the other kids. I get frustrated.
I don't think I get frustrated more than any other parent out there but it's definitely a lot of work and it does keep me in crisis mode when someone's screaming at three o'clock in the morning and there's, you know, vomit all over the bed and all those fun things.
WILLIAMS: You know, I actually thought, though, that it helped Brian and I started to wonder if it was chemical. That may sound really weird but, like, everybody knows that when women are pregnant and when they're breastfeeding their brains kick out a ton of oxytocin and apparently men who live with their partners and newborns, the same thing happens.
And that's the bonding chemical, the love chemical. And I started to wonder if that had actually sort of helped kick his recovery to the next level, being around newborns. Like, I could watch his face soften and watch him, like, open himself up to love in a way that is harder to do with adults than with infants. Because the kids, they don't have any judgment.
They don't have any preconceived notions, they just love. And I think it's a lot easier to love them back than it can be to love another adult who has all their foibles and issues.
GROSS: Brian, you have described how easy it is for you to go into a rage and how you kind of - things are often a little exaggerated in your mind, everything's a little amped up. What about joy and pleasure? Is it hard for you to experience joy and pleasure? And are those sensations amplified too?
MCGOUGH: No. They're not amplified so it is very difficult for me to experience those. I still do experience them but it's not the same and most of the joy and pleasure that I get comes from that amped up kind of high adrenaline, you know, situations. Like when the kids were born, you know, or, you know, when I was in the fire department, you know, running calls. And I still get pleasure from doing things like going out with Kayla or doing things with the kids.
But it's not elevated.
WILLIAMS: It's like living with Eeyore. And I think he thinks it's probably like living with Tigg'r.
MCGOUGH: Fair enough.
WILLIAMS: You know, it's like oh, oh, do you want to go the beach? Let's go to the beach. It's going to be so fun. Let's go. It'll be great. It'll be great. And he's like if it doesn't rain it might be OK.
MCGOUGH: If the surf's good.
WILLIAMS: Yeah. But it'll probably - the surf will probably be bad. And then it'll be sandy, it'll be gross. Really?
GROSS: And Kayla, do you feel out of synch with that?
GROSS: I mean, is your, like, is your interest and pleasure, your ability to experience it - you know, do you experience pleasure more easily and do you feel out of synch?
WILLIAMS: Yes. I do feel out of synch quite often. He calls me a hyper little Chihuahua sometimes.
WILLIAMS: I'm bouncing around like let's go do stuff. It'll be great. It'll be great. And he doesn't have that same reaction to things. And it can be really hard to live with somebody who doesn't match that same level. And I'm sure it's frustrating for him but, yeah, it can be frustrating for me too. And other times I just have to tell myself, like, he doesn't have to act as excited. OK? He just has to show up.
And maybe he'll enjoy it once he gets there. Or he doesn't have to be smiling while we do something. He can take his own level of pleasure in it and that's OK. But, yeah, I do. I'd say feeling out of synch is a good way to put it.
MCGOUGH: Even I feel out of synch with it, though. So, I mean, I know that there are things that should make me happier and they don't and that's something that it's very difficult to deal with but I am kind of like Eeyore.
GROSS: Well, I so appreciate you sharing your story and I know other vets' stories have been helpful to you and I'm sure your story will be helpful to many vets. I appreciate you telling it on our show. Is there anything you want a chance to say before we have to end?
WILLIAMS: Yes. If there are any veterans in crisis they can call 1-800-273-TALK and press one for assistance 24 hours a day. That's the Veterans Crisis Line.
GROSS: Have you used that?
WILLIAMS: I have actually used it for a friend. You can call and tell them that somebody else is in crisis and give them that person's contact information and they will reach out for you. Like if you feel helpless and don't know what to do. And, Brian, I don't know if you've ever called the number or not.
MCGOUGH: Again, I've called it for somebody else who needed the help. I have not used it myself but I do have the number memorized and in my phone pre-programmed in case I ever do need to use it.
GROSS: I wish you good luck. Thank you so much.
WILLIAMS: Thank you very much for giving us a chance to tell our story.
MCGOUGH: Thanks. It was our pleasure.
GROSS: Kayla Williams and Brian McGough. Her new memoir about their marriage is called "Plenty of Time When We Get Home: Love and Recovery in the Aftermath of War." You can read an excerpt on our website freshair.npr.org. This is FRESH AIR. Transcript provided by NPR, Copyright NPR.