Verified by 
After brain injury, the losses, changes, and adjustments can overshadow any sense of gratitude for survival. Both survivors and family caregivers can benefit from cultivating gratitude as a tool for connection, growth, healing, and resilience. Here are five ways to practice gratitude, even during a rough time.
1. Shout out "thank you" for what matters most.
When my husband Alan suffered a massive heart attack and cardiac arrest, his brain was deprived of oxygen for almost an hour while resuscitation was in progress. He was left with a severe anoxic brain injury. Alan was hospitalized for four months of intensive treatment and rehabilitation. He finally came home a few weeks before Thanksgiving. Alan insisted on hosting family and friends for Thanksgiving dinner, just as we had done for years.
On Thanksgiving Day, Alan presided proudly at the head of the table. "Welcome to my home," he said. "Thank you for helping me so much."
The impromptu blessings offered by our guests all included gratitude that Alan was alive and beginning to talk, walk, read, and write again. That night, Alan stretched out in his recliner, full of turkey and contentment.
"I'm glad I lived to see this day," he said.
My eyes filled with tears of relief. That was the first time since the cardiac arrest that Alan had said he was happy to be alive despite all the losses he'd endured. As the person who made all the medical and ethical decisions on his behalf, I received his profound statement with deep gratitude.
2. Embrace "instead" as a powerful word.
There are so many changes, losses, and adjustments after brain injury. It's no wonder that we feel cheated at times. But appreciating the power of accomplishing a goal by doing things in a new way can contribute to feeling more empowered, happy, and grateful.
Visual and auditory stimulation could be overwhelming for Alan. Our pre-brain injury tradition of bedecking an eight foot Christmas tree with dazzling lights and ornaments while belting out carols would now send him screaming from the room. Instead, Alan carefully placed a few sentimental ornaments on a small artificial tree with a smiled befitting Charlie Brown.
Instead of going to parties, where the noise and motion would be overpowering, we invited one or two friends in at a time for home-made gingerbread, laughter, and a short conversation.
This attitude pushed Alan forward in many areas of life. Instead of saying "I can't do-, try saying "I will do-. What a gift!
3. It's never too late to say thanks.
About a year after Alan became ill I finally had the time and presence of mind to write thank-you letters to the many people who had cared for us during the crisis. I started by tracking down the names of the Chicago paramedics who had performed cardiopulmonary resuscitation (CPR) on the airplane and in the ambulance on route to the hospital. I wrote personal notes to thank them for their insistence on continuing CPR, and sent commendation letters to their supervisor with a request that the letters be placed in their personnel folders.
Next, I wrote to the ICU staff who saved Alan's life and shored me up repeatedly. I detailed his progress over the year, and his gratitude that he had survived. On and on, through the rehabilitation staff, friends, neighbors, and dog-walkers who had sustained us. Being able to share a specific anecdote about why I appreciated their care opened my heart and mind. Writing also gave me a safe way of reviewing that arduous first year, and appreciating our resiliency and strength.
Best of all, we received calls and letters from everyone to whom I wrote. The healthcare professionals each said that they seldom get to hear what happens after a patient as sick as Alan left their care. Learning about his blazing life spirit and progress in rehab re-energized their dedication to their work.
Expressed gratitude becomes a complete feedback loop that connects, fuels, enlivens, and extends outward.
4. Keep a gratitude journal.
During a bout of depression due to the pressures of caregiving (more about that in a future post), I chose to focus more on what was good in our life. Each night I wrote about three interactions, impressions, or activities for which I was grateful. Entries ranged from a well-timed call from a funny friend to watching a red cardinal snacking at the snowy birdfeeder. I included warm moments with Alan, and my evolving understanding about how he perceived the world.
Alan got in on the act by recording his own gratitude journal. He appreciated going to a Chinese restaurant for lunch, and sharing leisurely telephone conversations with his busy nephews. As we talked about our sources of gratitude, we both became more attuned to the grace present in daily life, nature's wonders, and how we now expressed love.
Expressing gratitude became a tool in my recovery, even as I continued to process the grief and adjustments inherent in our new life.
5. Place gratitude at the center of your gifts.
Each year I wrote Alan a love letter detailing the reasons I loved the man he was now. Alan's had both short and long-term memory impairment, but he could re-read the letter to feel reassured and convinced of my love. In many ways, the brain injury changed Alan's personality, intelligence, and emotions. However, by promising myself to get to know this new Alan and learn to love him, I gave us both a life-expanding gift.
When Alan said, "Tell me again why you appreciate me," I read, "I love you for working so hard to learn the alphabet again, and for giving me good advice all the time."
Alan wrote to me, "I love you for always being able to find our car in the parking garage."
Like many caregivers, I felt inadequate when I wasn't patient enough, or couldn't boost Alan over a hurdle in cognitive rehab. With his persistent coaching, I learned to accept his gratitude and acceptance.
If you are one of the 1.5 million Americans, both civilian and military, who are approaching your first holidays after a brain injury I send you and your family my deepest respect, hope, and admiration for your journey.
