While on vacation recently, I had the opportunity to return to one of the most awe-inspiring places that I have ever seen.This unique site is located along the southern shore of Nova Scotia, and it features walking trails that overlook spectacular coastal cliffs. My husband and I first visited this place over five years ago, several months before my brain tumor diagnosis and neurosurgery. Fond memories of that previous visit inspired our return on this clear autumn day. My spirit was soaring as we started out toward the coastal path, and I was flooded with anticipation and and memories from our previous visit.

Not long after we began to walk along the seaside trails, I began to notice some differences in my ability to manage the uneven terrain. Although most of the time I avoid thinking about the physical and cognitive adaptations that I make on a daily basis, the physical demands of traversing these paths made those changes impossible for me to ignore. I experienced a lot of difficulty keeping my balance while walking along the variable elevations of the path and climbing the roughly constructed steps. Several times, I lost my balance and needed to reach out to my husband for support.

About halfway through the trail I tripped and fell to the ground. Thankfully, I was not injured, but my self-confidence was badly shaken. While I was delighted to have my husband’s companionship and his steady arm at my side, I was saddened by the realization that it was no longer safe for me to walk alone in a remote location like this. I experienced a profound moment as I considered the changes in my life since my previous visit to this trail more than five years earlier. At that time, I had walked comfortably along the uneven surfaces with few concerns about maintaining my balance. Brain tumors were something that I knew virtually nothing about, and back then I had no incentive for that to change.

While considering the differences in my own experience, I also thought about the variety of losses that many other brain injury survivors endure. Although some individuals experience symptoms that are obvious to those around us (i.e., paralysis, loss of vision, speech difficulties, etc.), others have less obvious deficits. Coping with challenges such as balance disorders, fatigue, cognitive changes, pain and other “invisible” symptoms can be especially distressing. Often, if we choose not to reveal details about how our lives have changed, even close friends and family members may not be aware of these residual effects that can be associated with brain tumors and treatments.For some survivors, coping with these “minor” brain injuries can have a significant impact, especially as we confront our own as well as society’s expectations about what we can – or cannot do.

I suspect that many of us occasionally play a game with ourselves, pretending that we are “fine” and that nothing has changed, while we recognize within ourselves that our lives are fundamentally different.

This recognition is about much more than simply acknowledging losses and adjusting to challenges.It is a renewed awareness of the meaning of our survival, and a concurrent choice to make the most of our remaining abilities and opportunities.

After falling on that path and getting up again, I took a moment to reflect on the changes in my life.Yes, it was hard for me to walk along this trail as easily as I had five years ago.But another part of that reflection was a vivid awareness that I was fortunate to be able to return to this beautiful place at all.I found myself overwhelmed with feelings of profound gratitude about being alive, thankful that most of my senses were still intact, and that I was able to appreciate the majesty of the ocean crashing against the magnificent cliffs below me.

Looking out at the intense blue sky and the clear blue ocean, listening to the waves hitting the rocks, and feeling the fresh sea breezes on my face, I knew how many blessings I still had in my life.And now, I carry that awareness with me on the paths I encounter with each new day.

Nancy Conn-Levin, M.A., is a health educator specializing in brain tumor issues.During the past four years she has been a guest speaker at several national brain tumor conferences.Nancy is a member of the Board of T.H.E. BRAIN TRUST and volunteers as coordinator forThe Meningioma List .

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