NMOSD Cognitive Fog In The Workplace

I’m not lazy, my brain just won’t always cooperate.

I sit at work, staring blankly at the computer screen and trying to make sense of the words, names and charts staring back at me. On a good day I can easily check a patient in, but today it feels impossible. My foggy brain processes absolutely none of it. It is a bad pain day, the kind where the grey plume consumes my brain, making it nearly impossible to do or understand anything.

And somehow in the midst of fighting against my own brain, I get questioned if I am capable of doing this job. When just days before I was praised for my hard work ethic.

I am let go.

What are brain fog attacks really like?

There was a time I worked in the service industry and I had what I call a “fog attack”. There are days my pain is at my normal 7 on a rating scale. But on fog attack days, my thoughts are muffled and out of reach. My understanding is skewed and a heavy mental haze sets in. Even keeping a conversation can be so physically exhausting.

To an outsider, it looks like I flip a switch. One day I walk in upbeat, dependable and efficient. The next I’m quiet, withdrawn and can appear rude for not responding or giving eye contact.

What they can’t see? I’m internally battling just to show up and function.

The job was made aware of my disability, but after that last fog day I was never fired or let go. Just simply never put on the schedule again. At another job, it was a tad more direct. I was reprimanded, and eventually fired, for sitting too much.

The hard reality of brain fog and employment

This was a hard reality I had to learn at a very young age. I will always have to navigate symptoms like these, and the comments that come with them.

I don’t owe anyone an explanation. But the gag is, without one, it’s easy to be seen as making excuses or just being lazy. The hardest part is, brain fog is nearly impossible to explain at all. So don’t ask me to explain it while I have it!

Imagine living in a world of fast, modern computers, but your brain is running like one from the early 2000s. Slow. Lagging. Constantly buffering. No matter how hard you try, the memory just isn’t there when you need it. It starts to build this internal conflict. I know I’m absolutely capable of working at any job, but it starts to make me feel incapable when I know that’s not the case.

What I have learned is not every workplace is willing to be understanding of people with chronic illnesses, especially invisible ones.

A system that isn't working for those with NMOSD

For a long time, my brain fog was what cost me jobs. Not ability or effort. I was battling something no one can see.

So I made a choice: I stopped working for people who weren’t willing to work with me. Just because those of us with NMOSD have foggy days doesn’t mean we are inadequate. We are just working for a system that isn’t working for us.

Little did those employers know, it pains me more than anything not being able to complete tasks due to a symptom that has no fix. We shouldn’t need to “power through” just to get the job done.

The reality is, bills still have to be paid and many jobs don’t offer PTO or sick days. Because with a chronic illness, our “sick days” don’t always lead to getting better. We just return to baseline.

Sometimes brain fog lasts a day and sometimes it lingers for a week. With no warning. It’s empowering to advocate our disability, until our paycheck is dependent upon it. The reality is, we’re expected to function as “normal” while living with a rare disease and symptom that can make it feel like our brain is short circuiting.

Navigating brain fog at work

So how do i navigate cognitive fog, especially at work?

• Ask for all communication to be written so you don’t need to depend on remembering verbal instructions and information
• Sometimes all we have the energy for is to be present and listen, and harder days extend our processing time. Asking for extensions to retain information without falling behind is possible.
• Use AI note takers for web meetings that give a transcript, summary and next step list so you don’t need to take extra notes that may use up your spoons (energy)
• Re-read and ask questions even if they have already been clarified. Brain fog can get in the way of remembering important information.

Finding ways to manage unpredictable symptoms

Brain fog is an invisible symptom that constantly interferes with the workplace. Once I learned to work with it instead of against it, I started finding ways to make my harder days more manageable.

What we need to remember is cog fog is unpredictable and not a sole determinant of someone’s intelligence and capability. I have had to remind myself that I am still very capable. My one bad day does not reflect my value.