I have a 79-year-old friend who I have lunch with about once a month. We met many years ago by happenstance, as she had a weekly appointment that ended when mine began.

We started to chat in the waiting room and over time became friends.

She is a smart woman who spent many years in corporate America. When she retired, her circle of friends became smaller and dwindled further since she is a caregiver to her husband with a chronic illness.

At our lunches we would chat about the goings on in our lives. During the year we exchange holiday and birthday gifts. In between our visits we talk on the phone.

We always end our conversations with one of us saying “I love you” and the other saying “I love you, too.”

A couple of months ago my friend had a very bad fall that resulted in a brain injury. She was hospitalized for a time, then went to rehab and is now home with a paid caregiver, who is doing double duty caring for her and her husband.

I have yet to see my friend, as I am told she is experiencing confusion and is at times agitated and prone to angry outbursts. Her caregiver thinks visits will cause her too much stress.

In reading about brain injuries, I learned that they can cause slight or sometimes significant changes in personality. There are a host of reasons for these changes.

There may be damage to specific areas of the brain. These damages may result in mood changes that include volatile emotions and lashing out at others either physically or verbally.

Those experiencing brain injury may have an emotional reaction to dealing with the loss of some functions and may be trying to communicate their distress or frustration.

There may also be a level of confusion as their executive functioning may be impacted. Executive function comprises three areas. The first is working memory.

In her article “What is Working Memory?” author Peg Rosen suggests we think of working memory “as a temporary sticky note in the brain. It holds new information in place so the brain can work with it briefly and connect it with other information.”

It is easy to imagine just how frustrating it must be for a person to be unable to hold on to information or for it to be jumbled in their brain.

The second area of executive functioning is cognitive flexibility. Those without this skill find it difficult, stressful or even panic inducing to deal with change in their lives.

The last component of executive functioning is self-control. Challenges to this ability may include getting overly emotional or fixating on things.

In one telephone conversation I had with my friend’s husband, he told me how shocked he was by his wife’s bursts of anger and that she said some very hurtful things to her best friend who came to visit. Of course, it was my friend’s brain injury taking charge, but regardless, it left some hurt feelings.

The doctors say my friend’s prognosis is uncertain. It may take six months to a year for her to recover, and it is unclear how much function she will regain.

I miss seeing her and talking to her.

I have sent flowers and cards and did get a chance to talk to her on the phone on one of her good days. She even remembered I had recently visited my mom in New Hampshire, so some things are connecting in her brain.

We did get a chance to say “I love you” at the end of that conversation.

For now, I will just stand by and allow her the time to heal without causing her any stress. I will continue to send cards and to call, hoping I can talk to her again on a good day. And of course, I will tell her I love her.