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A Shock to the Brain

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When I heard the news about Natasha Richardson I was instantly transported back three years ago to the ICU at Bethesda Naval Hospital. Suddenly plunged into the foreign the world of brain injury, I watched helplessly as my husband lay in a coma, tubes snaking around his body after an injury by a roadside bomb in Iraq.

My first thoughts were for Natasha's family, her anguished husband, children and mother. I knew that they would not be hearing comforting things in that ICU. Unlike other injuries, there are no "norms," or percentages, no reputable "cure" rates. I had listened to frightening pronouncements, terrifying potential outcomes. I knew what a brain injury could mean; recovery was possible, but no one in the medical community wants to offer much encouragement in the early days.

The odd juxtaposition between Bob's near death blast from a bomb just 20 feet from his tank and subsequent miraculous recovery against a Mom's simple fall on a bunny slope resulting in death is the very thing that makes brain injury so hard to comprehend. Yes, those incredible military docs knew exactly what to do with Bob -- cut the skull bone and let the brain tissue swell to preserve it. They've seen far too many of these injuries in Iraq and Afghanistan. Sadly, too few hospitals in the US perform this kind of trauma surgery.

But the fact also remains that the ultimate outcomes of brain injuries are impossible to know, often with confusing symptoms, and are virtually unknown to the average American. It might shock you to learn that 5.4 million Americans are living with a brain injury. In fact, 1.5 million Americans get a brain injury each year. That's more than MS, spinal cord injuries, autism, AIDS -- and yes -- breast cancer combined annually.

A brain injury can set people up for a lifetime of issues ranging from personality changes to the inability to work, socialize, organize tasks for the day or process information and emotions. Brain injuries affect mobility, coordination, and language; bring about epileptic seizures and the list goes on.

In the two years that the Bob Woodruff Foundation (ReMind.org) was established, we have met more families and individuals affected by brain injury than I could have imagined, both in the military and civilian worlds.

I can remember them all, however some loom larger than others. There was the marine with post-traumatic stress disorder from concussive bomb blasts that had tried to strangle his wife in her sleep. I can picture the adorable three year old baby whose sitter had shaken her in a fit of anger, so hard that it jostled her brain against her skull, leaving her blinded and paralyzed on one side. There was the teenaged football player in the Midwest who had tumbled in a routine tackle and when I saw him in the rehab hospital he was unresponsive, his skin ashen. And then there was the middle aged wife, a victim of domestic violence in Virginia, who 14 years after her injury still had a hard time tying her shoes and remembering to lock the door when she went out.

Unlike other diseases or conditions, brain injury has had no recognizable faces, no champions, no Christopher Reeves or Michael J Foxes. While dozens of high profile celebrities, and CEOs have sustained brain injuries over the years, they have chosen to either quietly recover or have faded from view. While this is certainly anyone's prerogative, it has served to keep brain injury in the shadows and has done little to rip away the veil of shame that shrouds it.

Brain injury has always carried with it a stigma -- that someone is slow or retarded. These are the people, as one doctor told me, who often live "at the back of the house." Socializing, appropriate behavior or language, tracking and processing conversations are often challenging, especially with frontal lobe injuries that often result from car accidents.

And while there are still so many things we need to learn about the brain, there are also simple things all of us need to know so that what happened to Natasha Richardson might be avoided if we take a concussion and head injuries seriously.

And this is where our sports culture has been both guilty and silent. No one in professional football, boxing or other contact sports wants to talk about the downside to all that glory. Concussions.

Recent studies of brains of deceased professional football players show dead tissue in areas different from those typical in a brain with dementia or Alzheimer's. The bottom line is that if you hit your head hard enough or enough times, you are going to destroy or rearrange some neurons. You're going to kill brain cells.

I think about Muhammad Ali the boxer and his early battle with Parkinson's and memory issues. What about OJ and his murderous rage, bad judgment and erratic behavior? It's hard to imagine some of this isn't attributable to all those intentional blows to the head. Professionals will tell you it is.

We've got to ensure that the first reaction by coaches and parents should not be to "shake it off" on the sports field after a collision or brief disorientation. Even if your child didn't black out -- Mom and Dad -- take those kids right to the ER and get a CT scan or MRI. Even a slight swelling of the brain tissue from a mild concussion can lead to serious issues in concentration, headaches, and dizziness and if there is a second insult before the brain has time to heal? Not good.

Yes, I see the world differently after Bob's injury. I see how precious life is. I see how many chances we all take, how infallible we believe we are. I see children without bike helmets, hockey players slammed into the glass, people with no seatbelts or skiers without head protection and I cringe. I know too much.

No, we can't bubble-wrap ourselves up from life. What happened to Natasha Richardson seems to be not just the wrong continuum of care on the part of those who treated her that day but also an illustration of the great randomness of existence. The fickle finger of fate.

So buckle up, strap in, buy a helmet, and talk to the coach. And remember what a Marine told me once -- even when you are having a lousy moment - every day above ground is a good day.