A Shock to the Brain

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.

 

 

Comments

[ghese]

i too like many posting have tbi after being hit by a car (as pedastrian) in march 08. after ms. richardson's injury i couldn't stop crying because it hit home again how random life is. i still have strong headaches, light sensitivity, difficulty with some high pitched sounds and can't smell anymore, but i know i am one of the lucky ones.

thank you mrs. woodruff for your post it has helped me realize along with all the comments how we were all affected by her death and the importance of spreading the word about traumatic brain injuries and the variated ways those effected by it by it. something that has been very difficult for my employers and has been used against me.

[waitforme]

This is a useful article, especially considering the posts from people who have experienced brain trauma. But also considering those of us who have read it and might know better what to advocate for with medical personnel if this happens to us or someone we know.

"...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."
WHY do 'too few hospitals in the US NOT perform this kind of trauma surgery? Why don't they perform it immediately after getting a brain scan? This is missing in the story, an advocating word to brain surgeons and ER personnel. And an explanation for why brain surgeons neglect this procedure. Are we all -- those of us who may in the future have a brain bleeding -- going to be met with blank stares, with injunctions to go back home, there is nothing (that we can see with our own eyes) wrong with you? What if Bob had had a head injury in the U.S.? Would he be alive today? And if we do get a brain scan and it shows bleeding, are we going to get the proper care, what you say surgeons on the battlefield now are getting? Or not? This is worrisome.

[Elizabeth]

before my softball size tumor was removed, my IQ was 188, i read the dictionary when i was 10 and words were a huge part of my personality and i was a successful writer.the arrogant surgeon said he did a perfect crainiotomy and i would be just the same as before. not. he took my words and i am someone else. i grieved for her but i also began ideating suicide again because any time your brain is opened something or everything changes. i'm so happy for you and your husband and followed his recovery.

[Startreklivz]

The awful thing about the kind of injury Ms. Richardson succumbed to is that the patient can feel perfectly fine, even got back to skiing and other activities, sometimes for hours, without realising the extent of the injuries. Only much later, when the bad headache starts, does one become aware that something is wrong, and by then it may be too late.

[michellecools]

My 16 year old son suffered a concussion in November - 5 months ago. He was playing high school basketball, just a practice. The coach let him drive home, and I still don't know how he made it. I drove him to the ER the moment I looked at him. He has had to withdraw from school, and just last week was able to begin an online program to catch up in school, one class at a time. This experience has taught both of us so much. One thing I have discovered, is that there is so much difference between good doctors who respect and care for their patients and those who don't. We have found some great specialists who have given us hope and encouragements, as well as coping statagies. I still don't sleep well, because every noise makes me wonder if he is up having a migraine. I worry every time he is out of my sight. Oh, and the coaches at his high school lost all interest in his condition once they found out he couldn't play basketball anymore.

[Johnloehr]

I had a TBI from an auto accident 8 years ago. Since then I have been much more cognizant of violence in sports and the "macho" culture. One of the most frustrating things about TBI is the difficulty of measuring the effects and the length of time for recovery. It takes years to recover from most TBI, and it is difficult if not impossible to measure progress. Put simply, you can appear and test fine, and still be suffering the effects.
All this was evident to me in the vents surrounding Ben Roethlisbergers injuries from his motorcycle wreck three years ago. He came back to play far too soon. To anyone who has experienced TBI, it was obvious watching the difference in his play from the year before. It was the macho culture of "get back out there as soon as possible" that had him playing probably a year before he should have, and the difficulty in discerning the extent of the disability that had his doctors say he was ready to play. The risk of further injury was chilling.

[redbridge]

Yes Jason, there is hope - always. I sit here and nod to myself while reading through the comments, so many of them similar to our experience - a horseback fall involving fractured skull, pelvis, arm and leg in a remote part of the Badlands. In our case the skull fracture actually got credit for somewhat relieving the swelling during a difficult transport to hospital of more than an hour.

It is very sobering to listen as the mother who raised you speaks about recycling her Cadillac or repainting her horse(not a typo). But at about the '4 or 5 year mark' my sis - who lives hours away - started remarking on changes she noticed. Things I didn't note while seeing Mom much more frequently. Long story short, ten years later looks SO much different and better than two years later. A woman who could not be left alone is once again independent, got re-certified to drive and is off snow-birding like so many other seniors here in the north.

I understand that there are TBI incidents where the prognosis is certain and not favorable. My heart goes out to those involved. Sounds like most of us posters have 'been there'.

I just wanted to add our 'favorable outcome' story to the mix here. If it helps someone bolster their resolve to get through another day of dealing with their TBI incident, it's worth the typing. Hang in there. There is NOTHING foolish about your hope.

[Mikecoatl]

Whatever you get out and do - skiing, skateboarding, cycling, whatever - WEAR A HELMET! You'll look a lot more cool wearing a helmet than you will in a coma...

[jasonspark]

Here is to flipping TBI on, dare I say, it's head.
My wife was 16 when she was in a car accident that left her in a 5-week coma. If it was a miracle to Yale doctors when she regained consciousness, then the rest of the story left doctors stunned. Human development started over from day one. She learned to talk, she learned to walk. Her dominate hand was now paralyzed, so she taught her brain to write with her left hand. Doctors said she'd have a hard time taking multiple choice tests in school. She graduated from high school, college and got a masters degree in special education. She fought the education system to better accommodate modifications for TBI students, and she won. Twelve years later she is now a middle school teacher, married and lives in San Diego. That day twelve years ago, surgeons cut through her shoulders to repair a tear in her aorta, leaving scars where angels wings would be. Those close to her say that angels were with her the whole time. Our thoughts are with the family of Ms. Richardson.

[dizzzie]

My first head injury occurred at 6 months. I was accidentally dropped on my head. The next one happened when I was 21 and hit by a car as I was crossing the street. It does affect you forever. Sometimes it is just frustrating others it is infuriating. I still cannot spell - I cannot remember the sequencing of the letters so I really find it difficult to express myself well. I always tell people to use helmets because they will save you a lot of hassle later. They look cool okey!? In Colorado there is a push to have helmets on the ski slopes. I was just up there and was glad to see so many of the skiers using them. It seems to be older people who think that they haven't had an accident yet so why bother?

[danielet]

CASE A:Contusion of brain leads to swelling of the brain. Since the skull is a closed space, limiting space for swelling the brain pushed out, herniating through the only open space in the cranial box at the base of the skull, compressing the brain stem and ending life. CASE B: But if contusion is of skull with side of a blood vessel on the brain, the vessel breaks, the skull fills with blood, pushing the brain down so it herniates through hole at bottom of skull-- the end. In the former case of brain swelling there are concussion signs and symptoms early after the event. But the latter case is more insideous in that the filling of space with blood generally shows no signs and symptoms until the herniation is ongoing and death soon follows.

[RRonin]

I can see a lot of opposition to the precautions advised in this post. Coaches and teachers are going to feel pressured not to take a kid out of a game. Parents are going to object to their little star being taken out of a game for "just a head bump." I can even envision E. R. staff questioning why someone was brought in for "just a head bump." We live in a macho culture where we learn from movie and sports heros to "just shake it off" and play through the pain.

[Freesia2]

Thank you for this article Mrs. Woodruff, and for your foundation and for the work you and your husband have done and do to bring awareness to this issue.

I remember reading another good article by you in "Guideposts" awhile back. I'm so terribly sorry for what happened to your husband, but admire so much the good that you've done as a result.

[Jennifer Adams]

I am a survivor of a Traumatic Brain Injury. Lee, first of all, THANK YOU for writing. I just found your blog! I was wondering how the media would handle this, as we haven't heard much about Bob lately. This is something I want to Advocate for....I will be disabled for life, but this is where my passion lies...helping other Survivors, and getting the word out.

Again, thank you.
Jennifer Adams

[Freesia2]

I'm so sorry for whatever happened to impair you. (You write very well by the way. No one would ever know you have difficulties going by your post.) But thank you for your positive attitude and wanting to help other people.

[WellSpouse]

Good awareness-raising article on TBI by Lee Woodruff!
Carolo 454 said: "18 years ago my then husband suffered a traumatic brain injury. I now call myself a widow- the person I married is gone... As it becomes more prevalent in our world ... people [will] need to understand and accept it."
Yes, TBI is becoming more prevalent, as medical science advances, and more people like Bob Wooduff are saved. Lee and Bob were very lucky. But Carolo54's comment shows the other side of the coin -- more family caregivers, and especially spousal caregivers are learning about and having to deal with the mysterious and often infuriating behavior exhibited by a loved one with TBI -- and they desperately need emotional support and help in coping with the endless aftermath of a TBI caused by accident or illness.
I'm the president of the Well Spouse Association, http://wellspouse.org. A non-profit, 501(c)(3) organization the WSA offers peer emotional support to husbands, wives or partners of people with chronic illness and/or disability. About 10% of our members are caring for a spouse with TBI. We would like to see more attention given to the caregivers, who after all are the supreme enablers of their loved ones with this most invisible of all invisible illnesses. I invite Carolo and others married to a person with TBI to check out the WSA, and those who know of someone in that situation to pass on the information about the group.