Thursday, February 24, 2011

What Happens Inside a Brain When it is Injured?

I'm not a doctor, and I'll never claim to be one.  But I can only imagine how challening working with patients who have suffered through a TBI can be.  The complexity that this injury presents must be mind-boggling, literally.  Given that no two brain injuries are the same, no two doctors will draw identical conclusions from a patient, and no two recoveries progress at the same pace, physicians who work in this field of medicine are absolutely, without a doubt, heroes.

For the first 3 weeks after my injury, I lived in a hospital in northern Michigan.  While I have zero recollections about this experience, and about the actual car accident, living in the intensive care unit of the hospital for this extended period of time must have been rather torturous for my parents.  Upon receiving the initial call in the middle of the night on 12/29/01, they jumped in the car a few hours later to drive the 8 hours to the hospital where I was.  Even though I have no memories of being in that hospital in Michigan, knowing that my parents were there with me comforts me greatly. 

When my recovery had progressed to the point in which I was ready to move on, I was boarded on a small medical plane with a nurse who accompanied the pilot and I on a flight to Cleveland.  My parents, who lived in Cleveland, were thrilled that their home city had such wonderful hospitals that contained such reputable trauma centers.  So our headquarters and our home shifted to MetroHealth hospital for the next 8 months.  For the initial 6-week stretch in Cleveland, I lived as an inpatient in the hospital.  From there, after 9 total weeks of living in hospitals, which seemed to actually last for 9 years, I was able to move home with my parents while we travelled to and from the hospital several times each week.

The First 5 Weeks

Of the 9 weeks living in the hospitals, I have no memories of the initial 5 weeks.  This stretch of time does not exist in my brain.  I am only able to think back to this period based on what others have told me about these troubling times.  The shock value of what I have learned about this period of time is truly unfathomable.  To think that I had zero control over the thoughts in my brain as well as the words that were emitted from my mouth are mind boggling. 

Jerry Seinfeld's Sister, a.k.a. My Mom

Jerry Seinfeld is someone who I've always appreciated and who can always make me laugh.  I've watched his sitcom just as much as anyone, as I think he is an entertaining, funny person.  Little did I know that he made such an impact on my life that I felt some type of connection to his sister.  For the record, I have absolutely no clue if he even has a sister.  But I convinced myself that he had a sister.

My mother tells me about the time that I was convinced that she was Jerry Seinfeld's sister.  While she was probably freightened beyond belief that I really did voice my insistence, and my very strong insistence from what I'm told, I can now smile and apologize for this mixup.  To this day, she tells me how she was in such a precarious position at this time. 

On the one hand, she was so upset that I genuinely was so mixed up and confused that I claimed she was Jerry Seinfeld's sister rather than my mother.  But on the other hand, she tells me how frightened she was at that moment.  She recalled that our heads were fairly close together when we had this conversation and that I became visibly upset when she denied what I felt so strongly about.  When telling me that she was not Seinfeld's sister, my eyes supposedly almost popped out of my head, as I was filling myself with rage and anger.  She claims that my sinister look forced her to stand up and move away from me since she was frightened to be that close to me at that particular moment.  I've never hit anyone in my entire life, and I'm sure I never will.  But my mom insists that the thought went through her mind that I was going to strike her at that moment.  Why was she lying to me?  How could she suddenly deny that she ws Seinfeld's sister? 

To this day, this story is only a memory due to my mom telling me the story.  I almost feel like she's telling me a story about someone else.  Obviously I believe her and her details from this story, but, for the life of me, I cannot imagine the persistence I demonstrated in this unfathomably heated conversation.  The fact that I have zero memory in mind of this exchange really and truly is mind-blowing. 

The Really Fun Cruise Ship

While my parents and I were fighting this battle, my sister remained in Chicago with her family.  She received regular updates from my parents, but she did not join us in the hospital in northern Michigan.  Frankly, as my parents have said, she wouldn't have wanted to see me in the condition I was in.  But during the first couple weeks in the hospital in Cleveland, she made the journey from Chicago to visit me. 

Not knowing what to expect, she exuberantly walked into the room, as she was so happy to finally see me after everything I'd been through the past few weeks.  And, from what I'm told, my jovial reaction to her "how are you" question entailed telling her how much fun I was having on the cruise ship.  Upon hearing me tell her some of the details about the wonderful cruise ship we were currently vacationing on, she darted for the hallway, as tears of fear and amazement overpowered her. 

Equating being in the hospital after having suffered through a severe traumatic brain injury with being on a cruise ship is, again, absolutely non-sensical and unbelievable.  What in my mind could have possibly triggered that response to her question?  While we are all able to laugh, somewhat, about this story almost 10 years after the accident, I can only imagine the shock and horror that echoed through her body. 

Once Good with Numbers, Always Good with Numbers

While each person's brain is wired differently, my brain has always allowed me to excel when working with numbers.  From competing in mental math contests in elementary school to rarely relying on calculators, I have always excelled when working with numbers.  While the minds of some people have resulted in them being especially strong in debates and argumentative matters, for example, my mind has always been sharpest when working with numbers.

While in my hospital room in Michigan, my doctor challenged me to count backwards by 7 starting at 100.  My parents, doctor, and nurses who were in the room were shocked to hear me rattle of the numbers just like nothing was wrong.  Granted, I was in bed in my own little, barely communicable world.  But the numbers flew out of my mouth more quickly than they would have for the majority of people who were not recovering from a serious TBI.  Everyone's jaws dropped, as they bewilderingly looked at me and were shocked by my mental aptitude for thinking with numbers even though I was in such a sad, sorry state at this point in time.

My competencies with numbers also translated over to my insistence to play the card game Uno with my parents for hours at a time.  And some more hours.  And maybe a few more.  I enjoyed the game so much, as I was able to pay attention and serve as a legitimate opponent for my parents.  They were good sports for playing the game with me for so many consecutive hours.  And I looked so forward to these games even when we weren't playing.  The game allowed me to use the parts of my brain that were still functioning so very well, and I enjoyed the competition, companionship, and the feeling of being "normal."

Tuesday, February 22, 2011

Recovering from a TBI

I've played my share of competitive sports over the years.  While I thought of myself as being slightly above average in terms of my abilities in sports when I was in middle school, slowly but surely others caught up to me and surpassed me by leaps and bounds.  Just like any athlete, I had my share of sprained ankles, broken fingers, and strained shoulders.  But with every one of these injuries, I followed the same routine.  Stay off the field or court for a couple weeks, apply ice, protect myself with a cast or splint, and bide my time until my injury healed.  And, every single time, I was able to get back in the game within a few weeks.  The body is very resilient, and these types of injuries are quickly overcome.  Sure, some of these impairments might stick around for a few months, but, for the most part, the healing process is fairly quick and the body returns to its prior condition.

A devastating skiing injury.  A horrific fall onto concrete.  A life-threatening car accident.  Nobody wishes any of these occurrences on anyone.  And while survivors of these experiences come closer to death than they've ever been, life frequently issues survivors the challenge of a lifetime: the dreaded TBI.  Traumatic Brain Injury.  Many people have heard or read about them, but few people really know how challenging and horrifying the hopeful road to recovery can be.

Intracranial Injury

A not so common injury is the life threatening, intracranial injury.  Also known as a traumatic brain injury (TBI), these injuries can be beyond devastating.  While a jammed index finger requires some ice, a splint, and some rest, an injured brain is so much more complex.  There is no such thing as a typical recovery, and, given that the brain is arguably the most complex organ in the human body, gaining an understanding of what the recovery process entails can only be fully understood through a first-hand experience. 

12/29/01.  That day is down in the books as the worst day of my life.  And my family's life.  At about midnight, I was a passenger in a car and was involved in a horrifying accident.  Given that I suffered a severe TBI, I have zero recollection of the details surrounding the planned road trip and the accident itself.  I firmly believe that I'm better off not remembering anything.  Flashbacks to traumatic events such as an awful car accident can harm people for years.   But, in my case, I don't have these flashbacks since my mind has permanently deleted the incident. 

The one thought I repeatedly have from 12/29/01 is the idea of my parents in Cleveland, Ohio receiving a phone call from a hospital in northern Michigan informing them that I was involved in a serious car accident and that I'm in the hospital and am unable to communicate.  Hello!  Talk about earth shattering.  In what has to be every parent's worst nightmare, I can only imagine the shock and horror that reverberated through my parents from head to toe.  That phone call received in the middle of the night must have nearly ripped the soul out of my parents.  To this day, this is the everlasting image in my mind of 12/29/01.

Pain and Suffering

So what does a TBI feel like?  How does a person go about recovering and bouncing back to the dream of returning to a "normal life"?  That's not an easy question to answer.  But I will say that the process entailed an unbelievable combination of tears, hard work, and gut-wrenching, soul draining, excruciately painful and terrifying moments that I never realized were humanly possible or realistic. 

I've always lived a life that has been fairly status quo.  Some might call it boring and uneventful.  But, I am a non-risk taker who has always lived a low-key life while tuning into simple pleasures and hobbies.  An exciting night might consist of having dinner at a restaurant that I've always wanted to try or even playing cards with some guy friends that I haven't seen in a few months.  That's about as exciting as it gets, right?  And a terrible day could entail having to wait on the train platform for three trains before I'm finally able to squeeze into a train that has no business accepting another passenger.  That's usually as bad as it gets.  Bottom line is that my peaks and valleys typically don't venture too far from my status quo.

But suffering through and recovering from a severe TBI elongated my peaks and valleys to extremes that I never knew were even possible.  Learning that I attempted to convince my family a couple weeks after the accident that my mother is actually Jerry Seinfeld's sister, which is absolutely not true, or that I asked my parents in the hospital a couple hundred times per day where we were are absolutely beyond difficult for me to comprehend.  The fact that my brain was so twisted inside-out and turned upside-down is almost impossible to believe.  And, similarly, the joy I think back to when I would wake my mom, who slept in the hospital with me for the first few weeks, up out of her sound sleep at 3:00 in the morning to take me down to the hospital cafeteria in my wheelchair for some ice ceam is mind boggling. 

The Road to Recovery

Many people have asked me or have wondered about the mental anguish associated with recovering with a traumatic brain injury.  The fact of the matter is that people will never ever understand the process.  Only those who have suffered through a dreaded TBI can understand the seemingly insurmountable road to recovery.  The challenge is so immense for so many reasons.  As the body is feeling better and healing, the brain is about a few hundred thousand steps behind.  The arms and legs are healing, but the brain still has a ways to go.  I found myself constantly terrified with the idea that my body is getting much better but that my brain was essentially still broken and not working.  Not being able to remember what I did 10 minutes ago, not remembering who my friends were, not being aware of my parents' birthdays, etc.  My brain was not working, and it was the scariest feeling I've ever had.

I've told curious people to imagine an enormous room filled with nothing but filing cabinets.  Not just 2 or 3 filing cabinets.  But hundreds.  Maybe thousands.  And this room is not just any room.  It is a room that never has any person step foot in there.  The room doesn't have an ounce of dirt in there.  It is an incredibly well-protected room that is never disturbed or disrupted.  Simply, the room contains an incredible number of filing cabinets, each with 7 or 8 long, pullout drawers.  And each pullout drawer has about 30 or 40 folders stuffed with copious amounts of tightly packed papers containing an inordinate amount of notes, text, and photos.  The volume of data and information in this room is staggering, as the filing cabinets have grown over the course of over 25 years.

The room described above is actually a person's brain.  My brain.  On 12/29/01, I was 27 years old.  After growing up in the suburbs of Cleveland for the first 18 years of my life, attending college in Michigan for 4 years, and then having lived in Chicago for 5 years after college, my brain was stuffed and overloaded with knowledge, data, information, and memories.  Similar to the filing cabinets.  Everything in my brain was arranged and organized.  The content of my brain had never been disturbed or disrupted.  Part of my brain was wired to store information about my experience in Mrs. Roman's kindergarten class.  This folder of memories contained pictures of other people in my class as well as a navy blue short-sleeve shirt I wore to school frequently that had my name embroidered on it.  Another folder contained images, sights, and sounds associated with all of my favorite foods.  Whether you're talking about ceviche from Fonda del Mar in Chicago as an appetizer, chopped salad from Cowboy Ciao in Scottsdale, pepperoni pizza from Geraci's in Cleveland, or the spicy Mexican hot chocolate from Hot Chocolate in Chicago, my encyclopedia of a brain related to food dishes was a voluninous textbook.

Well, on 12/29/01, this entire room of filing cabinets was absolutely blown up.  The room was devastated.  Every paper in every folder in every drawer in every filing cabinet came flying out of the drawer.  The insanely tidy and organized room had become sheer mayhem and pandemonium within the snap of a finger.  Utter chaos had been introduced to what had always been the safest and most off-limits part of my body.  Each and every item from the filing cabinets was still in the room, but the contents were now mangled beyond recognition.  Piles and piles of twisted and torn metal and ripped and crumpled papers now filled this room from top to bottom after the tumultuous explosion that ravaged through what was once the untouchable brain, my biggest treasure.

Where to go from here.  The challenge of a lifetime.  Literally, I was required to pick up one piece of paper at a time, dust it off, reacquaint my brain with the image and the associated experience and locate the original folder of the memory and deposit the paper in the folder.  My precarious condition forced me to literally re-introduce myself to every ounce of information that was previously neatly stored in my brain.  I had to re-learn everything, and I mean everything.  All of the contents from before the accident were still in my brain.  The problem was that the scene in my brain was so chaotic that there was zero order.  I was onsite at an earthquake and had to refresh each and every piece of information. 

Looking through my high school yearbook was incredibly helpful to my recovery.  As I looked at each picture in the yearbook, I honestly felt my brain picking up all memories associated with the person, dusting them off, and re-inserting them into the appropriate folder in my filing cabinets that were slowly and carefully being rebuilt.  The seemingly insurmountable challenge was terrifying.  Each and every person that's been part of my life, each and every sports team I've ever played on, each and every subject I studied in school, each and every book I've ever read, etc.  The list goes on and on and on. 

The idea of piecing my life back together in my mind was incredibly scary.  But there was no doubt that I was going to get there.  I was going to pick up one piece of paper at a time and restore it in my brain that was rapidly being replenished with information.  I was determined to move back to Chicago and return what I had called my "normal life."  The return to Chicago was not going to be easy, as I had just begun the MBA program at the University of Chicago.  As I was struggling to piece together the content of my brain, how was I possibly going to return to one of the top MBA programs in the world?  The challenge was enormous.  But so was the opportunity.

Piecing together the contents of my brain was not easy by any means, and so much of what is taken for granted by people was something that I had to re-learn.  I will never forget the preparation I went through before going to take a shower in the hospital with one of the nurses.  I was not familiar with the order of events in the shower, and I had to rehearse the routine with my parents.  If we knew that the nurse was coming to get me at 2:30 to go take a shower, I would start rehearsing the process with my parents at about 2:00.  "First I get in the shower and wet my body from head to toe.  Then I'll squeeze some shampoo in my hand.  Next I'll rub the shampoo into my hair and will scrub for a couple minutes.  Then it's time to rinse the shampoo out of my hair.  Etc. etc. etc."  The routine continued and continued, as I talked through washing my body with soap. 

My parents were such an instrumental part of my recovery, and  I cannot express this enough.  Without them, I wouldn't be where I am today.  There is no doubt about that.  They simply refused to believe, or let me believe, that anything less than 100% recovery was possible.  However, on one occasion prior to going to the showers with one of my nurses, I recall becoming furious with my dad.  He was with me in my room, and he was aware that the nurse would soon be coming to the room to escort me to the shower.  While I would typically rehearse my shower routine for about 30 minutes, my dad decided to challenge me.  He intentionally neglected to tell me that my shower time was approaching.  I will never forget the fear that shivered through my body when the nurse walked in and told me it was shower time.  Sheer panic reverberated through my body from head to toe.  But I cannot go to the shower.  I didn't rehearse my shower routine 15 times with my parents.  Dad.  Dad!!  How could he do this to me?  While I was beyond furious at that point in time, I soon realized that as I was recovering, these seemingly enormous steps forward were required in order for me to return to my "normal life."

Moving On

And return I did.  My doctors initially informed us that I would be able to move back to Chicago in 18 - 24 months.  But 9 months after 12/29/01, I signed a lease for an apartment in Chicago.  My recovery was in the past.  My return to normalcy was in the present.  And SRM was in the future.