The first thing I tell her is that I cannot help. Her son Jake is thirty-four, my age. His gray, bruise-flecked limbs are splayed out on a bed before me; his mouth is dry and agape. I know I cannot help him. I cannot file a lawsuit against the insurance company, I cannot conjure a way out of this dead-end nursing home, and I cannot sucker punch the aloof psychologist or throttle the ignorant psychiatrist. I hold no sway over the waiting list in my own hospital. I explain to her that I can do nothing at all, and she sighs. She is desperate to see Jake in a program where there is a sense of progress and direction. She knows that the rehabs and specialty hospitals are as inaccessible as the moon. She has called them herself, and she knows that nobody can help. She knows I cannot help, but she asks me anyway. She asks, in all earnestness, to do the impossible and find her son a bed, and in my weakness, I agree. It’s my job to agree.
Mason is not a doctor; he’s “an editor, writer, speaker, and journalist.” At the time this book was written, he was also a brain injury case manager for Brookhaven Hospital in Oklahoma. In this book, he blends medical information with patient stories and philosophical musings in smooth prose that’s a pleasure to read. But his main purpose, I think, is to generate awareness of brain injury: to improve prevention, treatment, and most importantly, rehabilitation.
Most of the chapters use a single patient’s story to illustrate some aspect of brain injury. He never gets lost in medical jargon, but includes considerable technical material, though I often wished there was more. I’ve been reading “doctor” books since I was a teenager, so I’m not afraid of a few Latinate words. Still, I greatly enjoyed the book, and I’m glad to know a little more about the issues he raises.
There are some happy endings here, but it’s more of a clarion call to action than an inspirational book of hope.
The Hermit of Hollywood Boulevard
In snowboarding parlance, Cheyenne had a yardsale – a crash so intense that personal effects are strewn over a wide area. In a grimmer manner of speaking, Cheyenne had just suffered a catastrophic injury.
In this story of Cheyenne Emerick’s snowboarding accident, we’re introduced to various classifications of seizure disorders and the effects of frontal lobe injury. We’ll return to Cheyenne at the end of the book for an update.
A Prisoner of the Present
We place a peculiar spiritual value on memory. Notwithstanding Revelation, the allure of heaven itself depends on memory. Most people act appalled when confronted with the prospect of having no memory of this life in the afterlife, and yet none of us seem to have a problem with the fact that we don’t remember our first few years following birth…..In some future dementia or god-forbidden accident, we may, like Julie, forget our first kiss or our best childhood friend, or we may forget the times we begged for death or let down our loved ones. Forgetting is hell, forgetting is heaven.
Julie’s short-term memory was disrupted in a car accident.
An Insult to the Brain
There’s a good chance you already have a brain tumor….Every fifth person has a tumor somewhere in his or her skull, quietly embedded in a gland or elsewhere, too small to see and too scary to want to see. For most of us this tumor will remain still and undetected, and we will pass our lives pleasantly unaware of its presence.
Rather than focusing on a patient, this chapter discusses what’s included under the term “traumatic brain injury.”
Rob Rabe Cannot Cry
Kathy Herring, Rob’s mother, is widely regarded as the matriarch of brain injury advocacy in Iowa – no small accolade, since Iowa has a reputation as one of the most progressive and survivor-friendly states. More options exist for Iowans with brain injuries than for most other Americans, and Iowans have Kathy Herring and a handful of others to thank.
Rob was injured in a car accident, spurring his mother into her role as advocate. Rob himself works with brain injury survivors at for the Greeley Center for Independence in Colorado.
Portrait of an Injury
At age twelve, Asya Schween was injured in a bike accident in Russia. This chapter details her successful efforts to deal with the sequelae: now living in California, she has earned two Masters degrees and a PhD, and has a successful career as an acclaimed photographer. Of her self-portraits, she says:
When I see them here on the wall, it is like looking at fossils. Sometimes I notice them and they are funny. They are humorous, not macabre. People look at my photos and say what a sad, sad creature I am. It’s probably the person looking at the photo that is sad, not me.
The Only Thing That Works
Violence and psychiatric disturbances as a result of brain injury; the process of rehab hospitalization, which can last years and may include transition to a step-down setting.
The Resurrection of Doug Bearden
Due to a brain injury caused by herpes encephalitis, Doug sometimes believes he’s dead. The chapter details the struggles he faced with the VA system, and refers to the Tibetan Book of the Dead and the levels of Bardo.
As a young child, Bryan suddenly started having behavior problems. These were eventually diagnosed as a seizure disorder traced to a diffuse brain tumor. The difficulties of negotiating the California special education system are described. Mason distinguishes between treatment of mental illness and brain injury; this is a bit vague, maybe the only part of the book that’s not very clear.
Fugue of the Pony Soldier
A Cherokee construction worker is injured on the job and begins to suffer dissociative fugues. Mason participates in a sweat and details the experience.
In All Earnestness
Post-concussion syndrome following a car accident – disorientation, memory problems, concentration issues, and the rare occurence of psychogenic anaphylactic shock. How Eastern-based mindfulness exercises, meditation, and yoga helped with various problems.
The Hospital in the Desert
A hundred years ago, a horse’s kick to the head wuld have done you in. In Iraq, you can take a golf ball-size missile through the skull and survive. Thirty years ago, a severe brain injury meant that you couldn’t go to work anymore, and five years ago, a severe brain injury could mean a long coma, a minimally conscious state, or a daily condition of total dependence. In the regrettable math of the Iraq War, truly severe brain injury now comes with polytraua: brain injury plus a plastic arm, minus your balls, divided by weeping burns. You can survive more injuries than you’d care to know.
Military care of brain injuries at the Air Force Theatre Hospital at Balad Air Base in Iraq, The Brain Injury Capital of the World. A fascinating and frightening chapter.
Balad Hosopital proves that we are no longer asking most soldiers to die in service; we are asking htem to accept a lifetime of severe disability.
A soldier and a three year old Iraqi girl are followed through the hospital; we see the differences in their care and aftercare.
Should a brain injury befall you in America, you stand a 71 pecent chance of being alive one month after your ER visit. If a brain injury occurs anywhere in Iraq and you’re medevaced to Balad, your chances of survival skyrocket to 98 percent, the highest rate of survival for any trauma hospital in history. .. Twenty years from now, American trauma care will be modeled after Balad Hospital’s pioneering work. It is healthcare unencumbered by insurers and accreditations.
“It’s the purest medical mission in the world,” Powell explained to me, “but it’s not one you would wish on people.
Wood of the Suicides
Get a serious head injury in Council Bluffs, Iowa, a town that borders Omaha, and odds are that you’ll qualify for a special healthcare waiver that will allow you to access a number of brain injury services and programs. Depending on the severity of your case, the state of Iowa may pay for years of rehabilitation, without any significant cost to you or your family. Cross the street into downtown Omaha, get the wrong kind of brain injury, and you’re f*cked six ways from Sunday – a predicament that isn’t exclusive to Nebraska.
Daniel is one of those caught in this predicament. As Mason details his case – anoxic brain injury due to attempted suicide by hanging – he’s torn by the memory of the hanging suicide of his artist friend, John. I’m not sure the multiple juxtapositions in this chapter work – Daniel, bureauocracy, John, a visit to a Buddhist monastery. They’re all important, and it feels cluttered; I’m distracted by so many themes.
Before that day, brain injury had always been my business; now it crossed into the personal. I felt violated by the intrusion, as though working with survivors had somehow inoculated my family and me from the risk of injury. With the development of the complication, that line had been erased.
In this brief chapter, Mason considers his own reaction to the possibility his baby will be born with brain damage (which happily does not happen).
The book ends with appendices of sources and a resource directory.
I chose to read this book almost on a whim. Since I spent virtually all of last year reading short stories, I wanted to read more novels and non-fiction this year, while keeping up with the three major short story prize volumes and a few other sources. I’ve been reading medical non-fiction since Dr. William Nolen’s Making of a Surgeon was excerpted in Reader’s Digest when I was a teenager. I have just about everything lay-medical: from the 50s’ The Intern by Dr. X (in which cancer isn’t treated – there isn’t any treatment – and an intern’s lunch of chicken a la king, pie, and coffee are outrageously expensive at 85 cents) to the hilarious and irreverant House of God by Samuel Shem (loose inspiration for the TV series St. Elsewhere to the philosophical musings of Oliver Sacks. So medical non-fiction was a logical place to start, and during a library visit I picked this book right off the 617 shelf because it looked interesting. To my surprise (that isn’t usually a successful tactic), it was.
I read this over a couple of weeks, usually one chapter at a time. If I’d read more per sitting, it might’ve seemed a bit oppressive; it’s not a happy book, although some of the people involved have done quite well after their injuries. But I thought it was excellent, informative and moving.