Living with Traumatic Brain Injury

Introduction
This is the story of the gradual recovery of a PhD student from traumatic brain injury acquired in August 2001. The first part of this story is verified by two college friends who visited me at the hospital within the first and second week of the accident. The remainder of the immediate post-accident era is verified by my daughter. The rest is my personal recollection after I regained my memory.

The accident and injury
I graduated as a school psychologist in Michigan in the summer of 2001. I was almost near the completion of my PhD. I had 5 classes left and my dissertation. I had a GPA of 3.94 for my EdS and my master’s degree was attained with a 4.0.average. Exactly one week after my EdS graduation I got into a serious car accident in Colorado. The ambulance arrived within eight minutes and I was intubated on the field. It was said that five minutes more without help and I would have died. I was thereafter diagnosed with traumatic brain injury, a fractured neck, torn scalp, broken left arm, two broken wrists and a leaking artery in my left eye. I was also in a coma for three weeks-Glasgow coma scale of 6-and had total memory loss for five weeks.

A tracheostomy was done and I was fed through tubes for a couple weeks. My stay in the hospital/rehabilitation center was three months. Recovery was uncertain because my family was told I may never walk, talk, use my hands normally, or be the same person again. I attended a Christian university and with my university, family, friends, and past students at least ten thousand prayers were said on my behalf. I also had an excellent medical team and exceptional auto insurance in Michigan that took care of me.

My college friends’ arrival one day after the accident
When my friends arrived at the hospital I was in intensive care and connected to many different tubes and machine. I was in a light state of coma where I could only slightly twitch my hands. A portion of my skull to the right of my head was removed to insert an intracranial pressure censor to detect any swelling of the brain. My hands had to be secured firmly to prevent me from removing any tubes. I was not responsive to my friends when they first arrived but a few days later I was more responsive and seem to know who they were. My friends said they talked to me everyday especially about people I was familiar with, read bible passages for me, sang and played Christian music for me on a tape. They said I appeared to like that. Whilst they were there I also had tubes in my mouth so I could not respond to them verbally. By questioning me and observing the movements of my right arm, they ascertained that I did not like or want the tubes in my mouth.

Another college friends’ arrival one week after the accident
My other college friend arrived one week after the accident. She indicated that after a week I had to have surgery to stitch my scalp, repair my left arm, insert a breathing tube into my trachea and place a tube in my stomach. I was in intensive care for a few more days and then transferred to another unit. She brought an audio cassette of greetings from friends and professors. Even though she played it for me I could not comprehend anything but she thought it did give me some comfort. She said that she gave me a pen and paper to write but it was not legible. I gave it back to her shortly afterwards.

She also explained to me about a year later, my reactions to my husband’s visits. We were separated then. Whenever he would visit and I heard his voice I would just close my eyes. As soon as he left I would reopen my eyes. There were times when my eyes were open and he spoke to me, and I would just glare at him. My friend knew about the impending divorce and could read my facial expressions. She knew I was not pleased to see him. He remained about two weeks. By the time my friends left after two weeks, the tubes were out of my mouth.

My mother and daughter’s arrival to the hospital three weeks after the accident
My mother and daughter arrived from my home country of Trinidad, three weeks after the accident. It was September 15, 2001. When they first entered my room, they said I was just lying on the bed. My back was turned towards the door and I was shaking my feet, a previous habit of mine. They said I turned to look when I heard the door open, and then I instantly recognized them. They said my looked was one of intense shock. I immediately began to cry. I couldn’t talk but I began to babble all sorts of things. My mother couldn’t understand what I was saying but my daughter figured out what I was trying to communicate. She said I was asking about leave I was supposed to have to continue my studies.

They were shocked because even though I could barely talk, that was what I was mentally preoccupied with. When they returned the next day I was up, trying to walk and babbling all the time. After my college friends had left, there was no improvement in my vital signs. I had become stabilized. Even though my daughter and mother did not always understand me, they were happy that I was trying to talk. They were asked to bring music I loved and they did. They said I basically babbled on and on about Bob Marley, saying nothing really but his name. They also said that though I had no recollection of basic facts, I was able to recognize President Bush on television. Within three days of my family’s arrival, I was approved to go to for rehabilitation at another facility, because of my progress.

My memory returns
Even though my mother and daughter were spending time with me daily, I did not have proper cognizance of them at first. I only recognized them after the arrival of my sister from Ireland. I believe it was the shock of seeing her, as we only saw her every couple of years. After calling out to her, then I remember actually recognizing my mother and daughter. I believe this was about 5 weeks after the accident. Prior to this, even when my professors from the university called I could not remember them. At this juncture, I had no knowledge of where I was or what happened to me. I specifically remember my mom asking if I remembered anything and I said no. My memory of other minute details was also gone. About 6 weeks after the accident my mother showed me a pen and a pencil, and I could not recall what they were. I did not know the names pen and pencil.

Awareness of injury
When one of my college friends revisited me after 2 months, she gave me a little bit of information about the accident. My other college friend had called me and asked if I remembered what I was doing at school, but I did not know. I did not process the fact that I was near the completion of a PhD, and just understood that I was ‘in school’. I remember trying to read a devotional book my friends had left me, and would read one page per day. Even though I was reading words I had no understanding of what I was reading. It took at least six months for me to begin to reason and understand anything. When I left the rehabilitation center in Colorado, after three months, the doctor had said no school for one year. However, my mind was never focused on the aspects of TBI. I always believed I just had an accident.

My mom and daughter were taught how to massage my left hand and stretch my fingers daily, because I was returning home to Trinidad. There, I would have no access to physiotherapy. After leaving the hospital, my cast was off and I had to shower by myself. I got to examine the trachea scar on my neck, the scars on the back of my hands, the scar on my stomach where I was fed and the scar on my left arm. I had not known there were scars on my stomach or on my left arm, because I had never seen them before. I had never bothered questioning why I had a brace on my neck or casts on my hands: I took them for granted as I was undergoing recovery and treatments. I had even called the titanium in my body ‘titanic’ because that was a new word to me.

When I returned to the university for my passport, I remember the faces of most of my friends but forgot some of the names. I remembered all my professors and knew my room in the dormitory. I had forgotten my password to check emails but with concentration remembered it after 5 days at the university. My fingers were not functioning well and I used only my right hand very slowly. I slept a lot and generally took lots of rest.

Home visit and return to university
Upon my return and during my stay in Trinidad, my balance was off and my vision was in the process of healing. Everywhere I went I had to hold someone’s hands for support. I am happy to report that I remembered all my family members, nephews and nieces included. During my visit they were careful not to say anything negative or hurtful to me: They accepted me as I was. One of my sisters told me long after my recovery that my functioning at the time was like a four year old’s.

My mom and daughter massaged my fingers everyday and I practiced raising my arms as well. Great progress was made by doing those activities daily. I was happy to be home for a while just to see my family but I wanted to return to the university. I was still very dependent on having help. I left after 6 weeks and my daughter and I returned to the university. I got an appointment for a complete medical in Michigan after a month and was recommended for physical therapy occupational therapy, cognitive training and visits to the rehabilitation doctor.

I chose to have personal therapy at the university. My daughter left after 3 weeks and I then relearned to be independent very slowly, with the support of many friends. I continued with all the therapy needed and closely followed the directions given by the doctors and other therapists.

My first experience returning for classes
Just before the end of the first year, there was one class that was on my list and I decided to take it to determine if I could manage studies once again. After the class was done my professor told me that I did well, and I made a decision to complete the PhD. Whilst undertaking cognitive training, personal therapy, and one class per semester, I asked some of my professors if I could sit in on classes they were teaching, to refresh my memory of what I had done before. I was still beset by fatigue and needed lots of rest. I slept after lunch almost every day and needed to relax after 3 hours’ instructions.

The first conference I attended was a brain injury conference in Michigan. I went with a friend and I attended all of the sessions for 2 days. When I returned to the university it took me 5 days to recover because of extreme fatigue. My involvement with studies had to be conducted very slowly and I could not focus on assignments for more than 2 hours at a time. I had to take a couple hours’ break before I returned to do more work. Doing exams requiring short answers was very challenging, because I could not retain information for very long, and there were many areas to learn. Doing the multiple choice exams were more accessible to me because of the option to choose.

Therapy
I did personal therapy for 2 1/2 years. I was unsure of my functioning and was able to ask questions on anything I did not understand. I learnt about my strengths and limitations and how to take things slowly. I had to learn to pace myself for any activity I had and to ensure that I got the rest I needed. During my long days I had to learn to take frequent breaks and never do too much at one time. These are some of the strategies I had to learn to become more functional.

Relearning my skills
At the university, about 2 years after the accident recovery I was able to volunteer and work with students who were on probation. I conducted interviews, administered and scored tests, wrote reports with recommendations and presented the results to the students. All these activities were monitored to ensure that I was on the right track. My skills were still there and I was able to process the information and produce acceptable reports.

Return to Work
After being taken care of by my car insurance for three years I received enough support and practice to return to work. Because of my fear of having to drive in the snow, I moved to the west coast. I worked for a contracting company, taking on assignments for psychologists in various districts/states. In my job I had to learn new state laws, district policies and work with new people. It was challenging at times but I had a mentor and I did everything that was required as I went along.

It was a continuous learning experience. The constant moving is always difficult but I believed it allowed me to grow and become more independent. Now that I’ve had four major moves I am ready to choose a state, a district, and settle down.

Conclusion
After reviewing my healing process there are certain major factors that contributed to my successful recovery.

• The ambulance arriving in eight minutes and being intubated on the field.
• Being taken immediately to a hospital that was used to working with cases like mine and getting the most appropriate care.
• Having knowledgeable doctors who ensured they provided the best care I needed.
• Being prayed for by many people from different religious backgrounds.
• Having the support of my friends and immediate family members present in the early stages after the accident.
• Having a car insurance company that provided all the medical care I needed.
• Returning to a familiar environment with supportive friends and being able to continue with all the therapy I needed.
• Having personal therapy to understand myself and be familiar with my strengths and limitations.
• Having the opportunity to practice the skills I learnt before in a safe and caring environment to be able to return to work with confidence.
• Being involved in a gym gradually increasing physical activities especially relearning the various routines involved in aerobic exercises.
• Being covered by the insurance company for three years focusing just on healing and not stressing about work.

The most important part for me is the recovery of my mental functioning. Just as you witness the progress of a child from birth to adulthood, I believe with my recovery can be categorized in similar phases. My early babblings are like that of an infant, answering five questions when asked one is like a two year old and my gradual memory of names/ objects/people are like that of the early childhood stage. I went through the stage of middle and late childhood when increasing my long-term memory, problem solving and developing analytical reasoning. I would say most of my adult memorizations and abilities were accomplished after two years. The physical therapy and occupational therapy helped with my physical functioning. The cognitive therapy improved my ability to function as a student and the personal therapy allowed me to be aware of my strengths and limitations and accept these changes.

Rosetta S., School Psychologist, Ed.S, Doctoral Candidate

Contributors: Lorraine H., BA - Daughter
Chamra O., MA - College Friend
Magdalina S. R., MA - College Friend