This most engaging memoir narrates the harrowing physical and psychological upheaval that followed a life-threatening head injury‘ – the outcome of an episode the author referred to as ‘a silly, horrible, stupid accident‘. With a great storytelling style and an appealing narrative, the author provided a vivid account of her husband’s accident and its disastrous aftermath, portraying it as ‘a blazing meteor that just happens to hit one family member on the head’ and ‘creates a huge rift in the landscape, dragging the unlucky one down to the bottom of the crevice it has made’. Depicting the transformation the accident had wrought on their life as a ‘chasm between the old life and the new’, the narrative eloquently contrasts the heavy burden of brain injury on one hand, and the love, hope and recovery that lightened the load on the other. The book also helpfully infused the clinical and academic dimensions of head injury into the illness narrative, thereby making sense of the complicated assessment, treatment and rehabilitation processes that it describes. The end result is indeed as the author stated from the outset – one family’s ‘new and bewildering journey’ of traumatic brain injury (pages 3-5).
At the heart of the author’s story is the grisly head injury her husband suffered in a freak boat accident which left him ‘splayed across the stern of our little metal skiff, strangely motionless except for an occasional rapid jerk of a leg or arm’. His subsequent clinical course was similarly agonising as the author narrated such distressing symptoms as agitation, seizures and fluctuations in body temperature which she attributed to damage to his hypothalamus. Just as she pointed out that he had sustained ‘extensive damage in the frontal lobes‘ – what she said was ‘the part of the brain…that makes us who we are’ – she also referred to how his brain cells had undergone diffuse axonal injury, explaining that the neurones had become ‘jangled’ and even ‘perhaps sheared off’. The memoir also described his admission to the intensive care unit where he required a ventilator, a urinary catheter, and a feeding tube, and where he was treated with ‘morphine-induced coma to minimize his movements’, mannitol ‘to keep the brain from swelling too much’, and Dilantin ‘to prevent further seizures’ (pages 5, 12, 15, 18, 20-21, 28, 30-31 and 131-133).
In her portrayal of his recovery from acute head injury, the earliest ‘signs of awakening‘ the author documented was on the fifth day when he opened his eyes, muttered incomprehensible words, and shortly after started following instructions. She however observed that he was ignoring his right side, and she attributed this to loss of spatial awareness arising from damage to his motor strip. He also insistently kept asking, ‘where is the mango princess‘, repeating this phrase ‘more imploringly each time’. Other early symptoms the author described included excessive sleeping, lack of self-awareness, and periods of agitation and thrashing around. He was also very easily distractible, the author explaining that this was because ‘the injured brain loses its ability…to filter out distractions and concentrate on the task or conversation at hand’. The memoir also marked various milestones in his early recovery, such as when he regained his ‘sense of continuity‘, his ability to read, and his orientation and attention span. And rather dramatically and momentously was when he regained the ability to walk – what the author referred to as ‘a revelation, an affirmation, a redemptive moment‘ (pages 44-47, 52-53, 62, 80-83, 120-123, 130 and 142).
A prominent feature of the memoir is its portrayal of the astonishing neuropsychiatric manifestations that accompany brain injury, and the most intriguing of these was perhaps the delusion that the author was not who she said she was. So strong was his conviction that ‘the real Cathy‘ was somewhere else, she said he refused to refer to her by name, and even phoned and left a message for her whilst she was right there next to him. Another symptom was that of confabulation, what the author characterised as ‘one of the more interesting side effects of brain injury’, explaining that it occurs when the brain ‘takes little bits and pieces of whatever it can gather and cobbles them together into a narrative’. Another similarly peculiar symptom he experienced was perseveration, what they author defined as ‘the aimless repetition of a task or an idea’. The range of cognitive and behavioural symptoms he displayed also included retrograde amnesia, topographical or geographical disorientation, loss of the ‘sense of objective permanence‘, denial of paralysis, embarrassing disinhibition, the use of profanities, and occasional physical violence. It was therefore not surprising that the author went through a roller coaster of emotions, reporting such feelings as ambivalence to his survival, grief even though her husband did not die, and fear of having ‘no idea what’s going to happen next’ (pages 16-17, 84-85, 93, 111, 120, 126-132, 143-147 and 205-206).
The author’s early rehabilitation was also a complex phase of the illness narrative, and the author discussed this in the context of how rehabilitation means ‘you go from being a passive patient to becoming an active participant in your own recovery‘. She described how the process revolved around physical, cognitive, occupational, and speech therapy. Noting that the therapy sessions were only half hour long, the author explained that this was ‘because brain injury patients tire easily and can’t concentrate for very long’. She explored these different aspects of his rehabilitation comprehensively, for example referring to how occupational therapy teaches seemingly simple but ‘actually quite complex’ tasks as dressing, washing, and feeding. She also explained that the kitchen is chosen for occupational therapy because it is ‘a good environment for relearning the organizational skills needed for independent living, and she illustrated this with the complex sequencing skills needed to load a dishwasher. She similarly explored speech therapy with a fascinating account of her husband’s unique deficit, losing the speech concepts of flower and bird, and with an enlightening discussion on the physiology of language. The narrative also chronicled her husband’s three year long and turbulent journey to ‘community reentry‘ and return to work as ‘an incredibly high-functioning survivor of TBI’ (pages 113, 117, 119, 127, 133-134, 139-141, 184-200, 216-218, 227-230 and 242-245).
The Doctors Bookshelf 