I fell at home one morning more than two months ago, tripping over a leather-bound sisal runner in our front hall. I was holding an armful of papers and probably got distracted while reading something, when my flip-flop hooked under the rim of the rug and sent me flying onto the floor. I stood up quickly, then saw and felt a nasty abrasion on the front of my right shoulder; a few hours later it would be painful and scabby.
Though I was annoyed at my clumsiness, this did not feel like much of an event. I rinsed off the scrape, applied some Neosporin, and went about my day. I didn’t even mention it to my husband right away. Over the next few days the scrape healed and I stopped thinking about it.
Soon afterwards, I spent five days in New York doing my usual: walking, going to museums and to the theater, reading, seeing family, friends and grandchildren, eating in restaurants, etc. I point out these ordinary activities to underscore that I felt virtually no impairment. Twice, however, after walking for hours, and again after a turn around the reservoir, I remarked that I had a headache. I don’t get them as a rule, so this was strange, but I attributed it to the pavement-pounding and the heat. I took some Aleve and felt better.
As we boarded the bus back to Maryland, a shooting throb and powerful sense of being out of whack in my head suddenly overtook me. It was as if the plates in my skull, previously in synch, had slipped several notches and were no longer aligned. It wasn’t exactly a headache, but rather like the feeling telegraphed when a cartoon character gets slammed on the head by a two-by-four, and you see squiggles and exclamation points and pound signs revolving in the air above him. Had I been in the illustration, my eyes would likely have been two little Xes. The balloon would have read, “Boing!”
But the change had come over me so swiftly, with the bus making its way toward the Lincoln Tunnel, neither my husband nor I—both of us frightened—could move fast enough to make the decision to jump off onto Ninth Avenue to get medical help.
I insisted we stay on the bus, not wanting to worry him, and feeling that all I wanted to do was to get home. The movement of the bus on the long ride jarred my head and made my whole body tense. We walked a little during a rest stop, and I moved about cautiously because the sidewalk didn’t seem to be where it should be. Sometime during the ride, the right corner of my forehead began to hurt and, when I touched it, it was tender. Only then did I remember that I had fallen in the house a week earlier. There had to be a connection. We went to the emergency room as soon as we got off the bus.
Ours is a small suburban hospital, but it happens to be the only certified trauma center in the county. It was Saturday, around 6:30 p.m., and nothing much seemed to be going on in the ER. After a very little while we were called in.
In the treatment area, I rested on a bed, my head spinning and heart racing. A nurse told me that no one had normal blood pressure in the ER. When a doctor came in, I told him about my fall and my symptoms: head pain, dizziness, disorientation, low energy.
He said, “We know you have a concussion. Now we just have to find out how bad it is.” He sent me for a CT scan, a quick and painless procedure, It showed no bleeding—the cause of the dreaded subdural hematoma Marcus Welby used to intone about. (A subdural hematoma is a collection of blood in the space between the outer and middle coverings of the brain. It can put significant pressure on the cerebral cortex.) The doctor called my injury a Mild Traumatic Brain Injury, or MTBI—an oxymoron if there ever was one.
I asked why I had not felt my head hitting, and the doctor replied that many concussions involve a loss of the memory of the impact that caused it.
That explained why for me the “event” was a fall and a scrape on the shoulder. Neither was it unusual for symptoms to appear a week later, he told us. The brain responds to trauma by swelling, and it can take days or even weeks for it to reach the point where it pushes against the skull, bringing on the symptoms. He told me only thing to do was to rest my brain. I wondered how I was going to do that. I am not the brain-resting type. In reality, however, I was not able to do much else. I followed up with my internist, who saw the CT report. She commiserated, but said there was really no treatment—just go home and rest as much as possible. “Honor the injury,” is what she said.
I spent the next three weeks at home, with a sense of disorientation that made me afraid to drive, clouded my thinking, left me sleepy and cranky, and kept me from reading or working at the computer for more than a few minutes at a time. I was not myself: I cut my thumb with a sharp knife; I shattered a glass that I crashed onto the kitchen countertop. One day I noticed I was wearing only one earring and on another day my dress was inside out. I was nasty to people who were trying to help, and depressed that my world had shrunk to the size of my house. When I coughed or sneezed, it was as if my head was exploding. I bent to pick things up in a plié, trying to keep my head upright in fear of another dizzying flash. I was scared. Was this ever going to get better?
Finally, I went to see a neurologist, which neither the emergency-room doctor nor my internist had even mentioned doing, and for that I fault them both. I have since been reading about how neglected and unreported Mild TBI is. Online resources I found very useful are the Mayo Clinic, www.mayoclinic.com; Centers for Disease Control, www.cdc.gov; and Brainline.Org, a multimedia project launched by WETA in Washington, DC in partnership with the Defense and Veterans Brain Injury Center, www.brainline.org.
Given that I am a take-charge person, it surprises me that I did not think of seeing a neurologist until four weeks post-injury.
It was probably a function of my own absence of clarity, and of my husband’s believing my minimization, designed to keep him from worrying about me. I think many women operate like this, to our detriment. I am sorry I did, but I am a caregiver, not a care- receiver, and the loss of control this event imposed on me has created some very strange behavior.
The doctor gave me a thorough neurological examination, including questions about current events and memory challenges, as well as checking vital signs, reflexes, balance, and vision. She was encouraged by the physical exam, but ordered an MRI, an EKG, and a carotid artery sonogram to rule out other issues. Over the next several days I had the tests, and my anxiety grew. Heart-pounding worry on top of everything else did not help. In the end, all three tests came back fine.
The symptoms abated somewhat in the next days, and I began to believe I would get better, finally be able to push away the fear that I would not. The periods of lucidity grew longer, and in a while, I was confident I would be fully back eventually.
Two weeks after the test results, the neurologist cleared me for a gentle vacation with my husband. Most of the time I felt fine, except for an occasional fleeting feeling that I have come to call “concussiony,” an internal dissonance in my head that keeps me from thinking clearly and renders me cranky and off-kilter. Aside from these brief relapses, I almost felt I could close the book on this episode.
We returned from vacation late on the night after the big storms that raked the mid-Atlantic in late June. It was very dark, except for a blazing half-moon. Live wires danced on the roads. Trees and limbs were everywhere. We have a generator, but it had blown out in the storm. Earlier in the day, I called our generator guy, and this saint of a man went over to the house at the end of his very long day to repair it. We had lights and AC. We were happy and grateful, but my head hurt again.
A little later, our son called to say that his house had no power, and could he and his wife, three children, and the au pair stay with us until it came on? They arrived after 1 a.m. The next couple of days were a circus. We also had a visit from my sister-in-law, whose mountaintop house in rural Virginia had no power or water. She brought her two playful Labradoodles to cavort in our backyard, since they were freaking out from being in the small apartment she and her husband keep in D.C. We were happy to see her, but it was a wild scene. So there were days of breakfast, lunch and dinner, baths, stories, noise, insanity.
I am feeling “concussiony” again.
There is no question that the stress of this particular re-entry has done it. So it is not over. The neurologist had said it could take weeks or months, or longer, to get completely over it. I remember the words of my doctor and am going to try to continue to “honor the injury,” although it appears that my brain has a mind of its own.
I had hoped in this piece to explain the medical and scientific implications of a concussion, to write about what actually happens to the brain on impact. There is much to say about high school and college athletes whose culture encourages them to be silent when they are hit on the head repeatedly. There are new and encouraging measures being imposed by coaches and teachers to ensure that a concussed student gets immediate treatment and is kept from playing until released by a doctor. Second Impact Syndrome, in which the individual has a second concussion before the symptoms of the first have resolved, is of tremendous concern. More than 60 former NFL players have filed a lawsuit in Los Angeles, claiming that pro football didn’t properly protect them from concussions.
But I am afraid I am not going to be that writer this time. My head is still too spacey, and I can’t concentrate long enough to do the research and wordsmithing it deserves. I am surprised that I was able to push through to write this piece. While rereading it during editing, I found I was not happy with a lot of the language or with the clarity of my thoughts. Still, I have decided to leave it as is. I think it might be useful to have an account of a concussion from the inside out.
WVFC has asked a neurologist to provide the author’s suggested follow-up article on the medical and scientific implications of head injury for one of our upcoming Medical Mondays.