Head injury became personal for me: A health professional’s perspective

Abstract

Head injury became personal for me in February 2007, when, during an afternoon of snowboarding at Sunshine Village in Banff National Park (Alberta), I was found crumpled on the slope with the occipital region of my helmet shattered. The accident was unwitnessed. Apparently I was conscious, although clearly confused, and was eventually seen at the Foothills Hospital in Calgary (Alberta). The most striking initial symptom was amnesia; I lost nearly 30 h of memory, starting from the evening before the accident until some 10 h after the injury. My emotions were, in retrospect, markedly abnormal; I remember an eager, academic interest in what my scan looked like, with, paradoxically, no fear or concern about the obvious implications. This emotional incongruity persisted for several weeks. I was quite happy at home watching television with a cat on my chest, while those around me quietly agonized over my prognosis. This despite being unable to stand without the room rocking like a boat in one-metre-high waves, being disorganized to the point where cooking supper was beyond me and being profoundly and dreadfully fatigued. My head pain was moderate, but the neck pain was dramatic enough that I eventually became quite concerned that a cervical spine injury had been missed. Ibuprofen was moderately effective, but it was sleep that truly improved my pain and brought back some measure of concentration and executive capacity. I did not ever experience nausea or emesis. I was fortunate to be assessed two weeks after the injury, and only then at the urging of others, by a colleague who was a neurosurgeon with expertise in minor traumatic brain injury. Any thoughts of returning to work or exercise were quickly squashed, and “complete cognitive and physical rest” was prescribed. At this point my dizziness was improving and my thoughts were more organized, but my planning, judgement and organizational abilities remained tremendously limited. Recovery was not linear. Rather, there were prolonged periods of equilibrium, followed by sudden state changes over a 24 h or 48 h period. I can recall suddenly realizing one afternoon that I might not work again, and with this realization the ‘happy’ period of my concussion was over. It was several weeks before I was able to concentrate on academic work, and four months before I began to cautiously try my hand at patient care again. I was not fully back at work until the middle of August, more than six months after my injury. Even then, I was subject to fatigue and high cognitive loads, or sudden movements could reproduce dizziness and migrainous headaches. Months later, academic presentations, which had previously been a personal strength, remained challenging, even embarrassing events. It was nearly a year before I returned to running. Critically, others were often as blind as I was to the true degree of my disability. Cocktail chatter, it would appear, does not require a lot of cognitive capacity. While my family was aware of my true level of functioning, my friends, neighbours and even medical colleagues were often fooled. Subsequently, I successfully returned to a full academic and patient care workload. A role as an advocate for concussion care and my research interest in decision support for concussion in children are perhaps the only ongoing consequences of my original injury.