Brain Injury: What's It Like?
Scroll down for book excerpt
“I, Claudia” / NBC: DATELINE
This interview of Claudia, produced by NBC: Dateline, was broadcast in April, 1998.
“I, Claudia” / NBC: DATELINE
This interview of Claudia, produced by NBC: Dateline, was broadcast in April, 1998.
TBI: THE INVISIBLE THIEF
This Up Close and Personal interview of Dr. Osborn was published on The Cooper Institute website January 14, 2000.
Out of sight, out of mind. But even when the signs of brain injury are apparent, short-term memory loss, inability to perform certain tasks,
behavioral problems, its victims (known as ‘survivors’) or their families may not connect their problems to the injury.
“Survivors consider their neurological symptoms unimportant or they blame other factors for their difficulties,” says Dr. Claudia L. Osborn, author of Over My Head: A Doctor’s Own Story of Head Injury from the Inside Looking Out.
“The survivor ‘recovers’ and returns to work or school, the family rejoices in the fact that their loved one survived and, beyond scrapes or fractures received in the accident, everyone believes no real harm was done.“
Over time, the brain injury may be forgotten and the patient and family unlikely to attach further significance to the event. Survivors may not tell their doctors later that they once had a brain injury, not even when those TBI symptoms produce problems for them.
“They do not make the connection,” she says, “between that injury and their worsened performance. People say, ‘I got knocked out, but no damage was done. I’m fine.’ How would they know? It is the brain that gives us our information. If the brain is injured, it cannot be a reliable reporter.
“Nor can close friends and family always judge what is ‘fine’. It’s easy to notice when the brain injury has paralyzed a limb, but the injury often causes changes in behavior, memory, attention, judgement, and organization. Families commonly attribute these changes to a lack of motivation, a stage of life (adolescence, menopause) or to depression.”
Dr. Osborn, who lectures throughout the US and Canada on TBI rehabilitation says it takes a neuropsychological exam to determine if the brain trauma has caused significant injury and if that injury would benefit from rehabilitation.
She believes such assessment is critical. “Not addressing a traumatic brain injury is a missed opportunity that will impact that person’s future. It spells the difference between just getting by and living a happy, productive life.”
She speaks from personal experience.
She is a survivor of a TBI. Her brain injury, sustained when her bicycle was struck head-on by a carelessly driven automobile, was minimized by others and particularly by herself. Determined to return to her medical practice, she was oblivious to her injury.
“Despite the changes in my behavior, my loss of short-term memory, and my poor language skills, I could still insist I was fit to return to work. Even those—doctors included--who thought I needed more time to rest and recover assumed that I would be myself again soon.”
It was in trying to return to her medical practice that her problems became manifest and she sought help. That included an eighteen-month rehabilitation program at the Brain Trauma Day Program of Rusk Institute of Rehabilitation Medicine, a division of New York University in Manhattan .
Would she have eventually overcome her problems without professional help?
“Absolutely not,” she says.
So, entering a program is the first step in rehabilitation?
“The first step,” she says, “is having everyone - survivor and family - recognize that there is a problem.”
She offers an example from her recent role as a consultant to a case-manager. “The patient is a 20-year-old who was injured at age 15 when she fell off her skateboard. She was comatose for just a few hours and had no other injuries. That was in May. In September, she seemed fine and returned to high school.
“However, this formerly high-achiever began falling behind. Her teachers complained she didn’t pay attention and she had disciplinary problems, using poor judgment, impulsive behavior, and fits of anger. She couldn’t get a handle on the practical side of her life. She couldn’t organize, prioritize or manage what is called “executive function,” a problem associated with frontal lobe damage.
“Her parents knew of the TBI diagnosis,” Dr. Osborn says, “but no one had ever given her a neuropsychological examination to evaluate the significance of this teenager’s deficits, or directed her to a formal program. Her problems were attributed to ‘adolescence’ and she drifted unhappily along. That she graduated at all and stayed out of serious trouble is due to her high intelligence and family environment.
“While trying for college entrance, the fact of her TBI was resurrected. She was evaluated and directed into a rehabilitation program and is doing very well. She can be thankful that all she lost was a few years, as opposed to a good future.”
Can one have a brain injury and not be diagnosed?
“It is not uncommon,” says Dr. Osborn.
“Patients don’t always know what happened during an injury, especially if they are alone when they strike their head. They may be unaware that they lost consciousness or may not even recall hitting their head. Yes, they had an accident, but they appeared to be uninjured and so they never consult a doctor.
“I had a patient in her fifties, living alone, who tripped and fell down her basement stairs. She told her daughter about it later that day saying she had been only slightly dazed and bruised her shoulder. I saw her three days later when her neighbor brought her in for a routine appointment. She was dragging her right foot. She denied this was a problem and wanted me to concentrate on helping her lose weight although she wasn’t heavy.
“I did a neuro exam and ordered a CAT scan. She had a sub-dural hematoma—a blood clot pushing on her brain—from her fall, which required surgery. When she recovered from the surgery, by the way, she no longer wanted a weight-loss diet.”
Frequently, a brain injury is simply overlooked or deemed irrelevant to the person’s problems. Or attributed to other causes.
“Sometimes symptoms overlap,” says Dr. Osborn, “or masquerade as other entities such as adolescent malaise, postpartum depression, emotional breakdown, substance abuse, work-related stress, or menopause.
“Athletes may assume they’ve never had a brain injury although they have been knocked unconsciousness on the football field.
“All primary care doctors should have a high index of suspicion for TBI when a patient has behavioral changes.” It is a point she emphasizes in her lectures to physicians.
“They should consider whether the patient may have an unevaluated TBI or if a previous injury was misdiagnosed or overlooked.
Is it ever too late?
“While seeking treatment early is the best course, good rehabilitation offers benefits at any time. It is almost always possible to benefit if only through understanding the implications of one’s deficits and learning some strategies and techniques to compensate for them.”
What are your thoughts about a TBI disabled physician returning to practice?
In your book, you tell about your return to your hospital duties, teaching medical residents and interns and seeing patients. Clearly, it is possible for a brain-injured physician to reenter the system unchallenged.
“If a doctor shows up for work,” she says, “the assumption is that the doctor is fit to work.”
She denies this is an example of ‘good ol’ boys’ sticking together. “It’s more a matter of doctors being taken at their own word. Sometimes we forget that having expert knowledge doesn’t mean you can treat yourself. Thus the axiom, ‘an attorney who represents himself has a fool for a lawyer.’
What does Dr. Osborn recommend?
“Every hospital should have a written code,” she says, “dictating the conditions under which a doctor with a TBI may return to work. This should include nothing less that a full neuropsychological examination.”
Such a code would have benefited her. But that is another story, one already told in her book.
An Essay from Over My Head
Please Don't Tell Me You Know What It's Like
I understand their motivation. People are being nice. They want to reassure me I am normal, that my problems are not different from theirs. It is a standard way to let me know they feel good about me.
Our conversation has few variations. They say about themselves, "My memory is worthless. I don't know where I'm going half the time. You think you're bad, I'm worse."
Or, "Thank God, they don't give me those cognitive tests. I'd never pass," " You're lucky you can blame everything on a head injury. You forget that most of us have a poor memory." "Just wait till you get to be 40 (60, 80) like me: You'll know what bad really is."
It is inane chatter. It occurs while I am running as fast as I can to stay in place, working to keep alert and energized, to follow their conversation, to consciously direct my mind using every strategy I possess just to do something which for them is automatic.
After 12 years of university education, I labor to read a short story, must ask my high-school-trained assistant for directions to my job, and use an alarm every three minutes to drive to the correct destination.
No, they do not know what it is like. People's abilities and inner resources vary widely in degree and kind. That is not the same as being stripped of the abilities one had and valued. Their occasional moments of absent-mindedness and quirks of intellect have not robbed them of intellectual exchanges, separated them from a beloved profession, or made them unrecognizable to themselves.
Without intention, they discount my struggle to compensate for my losses and minimize the small victories in my day. Surely, it would be outrageous to say to a person with artificial legs that walking is a challenge for us all. I try to take these insensitive comments in the well-intentioned spirit in which they are given, but how I wish others would try less hard to show me an empathy they do not possess.
How much better it is when people act naturally with me. Often, I benefit from their assistance. It feels good to laugh with them when my mistakes are funny and to sense their empathy when they're not.
So, laugh with me, cry with me, but please don't tell me you know how I feel or you know what it's like because "it's the same" for you.
How can it be? You have never lived in my head.
-- from my notebook, June 16, 1990
From the Dictionary of TBI Terminology in Over My Head
Executive Function: The ability to organize thoughts and work, to create plans and successfully execute them, to manage the administrative functions of one's life. Individuals with impaired executive function may appear to live moment to moment, fail to monitor their activities or social interactions to make sure they are carried out (or even initiated). With diminished ability to create strategies, to handle more than one task at a time, to be effective, reliable, and productive, the simplest job may be too challenging. (See OMH, pp 161-162, 163-165, 205-206 for examples.)
This Up Close and Personal interview of Dr. Osborn was published on The Cooper Institute website January 14, 2000.
Out of sight, out of mind. But even when the signs of brain injury are apparent, short-term memory loss, inability to perform certain tasks,
behavioral problems, its victims (known as ‘survivors’) or their families may not connect their problems to the injury.
“Survivors consider their neurological symptoms unimportant or they blame other factors for their difficulties,” says Dr. Claudia L. Osborn, author of Over My Head: A Doctor’s Own Story of Head Injury from the Inside Looking Out.
“The survivor ‘recovers’ and returns to work or school, the family rejoices in the fact that their loved one survived and, beyond scrapes or fractures received in the accident, everyone believes no real harm was done.“
Over time, the brain injury may be forgotten and the patient and family unlikely to attach further significance to the event. Survivors may not tell their doctors later that they once had a brain injury, not even when those TBI symptoms produce problems for them.
“They do not make the connection,” she says, “between that injury and their worsened performance. People say, ‘I got knocked out, but no damage was done. I’m fine.’ How would they know? It is the brain that gives us our information. If the brain is injured, it cannot be a reliable reporter.
“Nor can close friends and family always judge what is ‘fine’. It’s easy to notice when the brain injury has paralyzed a limb, but the injury often causes changes in behavior, memory, attention, judgement, and organization. Families commonly attribute these changes to a lack of motivation, a stage of life (adolescence, menopause) or to depression.”
Dr. Osborn, who lectures throughout the US and Canada on TBI rehabilitation says it takes a neuropsychological exam to determine if the brain trauma has caused significant injury and if that injury would benefit from rehabilitation.
She believes such assessment is critical. “Not addressing a traumatic brain injury is a missed opportunity that will impact that person’s future. It spells the difference between just getting by and living a happy, productive life.”
She speaks from personal experience.
She is a survivor of a TBI. Her brain injury, sustained when her bicycle was struck head-on by a carelessly driven automobile, was minimized by others and particularly by herself. Determined to return to her medical practice, she was oblivious to her injury.
“Despite the changes in my behavior, my loss of short-term memory, and my poor language skills, I could still insist I was fit to return to work. Even those—doctors included--who thought I needed more time to rest and recover assumed that I would be myself again soon.”
It was in trying to return to her medical practice that her problems became manifest and she sought help. That included an eighteen-month rehabilitation program at the Brain Trauma Day Program of Rusk Institute of Rehabilitation Medicine, a division of New York University in Manhattan .
Would she have eventually overcome her problems without professional help?
“Absolutely not,” she says.
So, entering a program is the first step in rehabilitation?
“The first step,” she says, “is having everyone - survivor and family - recognize that there is a problem.”
She offers an example from her recent role as a consultant to a case-manager. “The patient is a 20-year-old who was injured at age 15 when she fell off her skateboard. She was comatose for just a few hours and had no other injuries. That was in May. In September, she seemed fine and returned to high school.
“However, this formerly high-achiever began falling behind. Her teachers complained she didn’t pay attention and she had disciplinary problems, using poor judgment, impulsive behavior, and fits of anger. She couldn’t get a handle on the practical side of her life. She couldn’t organize, prioritize or manage what is called “executive function,” a problem associated with frontal lobe damage.
“Her parents knew of the TBI diagnosis,” Dr. Osborn says, “but no one had ever given her a neuropsychological examination to evaluate the significance of this teenager’s deficits, or directed her to a formal program. Her problems were attributed to ‘adolescence’ and she drifted unhappily along. That she graduated at all and stayed out of serious trouble is due to her high intelligence and family environment.
“While trying for college entrance, the fact of her TBI was resurrected. She was evaluated and directed into a rehabilitation program and is doing very well. She can be thankful that all she lost was a few years, as opposed to a good future.”
Can one have a brain injury and not be diagnosed?
“It is not uncommon,” says Dr. Osborn.
“Patients don’t always know what happened during an injury, especially if they are alone when they strike their head. They may be unaware that they lost consciousness or may not even recall hitting their head. Yes, they had an accident, but they appeared to be uninjured and so they never consult a doctor.
“I had a patient in her fifties, living alone, who tripped and fell down her basement stairs. She told her daughter about it later that day saying she had been only slightly dazed and bruised her shoulder. I saw her three days later when her neighbor brought her in for a routine appointment. She was dragging her right foot. She denied this was a problem and wanted me to concentrate on helping her lose weight although she wasn’t heavy.
“I did a neuro exam and ordered a CAT scan. She had a sub-dural hematoma—a blood clot pushing on her brain—from her fall, which required surgery. When she recovered from the surgery, by the way, she no longer wanted a weight-loss diet.”
Frequently, a brain injury is simply overlooked or deemed irrelevant to the person’s problems. Or attributed to other causes.
“Sometimes symptoms overlap,” says Dr. Osborn, “or masquerade as other entities such as adolescent malaise, postpartum depression, emotional breakdown, substance abuse, work-related stress, or menopause.
“Athletes may assume they’ve never had a brain injury although they have been knocked unconsciousness on the football field.
“All primary care doctors should have a high index of suspicion for TBI when a patient has behavioral changes.” It is a point she emphasizes in her lectures to physicians.
“They should consider whether the patient may have an unevaluated TBI or if a previous injury was misdiagnosed or overlooked.
Is it ever too late?
“While seeking treatment early is the best course, good rehabilitation offers benefits at any time. It is almost always possible to benefit if only through understanding the implications of one’s deficits and learning some strategies and techniques to compensate for them.”
What are your thoughts about a TBI disabled physician returning to practice?
In your book, you tell about your return to your hospital duties, teaching medical residents and interns and seeing patients. Clearly, it is possible for a brain-injured physician to reenter the system unchallenged.
“If a doctor shows up for work,” she says, “the assumption is that the doctor is fit to work.”
She denies this is an example of ‘good ol’ boys’ sticking together. “It’s more a matter of doctors being taken at their own word. Sometimes we forget that having expert knowledge doesn’t mean you can treat yourself. Thus the axiom, ‘an attorney who represents himself has a fool for a lawyer.’
What does Dr. Osborn recommend?
“Every hospital should have a written code,” she says, “dictating the conditions under which a doctor with a TBI may return to work. This should include nothing less that a full neuropsychological examination.”
Such a code would have benefited her. But that is another story, one already told in her book.
An Essay from Over My Head
Please Don't Tell Me You Know What It's Like
I understand their motivation. People are being nice. They want to reassure me I am normal, that my problems are not different from theirs. It is a standard way to let me know they feel good about me.
Our conversation has few variations. They say about themselves, "My memory is worthless. I don't know where I'm going half the time. You think you're bad, I'm worse."
Or, "Thank God, they don't give me those cognitive tests. I'd never pass," " You're lucky you can blame everything on a head injury. You forget that most of us have a poor memory." "Just wait till you get to be 40 (60, 80) like me: You'll know what bad really is."
It is inane chatter. It occurs while I am running as fast as I can to stay in place, working to keep alert and energized, to follow their conversation, to consciously direct my mind using every strategy I possess just to do something which for them is automatic.
After 12 years of university education, I labor to read a short story, must ask my high-school-trained assistant for directions to my job, and use an alarm every three minutes to drive to the correct destination.
No, they do not know what it is like. People's abilities and inner resources vary widely in degree and kind. That is not the same as being stripped of the abilities one had and valued. Their occasional moments of absent-mindedness and quirks of intellect have not robbed them of intellectual exchanges, separated them from a beloved profession, or made them unrecognizable to themselves.
Without intention, they discount my struggle to compensate for my losses and minimize the small victories in my day. Surely, it would be outrageous to say to a person with artificial legs that walking is a challenge for us all. I try to take these insensitive comments in the well-intentioned spirit in which they are given, but how I wish others would try less hard to show me an empathy they do not possess.
How much better it is when people act naturally with me. Often, I benefit from their assistance. It feels good to laugh with them when my mistakes are funny and to sense their empathy when they're not.
So, laugh with me, cry with me, but please don't tell me you know how I feel or you know what it's like because "it's the same" for you.
How can it be? You have never lived in my head.
-- from my notebook, June 16, 1990
From the Dictionary of TBI Terminology in Over My Head
Executive Function: The ability to organize thoughts and work, to create plans and successfully execute them, to manage the administrative functions of one's life. Individuals with impaired executive function may appear to live moment to moment, fail to monitor their activities or social interactions to make sure they are carried out (or even initiated). With diminished ability to create strategies, to handle more than one task at a time, to be effective, reliable, and productive, the simplest job may be too challenging. (See OMH, pp 161-162, 163-165, 205-206 for examples.)