X-Message-Number: 13423
Date: Fri, 24 Mar 2000 20:19:42 -0500
From: Jan Coetzee <>
Subject: Injured Brains
Injured Brains of
Medical Minds
Views from Within
[review] [excerpt] [endlinks] [purchase]
Edited by Narinder Kapur
Reviewed by Morten Kringelbach
Oxford University Press, 1997
Posted March 17, 2000 Issue
74
Review
Serious brain injury is a hidden epidemic in society. A
collection of first-person accounts by neuroscientists
and other biomedical professionals offers important
and timely insights for victims, their families, and
medical professionals.
Just before Christmas 1999, a tragic and meaningless
accident occurred in Oxford, England. A good friend of
this reviewer, G., fell some 20 feet by accident and hit
his head so seriously that he was in a deep coma by the
time he arrived at the hospital.
During the first days in the hospital,
G.'s condition was critical, and his
twin was advised to summon their
family from eastern Europe.
Normally, close relatives are
informed immediately in such dire
emergencies, but G.'s mother
suffered from chronic heart disease,
and it was feared that the news could provoke a fatal
heart attack. G.'s twin faced a terrible dilemma. After
long and hard considerations, he finally decided not to
inform the family, but to wait.
Injured Brains
Serious head injuries such as G.'s are unfortunately all
too common and yet, surprisingly, little has been
published on brain injury from the perspective of the
sufferer. The neuropsychologist Narinder Kapur has
tried to remedy this situation in his book Injured
Brains of Medical Minds: Views from Within, a
collection of around 50 self-reports from
neuroscientists, physicians, and others in the clinical
profession who have themselves experienced brain
trauma.
While it is true that each brain is
unique and hence its subsequent
recovery from injury will be unique,
it is also true that certain persistent
patterns are associated with
different types of brain injury.
Knowledge of these patterns can be
very useful information for patients,
their families, and doctors. Kapur's
book provides such timely knowledge, not only in the
self-reports, but also in Kapur's thoughtful
commentaries that accompany each first-person
account.
Miraculously, after 14 days of coma, during which the
only means of gauging G.'s condition was through the
vital numbers on the life support machines, he returned
to consciousness. Suddenly his pupil reactions worked
again, and he began to breathe by himself. He began to
follow those around him with his eyes, though he was
still too weak to move. He seemed able to recognize
friends and relatives, but was incapable of speech (a
serious case of pneumonia had necessitated the
insertion of a drainage tube in his throat).
As the days passed, G. began to
regain some skills. He was moved
from an intensive care unit to a
rehabilitation ward. G., who never
used to watch television, was now
watching it nonstop and listening to
music.
Personality Change
During the first six weeks after G. regained
consciousness, he made remarkable progress. When the
drain in his throat was removed, he was able to speak
immediately and phoned home to talk with his still
unsuspecting parents.
G. remained weak but without
permanent physical injury, and he
started to walk again. He was
allowed to sleep at home, but still
had to attend rehabilitation sessions
during the day at the hospital. G.'s
memory apparently had not been
damaged, and he essentially
regained his normal mental and
physical skills.
However, G.'s twin was worried about the personality
change that G. seemed to have undergone. Whereas G.
earlier had had a mild and rather self-effacing
disposition, he was now aggressive and self-centered,
much like a spoiled child. Yet, this also faded with
time.
G. is slowly becoming more like his
old self. It will undoubtedly take
time before he is fully rehabilitated
both physically and mentally; and he
will probably never be completely
the same as he was before the
accident. However, his progress so
far suggests his prospects for near total recovery are
good.
Bruised Medical Brains
G.'s story is an almost miraculous account of how some
people can recover from even the most serious brain
injuries. Indeed, some clinicians take the number of
days spent in coma as a rough indicator of possible
brain damage, and by this standard, G.'s case was very
serious. Such measures are imprecise and show the
magnitude of our ignorance. The truth is that despite
our
advances in neuroscience, we still know far too little
about the short- and long-term impact of brain injury.
Though earlier cases might bear resemblance to G.'s,
every brain injury is unique, and the course of the
illness depends on a huge number of factors that are
difficult to quantify.
When the situation
was looking most
bleak for G., and his
twin was preparing
to transport him
home, G.'s twin had
the good fortune to
read Injured Brains of Medical Minds, which helped
him to make some sense of the situation.
Doctors-turned-patients know all too well the
seriousness of their symptoms. Their dual roles can
provide them with insights and empathy that other
medical professionals at times would seem to lack.
Kapur's book is, by virtue of its many self-reports and
Kapur's subsequent clinical commentaries and
references to secondary literature, a gold mine of
important information for both the layman and
professionals.
The book is divided into three parts: cognitive
disorders, clinical conditions, and an overview. The
first part is subdivided into three sections, which deal
with disorders of memory, language, and the visual
system. The second part is subdivided into five
sections: Parkinson's disease, brain tumor, head injury,
stroke, and epilepsy. The overview contains notes on
patient management, training of medical staff, and
recovery of functions after brain injury.
Personal Stories
The personal stories are frequently
moving and heartfelt, yet not
maudlin. The fine essay Memoirs of
a Thinking Radish, by Peter
Medawar, Nobel Prize winner in
medicine/physiology, describes how
a stroke altered his life forever.
Medawar was treated by a senior
consultant who told him that his arm
"would never get better," and that it was therefore not
worth his "while to prescribe any treatment for it."
Medawar's wife was also told by a clinical
psychologist that Medawar had become mentally
impaired. Mental impairment seems unlikely, since his
essay is written with a poignant wit that probably just
escaped the comprehension of any of the diagnosing
doctors.
Another particularly commendable
essay was written by Frederick
Linge. Linge, who endured a car
accident, writes about injuries to
both brain and body. His 1990 essay
describes his continuous struggle
since his accident 12 years earlier.
All in all, Kapur's book is full of
interesting observations, and should be made
compulsory reading for doctors and others dealing with
patients with brain injury.
Morten Kringelbach is a neuroscientist at
the University of Oxford.
Alexandria Heather-Vazquez is art director
of HMS Beagle.
Excerpt
I no longer measure the worth of my life or that of
others by standards such as money or appearance
or even by usefulness to society. I believe that all
life
is worthy of respect and is precious. I no longer
evaluate a victory in terms of power and prestige.
In
the eyes of society, the daily struggles, defeats,
and
successes of a survivor may be trivial, but to me
now, they are greater than the televised victories
of
a professional athlete. And finally, I believe that
it is
the struggle itself that gives life dignity, at the
last.
(Frederick Linge)
You may purchase this book (442 pp., hardcover)
directly from:
Publisher ( 29.50)
Amazon.com (list $57.50, Amazon price $52.50,
you save 9%)
Tell us what you think.
Endlinks
Facts about Concussion and Brain Injury and Where to
Get Help - provides information about concussion,
brain injury, and where to get help. From the Centers
for Disease Control and Prevention.
Dana BrainWeb - list of links to authoritative
information on brain disorders and injury.
Brain Injury: A Guide for Families and Friends - part
of the University of Iowa's Virtual Hospital site;
contains reference guides on evaluation, definition, and
treatment for brain injury.
Neuropsychology Central - is a resource on
neuropsychology and its application to brain and
behavior.
Coma Recovery Association - helps families of coma
and head injury survivors by providing information and
referrals that enable them to make informed choices
regarding treatment, rehabilitation, and socialization
alternatives.
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