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. Previous Book Reviews Nabokov's Blues: The Scientific Odyssey of a Literary Genius by Kurt Johnson and Steve Coates; reviewed by Jonathan D. Beard (Posted March 3, 2000 Issue 73) Sensory Exotica: A World Beyond Human Experience by Howard C. Hughes; reviewed by Ed Voves (Posted February 18, 2000 Issue 72) The Sun, the Genome, and the Internet: Tools of Scientific Revolutions by Freeman J. Dyson; reviewed by Jim Dawson (Posted February 4, 2000 Issue 71) The Mammal in the Mirror: Understanding Our Place in the Natural World by David P. Barash and Ilona A. Barash; reviewed by Ed Voves (Posted January 21, 2000 Issue 70) Phantoms in the Brain: Probing the Mysteries of the Human Mind by V.S. Ramachandran and Sandra Blakeslee; reviewed by Morten Kringelbach (Posted December 24, 1999 Issue 69) The Missing Moment: How the Unconscious Shapes Modern Science by Robert Pollack; reviewed by Alan I. Packer (Posted December 10, 1999 Issue 68) more 2000 BioMedNet Ltd. All rights reserved. Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=13423