I ' d think about the type of kid I was before. I'd start crying. I thought someone was playing a joke on me. --Charles, 20
What's so scary is, it's like you're lost. It's like you're in space. All of a sudden your surroundings just drop out from underneath you. --Jeffrey, 29
My biggest problem is, people look at me and say: "You're fine." --Diane, 27
A lot of the people in this story have had their names in the newspaper before. They appeared in brief news items with headlines such as, "Crash Halts Rush-Hour Traffic on Interstate 405." They were the survivors, the ones "reported in critical condition with head injuries."
Last year, more than 700,000 Americans, mostly males between 16 and 25, received head injuries severe enough to require hospitalization, according to the National Head Injury Foundation in Framingham, Mass.
Because of major advances in emergency medical care, people now live through blows to the skull that were almost always fatal just a decade ago, experts on such injuries say. Ambulances and helicopters arrive at accidents more quickly and carry increasingly sophisticated life-support gear. Improved imaging devices, such as computerized axial tomomoters (CAT) and nuclear magnetic resonance scanners, help doctors diagnose brain damage more effectively; new neurosurgery tools and techniques help surgeons minimize continuing damage to the brain, and innovative rehabilitation programs give patients increased hope for physical recovery.
Left With Problems
Despite all this technical wizardry, Head Injury Foundation statistics show that 50,000 to 90,000 of the people who suffered head injuries last year were left with intellectual, physical and behavioral problems that may prevent them from ever living independently again. Specialists in the field call the problem "the silent epidemic," and say there is a tragic shortage in this country of programs to which the injured can turn for help in putting back together their shattered memories and thought processes and dealing with their crushed emotions.
One place that professionals and patients are looking to as a model of what can be done is the Traumatic Head Injury program at Coastline Community College in Costa Mesa. It is the first low-cost program of its kind in the country, according to Pat Arlington, dean of handicapped services for Coastline. For a tuition of $50 a semester, Coastline provides the sort of structured "cognitive retraining" that was previously available only at New York University (at $1,500 a month) and a few innovative hospitals (at prices ranging from $3,000 to $15,000 a month), staffers at Coastline say.
In the Los Angeles area, long-term rehabilitation for the head injured is also offered by the New Pathways program at Daniel Freeman Memorial Hospital in Inglewood, Casa Colina in Pomona and Northridge Hospital.
Four mornings a week, 70 people with head injuries arrive at Coastline's Mesa Verde Learning Center in Costa Mesa. From their clothes to their hair styles and their casual flirting in the hallways, it would be next to impossible to tell these students from those at any community college in Southern California. And therein lies a key problem, a paradox of sorts that takes patience and a bit of philosophizing to understand, Coastline staff members say.
Hard Pressed to Understand
Because these people look, and in many ways act, much as they did before their accidents, friends and family and employers are hard pressed to understand the complex ways in which they have been affected. They fail to realize, instructors point out, that in a certain sense, the person who was injured didn't survive after all.
"When you think about it, what is man but the sum total of his experiences, which he can only remember?" instructor Bobbye Killian asked during a morning class at Coastline. "If you lose your memory, you lose yourself, and a lot of these people have severe memory problems. It's got to be the most hideous form of torture."
Ida Smithson, 30, would not dispute that remark. Two years ago next February, Smithson, who is now a THI student, was seated in the grandstands at Centinella Park in Santa Ana, watching a slow-pitch softball game. A batter struck out, and in a flash of rage, threw his bat. It cleared two fences and struck Smithson on the head.
"I'm a different person," Smithson said. "Part of my life is gone."
Repeatedly prefacing her remarks with what may be the four words people with head injuries use most--"It's hard to explain"--Smithson tried to describe how her life has changed. "I walk around and it's like there's something in my head," she said. "It's cloudy. I'm not clear-headed."
Someone meeting Smithson for the first time wouldn't notice anything unusual about her. But with a matter-of-fact frankness common at Coastline, Smithson said that the injury affects virtually every aspect of her life, from such profound tasks as caring for her 4-year-old daughter to the minutiae of getting through the day. Smithson used to be "a gourmet cook," for example, but now she often can't follow a simple recipe.
"I'll get out the pots and pans, then wind up throwing in something bizarre, something that doesn't belong," she said.
An inability to concentrate affects most people with traumatic head injuries, Pat Arlington explained. And, as former doctors and executives and honors students who have suffered head injuries will attest, that mental drifting can result in problems much more tragic than odd-tasting meat loaf.
Killian told of a THI alumnus who had been within easy grasp of the presidency of the bank at which he worked when a polo pony threw him on his head.
"Now, three years later, he's a teller," Killian said. "Consequently, he feels as if he's not worth anything as a man. He was brilliant. Truly brilliant. Now he's average. . . . He's still a real nice guy. But I guess in our competitive world that's not enough."
Doug Harrington, the consulting neuropsychologist for the Coastline program, offered a summary of the situation that may explain, in part, why ongoing help has been so slow in coming: "Traumatic head injuries are the most difficult, most complex type of problem to understand and work with that I've encountered as a professional."
Most of the people in Coastline's program have what is referred to as a "closed head trauma," Harrington explained one morning as he sat in the large mobile home that serves as offices for THI and Coastline's other programs for the handicapped.
Tremendous Energy Process
"Brain tissue is a gelatinous substance, and like Jell-O, it's subject to movement," Harrington continued. "A traumatic head injury is typically what is referred to as an acceleration-deceleration injury. The brain tissue goes through tremendous energy processes within the cranial cavity."
Besides whatever damage might occur at specific parts of the brain by the actual pounding it gets, the movement of the brain and its impact against the skull can cause "diffuse damage."
"It's a very, very serious type of accident," Harrington said.
To illustrate the far-reaching effects of such injuries, Harrington compared the brain--"a mass of millions of brain cells connected by fibrous tissue called axons"--to a complex urban communications network.
"These axons are very susceptible to injury, and the shearing forces of a closed head trauma can interrupt these 'communications lines,' " he said. In many cases, the rotation of the brain within the skull can also damage the brain stem, which Harrington calls the trunk line to the brain's communications network. Any breakdown in this network translates into less-efficient thinking, Harrington said. Thus most people with traumatic head injuries face serious physical, cognitive and behavioral problems.
Stressing that with head injuries, more than in any other type of disability, each case is unique and exceptions abound, Harrington offered a few general observations that researchers have made.
Besides a diminished short-term memory and "a disorganized filing system for retrieving information from long-term memory," people with head injuries often have trouble with other thought processes, he said.
For one thing, their attention span and their ability to have their interest in something aroused is impaired. "The tone and quality with which someone can tune into the world is damaged," Harrington said.
Perceptions Out of Kilter
Many people who have suffered head injuries also find their senses and perceptions out of kilter; their organizational skills may not be as sharp as they once were and their "applied problem-solving skills" falter.
"The brain is not able to coordinate the flow of information as efficiently as it once did. What one part of the brain is thinking about, another part may not be aware of anymore," Harrington said. "They're like bulls in a china shop. Even though the obstacles to a goal are readily apparent, they continue on in a bullheaded pattern. They're no longer flexible."
As might be imagined, those problems can prove intensely frustrating, Harrington said. Neurotic reactions, including deep depression, are common, and a minority of people with head injuries lose the ability to grasp reality--"they're not crazy in the classical sense, but their ability to develop accurate perceptions and judgments of the world is compromised."
Because the brain damage is so diffused, it is difficult to determine which behavioral problems are physical and which are mental. But behavioral problems almost always arise, Harrington said.
"One of the things the brain does best, when it's working well, is control the emotions," he explained. But in people with traumatic head injuries, "the ability of the frontal lobe to act as a good emotional quarterback is diminished. Their emotional activity is less inhibited. They react to anything and everything, and they don't recognize their emotional outbursts for what they are.
"Stress is the big thing in medicine now," Harrington said. "And probably more than anyone else, these people are dealing with constant stress in their lives." Because of the nature of their injuries, however, these people are often the least able to cope with that stress, he said, adding that a main goal of the Coastline program is to teach students how to live with the stress that, in most cases, will always be a part of their lives.
Compensate for Problems
"There's not a pot of gold at the end of the rainbow, where everything's going to be OK," said Celeste Ryan, an instructor and employment counselor in the Coastline program. "But what we find is that students learn to compensate for their problems. If they're able to understand what their situation is, they're able to live with it."
At Coastline, a staff of 11 counselors and instructors and seven aides guide students through a series of "modules" designed to help them relearn some of their lost thinking skills and to contend with their behavioral problems, which they may or may not recognize when they enter the program. Students complete their re-education at their own pace, usually graduating in two years.
Recently, students in Module I labored over written tests designed to improve their mental concentration while in another classroom, about two dozen Module II students sat before computer screens, completing intricate visual exercises or playing computer games. "They're working on their psycho-motor skills," instructor Margaret Hickey explained, as she hovered over a young man at war with an army of alien "Space Invaders."
In an exercise intended to help them compensate for their perceptual deficits, students in Module III listened to a recording and tried to identify an odd assortment of sounds--a vacuum cleaner humming, a radio dial being spun quickly from station to station. In another classroom, students watched videotapes of their classmates acting out a skit, then tried to determine who was demonstrating passive, aggressive or assertive behavior. "Many of the students aren't as aware as they were before of how they're coming across," Arlington explained.
In Module IV, the last stop for students before they attempt a transition into the community, instructor Bobbye Killian's class was completing a "mind-bender" puzzle that might stump people who had never had so much as a rap on the noggin. Killian's students, some a bit cocky as they approach "graduation," bantered casually with their instructor. They joked about "waking up stupid," but carried on a witty exchange punctuated with real laughter. And one by one they politely paused to tell their stories, almost always citing an exact time and place when a drunk driver swerved across freeway lanes or a ski boat overturned, putting an abrupt end to one life and marking the start of another. They also volunteered unsolicited testimonials to the Coastline program.
"It gives you a sense of self-worth and value," explained Jeffery Jeeves, 29, whose life changed when he pulled over on the Garden Grove freeway to help a motorist and was hit by another car. "After my accident, I went out with my friends a few times, but I felt like I was a burden. They treated me like a stranger--you can't remember a lot of things so you can't really converse."
'We Laugh a Lot'
"Being here with other people who have head injuries helps a lot," added Dyan Funk, 27, who was sleeping in the back seat of a car when another vehicle made an illegal turn into her life. "A lot of the time your family and friends don't understand. They feel sorry for you. Here we all have the same problems. We tell stories and laugh a lot."
Many of the people in Killian's class are already back in college, and some hope to pursue the careers they had dreamed of before their accidents. As Harrington pointed out, however, even after the program, "the prognosis (for a return to complete independence) is not good."
"I love these students, everyone of them," Killian said. "There's a lot of unconditional caring that goes on here, and the reward is all the growth that you see.
"I've never seen a miracle, though," she added, with what may have been a trace of moisture in her eyes.
But more than a few students in the program said they got their miracle when they survived. Having overcome the denial that most people with head injuries feel when faced with lowered expectations, they're now willing to accept a lifetime of continuing improvement as a goal. And they say they're grateful for the opportunity Coastline offers them.
As a visitor strolled across the campus one morning, Tina Eads, 39, darted out of a classroom.
"I just want to tell you something," she said, the emotions she had been unable to control following her accident now restrained behind flashing blue eyes. "I've spent lots and lots of money trying to get help. I was an RN. Six years of college. . . . And I was ready to check myself into the cuckoo bin when I heard about this place.
"All anyone (in other programs) wants to do is teach you basket-weaving," she said. "I searched and searched for this program. They understand! These are the first people who really cared.
"But do you know something?" Eads asked, the words coming in a passionate rush. "This is the only program of its kind in the country. It is. And I can tell you, there are a lot of people out there who are just like us."