During
Slowly Making Progress
There was so much the rehabilitation unit staff did for me, I will always be enormously grateful to all of them. The work they do may not be as glamorous as other clinical disciplines, however, they are as important as anyone to a successful recovery outcome. I felt especially close to the rehabilitation folks as they were the first people I properly engaged with post TBI.
I made the Lego rabbit in the adjacent photo while at the Haywood, it was intended for 7 year olds - I was 46. I was exhausted from making it, we still have it to remember some of the challenges we faced.
I've transcribed the discharge diagnosis letter sent to my GP from my NHS rehabilitation consultant (below), the actual letter can be viewed by clicking on this link.
Before
Road Traffic Collision
My name is David. I was a 45 year old man riding my bicycle about 15 miles from my home in Newcastle, Staffordshire (England) on July 31st 2015 when I was struck at 40 MPH by a car whose driver didn't see me. In the following photos of the car which I collided with, my head made the impression on the windscreen and my bicycle is underneath the car's front grill. I lay comatose in the centre of the carriageway, foaming at the mouth and bleeding from one of my ears. Click this link to see more information about the collision.
The surgeon needed to saw away part of my skull (starting at the upper right side of my forehead) to facilitate requisite drilling to relieve the pressure building up in my brain. The pressure was monitored using an Intra-Cranial Pressure (ICP) bolt, following this link will take you to a page about ICP. After surgery, the detached piece of my skull was re-attached and fixed into place with 4 nylon screws - 3 are under my hair and 1 is still partially visible on my forehead.
You can view my thoughts on being a TBI survivor by clicking on this link. I personally prefer the term recovering person to "survivor" when considering my own particular outcome.
Black Friday
My life partner (Ruth) kept a diary of my first 9 weeks in hospital. She recorded one particular day as "Black Friday", which wasn't the actual day of my TBI (31st July 2015). Black Friday was a week later on 7th August, when the expectation was that I wouldn't make it through the night following complications. Follow this link to view the transcribed diary, then follow this link to see my consultant neurosurgeon's own assessment of my "black Friday".
Glasgow Coma Scale (GCS)
"GCS, or Glasgow Coma Scale, is a measure of conscious level. You get a mark from 1–4 for eye response, 1–5 for verbal response and 1–6 for motor response, giving you a maximum total score of 15 if completely normal and a lowest possible score of 3 if you’re dead." The preceding paragraph was taken from a diary / novel of a hospital doctor - see link. While accompanying my mother in an ambulance to hospital in 2018 after she'd suffered heart attack symptoms I enquired of GCS 3 during conversation with the paramedics who said something long the lines of "It basically means you are dead".
I learned that between 31st July and 15th August 2015 I was GCS 3, this data is from a neuro-psychologist's report who pieced together relevant information from my NHS records, click this link to view it. You can see a breakdown of my various GCS values recorded during my post-op hospital recovery phase by clicking on this link, there's also more background information on GCS in general.
Locked-In Syndrome
My natural coma was followed by an induced coma, it was 28 days before I emerged from comatose state. The following words are taken from email dialogue I had with Ruth in January 2018 regarding the time I came out of coma in the critical care unit. "People's general perception is that you just woke up and started asking about simple matters such as sports is very different from mine. I went through a week when you were awake and looking at me but not talking or responding - and the nurses talking to me about the potential of 'locked-in' syndrome. Then, when they finally had you 'sitting up' it was slumped in a special chair staring at the floor. When finally you stuttered some words, the first thing I can remember you saying to myself and Chris was "it's been terrible...."
Click on this link to view clinical information about the syndrome, furthermore, this link takes you to a BBC documentary about a person with locked-in syndrome (it has a happy ending).
NHS Rehabilitation Centre (Haywood Hospital)
Presenting Complaint
This gentleman was a cyclist and sustained injuries as a result of collision with a car. He had extensive facial, brain injuries for which he was admitted under neurosurgeons at UHNM. He underwent evacuation of the right extradural hematoma and ICP bolt insertion on 31/07/15. He had a prolonged ITU stay in view of lung injuries and slow tracheostomy weaning. Upon stabilisation, he was transferred to Broadfield ward for multidisciplinary rehabilitation.
Diagnosis
Right temporal extradural haematoma, fracture right parietotemporal skull, right pneumocranium, left small temporal subdural haematoma, 1cm contusion right midbrain, small traumatic subarachnoid haemorrhage right precentral sulcus, multiple small contusions in both frontal lobes & left temporal lobe. Base of skull fracture-Right greater wind of sphenoid, extending into left middle cranial fossa & both superior orbital walls. Right Zygoma fracture, multiple fractures to both orbits: lateral & medial walls. Moderate right anterior pneumothorax, extensive right lung contusions. Fracture right 4th rib. Right middle lobe lung lacerations.
Cognitive Function Assessment and Memory Testing
A neuro-psychologist assessed me in May 2016, producing the report which you can view in PDF format by clicking on the following link. I have bullet-pointed some observations which I personally found fascinating:
- The learning disabilities range extends from the 2nd percentile to the 9th percentile
- David achieved a mental arithmetic evaluation indicating 99.9th percentile
- David’s scores for both immediate and delayed recall regarding his day-to-day memory ability were at the 5th percentile.
The observations were accurate, I never lost my very good maths skills but my short-term memory is dreadful. This link takes you to a PDF of my university exam maths paper, I graduated with a first class honours degree in engineering.
Some Things I Learned about TBI
- You're unlikely to recover as you were prior to a TBI - accept yourself. In the words of a friend I made during my recovery: "Things are still normal, it's simply a new normal".
- Stop apologising to people who care about you, they recognise and accept your limitations.
- You'll probably be very anxious, don't be afraid to share your anxieties. Follow this link to view some of my anxieties which I noted prior to a meeting with my rehabilitation consultant.
- When doctors discuss coping strategies with you listen to them intently and be prepared to try them. This link takes you to a page listing a few of my own coping strategies.
- For short-term memory problems, stop testing yourself. Follow this link to view some of my thoughts on self-testing.
- Set realistic (low) goals and expectations, baby steps is the sensible approach. It is expected to want to get better rapidly, that is probably unrealistic. This link takes you to a "discharge note" I wrote for the NHS in 2019, it mentions managing expectations.
- Recovery is non-linear (not a straight line). You can have 3 good days followed by a rubbish day, it doesn't mean that you are back at square one, just like life in general
- You'll probably be a little different, but you WILL make it. This link takes you to a page describing matters which I still struggle with as a consequence of my TBI.
I Needed to be Needed
The name of this web-site came unwittingly from my mother when she was articulating what she saw as the biggest influence on my recovery, her exact words were: "You needed to be needed". My recovery could also be stated in a less cryptic manner: I desperately wanted to be useful again! Follow this link to view some of my thoughts on the importance of having a fulfilling purpose during recovery and the goal of this web-site.
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In my hospital room at the Haywood the message written by Ruth (adjacent image) was pinned to the wall at my bedside, I probably read the note at least twenty times per day. It helped enormously to know that people were out there who cared about me. I didn't know what year it was, but my cognition was still intact and I was able to use my iPhone to take a photo of the note.
I needed to learn to walk again, not as a consequence of any physical impairment, it was simply because my brain couldn't send messages to my limbs to do what I wanted them to safely.
I learned I had been doubly incontinent while in critical care. I lost 3 stones (42 lbs / 19KG) in weight during the nine weeks following my TBI.
TBI Through Recovery Overview
A simplified timeline of my hospitalisation, recovery and return to work can be viewed by following this link.
NHS Neurosurgeon Brain Surgery
The following is the injury diagnosis by my neurosurgeon prior to operating on my brain (see adjacent image):
- Right pneumocranium (air inside skull)
- Fracture right parieto-temporal skull
- Large 1.88 x 8.5cm right temporal extradural haematoma (blood clot)
- 7mm left temporal subdural haematoma
- 1cm contusion (bruise) right midbrain
- Small traumatic subarachnoid haemorrhage right precentral sulcus
- Multiple small contusions: Both frontal lobes & left temporal lobe
- Base of skull fracture: right greater wing of sphenoid, extending into left middle cranial fossa & both superior orbital walls
- Scalp laceration
A Story of Hope...
From Severe Traumatic Brain Injury (TBI) Through Recovery
After