An NHS Neurosurgeon Operated on my Brain

The following is the injury diagnosis by my neurosurgeon, prior to operating on my brain:

  • 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

I unwittingly tracked the helicopter journey with the GPS function on my iPhone - click on this link to view a charity magazine article which displays it.


The RTC incident was reported in the local newspaper (Nantwich News), it can be viewed by clicking on this link.


My close work colleagues sent out a series of emails informing other staff of my accident - see this link.


A simplified timeline of my hospitalisation and recovery can be viewed by following this link.

During

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 RTC.


I made the Lego rabbit in the adjacent photo while at the Haywood, it was intended for seven year olds - I was forty-six.  I was exhausted from making the rabbit - we still have it to remember 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.

A Story of Hope...

From Severe Traumatic Brain Injury (TBI) Through Recovery

Before

After

I Was Flown to Hospital by an Air Ambulance Helicopter

I Had a Road Traffic Collision (RTC)

My name is David, I was a 45 year old man riding my bicycle about fifteen miles from my Newcastle, Staffordshire (England) home on July 31st 2015.  I was struck at 40MPH by a car whose driver didn't see me - click this link to see more information about the collision.  In the adjacent photo, my head made the impression on the car windscreen and my bicycle is underneath the front grill. ​ I lay comatose in the centre of the carriageway, foaming at the mouth and bleeding from one of my ears.

The surgeon needed to saw away part of my skull to get inside for requisite drilling to relieve the pressure building up in my brain, which was monitored using an intracranial pressure (ICP) bolt - see link.  After surgery, the detached piece of my skull was re-attached and fixed into place with screws.

You can view my thoughts on being a TBI survivor ​by clicking on this 
link - I personally prefer the term 'recovered person' to survivor when describing my own particular outcome.


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 going to hospital in 2018 after she'd suffered heart attack symptoms, I enquired of GCS 3 during conversation with the paramedics - they said something long the lines of "It basically means you are dead".  Between 31st July and 15th August 2015 I was recorded as GCS 3 - I obtained this information from a neuropsychologist's report who pieced together relevant information from my NHS records.  The report is discussed further down this page in the 'Tested Extensively' section - click this link to view it.  You can see more about my GCS by clicking on this link, where I include a breakdown of the various GCS values recorded during my post-op hospital recovery phase.


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 an email exchange I had with my life partner (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 information about the syndrome, alternatively, this link takes you to a BBC documentary about a person with locked-in syndrome (it has a happy ending).


I was Discharged to an NHS Rehabilitation Centre

​​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.


I was Tested Extensively

A neuropsychologist assessed me, clicking on this link will open the report which was written in May 2016.  I have bullet pointed some observations which I personally found fascinating:

  • The ‘borderline 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 was / is very poor.  This link takes you to my university exam maths paper - I graduated with a first class honours degree.


​Some Things I Learned

  • You're unlikely to recover as you were - accept yourself.  In the words of a friend I made during my recovery: "Things are still normal, it's simply a new normal"
  • You'll probably be a little different - but you will make it, this link describes matters which I struggle with / aren't recovered
  • Stop apologising to people who care about you - they accept your limitations
  • You'll probably be very anxious, don't be afraid to share your anxieties - see link
  • When doctors discuss coping strategies with you, listen to them intently and be prepared to try them
  • ​For short-term memory problems, stop testing yourself - see link
  • 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
  • Recovery is non-linear (not a straight line)... you can have three good days followed by a rubbish day, it doesn't mean that you are back at square one - just like life in general


I Needed to be Needed
The name of this blog came unwittingly from my mother while she was articulating what she saw as the biggest influence on my recovery.  I became involved in volunteer work during the second year after my RTC (I was unable to do anything in the first year) - I have since learned that this approach is clinically referred to as vocational rehabilitation.  My mother's exact words were: "You needed to be needed", it could also be stated in a less cryptic manner: 
I desperately wanted to be useful again - see this link


Looking Forward

I now have a very positive outlook on life, I consider every lived day beyond my RTC as a 'bonus'.  I can sum up my recovery in a single word: contented - see this link

​​​In the Haywood Hospital rehabilitation centre this 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.  I learned I had been doubly incontinent while in critical care, I lost 42 lbs (3 stones) in weight during the two months following my RTC.


I wrote down some of my thoughts about being brain damaged, you can view them by following this link.