The brain’s ability to heal
by Eliza Stein, illustrations by Emma Kerr
“Alan’s brain got run over by a speedboat,” Cathy Crimmons’ book, “Where is the Mango Princess?” begins. It’s the story I know all too well: the loved one is going about her day, eating her food, caring for her children, when smack! her brain and her life are run over by a goddamn speedboat.
My mom’s brain got run over by her own bicycle. No one saw it, but the friendly neighbor out watering his friendly lawn says he thinks she might have hit a divot in the road. She went head-over-handlebars. I arrived at the hospital three hours after they’d discovered her identity, 40 minutes after turning in my ACT bubble sheet.
So there I sat in the waiting room, worried uncle on my left and joke-cracking aunt on my right. My younger brother was on his way with the rabbi. The doors to the ICU swung open, and my dad emerged, motioning for me to come in. My uncle patted my back but remained seated—only two visitors allowed in the room at one time.
The room was dark, and nurses whispered outside. A doctor talked to me. His coat, his mustache, the thick hairs on his arms, everything about him was white. I couldn’t look directly at him; it hurt my eyes. I touched the Velcro around my mom’s sleeping wrist, then followed it with the tip of my index finger as it wrapped around the bars of her bed. The doctor assured us that the restraints were just precautionary. They didn’t want her to injure herself further.
It would be a few days until they could tell us more than this: she had suffered a traumatic brain injury. There was significant swelling, and they wouldn’t know the full extent of her injuries until the swelling had gone down. For now, all we could give her was time.
The three of us—my dad, my brother and I—went to Chipotle for dinner. My dad talked too much, and my brother, Max, didn’t say anything. Between bites of my burrito, I offered advice to my dad for how to word an email to my mom’s boss, letting him know that she would be out for a while. She was the Director of Curriculum and Instruction, as well as a founder, at DSST Public Schools, a charter school district within Denver Public Schools that was in the process of opening eight campuses across the city. A former English teacher, she was articulate and thoughtful, and she had made big waves in the Denver public school system. It was hard to imagine how the CEO of DSST public schools would take the news that she was currently in the ICU, unable to move or form words.
I finished my burrito as my dad pressed send. I rose casually, walked to the bathroom, locked thestall door behind me and vomited.
We arrived home to find our close family friends waiting for us. Abbie is nine months younger than me, and we grew up six blocks away from each other. I ate as many meals at her family’s table as I did at my own. Abbie slept in my bed that first night after The Accident, and I spent the first of many nights toss ing back and forth, trying to shake the thought that would plague me for months: What if she doesn’t get better? I played out scenes in my head of our future, a family of three, visiting Mom in the hospital once a day, then once a week, then once a month. We’d feel bad that we were coming less and less, but she wouldn’t remember us anyway. Was this our future?
On the fourth day after The Accident, they moved her out of the ICU. The swelling in her brain had gone down enough that it wasn’t life-threatening anymore. Well, it wasn’t death-threatening anymore. Life as she knew it had already been completely obliterated.
My dad filled out an application for her to be admitted to Craig Hospital, one of the best rehabilitation hospitals in the country, which happened to be five miles from our home in Denver. On the day the representative from Craig came to visit my mom, I talked to my grandmother on the phone. She was convinced that my mother would do well in her interview.
“She’s always been good at admissions,” my grandma assured me. “I mean, she got into Stanford, for heaven’s sake!”
Indeed, she was admitted to Craig hospital in the middle of June of 2012. Thus began a summer in the hospital and a lifetime of recovery.
* * *
“Plasticity is the brain’s ability to change,” Lori Driscoll, Associate Professor of Psychology at Colorado College, tells me. It’s the fall of 2015, and I’m writing the first piece about The Accident. Profes sors at CC were eager to talk to me about this concept of neuroplasticity, although they were confused by my interest in the subject. It’s a journalism piece. I didn’t want to sway the interviews by sharing my own personal baggage with them.
“In the context of TBI [traumatic brain injury],” Driscoll says, “plasticity typically refers to the brain’s ability, or lack thereof, to recover from trauma. This is a particular challenge for the brain, which is trapped inside a limited space. When TBI occurs, the brain, like all other tissue, tends to swell. Inflamma tion is induced by cytokines and other chemicals, and glial cells, the housekeepers of the nervous system, are recruited from neighboring areas to assist with removal of dead and dying neurons.”
The process Dr. Driscoll refers to is known in more common language as “pruning.” As in a garden, glial cells prune the dead ends of our neurons to make room for growth. Unlike rose bushes, however, growth doesn’t necessarily stem from the dead ends of the same neurons. Rather, a collective growth process takes place in which parts of the brain that originally had different functions begin to compensate for damaged sections.
Kristi Erdal, Professor of Psychology at CC, names the departed neuron “Joe.”
“Listen guys,” she says, anthropomorphizing the neural network, “Joe’s out of it. We’ve all got to get on board and cover.”
Unfortunately for my mom, Joe was a significant portion of her frontal lobe. The frontal lobe is the personality and higher-order thinking epicenter, responsible for planning, speech and abstract thinking. It wasn’t unusual during her recovery for my mom to call me by her sister’s name, and she periodically asked when her dead brother was coming to visit.
She asked about her boss, Bill, and if he had emailed
her assignments for the week.
“Where’s my…?” she asked one afternoon as she lay in her room at Craig, looking up at the ceiling.
“Your what?” I replied gently.
“Laptop.”
“It’s at home. You don’t need it now.”
“I have to work.”
“It’s okay. DSST is doing just fine without you. All you need to do now is focus on getting better.”
“I am better. I want to go home.”
So did I. Her doctors assured me that she was improving each day. I did notice her speech getting better, but she still didn’t quite understand where she was or why she couldn’t go home. The brain is plastic, they told me over and over. It will bounce back. Every day, though, I doubted this more and more.
* * *
The back of my shirt stuck to my skin as I approached the front entrance. The summer was only getting hotter. Craig Hospital had free two-hour parking for visitors, but after the first day of having to excuse myself several times to move my car, I began parking it in the surrounding neighborhood. I smiled at the woman behind the desk. A person who warmly returns as many sad smiles as she does deserves some sort of Medal of Honor.
I stepped off the elevator onto the second floor and turned right. Room 219, 221, 223, there it was. 225. The door was open, and the room was empty. I stiffened. My left hand reached for the door handle for stability, but my drenched palm slipped, and I stumbled. My head was spinning. I gasped for air.
“Hi, Eliza!” I turned, and there she was, a nurse pushing her wheelchair down the hall toward me. “I just ate breakfast in the cafeteria!”
“That’s a first,” I said, kissing her forehead. I ran my fingers through her growing curls. “It would have been nice to get a heads-up,” I directed this last part at the nurse. She didn’t say anything, just handed me the binder and left.
“I don’t like this nurse,” my mom whispered to
me. “She’s not as nice as the others.”
I gave her a chuckle and opened the binder. I flipped past the first page, which had pictures of her nurse, supervising doctor, surgeon, psychiatrist, physical therapist, occupational therapist and speech therapist smiling stoically out from the page. Her first appointment today was in 20 minutes with the occupational therapist. We brushed her teeth, changed her clothes and took the elevator to the fourth floor of the hospital.
Occupational therapy helps patients recover the basic skills they need to go about their lives. This includes putting on clothes, writing and reviewing the names of kitchen appliances (and which ones are hot). Today, my mom was working on a puzzle. It was a large, wooden puzzle, and each piece was its own farm animal. They had plastic knobs in the middle for easy gripping.
“Almost,” said the therapist, as my mom twisted the rooster back and forth. She turned to look at me, seated a few feet behind, giving doctor and patient their space. Her eyebrows arched and her mouth quivered.
“Can you help me?” she asked.
My throat tightened. Of course I could. I could show her how to turn the piece so it would fit. I could read aloud to her, whisper names in her ear every time an old friend came to visit. I wanted to push her around the world in that wheelchair, just so she wouldn’t miss out, and when the wheelchair broke down I would carry her. I would do everything for her, and then I would do it all over again. But I knew that I couldn’t.
“I’m sorry,” I managed. “You’re going to have to do this one on your own.”
* * *
The human brain is plastic throughout our entire life. As we age, however, this plasticity decreases. Dr. Erdal refers to this plasticity as “what you and I do all the time as our brain changes.” She explains that when babies are born, they simply have more neurons, so their brain can form and strengthen neural connections more easily. As we age, our brains go through a different type of pruning when the brain determines what it needs to do to survive. This is based largely on what our brains are exposed to as we grow. The brain is a machine that values efficiency—if it determines that certain connections aren’t utilized, it gets rid of them and directs energy toward the connections we use everyday.
This is why it is much more difficult for adults to learn new languages. An eighty-five-year-old can absolutely learn French from scratch, but she will do so at a slower pace than a five-year-old. And so, when the neurons in my mom’s brain got together and decided that they needed to cover for Joe, who controls speech, they had to determine which part of the brain they would teach—a part which, for forty-five years, didn’t control speech. Through practice, it would learn to.
During the first few days after The Accident, nurses moved my mom’s arms and legs for her to let her brain know that they were still there. After several weeks, she began to pair names with faces. Her occipital lobe began to process the image in front of her, the medulla recalled where it’d seen the image before, and the Broca’s area formed the name before she was able to say it. This process, which takes a healthy adult brain a fraction of a second, is laborious for TBI patients. Remember, it has become a teaching process—the part of the brain that used to be responsible for facial recognition has been damaged beyond repair. With the star player out of the picture, the benchwarmer must take the field and play a game that, for years, he’s been watching from the sidelines.
* * *
Though the human brain and the human lifestyle are both renowned for their plasticity, the process of changing both is neither easy nor rapid. In her book, “Where is the Mango Princess?,” Cathy Crimmons describes her husband Alan’s recovery process as such:
“One day, you and your family are hiking across a long, solid plain, when out of the sky comes a blazing meteor that just happens to hit one family member on the head. The meteor creates a huge rift in the landscape, dragging the unlucky one down to the bottom of the crevice it has made. You spend the next year on a rescue mission, helping him climb to the top, but when he gets up there, you realize that he has been greatly changed by the hardship. He doesn’t know a meteor has hit him. He will never know, really. He only knows that he has spent a lot of time in a dark, confusing place. He left a lot of stuff behind, the stuff he was carrying with him, down in that big hole, and it’s impossible to get it back.”
My mom was discharged from Craig Hospital in the middle of August of 2012. The final weeks were excruciating, both for her and for us. The leaps and bounds were behind us; her speech, memory and motor skills were still improving, but not as quickly or as noticeably as they had been a month ago. This “plateau” was normal, the doctors explained. It was most likely because the swelling had entirely subsided, so the parts of her brain that were merely obstructed were functioning again, and the slow process of rewiring was chugging along. She asked us questions about the time she had spent in the hospital. Who had come to visit her? Her close friends, Elyana and Leanna, had come often. What had she eaten? Mostly bagels and yogurt—not much has changed there. Could we tell that she had gotten better? Yes, absolutely. When would she be able to go home? Soon.
August is a notoriously hot month in Colorado. I came home from the hospital one afternoon, shortly before her homecoming, to find the back porch crowded with food baskets and large tupperware containers. I turned my key in the door and pushed it open, stepping into the cool kitchen. An overturned raspberry container lay on its side, surrounded by little red raspberry soldiers. Scanning the room, I saw the rest of the casualties: a carton of milk, grapes in and outside of a plastic bag, a box of baby arugula jammed in the flap on the door. A platoon of perishables had made a valiant attempt at invading through the cat door.
I set my keys on the counter and returned for the rest: fresh baguettes, cereal, apples, oranges, homemade lasagna in a plastic container labeled “Wiggans.” Flowers, letters with warm regards. I removed a vase from the cabinet and put the food in the freezer. My dad would be home soon, and cooking was one thing he could control, get lost in and create beauty out of. He, Max and I still ate together outside on the patio. We used the placemats and napkins that my parents had bought in Mexico. They were brightly colored red, blue, green and yellow. They belonged at a garden party.
Once the food and gift baskets were removed from the smoldering heat, I went upstairs to my room. I used to sleep in the basement, but after The Accident, we moved all of my belongings up to the guest room. We’d anticipated that we might need a live-in nurse to help with the day-to-day, and the basement seemed like the most appropriate longterm living arrangement. Now, however, we’d been told that this wouldn’t be necessary. I opened the closet, grabbed a handful of T-shirts and carried them down to the basement.
* * *
Dr. Erdal was a clinical psychologist before she became a professor. She threw her hands up in the air as she told me that patients with head injuries were by far her favorite patients.
“Through no fault of their own, they’ve had their whole life ripped out from under them,” she said, looking at something behind me now. “The motivation is unparalleled.”
My mom has done the Denver Post sudoku and Word Jumble every evening for three years now. She returned to working a full-time job only fourteen months after The Accident. She and I will tell you together, though, that things have changed. At the molecular level, new parts of her brain are performing old functions. They’ve practiced, and they’ve learned, but even after years, the benchwarmer cannot be the same as the star player once was.
While she can’t get back some of the things she left at the bottom of the meteor crater, she accumulated quite the collection on her way back up. Recall is the most obvious difference, particularly with names. A few times each day, she needs to be reminded of the name of a person or object. She cries more, too. One of the most crucial functions of the frontal lobe is emotional control. Thus, it’s understandable that she feels all emotions—happiness, sadness, anger—more intensely than she used to. She cries when she tells me she loves me, and she cries when I’m too embarrassed to say it back. Her smile is broader and more frequent than it ever was before The Accident.
We ate dinner together, just the two of us, last week. I was in Denver for a doctor’s appointment, and she was there for work.
“How’s Carmen?” she asks while we wait for our food.
Katherine is my best friend and housemate.
“She’s good,” I say. “We’re cooking a lot of fancy meals these days.”
“Oh, I’m so happy to hear that! You two must be having a blast living together.”
“Yeah, it’s fun.”
The waiter places a burger in front of me, smothered in green chili and guacamole. He tops off my water glass and winks.
“Enjoy!”
“He thinks you’re cute!” My mom sings as she cuts into her salad with a fork and knife.
“Whatever,” I say, “he was just being nice.”
The patio is crowded on this late August evening. Coworkers clink happy hour glasses, babies cry in high chairs. A mother teases her sheepish 20-year-old daughter from across the table.
“I’m writing an article for my school’s magazine,” I say.
“Oh, I’m sure they’ll love it! You’re such a great writer.
I can’t wait to read it when you’re done,” she says.
Thirty minutes later, she’s paid the check and we hug goodbye. As I drive home to Colorado Springs, it starts to rain. Just a mist at fi rst, but soon large liquid bullets slam against my windshield. I take the exit for Greenland, population zero. The setting sun shines through the mountains west of the highway, but the rain still falls steadily. I pull off onto the gravel shoulder of County Line Road. Back in Carbondale, my mom will be checking the mail, waiting for her copy to arrive.
I grip the steering wheel and watch my knuckles turn white. My vision begins to blur, and I let the tears fall freely down my cheeks. I’ve ventured into something I can’t fi nish. But what kind of journalist is deterred by the fear of what her mother will think? I can hear my mother, the English teacher, in my head.
“Put it all out there,” she says.
“I can’t. I don’t want to hurt you.”
“You won’t.”
“But I’m a journalist. I just want to tell the facts, I don’t want my emotions to get all mixed up in it. It’ll keep me from telling the truth.”
“What’s more true than raw emotion?”
“I don’t want to make you feel sad.”
“Make me feel sad,” she says, “and then make me feel happy. Make me feel humbled, afraid, bewildered and ecstatic. Then, you will have done your job as a writer.”
The windshield wipers thrash back and forth, and I shake her voice out of my head. A sliver of a rainbow peeks out from behind the clouds to the east. I shift into drive and turn back toward the highway.
“Okay,” I say aloud. “Okay.”