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Sydney Morning Herald Ian "Molly" Meldrum's fall and head injury has led to a great outpouring of sympathy for the Melbourne icon. Seemingly, everyone wants him to get well and "make a full recovery". I, too, wish for the best for Molly. Being a little more aware of the journey he is now likely embarking on, however, I am more mindful about its outcomes. Three and a half years ago my husband, Damien, and I were involved in a motor vehicle accident in which I sustained a serious head injury. The nature of the injury was probably not dissimilar to that of Molly's; a specific site injury and general swelling. We all know about the road toll in terms of deaths, but we hear almost nothing about the long term consequences of the equally common head injuries. And being in a coma is not like in the movies, where people wake up as though waking from sleep. Although there are some very good brain surgeons, they still know very little about how brain injuries affect mental activity. Apart from relieving pressure on the brain, the process is mostly about good intensive care nursing and a whole lot of luck. Having a forceful or "tough" personality before your injury does not affect the outcome. Most patients who end up in a hospital's intensive care unit (ICU) usually leave within two or three days. They either go to a high dependency unit in transition to some sort of recovery, or they die. My stay in the ICU was more than 10 days and during that time, I have since learned, there were bleak and confronting discussions about my prospects. Neither Damien nor I want to exist brain-dead on life support machines, but his view was "not yet". And then, thankfully, I slowly started to regain consciousness. In such cases, consciousness is recovered by degrees and is marked by post-traumatic amnesia (PTA). PTA a dream-like state in which there is a high degree of confusion and disassociation from reality. Everyone who has a head injury resulting in loss of consciousness undergoes some degree of PTA, with the length of unconsciousness roughly associated with the length of PTA and the extent of permanent injury. As PTA fades, assuming sufficient remaining brain function, simple skills such as walking and then more complex skills are re-learned. Some people never talk or walk again, while others make very much better recoveries. The spectrum of brain injury outcomes is very wide. Brain injury kills off part of the brain and, while it is possible to learn compensatory skills, the dead part of the brain does not grow back. The return of cognition is, therefore, emotionally painful. The slow waking from a coma introduces the injured person to an awareness of what has not yet returned and what may not return. Along with initially limited cognition, self-confidence can dissolve. More than three years later, I have some short-term memory loss, occasional poor balance and recurring fatigue. Although unable to return to my former job, I now volunteer co-ordinate a women's community group and community partnerships with East Timor. For me, my husband and my children it has been an exceptionally good outcome, especially given the earlier prognosis. But I am also very aware of the stigma that attaches to having had a head injury. Some former "friends" are no longer. But my recovery has been about as "full" as is possible. Molly Meldrum will, if he is also lucky, go down a similar path. But, as he returns to the world he knew, he will likely face significant challenges. What he will need is not people expecting him to be exactly as he was, but to be Molly, the same person, dealing with these new challenges. Molly will need long-term love and support from family and friends. From others also he will need more realistic understanding of the issues he will likely be dealing with. So, too, the many hundreds of other people who have suffered head injury and live daily with the consequences also need more realistic – and sympathetic — understanding. It is important, though, to move away from the idea of a "full recovery", which is not really possible. As Damien and I have learned, to rebuild life and to be happy in it is as full a "recovery" as is possible. Perhaps it is also as much of a "recovery" as is necessary. |
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