Surviving Brain Injury: In The Blink of An Eye

A Life Changes in an Instant

In the Blink of an Eye

By Catherine Borden

When my brain injury happened

My name is Cathy Borden. I am your average mother of two and have been happily married for the past 28 years. I am a 55-year-old woman whose life was shattered on Christmas Eve, 1998, ironically just a short time after I had begun to get a grip on my 23-year battle with agoraphobia.

It all happened on my way to work, or so they tell me. I have no memory of what occurred the year before the accident or what happened after the accident, until I woke up five days later in the ICU with a nurse yelling in my ear, “Wake up, Cathy, you’ve been in a terrible car accident.” I closed my eyes and wondered to myself why Peter, my husband was still awake watching television. There are flashes of memory of those two months in the ICU. Most of my memories of that time remain a blur.

What they DID tell me is that I skidded on a patch of ice, on the same street where I live, less than a mile away from home. According to what I’ve been told, I slid so badly I must have panicked and hit the accelerator pedal, pounding into a telephone pole at 60 mph. I broke the steering wheel with my face and sustained several injuries: A severe concussion (a TBI or Traumatic Brain Injury – closed head trauma to the brain with swelling and bleeding), almost lost my left eye, broke the tip of my nose from my face, shattered every bone in my face against the windshield, destroyed my sinuses on impact, broke my jaw in sixteen places, broke my palate (actually had what is known as a facial fold), lost almost all my upper teeth, broke my clavicle and punctured and collapsed both lungs. I was rushed to our nearby hospital, which fortunately happens to be a Level-One trauma hospital. I was brought in on what they call a Code 40 (a code used for an incoming trauma patient). In my case, I was unrecognizable, unresponsive and bleeding profusely.

When I arrived in the ER, the staff worked on me feverishly to ensure that I was stable. I had lost 2 pints of blood and they inserted an intracranial monitor because the pressure in my skull was erratic. I was given medication through the opening they drilled in my head. I underwent an 8 1/2 hour operation by 12 surgeons. They didn’t even bother to x-ray to check for internal bleeding. They merely cut me open. I had been intubated (placing a tube down a patient’s windpipe that brings oxygen to the lungs, often the first step in saving a person’s life) on my way to the hospital. Chest tube linings and feeding tubes were inserted. The problems arose when they wanted to insert the tracheotomy. They were certain I had crushed my esophagus, but actually what happened was the esophagus broke away from the bone on impact and an ENT (an ear, nose and throat doctor or an otolarynologist) had to be called in to ensure the anesthesiologist that he would cause no further damage by inserting the tracheotomy. Each surgeon informed my husband to expect the worst … the surgeons were certain I would die.

That morning at the hospital when my family learned I had a brain injury

My daughter Stephanie told me that morning had started like any other morning; my husband Peter had left for an appointment. My son Peter (or Petee as we call him) was home on winter break from college and was recovering from major surgery, which he had undergone one week before. He was in so much pain; I was reluctant to leave him. His shoulder had been separated and he was in a full shoulder and arm cast. Immobile and unable to care for himself, he was sleeping in a recliner.

Stephanie was also home, preparing for work; during that time two of my closest co-workers had called our home. Ironically, they were aware of the condition of the roads, and given that it was 9:20 a.m. and I hadn’t yet arrived at work, they were afraid something might have happened. Shortly after they made that call, the police arrived at my door. Stephanie accepted the news that I had been in an accident without a great amount of concern; I had always been the responsible one, so in her mind she felt it was a “fender-bender”. She kissed her brother good-bye, and headed off to pick me up at the hospital.

Upon her arrival at the hospital, Stephanie immediately realized that this was a very different situation than what she had envisioned. When she went to the front desk and told them she was there to pick me up, a social worker called her into his office to tell her that her Mom might not make it. Stephanie felt a surge of panic and immediately called her brother. At first, all she could relay was, “Find Daddy immediately.” She then told her brother the truth. Shortly thereafter, my brother, Albert, called the house to check on my son and to see if he needed anything (after all, it was Christmas Eve). That’s when my son told my brother about the accident. In disbelief, my brother headed for the hospital just to be sure. When my husband arrived at the hospital, he found Stephanie wandering aimlessly in the street. The shock was too much for Stephanie to comprehend.

I became the woman with no face

To everyone who knew me, I was unrecognizable. The ER personnel were not sure if I was a male or female, nor what my age was — only that I had a pair of black slacks on and camel colored winter coat. I was tagged as Nancy Doe because the EMS had not seen my purse in the car, but the police did. When my husband arrived, he couldn’t imagine what had happened. I had no face and did not respond…. I was comatose. He had been told I probably wouldn’t make it, but with all that was going on, he was probably in shock and unaware of what they were really telling him.

After I was taken to the OR, my husband returned home briefly to soothe our kids. His mind racing, he called his mother. Due to my father-in-law’s declining health, she was unable to be with her son, but she telephoned my sister-in-law Pattie who headed to the hospital to stay with my husband. I was brought into recovery at about 10:30 PM, after 8 1/2 hours of surgery. The surgeons came in and out of the “private OR” area to reassure my husband that I was still alive. The reconstructive surgeon, a very kind man, excused himself while he spoke to my husband saying he had to go “put Humpty-Dumpty back together.” Peter was so very concerned, not only for me, but also for our children. He went to the chapel to say a few prayers, with hopes that I would survive. In a nearby hallway, Peter ran into his father’s cardiac surgeon who asked Peter what he was doing at the hospital. When Peter told him, the cardiologist, perhaps not making the connection at first, said, “Oh, the woman with no face, she was in the OR next to mine. Very sad.”

Waking up from my coma

When I awoke from the coma, I felt so dazed I couldn’t comprehend what anyone said to me. The morphine helped to ease the pain in my body. All I could do was sleep. I was in the ICU for five days, and then transferred to another section of the ICU known as a “cluster” room; 4 patients and 4 ICU nurses … all patients in this area are critical. I had passed the 72-hour wait-and-see period. One week later, I underwent a 3-hour surgery to insert 3 more titanium plates in my jaw and to wire my jaw. I awoke after this surgery with a fever of 107 caused by a severe blood, lung and sinus infection. Again CT and Body Scans were performed. All pain medication was withdrawn. For some reason, I have a very vague memory of someone asking me to hold my breath as they removed the chest tube linings. I do remember how painful that was, but all obvious openings to the body had to be closed. With so many lacerations to my face, the trauma surgeon was sure that they had contributed to the fever.

No one ever told me about my altered appearance. Peter had brought in pictures of me to help the reconstructive surgeons with visual aids and to see what I looked like. So many nurses asked who that pretty woman was in the photo. Because I did not comprehend the full extent of my injuries, I was wondering if lack of make-up and this sticky hair made me unrecognizable. I realize now that the staff was trying to shield me from understanding the true extent of my altered appearance. The first time I was allowed to see my face was the evening before I was released. On that particular evening, I was taken to another room for my first physical therapy session. I was told to walk, with the help of a walker, about twenty feet towards a wall. I saw an extremely unattractive woman approaching me. I thought to myself, that I should smile and nod to her. To me this lady was grotesque. As I became closer to her, I realized it was not another woman; I was walking towards a mirrored wall.

My hospital stay had been extended because the trauma surgeon was waiting for the fever to drop. I was finally released as they were worried I would contract more infection. I was sent home on January 10, 1999, by ambulance. The trachea stoma had been removed, but the J-feeding tube and catheter were in place. I had with me several prescriptions and many doctors’ visits already scheduled. In a daze, my husband and I headed home “somewhere”; nothing felt familiar.

Coming home and livinig with the consequences of my brain injury

Once home, my activities were greatly restricted. My privileges included permission to use the commode in our bedroom and with a walker, walk once a day from the bedroom to the living room and back. I thought it would be a matter of healing and in a few weeks, and I would feel like myself again. Boy, was I wrong! In the ambulance, I had felt very strange. I can recall that my stay at the hospital was filled with delirium and confusion. Home now, I looked at the familiar streets in my town; I knew them well, traveled them frequently, but they still didn’t FEEL familiar. Neither did my house, my dog, and most of all, neither did my husband and children. I felt so detached and weak. This feeling of detachment is still with me.

My sister-in-law Pattie stayed with us for one month so that she and Peter could be my caregivers. They were not thrilled about having me home; in fact they were terrified. They had to feed pureed foods to me through a feeding tube, make my bed, bring me basins in which to wash, and help me dress for doctors’ appointments. I vaguely recall that my terror of the car was unbearable and all motion made me so dizzy. For the first six months, I had to sit in the back seat of the car. I was too terrified of the front. I lived as in a dream walking state.

After my sister-in-law left and my son returned to school, I had to turn to my husband for my sole support. In mid February I began to experience crying spells. I found myself in an uncontrollable situation; I would cry for weeks nonstop. I also awoke several times at night with palpitations and tremors. I don’t know what I dreamt; I remembered nothing of the accident. It was then that I learned, through my doctors, of post-traumatic stress disorder or PTSD. Therapy has helped, but I continue to have nightmares and difficulty sleeping to this day, over five years later.

Recovery after brain injury is is slow…physically and emotionally

Since the accident, recovery has been an uphill battle. I have many deficits, both physical and emotional. I have worked very hard to overcome them. I went for physical therapy twice a week because of balance problems and to build my endurance. I am trained to look left and right, up and down, quickly, then close my eyes and stand on one foot. This is to induce vertigo, to teach me how to deal with this unwanted sensation. When the vertigo starts, I am told to focus on something large and stationary. Sound like fun? Well, it is when you are no longer afraid of being dizzy. I hated PT at first, but I must say it does work. In my home, I am able to walk without my cane. After one year, I was dismissed because no progress was being made. I never spent time in a rehabilitation hospital because of the massive infections. Speech therapy was prescribed by my neurologist at Kessler Institute, on an outpatient basis. To this day my speech remains impaired, in part because of the brain injury and because of the physical damage done to my mouth and jaw.

Learning about brain injury…and how to live with it

Although my family members knew of the brain injury, I was unaware. For almost ten months I thought I had daily headaches and chronic dizziness from being in bed for a very long time. The past seldom entered my thoughts, so memory deficits were unbeknownst to me. Speech problems, I thought, were due to the jaw injuries only; the word “aphasia” (impaired ability to communicate through words or speech). As for intelligence, I’d lacked confidence most of my life. Inability to concentrate while watching a movie or television was a mystery. Since I did very little, focusing, sticking to task and comprehending instructions seldom were an issue. After having my first neuro-psychology test, I learnt of these so-called “deficits”. Yet I still did not realize I had a brain injury. Only after a courtesy visit from the Brain Injury Association did I know that I had been affected by this traumatic brain injury.

I had my third surgery on 7/20/99 to reconstruct my nose. Reconstructive surgery is an ongoing process to repair a face that looked like Silly Putty thrown against a brick wall. I have had numerous surgeries on my face and jaw. I have undergone three oral surgeries. Bone grafting has been done by a procedure known as an “Alveolar Distraction Osteogenesis”, performed by my highly skilled oral surgeon. In all, I have had a total of 10 dental implants and permanent crowns. The surgeries have been bothersome, yet somehow I’ve survived. I’ve asked the reconstructive surgeon how he thinks I will look after all these surgeries and he said he’s never had a patient who had sustained such extensive facial trauma and survived. Well, I can tell you that really made me real special. I want more than survival; I want my life back.

I have worked very hard to try to be the person I once was. With the surgeries and rehabilitation for short-term memory loss and other deficits behind me, I recovered over one-half of what I have lost. I still have balance problems, permanent loss of my peripheral vision, speech and chewing issues, as well as problems with comprehension, coordination and organization. I lived in the kitchen before my accident. Mentally I have not forgotten what needs to be done to prepare a special meal; the first two years after I could not seem to get it all together. I would love the depression and anxiety to end without the need to take antidepressants. I would also like my feelings to be more grounded. It would be so nice to connect with my surroundings.

Nowhere feels comfortable; at times I feel like my skin doesn’t fit. In the past, one of my favorite things to do was to go to the mall with my daughter. For the first three years after my accident, shopping was unbearable because of the lighting and the crowds. It was as though there were 100 conversations going on at once — sensory overload, I’ve been told; a phenomena suffered by most traumatic brain injury survivors. Slowly I ventured out, and most of those feelings have dissipated. I would like to be able to eat out at restaurants during normal dining times, not at 4 PM when no one is there. And most of all, I hope I can go back to where I was with conquering my agoraphobia. I had worked so hard to regain my independence and drive alone within 15 miles of my home. I don’t know if I’ll ever drive again, but if I do, I assure you it won’t be after a snowfall. Permanent loss of my peripheral vision has made driving again impossible.

Hanging on to hope…

In April 25, 2003, I underwent my 13th surgery, which was supposed to be my final facial reconstructive surgery. Unfortunately, it was a complete failure. I looked almost like the “same old me” for about 48 hours, then swelling, infection and rejection turned my world upside down again. Yet, I have not given up hope. Since that time, I have been searching for a reconstructive surgeon, who is proficient in repairing and rebreaking already broken bones. With prayer and luck, I hope the day will come when I will be able to look in the mirror, and recognize the woman staring back at me. I have learned to be thankful for what I have. Somehow I have become a stronger and accepting person. Most of all, I have realized that my accident didn’t just happen to me, it happened to everyone in my entire family. I have to thank my wonderful husband, my two devoted children and my loving sister-in-law Pattie for all the tender and unquestionable care they have given me.

I would also like to thank Brian Moore, the Webmaster of TBI Chat; a wonderful man who also experienced a traumatic brain injury and created a chat room for persons with TBIs and their caregivers and families. I am so grateful to all the friends I have made with the members of TBI Chat. Without their acceptance and understanding, I do not think I could have gone through the past 5 years. This chat room can be found at the web site www.tbichat.org. It was through this site, that I discovered I wasn’t the only person who experienced a severe brain injury. I would also like to thank The Brain Injury Association.

Copyright by Catherine Borden. Please do not copy without permission from the author.