By Denise Boggs

Child’s recovery from brain injury is emotional as well as physical

If your child or teen has experienced a traumatic brain injury (TBI), you may be aware of their struggle with emotions. Emotional recovery is very important after a brain injury and should not be overlooked.

There are five levels of emotional development. In some cases, people with a traumatic brain injury will go back to the very first level and start all over again in their emotional development. The ability to connect on an emotional level in a healthy relationship is the long term goal of emotional recovery.

When our son was fifteen, he suffered a TBI. We were not really sure what to expect as he came out of a forty day coma. He began to awake only to discover he was, in a sense, a “six foot infant.” He had to start all over, like a new born, slowly learning how to do everything.

Stage one of emotional development

Stage one of emotional development is the ability to receive love. For a child or teenager with a TBI, it is vitally important for both parents and siblings to be present during this stage. They should be interactive so their child’s spirit is awakened through nurturing. Physical touch such as holding your child for extended periods of time daily is most effective. In our son’s recovery, it was very obvious that physical touch activated the blood flow and drew his spirit to life. If holding your child is not possible, you might hold a hand, rub arms and legs, or kiss a forehead or cheek.

In our son’s case, the right side of his brain was injured. While he was in the coma, we gently rubbed his head on the right side to activate more blood flow, which proved to be very effective as he regained more and more movement in his left side. We could actually see the difference in alertness after his cheek was kissed and gently rubbed.

I believe that lack of nurture in early stages of recovery:

• Causes the spirit to remain in a slumber.
• Causes the child or teen to feel unloved, leading to insecurity and the need for constant reassurance of love later in life.
• Causes emotional growth and development to be stunted.
• Creates a void in the foundation stage of emotional development. If the foundation has a void, something is missing.

Stage two of emotional development

Stage two is “Independence.” Each child or teen is uniquely created by God as an individual. During the second stage of emotional development, a child will begin to explore their independence. We as a family observed that as our son felt secure and loved, he progressed quickly into this stage. He wanted to venture out in his own uniqueness. During this stage, a child or teen will test his parents’ love with acts of independence. For emotional development purposes, these acts of independence need to be handled correctly.

I believe it is important for parents to be careful to correct their child without crushing his or her spirit. Proper discipline is very important at this stage. A child needs to experience unconditional love. Even when a child is disobedient, love is still there for the child to receive. During this stage, a child will test a parent’s love in many ways. One way is by expressing their own desires, which may be different from their parents’ desires. Children need to feel secure enough in their parents’ love to say “No” without the fear of being cut off, shut down, or rejected.

Parents must allow their child opportunities to say “No” when it is appropriate in order to express their independence. Parents should give their children choices so they can learn to determine what they like or don’t like and feel the freedom to exercise choice. This continues to build trust in the parent/child relationship and prepares them to say “No” in adulthood. The adult person who has not learned how to say “No” can very easily be controlled and even abused by others.

Many times parents want their child to be just like them, but God created each child as a unique individual. Children need to have a loving and safe environment to discover who God created them to be. As they discover that they are unique, they need to feel that it is all right to be different from their parents.

Recovery after brain injury

This is also true in the recovery process. There is a time when the survivor begins to realize and embrace the reality of being different from who they were before the brain injury. It is important for parents to support their child who is learning to embrace a new self. Parents can give emotional support as their child learns to say, “Yes, this is what I believe and what I choose” or, “No, this is not me.” By encouraging new preferences, the child starts to build a new identity after the brain injury.

Our son Will loved to ride horses and wear western jeans and shirts before our car accident. However, as his uniqueness was being developed after the accident, he didn’t want anything to do with western wear and our family had to accept the new him. We allowed him the choice and when he said no we respected this new choice. This was especially hard for my husband because he and Will rode horses together and now his “new son” didn’t like horses at all.

The role of a parent in this stage of a child’s emotional development is to:

• Affirm who they are and their differences
• Allow the child to make choices with safe boundaries
• Provide accountability to stay within boundaries
• Set and encourage attainable goals
• Carry out appropriate disciplinary consequences when behavior is unacceptable (see Proverbs 22:6, Proverbs13:1, Proverbs19:18)
• Encourage unique gifting, abilities, and interests

Caregiving after brain injury

Now, if you are the caregiver of a child who has had a brain injury, go back over the role of a parent and recognize that this is also your role as a caregiver. A caregiver who does not take this role – to monitor and encourage emotional development – will see the effects in years to come.

The brain can be re-trained, just as a child is trained in right from wrong. A child who is not taught right from wrong and how to choose what is right will become rebellious and will not respect authority. A survivor of a TBI who has not been taught how to make the right choices will flounder in life. They will also have a greater chance of getting into trouble and rebelling against authority later on as they get older. They may try to gain independence in the wrong ways by finding fault with the family as a reason to separate and individuate from them. The right way to gain independence is to have a solid and secure foundation, knowing one is loved and accepted and therefore having a strong self-worth regardless of disabilities.

For information on the additional information on emotional recovery, please contact us at:

Living Waters Ministry, 828-632-3906 or www.tbihope.com

By Lainie Cohen

A car crash left my son with a traumatic brain injury

When my seventeen-year-old son, Daniel, sustained a severe brain injury in a car crash, we didn’t know that Tic Tac Toe would be an important element to his recovery.

After Daniel emerged from his five week coma, his recovery was slow paced. The physicians weren’t optimistic about his prognosis. They told us that in addition to his right-sided hemiparesis (weakness on the right side of his body), they were concerned about his language skills. They predicted significant impairment in Daniel’s receptive language skills (his ability to understand what was said to him) and his expressive language skills (his ability to express himself either verbally or in writing).

Friends visit and play games after his coma to help his recovery

 At the time, Daniel’s friends were regular visitors. They brought in music tapes, hung posters to decorate his hospital room, and told him stories of events from school, hockey and summer camp. And they started playing games with him. The first was Tic Tac Toe. Using a white board that can be written on with markers and wiped clean, they drew a grid and filled in the first X. Then they handed Daniel the marker. He drew a wobbly O in a square beside the X. That game was the first of many.

We’d discuss the placement of each symbol, although we weren’t sure if Daniel could understand. “The X is in the middle. You drew the O in the bottom left corner. Now here’s another X. Uh, oh! Better watch out,” we’d cue him. The first time he deliberately blocked two Xs was very exciting. Soon, Daniel insisted on going first, and then he started winning.

Games and activities are cognitive rehabilitation

Game playing places demands on cognitive, physical and sensory skills. Deficits from an acquired brain injury can limit success. However, games can serve as a wonderful medium for rehabilitation because the “fun factor” promotes repetition. Consider the basic skill sets needed for games: attention and concentration, turn taking and following rules. Even simple card games like War or board games like Snakes and Ladders tap into multiple skills: color differentiation, number recognition, identifying higher and lower numerals, and associating the spatial arrangement of dots on dice with a numeral.

The recreational therapist in the rehabilitation center showed us that teenagers could still have fun after brain injury. Daniel participated with others in cooperative activities like cooking, baking, artwork and music. We couldn’t believe our ears when we first heard him play a harmonica, long before he had the breath control to speak. Daniel was encouraged to try new activities, and as he improved, we watched him engage in wheelchair sports: basketball, hockey and balloon badminton. Not only was he increasing his skills, but also more importantly, he was socializing with his peers.

Make changes that are needed to accommodate a brain injury

Observing Daniel in this environment made us acutely aware how important it is to monitor for low frustration tolerance and fatigue, issues that can be challenging following a brain injury. Modifications were often needed to ensure his safety and enjoyment. When Daniel returned to high school, his Special Education teacher helped him organize a weekly Euchre club at lunchtime. Daniel started carrying around a deck of cards. Years later, on a flight home from a family ski holiday, I watched Daniel use his cards as an icebreaker as he invited his seatmate to join in a game.

Our society emphasizes competition. After a brain injury, it’s important to change the emphasis from winning to participating. Just play the game and have some fun. You’ll be surprised at the results.

Helpful hints for families and friends when visiting after brain injury

• Keep it short and sweet. Focus on having fun. Don’t worry about finishing the game.
• At first, play a familiar game. (You’re tapping into procedural memory.)
• Simplify the rules if needed to increase success. (e.g. for the card game Fish, make sets of two matching numbers instead of four; for board games use one die instead of two dice.)
• Use aids to modify demands, e.g. a plastic cardholder to display the hand of cards, cards with large print numerals.
• Avoid verbal challenges with games featuring a visual-spatial component: Checkers, Connect Four, Chess, and card games (War, Fish, Crazy Eights, Gin, Euchre).
• Choose activities that can be done cooperatively, such as puzzles.
• Some games can be played individually: Solitaire, Rush Hour and many computer and video games.
• Lainie Cohen speaks at ABI conferences and conducts workshops on family-centered care for rehab students and professionals. Visit her website: www.crookedsmile.org if you are interested in learning more.

Dixie Fremont-Smith Coskie’s articles by herself and two of her children give readers a special glimpse into the many ways that a traumatic brain injury can touch every single member of a family. Her son, Paul, who had a brain injury, also gives his point of view.

We thank them all for their honesty and their willingness to share their emotions.

For information on her new book, titled, “UnTHINKkable” click here.

IMPACT

By Dixie Fremont-Smith Coskie in Massachusetts

Five years of confusion, helplessness, and torment stung my nerves as I saw familiar terror in my daughter’s eyes. I knew she was about to reveal something horrific. And finally, as the sobs escaped, she told me. Four of her closest friends had just been in a car crash.

They had been returning from a carefree day at the beach when their car lost control, flipped over and rolled down an embankment, which forced three of the teenagers through the windshield. Only the one wearing a seatbelt was not hurt.

She paused to take a long breath and I urgently asked, “How serious is it?”

Her voice cracked, “Not good. I heard James is in a coma.” Breaking away from me, she began to pound the keyboard, instant messaging anyone that she could. As she hysterically typed, I asked questions, “Were they drinking? Speeding? Who was driving?”

A flashback brings back memories and compassion for parents

“I don’t know, Mom,” she said, “But I almost went with them today.” I quickly pulled her close to me. As I did, my mind flashed back to the day when our lives were forever changed. The moment when my thirteen year old son was struck by a car while riding his bicycle. He had not been wearing a helmet and suffered a severe head injury. I thought the wounds were starting to heal. But my daughter’s frightened eyes had ripped through the scars.

Immediately my thoughts shifted to the mother of the injured boy. I didn’t know this woman, but I understood her. I understood her anguish. Her confusion. Her loss. I knew it all too well. I wanted to find this mother and shield her from the horrors of brain injury.

You can’t console a parent in crisis; the numbness that comes with trauma coats everything. And yet, reflecting on the images of my son Paul, lying in a coma, the only noise from the ventilator to aid his labored breathing, I remembered when the chilling realization hit me: even if he did survive, he possibly could be deformed, handicapped or impaired.

I instinctively wanted to phone James’ parents. I wanted them to know they weren’t alone. But knowing the chaos, the protective barrier that comes with crisis, I didn’t. I knew they were trying to grasp the medical realities, demanding answers from the doctors, doing anything they could think to improve their son’s chances of survival. I knew they were inconsolable because I was inconsolable then, too. There is a powerlessness you feel when you see the child you brought into the world lying defenseless on a hospital table.

From last rites to a new life for our son

My husband, Steven, and I stayed by our son’s bed side in shifts. One of us at the hospital, the other at home with our son’s six siblings, allowing them to cry, and to ask questions, giving them whatever information we could in an effort to ease their grief. Occasionally we even timidly talked about life and death. When reality overwhelmed us, we simply prayed for Paul to live, to heal, and not to have any lasting repercussions.

Two months after our son’s crash, Paul’s eyes finally blinked open. He could not walk or talk or even remember who he was. With help from therapists, his family, and his self-determination and perseverance surfacing, he fought through days, months and years of rigorous physical, occupational and speech therapies. Today his efforts have paid off. My son Paul walks off-balance, but it is a blessing he is walking at all. His voice is slow and monotone, but the fact that he can respond and speak is amazing. Cognitively, his brain may move slightly slower, but it is beyond belief that he interacts with maturity, humor, and intellect. The left side of his body shakes due to ataxia, making it hard for him to accomplish simple tasks we all take for granted, but the reality that he is not paralyzed is miraculous. Paul has been on the honor roll and graduated from high school. He works full time, and his hobbies include paintball, golf and even bike riding. Five years after our son was given last rites, we still see slight, incremental improvements, all of which have redefined what hope means to us.

Making a connection with James’ mom

I was told James had awoken. His mind was in a haze, but he was gaining more movement with his limbs. To my surprise, his mother phoned me – searching for guidance, reaching for support, telling me the intensive care administrators were suggesting sending her son to a rehabilitation hospital. Tears brimmed over and I tried to compose myself. I didn’t know this woman, but our connection was real. I felt the relief in her voice that her son was alive, but I also sensed her fear, not knowing the future and the quality of life that James would lead.

Gripping the phone I said, “Connie, I know your uncertainty, but this is good news The doctors have stabilized your son, now a rehabilitation hospital can begin to get his body moving again.”

Hesitantly, she responded, “What if he remains in a catatonic state?”

Knowing she was fragile and on the brink of collapse, I spoke softly, reassuringly, “You’re moving forward to help him to heal, there’s hope.”

Emotions flood back to when it was my child

Putting the phone down, I felt hidden emotions and images surfacing. Everything came back at once. Cradling my son’s body on the cold dark pavement. The blaring ambulance, the helicopter ride, and the doctors stating, “Paul may not survive the hour or the next twenty four.” I experienced the same fear I felt when I watched my child hooked up to tubes, wires and a ventilator. And suddenly, my body began to tremble as I recalled the horror we faced whether to take Paul off life-support. And I remembered with shock, the uncertainty of when we eventually arrived at the rehabilitation hospital, seeing children disabled from birth, or accidents- and I remembered the physical therapy rooms, and the grueling days and nights fighting to gain back what was taken from Paul on that fateful day of the crash.

These parents didn’t know the up hill journey and repercussions they would be facing, but I did. I wanted to spare them all of the grief my husband and I had gone through, but I had to keep reminding myself that there is no way to accelerate or soften the healing process. I wondered how they would cope, knowing the despair and agony they would witness. I wondered if they had it in them, to not give up.

The other piece of the equation, of course, is how would their son cope? We watched as my son Paul began to regain use of his limbs, and basic cognitive judgment skills. We encouraged him as he learned to sit up, roll over and to take steps. All the while waiting for the day he’d try to form thoughts, to process information, to speak. We were beside him reaffirming that he would get better as his brain sparked, sputtered, and played a cruel game of hide and seek.

A familiar story of hope and sorrow

Months later, another phone call from James’ mother revealed the same type of devastation I too had faced. Her son had maxed out his therapy benefits and her insurance company would no longer pay for therapies at the rehabilitation hospital. A decision had to be made whether to bring her son home, far from fully recovered, or send him to a residential educational setting.

Again her sorrow was evident as she whispered, “I know we haven’t met, but I have heard bits and pieces about your son’s recovery…what should I do How can I best help my son?”

I said, “Every head injury and recovery is unique.” I simply told her the decision boiled down to this: A) Bring him to a nursing home, and there is little chance he will advance in his recovery. B) Bring him home, be his sole caregiver, and fight through the special education bureaucracy at his local school. Or, C) Admit him to a boarding school or program with expertise in head injury rehabilitation.

She was shocked when I again suggested the latter. But knowing the realities of bringing a brain injured child home, I somehow wanted to make sure she was making informed decisions that could best help her son in his recovery process.

Mentioning my experience, I told her we interviewed other facilities and spent hours with school administrators. Our instinct was to return our son to public school, with special assistance. At that point, our son was struggling just to remember “2+2 = 4.” We needed to start a special program to help Paul relearn simple math, history, and English in a quiet room. We searched for a personal aide to help reinforce his studies and to help him physically move through the crowded hallways. Due to Paul’s lack of concentration and double vision, Paul listened to books on tape. A computer helped with his lack of motor skills and gave him a tool to write. We blocked out time on his school schedule so he could work with physical, occupational and speech therapists. And, his afternoons were spent, working with weights, cognitive workbooks, and swimming in the therapeutic pool, struggling to get better at a rehabilitation facility twenty minutes from our home.

Connie hesitantly said, “I want to bring my son home, but I’m not sure if I can cope with all the changes or what I’m up against.”

Holding on to hope

Back then, to look at Paul some would have thought my son should be attending one of those schools for the physically and mentally challenged. Stubbornly my family saw him as challenged, but not handicapped. We wanted to see beyond his mangled body and mind; hoping for endless possibilities. Never having faced such a situation before, we stuck to faith – a faith adjusted to the situation at hand. We sacrificed our own needs and wants, wanting to surround Paul with the love he had always known. Paul sacrificed and endured too. He did not slip backward or plateau; he fought–like an athlete training for the Olympics.

Surprisingly, Paul recovered enough to be reintegrated into “regular class rooms” in a wheelchair. Not all head injury victims are as lucky, and I did not want to give this mother false expectations. But I shared with her that after months and years of heartache and struggle, Paul amazed his family, his teachers and fellow students when he walked to receive his High School diploma, taking steps doctors thought were not possible. Whistles, screams, tears, a standing ovation and Paul’s smile had overpowered the room. Reflecting on this, I realized what to say to this mother; I knew I didn’t have all the answers. I could only tell her from my experience. If she chose to bring her son home, be prepared for mood swings, anger, confusion, and the loss of independence. There would be a lot of driving to and from therapy sessions. And to be prepared that her marriage and her other children’s needs would be placed on a back burner. She needed to know she probably would have late dinners, piles of undone laundry, and the gnawing gut feeling that no matter how hard she kept trying to get him better, it would feel like it was never enough. Then I said to this mother, whose grief and sorrow I connected with so tragically, “The important thing is this – choose what you think you can handle, and where you think your son can best recover – and then don’t give up. Never, ever, ever give up. Pray and hope.” I added, “For hope is what keeps the spirit alive and our souls in motion.”

For information on her new book, titled, “UnTHINKkable” click here.

 Split Second

Dixie Fremont-Smith Coskie in Massachusetts

The doctors were right. My son Paul nearly died.

And today he is not the same person he was before the accident. Nor am I.

I prefer to be alone. To think and ponder. To try to make sense of life, death, suffering.

I have no patience for trivial things, conversations, most people.

~ ~ ~

I prefer to keep a dialogue with God.

I somehow, still believe – even through our harrowing experience, and even through my anger and doubts – that He is infinitely there. In everything. In all His power, divinity, simplicity.

I seek to hear His whispers through the swaying of the trees, and through the shapes and colors of the clouds, which drift through a storm. A rain drop, a teardrop.

I look for Him in others’ eyes, a neighbor’s gesture, my husband’s embrace, my children’s

laughter.

I seek Him everywhere.

I have found no answers, but at times, though it is rare, I feel His presence, His comfort, His unconditional love.

And though I question and sometimes find it hard to greet my days, what gives me purpose and meaning is seeking His will.

~ ~ ~

As I write in my journal, I realize five years have passed since Paul’s bike and the SUV crashed.

My husband and I are still unable to fully verbalize our grief, yet, we are unified in our

experience, and our love.

Sunrises are filled with thanksgiving – anticipating the silhouettes of our eight children.

Especially the curve of Paul’s nose, his bushy eyebrows, and his lips twisted upwards.

I often can’t wait to marvel at a moonlit night, for the circle to sink behind the hills, to count the stars, and to contemplate and question the universe.

~ ~ ~

Paul continues to walk a little off balance. To me though, it is a blessing he is walking at all.

His voice is slow and monotone. Yet, the fact that he speaks and forms thoughts blows my mind away. Cognitively, Paul may be slightly slower to respond to a question or to process information. But, it is amazing that he responds with wisdom, maturity, humor and intelligence.

The left side of his body shakes and has tremors, which makes it hard for him to do the simplest of tasks. But the reality that he perseveres and is not paralyzed is miraculous.

Seeing Paul’s progress over the years keeps me in denial – thinking, hoping, and believing that my son will fully recover. Day by day, cell by cell, neuron by neuron.

~ ~ ~

The biggest difference, which I see or experience, is not really with Paul.

He will always be my son. My hero. My strength.

He lives!

He survived the impact of the heavy metal. Two months in a coma, a broken jaw, a

collapsed lung, a traumatic head injury, shearing of the brain, and weeks, months and years of rehabilitation.

The startling differences I witness daily are in how others perceive and treat him.

I’m only reminded of my son’s handicaps, when I see how people stare as he walks down a crowded sidewalk.

Or if they mistakenly interact with him, I internalize the questioning in their eyes – their impatience at having to wait for his speech to catch up to his thoughts.

~ ~ ~

They put up walls, barriers.

Paul has become painfully invisible to his friends.

The phone never rings.

His teenage years lost. Not normal.

Filled with the absence of the sensuous smell of a pretty girl’s perfume.

Never hanging with the guys.

His independence taken away.

No driver’s license. No tunes on the radio in pursuit of adolescent adventures.

~ ~ ~

Within a split second years ago, life as he knew it, changed. Forever.

Despite Paul’s determination, humor and intellect, my heart seeps with sorrow.

I see the loneliness in my son’s struggles and half smile.

What keeps me focused and hoping comes from the other side of that smile.

The one that lasts for hours when he greets his days; ready to conquer.

The other side of that smile that lingers, knowing something that you and I do not.

“Perhaps, the angels’ wings do make a noise?”

For information on her new book, titled, “UnTHINKkable” click here.

 A Moment In Time

By Brianna Coskie, age 17, 2004

There have been times in my life when words don’t come easily, and it’s hard to verbally express my feelings, thoughts, or concerns. I communicate best through my artwork, most particularly through drawing and painting. When something comes to heart, it’s hard to put in words, but my fingers and hands urge me to find another way to express those emotions for which I cannot speak. This is why I turn to drawing; it is my way of telling a story and letting out my emotions for all to see.

Growing up with siblings always around, there was a certain joy in knowing I always had someone to lean on. On September 6, 2001, my family and I went through a traumatic and emotional time in our lives. My brother, Paul, was severely struck by a car while riding his bike. He was only thirteen at the time, and was not wearing a helmet. He suffered a severe brain injury that left him in a coma for two months and in a rehabilitation hospital for nearly five. He had to relearn everyday activities that we all take for granted such as feeding ourselves, speaking and walking. During this time my emotions got bottled up inside because the ones I looked to lean on, were in a need of a shoulder themselves. The only way I was able to begin expressing those feelings and to begin coping with the situation was through illustration.

The piece of art that I have selected represents the accident, struggle, and pain that my family endured during this time. As I began to tell my brother’s story in mosaic form, my anxiety slowly began to subside. I worked on this piece for over a summer, spending a particularly long time on the twisted wreckage of the bike, perhaps blaming the bike for all my pain. Each detail let me express an emotion I felt, as the bike represented my anger. Every individual drawing is symbolic to me and may allow others to see pieces of their own lives in it and the emotions they hide within. There are hidden drawings in this piece, such as a wheelchair, walker and a teardrop. The reason they are hidden is because my emotions were kept deep inside, masked from people, not easily seen. It was the faux smile I showed everyone, even though all I had inside were tears that could only be seen when you took a better look.

When my hands stopped moving and my heart fell back into place, I looked at what I did. I created an art piece of raw emotion. Among all the details of grief and pain it felt as though the painting lacked a moral. I felt compelled to superimpose the concrete image of the helicopter on top of all the others to show the truth behind the world, moving as it does. The helicopter’s speed and grace loaded with medical equipment was vital to my brother’s survival. It was representative of all the help and ultimate rescue of my brother, the symbol of life and hope that was brought to the artwork and back into my family’s hearts.

Working on this project allowed me to create a conflicting composition that is simultaneously visually appealing and disturbing. Bringing to life the images, colors, and different sections of this project were very cathartic for me. I hope that all my work will reach out and have a healing effect or bring about a change in people who may experience its deeper meaning.

This art piece allowed very different people to share a horrible moment in time that changed my life and my brother’s life forever. It also gives others hope and inspiration to believe in miracles, as my brother miraculously recovers, day by day from his injuries.

 After Thoughts – Brianna

By Dixie Fremont-Smith Coskie in Massachusetts

As her mother, I have always been in awe as to the way my Brianna sees life through her heart. How she interprets a stranger’s glance or a tree bending in the wind, and through her art and gentle sensitive ways, how her ability and talent can create life, and feelings upon a canvas.

Brianna was fifteen during Paul’s first year of recovery. Her carefree life shattered.

Panic attacks and nightmares followed. She hid her fears by becoming quiet, by taking care of those around her, by releasing her grief through oils, pen and ink.

Our family watched how Brianna’s heart shook as her brush was in motion. How her tears mixed with the paints. We saw her silenced emotions scream with images within her artwork- they portrayed Paul’s accident.

His crash had hit her hard.

I finally saw a healing process beginning to surface. Her artwork raw, real and releasing.

Brianna will leave her mark on the world through her inspirations, adventurous spirit, and funny sense of humor. She will stay true to being who she is, a caring, giving, hopeful, creative individual who sees beauty in the most tragic of circumstances.

For information on her new book, titled, “UnTHINKkable” click here.

 My Big Brother

By Anna-Theresa Coskie, age 11, 2004

There are many people in my life that I could consider a hero, but if I had to choose just one, it would be my big brother, Paul. I have eight kids in my family, but I look up to Paul most because he has been through so much and never gave up. He has taught me many things from how to tie my shoes to some of life’s greatest lessons.

When I was five, my brother was there teaching me how to blow a bubble with bubble gum. When I was six Paul was the one who took the training wheels off my bike and taught me how to ride it. As I got older, Paul was there to teach me many things, help me with my homework, or to simply hang out with me. I love Paul for that; everyday he had something new to teach me or a new game to play. He was the best big brother anyone could ever have.

On September 6, 2001 my brother got into a serious bicycle accident on his way to his friend’s house. Since his friend lived right down the street, Paul decided not to wear his helmet. He didn’t know that in the middle of his ride his helmet could have made his injuries less serious.

Paul was in a deep coma, and was unable to breathe on his own, so doctors connected him to a machine that breathed for him. Paul had a collapsed lung and suffered from a serious brain injury. He lay lifeless in the Intensive Care Unit with wires coming from every direction. We didn’t think he would live, but Paul decided he could not leave our gigantic family.

After two months of waiting, hoping, and praying, Paul awoke from his coma and moved to a rehabilitation hospital in Boston to begin physical therapy, occupational therapy, and speech therapy. I look up to Paul more now for hanging in there for so long. From this point on I knew everything would be all right and Paul would soon be home with the rest of my family.

When Paul could be moved by wheelchair, he came home on the weekends. He suffered from short-term memory loss; it was part of his brain injury. I was so happy Paul could come home I didn’t care that every five minutes I heard, “Can I call Sean?” Soon Paul was walking with a walker and could return home for good!

Paul returned to his eighth grade classes for half days in January. He would go to school in the mornings and go to therapies in the afternoon. After missing about five and a half months of school, he still got honors on his next report card! Intelligence is something I want in a hero and he has it. In June 2001, Paul graduated the eighth grade with the rest of his friends and put the whole auditorium in tears. He gave a marvelous speech that touched the hearts of everybody. I don’t think I could write a speech that beautiful, or have the courage to go on stage in front of family members of classmates and recite the speech from memory. I just want to be more and more like him everyday.

One of the other fantastic qualities Paul has is his sense of humor. He always finds the good in a bad situation when all anyone can do is focus on the bad. Paul always seems to make me laugh with one of his jokes when I am upset. He always has the best jokes to share and funny stories to tell. I have none of that, and I want to. I wish I could be happy and cheerful all the time like Paul is, but it’s hard sometimes.

Paul has been through so much in his life, and people can be mean sometimes, but he keeps on going not caring what people think of him. As a sixth grade girl, it’s hard for me to not care what people think, I want everyone to like me. So maybe I spend more time in front of the mirror, but Paul could roll out of bed and go to school just like that and not even care. If someone makes a rude comment, he’ll just walk away, but me, I can’t seem to let it go. I strive to be like Paul everyday of my life, and I think I always will.

Paul has overcome many things in the last couple years, and so have I. From Paul I learned things that people learn in a lifetime. I want to thank Paul for that, for being my teacher, someone that I can look up to, and the best big brother in the world. I hope he knows it!

 After Thoughts – Anna-Theresa

By Dixie Fremont-Smith Coskie

I will never forget the panicked look on Anna-Theresa’s face during the period of time when I needed to be with my son Paul at the rehabilitation hospital. She was just nine.

Her small arms desperately not wanting me to leave, clinging, scratching, grabbing my waist, arms or neck. Her eyes crying fearful fretful tears. Her sobs echoing in my heart.

So many tormented days.

Up until Paul’s accident, her biggest concern was whether she was going to have a peanut butter sandwich or swing on a swing. She was devastated. Silent, except for the never- ending weeping.

Anna-Theresa had always clung a little harder, wanting reassurance that her brother who she loved and idolized, would be o.k. – would live.

She kept tight to her older siblings’ comfort, growing in insight, wisdom and sensitivity.

She began to pray.

There is a dimension to Anna-Theresa that is deep, angelic, sweet and sincere. As she matures, I see the subtle scars left behind; the fear that lingers. Yet, what shines is her cheerful smile, her intuitive eyes and mind, and loving unselfish heart. Her love for family, her brother, everlasting. Real. 

For information on her new book, titled, “UnTHINKkable” click here.

Paul’s Point Of View

By Paul Coskie, age 16, 2004 

To this day I still believe the accident that occurred on September 6, 2001 has an effect on my attitude and views on life. It definitely proved to me that life is delicate. Though I have seen some hard times, everyone who helped me through it was pleasant and really helped me.

The first stages of my consciousness I do not remember very well. I do remember feeling that most everyone now thought of me as lesser of a person. People coming in and talking to me as if I were a baby really got me down for a while. My best friend who had awakened me from my coma was always a great motivational support. He never doubted that I was stronger than that car and I could come out of that haze of injury just fine, that’s why Thomas my cousin was still talking to me and telling me jokes when I was fully unconscious. Not everyone can say that a scab joke saved his or her life; I woke up laughing.

Coming back to my hometown was very difficult after I was in the hospital for so long. Everyone was nice to me and all, friendly, but I could easily see past that. After I got used to being around so many people again I could tell most of my peers were just almost mocking me by being so friendly. Because I was feeling this, I lost a lot of trust in them, and as they realized I was not as gullible as I was in the past, a lot of them lost interest in being around me. I can say I was never the most popular person before this anyway, and I am glad to have the few but real friends that stood by me.

As far as my education I never really felt that people had given up on that. I also never forgot that an education was essential for my larger goals in life. My high school accommodated the classes that needed to be, to help me. I still believe that an education is vital to the life of ease I hope to one day live.

I do not believe the accident has changed me too much. It surely has changed the way people look at me. There are still some people that treat me differently than they did before my accident. It may be lack of belief that I will ever be the same, or maybe it is my self-confidence that simply scares them away.

For information on her new book, titled, “UnTHINKkable” click here.

By Harvey E. Jacobs Ph.D.

Growing up and losing “Normal” after my father’s brain tumor

I was no more than two the first time my father was operated on for his brain tumor. By the ripe old age of five, I was a pro for his third and most major operation – the one that saved his life at the sacrifice of his lifestyle and most of his identity.

As a youngster, I never remembered any of the times he went to the hospital, but I often recall a stranger returning – someone different from the person I knew just weeks ago as my father. Each time in a different bandage or cast. Each time with different equipment. Each time a little weaker and a little more disfigured. Eventually my daddy would come back, albeit in a slightly different form.

After the first few years of a “normal childhood” there were suddenly no more games, no long car rides, no going to work with him on Saturdays, no friend to confide in anymore. Just slow and painful recuperation that even a toddler could feel.

My younger brother was born just about the time of my father’s most major surgery. For the first two years, his development paralleled dad’s recovery. Then my brother surpassed him. I guess every father hopes that their children will accomplish more in their lifetimes than they, just not at such an early age. As the middle child, my sister got lost somewhere in the middle.

Mom’s challenges and losses after her husband’s brain tumor diagnosis

In many ways my mother was the rock. They were newly married when the tumor was first discovered. Within a few short years, they twice celebrated its apparent surgical demise. Then, three operations later, with three children and a severely disabled husband, she held us all together and stayed my father’s partner. The cost for her fortitude was the sacrifice of much of her own emotional life. Something had to give to meet the overwhelming demands and painful challenges of each day. Years later, after we had all safely passed through the many storms, it was still hard for her to hug and hold for more than a brief moment. Her love and devotion were without question. The fatigue and callouses of the fight had simply weathered the more delicate areas of her heart’s expression.

In time of acute personal need, mom or dad weren’t always there. Not because they didn’t want to be, but because they couldn’t. But a young heart didn’t know this and abandonment set in. With no one to turn to there was discounted acknowledgement of personal needs. Yet, this unconscious defense didn’t stop the pain of repeated disappointment and rejection. It only served as fertile ground for self-devaluation, limits on trust, and overbearing vulnerability. The world is a very big place for a small person. When it is not possible to understand the world (alone or with the help of others), you make it smaller; unknowingly casting off the very gifts that sanctify your dominion.

Children become caretakers at a cost to their youth

All three of us children became good caretakers at a very early age. Both parents tried to shield us from much of the chaos and commotion. But, there was just so much time and energy. Attention customarily devoted to nurturing and learning had to be deferred to basic survival. The tables of caretaker (parent) and recipient (child) began to turn much earlier than expected. Inadvertently, a disproportionate piece of our personal values was shaped by what we “did” instead of who we “were.”

The pressure of the situation was played out in confused roles and conflicting emotions. With the loss of his work and independence, we children became a larger source of dad’s identity. The good intentions of his attention were often overwhelming. He tried hard to be the best provider he could be, and wished he could have been. In the process, many boundaries were crossed as he inadvertently sought to live those now denied parts of his own life through his direction of ours. The ensuing confrontations resulted in heated emotions, but little chance for communication. We often did not have our respective roles and boundaries to return to; to work out the pieces, to sort out the love from the frustration, or the hurt from the caring.

Life’s critical lessons for children growing up with a parent who is disabled

Friends and family helped, but even within the warmth of our house and the presence of others, we children were alone more than we realized. We each developed “independent spirits” yet missed many of life’s critical lessons in intimacy, communication, self-esteem, conflict resolution, and other areas that would become so important as we grew older.  Remediation of these lessons has often been painful and incomplete with the effects visited upon our own loved ones as well as ourselves.

Over time each of us has come to place these experiences within the greater perspective of the many other gifts and challenges in our lives. No matter how profound the experience was, it remains as only one aspect of our development. At the same time, we remain acutely aware how past circumstances still influence us. Thus, my sister, whose early years paralleled dad’s multiple surgeries, still fears becoming ill and not being able to care for her daughter. My brother, who never knew dad before his disability, looks for a role model he never had now that he is a father. As the oldest child, I continue to search for the “holy grail” of earlier years I exclusively knew, before our family was changed by disability.

Dad passed away a decade ago. He got his dream to see each of his children achieve adulthood and self-sufficiency. I got mine too, as we re-established our friendship several years before his death. Mom died six years later, suddenly, of cancer. An unfair lot for someone who was just beginning to live after giving her life so selflessly to others.

The relationship between my brother, sister and myself remains magnetic. Attracted to one another as only family can be, yet repelled at times by past issues that have not yet been identified or resolved. In that way we are no different from any other family…

This article has been adapted from its original publication in Innovations section of TBI Challenge!, National Head Injury Foundation, Washington, D.C., Fall 1993.

Dr. Harvey Jacobs is a partner and VP/Director of Training for Lash and Associates Publishing/Training, Inc.