A few months back Michael Brooke from Concrete Wave sent out this story pulled from the San Diego Reader. As we have been developing some new initiatives to promote helmet use while longboarding, I thought I’d post it to our blog so that people get a better understanding of why you wear a helmet while longboarding!
Broken Skull, Broken Heart
By Dorian Hargrove | Published Wednesday, April 21, 2010
Inside the Live Wire, it was dark and dingy, and the music was cranked to 11, just the way I remembered the place. Only half of the six red vinyl booths were occupied. Five friends and I took the one at the far end of the narrow bar. It wasn’t much of a celebration, but it was the closest thing to a party I’d been to since I’d fallen from a skateboard and landed in a coma, awaking 19 days later with a piece of my skull missing, scars on my arms, and a plastic pipe in my throat. Two days before entering the small bar in North Park, my doctor had said it was all right to consume an alcoholic beverage, and that is what I was there to do.
“Your tolerance will be way down. A half of a beer will feel like three,” he said. Heading into the bar, I was nervous. Nurses had told me I would never be able to drink again, others said I should wait a year, and most all of them warned me that drinking might induce posttraumatic epilepsy.
The nerves remained as I ordered a Bud Light from a dark-haired, tatted-up female bartender. They were there after my first sip. I did my best not to think about the anxiety. Before I knew it, my beer was gone. My wife Aimee asked me how it tasted. She had a smile on her face but worry in her big brown eyes. I had grown accustomed to that look. I reminded her for the millionth time that I could no longer taste or smell. She asked how it felt going down. I said good.
I felt at home sitting in the bar, talking about movies, music, and life. It had been four months since the day I left the house with my dog’s leash in one hand and my skateboard in the other.
That day was September 22, my second wedding anniversary. It was hot and cloudless, nearing five o’clock, an ideal time to take my dog Artie to the park. It was something I did nearly every day, and I had the routine down. I stuffed the essentials into my army green messenger bag: blue ball, water, treats. I put Artie’s leash and harness on him, then placed my bag in the front basket of my old Schwinn and hopped on. Holding his leash in my left hand, we coasted down the driveway and onto the street. Fifteen feet from my house I squeezed the brake and turned back. I wanted to skate instead. That decision changed my life forever.
I grabbed my board and Artie’s leash. The brown dog had some energy. Just moments after leaving the house, he was pulling me at full speed on the rough and rutted pavement. The wheels didn’t seem to be gripping. I had speed wobbles. That day, construction trucks and a Bobcat cluttered the street. They were tearing up asphalt to replace water mains. I directed Artie toward the sidewalk.
Artie was again running at full speed. I crouched to steady myself. Fifty feet from my house, my wheels stopped at a crack. I didn’t. Flying through the air, I looked at my right hand clutching the leash. That was my last memory before the right side of my forehead met the pavement.
A neighbor, Laurie, found me in the street, clawing at my head, screaming in pain. Artie stood next to me. There was no blood. No sign of injury. Laurie told me months later that I begged her not to call paramedics. I just had a headache — I wanted to go home and sleep. Then I vomited on myself, and she dialed 911.
When the fire department arrived, I refused service. I said I was fine, and I couldn’t leave my dog. I threw up a second time. The firefighters forced me inside the truck and took me to Scripps Mercy Hospital.
I had already been admitted by the time Aimee arrived. She sat next to me on a bed in the hallway. She says that I was alert and oriented. I knew I had fallen, but I assured her that I wasn’t injured and insisted on going home. I was taken to get a CT scan. The scan revealed bleeding and bruising on the frontal lobes of my brain, and I was moved to the intensive care unit trauma room. Twenty minutes later, Aimee says I turned into a different person. I was disoriented and combative. As time progressed, my confusion turned violent. I fought the nurses. I ripped out my IV and stabbed a male nurse with the point. Aimee says it took nine people to restrain me and enough sedatives to tranquilize a horse.
Intensive care nurses ushered Aimee and my sister, who had driven down from San Marcos, out of the room. When they returned an hour later, I was in an induced coma; a blue breathing tube was inserted into my mouth, and a “tap” had been put into my head to measure the intracranial pressure, which was high due to swelling in my brain.
The intensive care unit would be my home for the next 19 days. All I have to go by are the passages in Aimee’s journal and the nightmarish visions I had each time they tried to lower the sedatives and wake me from the coma.
Day 1: If the brain swelling goes down he will be here three days, best-case scenario. Worst-case scenario, he might have part of his skull removed to allow room for the swelling. Doctors said this is a long road to recovery and we are at the beginning. They put a tap on his brain to measure the pressure. The reading was 30. Normal is in the low teens.
Day 2: I signed a release for them to put a direct line into his carotid artery for medicine to control the swelling. They said they have begun aggressive medical treatment. I have decided to sit next to his bed full time. I am now going on 36 hours with no sleep. I have weird chest pains. I feel like I am in a dream.
Day 3, 3:30 p.m.: Dorian’s family arrived from Colorado. To prevent further brain damage, doctors removed a four-by-five-inch piece of his skull to allow room for his brain to swell. Doctors said his skull will be taken to a UCSD tissue bank and kept there until he is ready to have it put back on. The brain has expanded, and the pressure has come down. We know that we have made the right decision.
Day 4: I asked the doctor to come and talk to us. He said that Dorian suffered major head trauma and patience from us is key to his recovery. He told us that we have to prepare for a new life, caring for Dorian. He said that Dorian will be different, but to what extent and for how long no one will know until he wakes up. He ended the discussion by telling us that Dorian is “not out of the woods yet.”
Day 5: I am having a hard time holding it together.
Day 6: He has contracted pneumonia. Now his body is fighting two things. They said they have to treat his pneumonia, but when they do, the pressure in his brain goes up.
Day 7: Dorian’s intracranial pressures are high today. I am so scared. Why aren’t they going down? Doctors say if the pressure doesn’t go down they will remove another portion of his skull. They also fear that the medicine might send him into renal failure. They took him off sedatives to check his responsiveness. No response.
Day 8: It’s official: I think Dorian’s family is falling apart.
Day 9: He’s developed another case of pneumonia…more ice baths.
Day 11: Dorian is doing better today. He is on lower sedation. His pressure is in the low 20s. The nurses are smiling at me. He opened his eyes.
Day 12: Dorian looks even better today. Sedation has also been taken down. In a sense, they are trying to waken him a bit. His intracranial pressure is way down, and the nurses have not had to do any medication. They decreased the morphine.
Day 13: Today, Dorian woke up. Yeah! He was responsive and breathing so they took his ventilator tube out. He asked for me. I came running, and he said, “I love you. Where’s Artie?” His voice sounded funny, and he was agitated. An hour later, his throat closed. They had to perform an emergency intubation. He almost died. He is back in the coma. My heart is broken. I think about all the things we won’t be able to do, and it makes me so sad. We were going to start a family. We just bought a Volkswagen camper van. We were going to travel, write, and I was going to take pictures. Why is this happening to us?
Day 14: Dorian was given a tracheotomy. When they wake him next time he won’t be agitated from the ventilator tube and his vocal cords won’t be damaged. He’s going to hate this. He’s always been so sensitive about his throat. They also started him on a psych drug that will ease the wake-up process. There is a student in here now and they are teaching her about neuro patients. That’s what they call Dorian, a neuro patient.
It was on day 15 that I started to have visions. The visions all were about my unquenchable thirst. After the tracheotomy I couldn’t talk for a couple of days. I remember pointing at a large glass of iced tea that was feet from my bed. I did everything to get to it. I tried to wave down the faceless people in the room to get them to pay attention to me. I tried to grab the glass of tea myself. Each time I tried, the wind would be taken from me. I imagined that one of the guys in the room punched me in the chest each time I tried to get up. I later was told that the tea I reached for was a cup full of my own urine.
On day 18, Aimee says that she brought me a dry-erase board and I wrote a whole paragraph. It was mostly illegible, but she could read one sentence: “Get me the f* out of here.”
Nineteen days after my fall, I awoke for good, 25 pounds lighter, missing the right side of my skull, and fitted with a blue plastic tube in my throat. Still requiring constant supervision and still on morphine, I was transferred to a “safe room” on the tenth floor. My mind and body felt numb. I had no strength. I had no clear thoughts. I felt drunker than I had ever been — everyone and everything seemed in an alternate reality.
Two older men shared the hospital room with me. My bed faced theirs. I stared at them, trying to process the surrounding environment. One man had a bandage wrapped around the top of his head. The other had dark lesions on his face. He shot strange expressions my way if I stared too long, like the ones an adult might give a baby that’s on the verge of tears. I remember him staring at me while pounding his head with a soft, axe-shaped toy. No one else saw this.
The second day on the tenth floor, a male nurse arrived holding what appeared to be a small metal crowbar. I felt the bar inch along the top of my head, and then I felt a pain rip through my skull. Another pain, half an inch from the first. I yelled as he pulled out large metal staples. The staples, 30 in all, had been used instead of sutures to hold my scalp together. After the doctor had removed the piece of skull to allow my swelling brain to expand, he’d laid Gore-tex over my brain and pulled my scalp back in place, reattaching it with the staples. As the staples scraped my skull and tore through my skin, I cried out so loud that the nurse stopped, and a doctor was called in the next day to finish the job. It was the only real feeling I had in 21 days.
The next day, staples removed, two young paramedics placed me on a gurney and pushed me through the hallways of the tenth floor and into an elevator. They said they were taking me to Alvarado Hospital’s rehabilitation institute in the College Area.
Once inside the institute’s lobby, they transferred me from the gurney to a wheelchair. Aimee walked alongside as a heavyset nurse pushed me through the hallways. I wore a maroon helmet for protection. I had no idea what I needed protection from. The hospital reminded me of the asylum in One Flew Over the Cuckoo’s Nest. It looked old and dilapidated. When we arrived at my room, the nurse helped me onto the bed. I felt dizzy each time I moved. I barely had the strength to lift my arm.
Although I’d been taken off the morphine and sedatives, the drugs were still in my system. I believed I was working on assignment, undercover. I told the nurse that the exposé focused on the bureaucracy of healthcare. She laughed. After she left the room, Aimee, my mom, and my older brother stood near my bedside. They looked tired. They stared at me with glossy eyes. I thought they were overreacting.
Later that day, I rose from my bed and shuffled toward the bathroom. I placed my palms on the walls for support. My legs and right arm trembled.
I took off my helmet in front of the mirror. It was the first time I’d seen my reflection since the fall. The right side of my head was missing. Scraggly brown hair covered the left side. I had no hair on the right, just a large crater and a dark red scar running along the crater’s edge, from the top of my forehead, back above my ear, and then toward my face. A large pocket of fluid and tendon, cut during the surgery, bulged through the skin in front of my ear. My beard and mustache hairs were long, wiry, and out of control. I looked at my throat and at the blue plastic pipe stuck inside. It looked as if a kazoo were lodged in my neck. I was oblivious to what had happened. I stood there and stared, detached and devoid of emotion.
On the second day, I met my doctor. He was an arrogant, smug man in his 50s. He had long, slicked-back gray hair. I hated him at first sight. I hated the new shiny black shoes he wore. I hated that he looked at me as some long-haired, tatted-up skate punk, as if I deserved to be in the condition I was in.
He told me I needed to see the throat specialist. Two hours later, Aimee wheeled me up to the specialist’s office on the fifth floor. We waited inside for 15 minutes. I stared at the posters inside the examination room. They featured drawings of tubes inside throats. Then a doctor in his early 40s entered the room. His gray and black hair was long and wavy, tucked behind both ears. He asked about my accident. We talked about skateboarding and surfing. I saw his hand reach toward my throat as he talked. He grasped the blue pipe without giving me notice. I felt it shift inside my neck, and as he pulled the trach tube out, it felt like a slug crawling up my trachea. The tube was white and perhaps eight inches long. Brown and white phlegm coated its sides. I felt cold air enter the open hole. The doctor bandaged the hole and told me to put two fingers over it when I spoke. He told me it would close in two days. The next two nights, I would wake up gasping for breath. When I inhaled, I could hear air escape, a whistling through my neck. I had dreams that the opening never closed and I had to clean it with Q-tips and alcohol for the rest of my life.
I started physical therapy the following day. My therapist, fresh out of college, was a short, amiable Asian-American male. On our way to the hospital gym, he walked by my side.
“Did you always walk like this, crossing one foot in front of the other?” he asked.
“Yeah,” I answered. “I used to be a runway model.”
During that first session, I realized my balance was gone. I couldn’t walk in a straight line. I couldn’t balance on one leg. The therapist did not tell me why. I didn’t find out for two weeks that my vestibular system, the part of the brain that controls balance, had been damaged in the fall.
An hour later, I had occupational therapy. A therapist scattered plastic objects of different shapes in front of me next to a game board that had cutouts of the same shapes. She asked me to fit the pieces into the matching slots. Despite a little tremble in my right arm, I was able to do this. My therapist looked surprised, and then she seemed unsure of the next task. I began to get the impression that the staff didn’t know anything about brain injuries. I slowly realized that they had no way to know how badly my brain was damaged. My doctors and therapists were playing the waiting game to see what symptoms might arise.
Every other day, my doctor dropped by my room for minute-long checkups. He said nothing about my condition, nothing about my strengths and weaknesses. My disdain for him intensified. He never told me what to expect. I started a blog and wrote about him.
“This isn’t just about my middle-aged doctor, who seems to be too busy battling his midlife crisis by gelling his hair and looking for new slick black leather shoes,” I wrote in my blog, six days after waking from the coma. “This is about being a number, a policy number. This is about being nothing more than a bed-filler at night. Since admittance, I have not been properly evaluated, nor have I been given information on my injury, a prognosis, nothing. Money and insurance rule this place. So much so, the patient is only an obstacle, and a nag. I guess that’s what I am.”
The next day, I collected my belongings. Aimee and my mom, sister, and brother begged me to stay. They said I was delusional. I didn’t believe them and started to walk to the elevator, down the cream-colored linoleum floors, past a large meeting room that looked as if it hadn’t changed since the swinging ’70s. My case manager stopped me in the hallway. I said I would leave if I didn’t get a new doctor. She agreed.
When I awoke the following morning I was more lucid. Things seemed in focus. I asked Aimee about my injury. She did her best to tell me about my condition. Maybe the morphine was out of my system. I began to understand the gravity of what I had been through and what my wife and family had been through. I told Aimee I wanted to help people. I told her I wanted to speak to kids about wearing helmets. I apologized to Aimee for what I had put her through. I told her that I was selfish. I vowed to become a better husband. I cried at the thought of her sitting by my bedside for 19 days while I was in a coma, reading to me and singing Wilco songs. I promised to embrace life, and her, more, instead of embracing the dark side, the Charles Bukowski image that I conjured up about what a writer should be. I promised her that I would change, not just for her but for myself and for everyone around me.
But, instead, in the days that followed, I grew irritable and depressed. I couldn’t control the anger, and I was unable to break the sadness. My hands began to tremble uncontrollably. I had no focus. I couldn’t read for more than a minute. I tried to post entries in my blog each day, but I had little to write. As the wound from the tracheotomy healed and I began to eat more solid food, I realized that I had lost my sense of taste and smell.
My new doctor and I met for the first time. He told me that more symptoms would appear as my brain healed, as my neural pathways reconnected. It was the first time that anyone told me it would get worse before it got better. I felt relieved to know what to expect.
Two days later, my sixth day at Alvarado, after solving more puzzles for therapists and trying to walk down more straight lines, with no new information about my injury or my recovery, I was released.
Suddenly, I was back home. I spent most of the next week and a half sitting in my big brown leather chair, feet propped up on the matching ottoman, staring at movies and bad TV. My head felt as though my brain were swollen, as though someone had pumped air into my skull. The feeling of pressure increased with fatigue. I was lightheaded, and I had no balance. When I stood up, no matter how slowly, I’d get dizzy. The red scar along my head itched nonstop. I’d scratch it and feel the rough, thick edge of my skull. It dropped off about an inch to the inside of my head, which was protected only by my scalp and Gore-tex. The skin over the area where my skull was missing felt like a plastic balloon. If I pushed down on it, it would give, like the palm of your hand but without as much muscle. I didn’t push down too hard, scared that I would touch my brain.
Aimee and I battled over wearing the helmet, which I was supposed to put on when I got up from the chair. I considered wearing the helmet to the bathroom weak, and I didn’t want to be weak. Early on, stepping down three stairs, my legs buckled and I nearly fell. Aimee started crying immediately. After that, I didn’t have the strength to argue, and I didn’t want to upset her any more than she already was.
Every day, I woke up dizzy, irritable, and in a darker depression than the day before. I often wished that I had died. I was scared that I wouldn’t be as smart. I was frightened that my brain would be damaged for the rest of my life, that I would never again do the things I liked to do, such as surfing, skating, playing guitar, and writing. Shooting pains fired in my right arm. Nerve damage had finally showed up from fighting through the restraints. By seven o’clock every evening, I felt as if my brain were giving birth to an alien. The bulge of muscle and fluid near my ear was the alien’s womb. It pounded and swelled. A few minutes later my mind and body would crash. I couldn’t move, think, or talk. I just sat there like a big pile of nothing, as though I were in a vegetative state.
Aimee was constantly by my side, asking if I needed anything, trying to look strong. She would call through the bathroom door while I was in the tub, making sure that I was all right. Sometimes, sitting silently in my chair, I’d look over to see tears streaming down her face.
My third day back from the hospital, Aimee and I walked to the Uptown District Shopping Center to fill a prescription. We stopped at the Blockbuster to get more movies. The music inside the store made my head spin — I felt confused, overwhelmed, and dizzy — and I told Aimee I’d wait outside. As I sat in front, wearing my maroon helmet, I heard someone yelling, “Hey, helmet head. Helmet man. Nice helmet.”
I looked over and saw a guy in his mid-20s wearing baggy jeans and a large yellow T-shirt. He was cupping his hand over his mouth, laughing. “Go into a coma and see what you come out looking like, asshole,” I snapped back. He turned around and walked away. Rage filled my mind. My right arm began to shake. The brief tantrum sapped all of my energy, and I barely had the strength to walk home.
On October 28, I was admitted into Sharp Hospital’s Community Reentry Program for outpatient rehab. I was given neuropsych tests. The technician, a young guy in his 20s with long blond hair and a shaggy blond beard, asked me to draw a cube. I couldn’t. He asked me to repeat 12 words. He said them out loud and waited a few seconds before asking me to repeat them. It took me four tries to get all 12. I couldn’t do long division. I thought I was stupid and inept. I realized that my brain was more damaged than I had thought.
The next day at rehab, a young man in his late 20s sat next to me in a wheelchair. His eyes wandered around in his eye sockets. A puffy red scar ran from his left earlobe to his left nostril. His dad flashed brightly colored objects in front of his face. Occasionally, he’d guess the right color. When he did, everyone around him cheered. He introduced himself to me later that day. His name was Chris. He asked me what had happened to me. I told him my story. He went into his. He was asleep one night when someone he didn’t know broke into his apartment and butchered him and his girlfriend with a hatchet. His girlfriend survived. He died twice that night, but each time doctors resuscitated him.
“I’m so sorry to hear that happened to you,” I said.
“It’s okay. You have to try and stay positive, and each day you see some progress. It just takes time,” he said. I couldn’t believe what I was hearing. I was upset that I couldn’t do long division, and this man, whose injuries seemed so much worse than mine, was telling me to stay positive. I began to think how fortunate I was to be able to walk, talk, swallow, and see.
Later that day, at a trauma checkup at Scripps, a nurse recognized me from my time in the intensive care unit. She was shocked at my present condition. She said that she and the other nurses didn’t think I would survive, let alone come out in the state I was in. That, and the conversation with Chris in rehab, made me realize how close I had come to dying. It gave me a perspective and insight that I had lacked since waking from the coma. I began to appreciate my second chance and vowed to focus on the positive and not get hung up on the negative.
At Sharp rehab, a month after waking from the coma, I finally learned about the damage that was inflicted on my frontal lobe. The area of the brain that I injured acts as the brain’s emotional filter, or as my neurologist explained it, the frontal lobe acts as the conductor of the orchestra.
My neuropsychological tests revealed that out of a peer group of 100 healthy people — same age, same education, no brain trauma — I scored above average in most categories. I came in fourth from the bottom in spatial orientation. My visual memory was weak, as was my ability to adapt to new tasks. My neurologist said that depression, irritability, and a lack of focus would worsen as my recovery progressed, a recovery that could take years.
Now, six months after the fall, I see how right my neurologist was. I’ve started to write again. The missing piece of my skull has been reattached. I go to see bands play, and I go out for dinner — a waste of money considering I can’t taste it. I am back surfing. But I am not the same person. I notice new things every day. I see blanks where thoughts once were. Not a day goes by that I don’t think about the injury. That positive mind-set and renewed insight are difficult to hold on to when the depression and irritability take over. Post–brain injury, everything — not just minor accomplishments but also small setbacks — gets blown out of proportion. Insignificant physical feats are treated as record-breaking achievements. A mistake on a math question is evidence of permanent brain damage. A minor headache could be the onset of a posttraumatic epileptic fit. The people around me react the same. If I take a nap during the day, Aimee congratulates me and praises me for changing gears and resting.
One day, I hope to speak to kids about wearing helmets. I think that if I can persuade one kid to put on a helmet before skating then something good will have come from my misfortune. Despite the desire, I can’t concentrate long enough to write out my presentation and I don’t have the energy to take on a new venture.
Occasionally, I think of the promise I made to Aimee that day in the hospital. I try to show her how much I appreciate her and how sorry I am for what I’ve put her through, but my irritability, caused by the brain injury, prevents me. I hate to think that I am returning to my former self: a self-centered, self-absorbed person who went skateboarding one day without a helmet because he considered helmets uncool and unnecessary, a person who fails to appreciate the second chance. I hate to think that I am just another ingrate caught up in the trivialities of life. I hate to think that even a major blow to the head and a near-death experience aren’t enough to bring about change.