Features

Broken brains

"Broken brains" Continued...

Issue: "Another dark day in America," Jan. 12, 2013

More soldiers are coming home with TBI symptoms simply because more soldiers are surviving other wounds that would have killed them in previous wars. Soldiers whose heads got rocked by an explosion along the beaches of Normandy or the jungles of Saipan during World War II or inside the tunnels of the Viet Cong during the Vietnam War probably died from visible physical wounds long before doctors had a chance to discover the aftereffects of the blasts on the soldiers’ brains.

But improved protective gear, advancements in medical technology, and a triage system that yanks severely wounded soldiers out of the battlefields and into military hospitals in Germany and the United States have given military doctors thousands of new patients who are experiencing the consequences of rattled brains.

These invisible wounds often go undetected, and they are hard to explain to patients and their families.

If a brain is like a city where information travels along roads from building to building, then TBI unleashes an earthquake on that city. Usually it’s the type of earthquake that doesn’t knock down the buildings. But it damages the roads enough to disrupt the way the brain communicates. In extreme TBI cases, even the buildings are knocked down, crippling the patient’s mental capacity.

TBI cases are divided into subcategories. Doctors have classified about 77 percent of the military’s TBI cases as mild, including Holt’s injury. Nearly 17 percent of cases have been labeled moderate, while just 1 percent of cases have been diagnosed as severe. The classifications depend on the length of unconsciousness, disorientation, and memory loss.

In a mild case, a loss of consciousness lasts 30 minutes or less while confusion may persist for less than a day. A loss of consciousness for more than 30 minutes but less than a day with disorientation that persists more than 24 hours characterizes moderate TBI. A severe case occurs when the victim losses consciousness for more than 24 hours and endures acute memory loss for more than a week. Penetrating TBI is an open head injury occurring when membranes covering the brain are penetrated by objects like projectiles, knives, or bone fragments.

Doctors stress that the labels “mild” to “severe” have more to do with the duration of the injury and not the aftereffects suffered by the patient. Those include a wide range of symptoms that can vary from person to person in quantity, duration, and intensity. Bouts of vomiting, sleeplessness, persistent headaches, sensitivity to light, memory loss, mood disorders, inability to focus, slow reaction time, dizziness, depression, blurred vision, and loss of balance are some of the problems that arise when parts of the brain lose the ability to function. These problems can last weeks, months, or years, even for patients with mild TBI.

Such was the case for Holt.

After his visible wounds healed, Holt, now 35, told everyone that he was fine. “I’d call it the recovery of the century,” he said. But his hidden wounds continued to wreak havoc on his daily life.

While driving he’d be so unsure whether he had locked his doors that he’d return to his Raleigh, N.C., home even if he’d already gone 45 minutes down the road. He couldn’t find his car in a parking lot. Reading gave him headaches. He kept losing his place so much that after finishing a page he wouldn’t be able to recite what he’d just read. He’d forget names.

It was a frustrating contrast for Holt, who had endured 15-hour days of intense study and testing for months while in the Army’s medic school.

Still, he didn’t want to go public with his problems. He thought that admitting the weakness would be another sign of weakness. He was fearful of the stigma he’d face as a Special Forces soldier who suddenly couldn’t remember to put cold food back in the refrigerator. Maybe he wouldn’t be able to rejoin his unit.

For two years he endured a life with a brain operating in slow motion like a computer frozen by too many open applications.

He began to adapt. He left notes to himself all over his house:

Make sure the alarm is on.

Turn off the air conditioner.

Put the trash out.

Make sure nothing is in the sink.

Lock the back door.

He woke up most nights so concerned about what he had to do the next day that he couldn’t go back to sleep. So he’d get out of bed and make more lists. “I was certain that if I had a thought and didn’t write it down then I’d lose it,” he said. “I just had to get really detailed. I was so amped up about forgetting something that it was all-consuming.”

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