St. Louis Vs. The Police IV: Now It Gets Real!

When I was a child of ten, I got bucked off a pony and landed on my head in the street. In those days, no one wore helmets when riding anything—horses, bicycles, motorcycles, whatever. I was incredibly lucky not to have been killed. I was doubly lucky in that my head is as hard as a block of granite. I lived in a very rural place with no hospital, no helicopter to whisk me off to a trauma center. We had a cranky old town doctor who was none too happy to be called to his office on the Fourth of July. He came in complaining and smelling of what I would later come to recognize as whiskey. He held fingers up in front of my face and asked me how many I saw. I guessed two, and he sent me home. No X-rays. CT scans and MRIs were the stuff of science fiction. My mother sat in my bedroom that night waking me up every time I started to fall asleep because that was what she had been told to do with someone who had taken a bonk on the head.

The reality of that situation was that I had a concussion, something that was regarded very differently in 1969 than it is today. I had suffered a mild traumatic brain injury (TBI) that was never diagnosed, let alone treated, and I have suffered with the effects of that injury my entire life. While the severity and frequency of my headaches have lessened over the years, I still get them. I have one right now as I write this note. Over the decades I sought help from a number of doctors, none of whom diagnosed me with TBI. My headaches were blamed on allergies, sinuses, eye strain, stress, hormones, and, my personal favorite, my imagination. I don’t deny having a vivid imagination, but I don’t know anyone who would choose to imagine the feeling of an axe cleaving his or her skull for hours and days at a time.

The fact is that many people who suffer mild and even more serious traumatic brain injuries often go undiagnosed and misdiagnosed even today. Closed head injuries are not always obvious. They may present themselves in ways that can be minimized or rationalized away. After all, the person has no outward signs of injury, and they can be very clever in compensating for the cognitive deficits caused by the injury. Every TBI is as unique and mysterious as the brain it impacts. A fellow competitor of mine in the equestrian world took a fall on soft footing that would not have been considered serious by any of us but for the fact that she bumped her head. She was in a coma for weeks and suffered severe physical and cognitive deficits that ended her riding career, which she struggles to overcome to this day, years later. Meanwhile ol’ Ironhead here was thrown with force onto concrete, and the only lasting aftereffects I have are headaches.

The good news is that great strides have been made in the study of TBI in the past ten years. The bad news is the major reason for these advancements: war. The U.S. Department of Defense reported new TBI cases among military personnel in 2013 alone at 27,187, with many of those injuries incurred by deployed active-duty personnel. I have personally witnessed the result of TBI incurred in war by a friend’s husband. The ongoing struggle of the wounded warrior is a heartbreaking thing to watch. The post–brain injury person is often not—and often never will be—the pre–brain injury person remembered by friends and family, and the reality of that is difficult to accept for all involved.