The Journey Toward Recovery: Youth with Brain Injury

Gone

The sun felt warm on Jerome’s bare shoulders as he sat munching on the granola bar he’d just taken from his bike pack. His legs and arms felt crusty with dirt and sweat; his hair dripped with perspiration. He was chilled, but it was a good chill, the kind that comes after your body works really hard, then pauses to rest a while. Granted, the cold, lumpy boulder he reclined on wasn’t comfortable, but it provided relief from the constant jarring of the mountain biking he and his best friends, Eric and Tommy, had been doing all morning. It felt good to relax in the sun.

“Yo, Germ,” Eric called to Jerome.

Eric was one of only three people who could get away with calling Jerome by his childhood nickname, a name he earned in first grade when he gave the chicken pox to everyone else in his class. That was nearly ten years ago. Now, only Eric, Tommy, and Jerome’s kid sister Jenny, who first said “Germ” when she was little because she couldn’t say “Jerome,” dared to call him that. He wouldn’t stand it from anyone else.

Eric slowly sat up from his grassy spot next to the boulder where Jerome rested. “I’ve been thinkin’ a lot about what happened at practice.”

“What! You feelin’ sorry for the geek now?” Jerome cocked his head in disbelief.

 “Well . . . no . . . I don’t know. I mean, like, yeah . . . well no . . . I guess it could’ve been funny.

“It was funny,” Tommy cut in. Blindly loyal to Jerome, Tommy always took Jerome’s side no matter which side of right or wrong Jerome found himself on. “Did you see the look on Stevie’s face when he plowed into Coach?”

 “I guess. But, I don’t know,” Eric continued. Ignoring Tommy for a minute, he looked up at Jerome, took a deep breath, and exhaled slowly. “It’s not like he can help being the way he is.” Then he glanced away.

Eric played the conscience of their trio. It had always been that way. They each had a role to play and played it well.

Jerome was a popular, do-no-wrong prankster, unquestioned leader, and athlete extraordinaire—everybody loved him and wanted to be like him. At Northeast High School, being Jerome’s friend meant that you’d arrived—a pretty impressive status considering that Jerome was only a junior. But then again, he’d always been ahead of the game. Now, as a starting varsity football player, Jerome’s standing in the invisible hierarchy of senior high social life was secure. He reigned supreme.

Tommy, meanwhile, played the consummate groupie. He was Jerome’s go-fer and all-around yes-man. Everyone knew he belonged to Jerome’s inner circle only because they’d grown up together and their families had been life-long friends. His athletic prowess certainly didn’t qualify him; he played third-string football. But bench-warming on Jerome’s team was better than not being part of the team at all. He was content with his part.

But Eric was different. Sure, he clowned around with the best of them and was a gifted athlete, but he also cared about the underdog, a concern that had intensified after watching his mother struggle with cancer. She’d won the first skirmish and was cancer free, but her battle changed the way Eric looked at things. Life wasn’t a game anymore. Things happened. People got hurt or sick when it wasn’t their fault, and sometimes there was nothing anyone could do. His mom’s illness taught him that, and he discovered compassion and boldness along the way. Eric was willing to speak up now in ways he’d never risked before—something Jerome found irritating. Still, although he’d never admit it of course, Jerome secretly admired Eric.

“C’mon, guys,” Eric confronted his friends. “I mean, tying Stevie’s shoelaces to the practice bench while he was sitting there keeping the books?” Eric looked at Jerome questioningly, then dropped his gaze and started pulling the grass next to him. “The kid has enough trouble walking as it is. He coulda gotten hurt, you know. And he was only doing what Coach told him to do.”

 “We don’t need some gimp like him keeping our stats!” Jerome seethed as he sat up on the boulder. “Especially when I’m starting varsity. All I need is for him to screw up the record, which he will, and then my stats go in the toilet. I’m counting on those stats for a scholarship. Besides, a kid like that doesn’t belong on any football team, let alone ours. We’re better off without him.”

Jerome’s anger surprised Eric, but he persisted. “Look, Germ, Stevie may not be able to walk right, but he’s good at math; he’s in geometry with me, and he’s really smart.” Eric paused, then plowed ahead. “He’s okay, once you get to know him. He’ll do a great job on the . . .”

“Just get off it, man!” Jerome stood up. “What’s wrong with you? I was only thinking about the team. I thought if I did some of this stuff, maybe he’d get the hint and just quit. I don’t get what the big deal is anyway. Everybody else thought it was funny. Even Stevie laughed.” Jerome snatched his lunch pack and stormed back to where the bikes were parked by the trail.

“What’s up with him?” Eric looked at Tommy. Tommy shrugged. Then, glancing back to where Jerome had just reclined, Eric noticed Jerome’s biking helmet.

“Yo! You forgot your lid,” Eric called after his retreating friend.

“I don’t need it.” Jerome shouted over his shoulder as he mounted his bike. “I’m outta here.”

Tommy and Eric scrambled to gather their gear, but by the time they reached the bikes their friend was gone. They’d have to ride fast to catch him.

* * *

I don’t get Eric anymore. Jerome fumed as he pedaled down the mountain. The wide, flat, cinder path made for smooth riding, a nice change of pace from the rocky woods trail they’d covered earlier in the day. Jerome’s mind wasn’t on the changing trail, though; it was on his changing friend.

Ever since his mom got sick. He can’t take a joke. He’s always defending people. Man, I just wish the old Eric would come back. The old Eric would’ve helped me tie Stevie’s laces to the bench post! The old Eric would’ve laughed along with the rest of us. The old Eric wouldn’t have apologized or helped the kid up.

But something else was bugging Jerome. He suspected his friend was right.

A sudden rustling ahead startled Jerome out of his daydream. Pumping the brakes, he strained to see what caused the commotion. In an instant, a dog, its leash dragging on the ground, darted out of the shrubs, then stopped dead in the trail.

The next several seconds seemed to pass in slow motion. The confused Labrador looked straight at the oncoming rider. Jerome squeezed hard on the hand brakes, but it was too late. His front wheel collided with the hundred-pound animal; the dog yelped, and Jerome somersaulted over his handlebars.

Tommy said later that he would never forget how his friend flew through the air and collided head-on with the sycamore tree’s trunk. Eric said he’d never forget the sickening thud the impact made. But what his friends would never forget, Jerome would never remember. In a brilliant white flash, Jerome’s world and life as he knew it was gone.

* * *

“Oh man, what do we do?” Tommy yelled to Eric as the two leapt off their still moving bikes and ran toward their injured friend. The dog, who seemed remarkably unhurt, scurried down the trail with only a slight limp.

“Wait. There’s a ranger station up ahead about a half mile. You go get a ranger, and I’ll stay here with Jerome.” Eric commanded.

Tommy started running down the path.

“Tommy! Take your bike, dude! It’s faster.”

“Oh yeah, right.” Tommy turned around, came back for his bicycle, and rode toward the ranger station like a man possessed.

Eric turned his attention to his unconscious friend. Jerome looked like a rag doll carelessly tossed aside by its owner. His forehead swelled with what looked to be a sizeable, bark-smudged goose egg. A small trickle of blood oozed out of the egg’s center. But, all-in-all, the teenager didn’t look bad—at least not to Eric. Lying flat on his back and unmoving, Jerome looked like the kid Eric had seen on countless sleepovers. Except for the bump on his head and the tree canopy that surrounded them, Jerome could’ve been sprawled out on his bed at home.

Don’t move him, Eric recalled from his health class. If Jerome’s neck were injured, moving him could risk greater damage, even paralysis. Eric could tell by the rhythmic rising and lowering of Jerome’s chest that he was still breathing, but breathing fast.

Eric ran to his bike pack and grabbed the emergency first aid kit his mom made him carry. Running back, he pulled out a gauze compress and knelt by his still unmoving friend. As he began to gently dab the blood trickling out of Jerome’s head, Eric started talking.

“Yo, Germ. You okay? Can you hear me?”

Nothing.

“C’mon, man. Wake up!”

No response.

“Jerome! Yo, Jerome! It’s me, Eric. C’mon wake up!” Minutes passed. It seemed like hours.

Jerome finally stirred. His eyelids fluttered, then opened, then closed again. He gingerly lifted his left hand to his head.

“Owwwwww.”

“Hey, you okay?”

“Head . . . hurts.”

“Yeah, don’t move. You really wiped out. Tommy went to get help.”

“Wwwho? . . . Tommmm . . .” Jerome panted heavily. “Ww . . . what. . . . wwwhere am I?” Jerome’s words, barely a whisper, came out in gasps.

“Don’t you remember? We were biking. You know, the old railroad bed? That dog came out of nowhere. Man, like, you really scared me.”

“Ddd . . . dog? Wwwh . . . what . . . dog?” Jerome moved like he was going to push himself up, then winced.

“No, don’t move, man, I mean it. Wait ’til help comes.”

“Yeah. . . . ’kay . . . tired.”

Jerome seemed to doze again. He was still dozing off and on when the ranger returned with Tommy. He dozed again when paramedics stabilized his neck with a special collar, rolled him onto a backboard, and then strapped him onto a stretcher.

* * *

By the time the emergency-room doctors treated him at the hospital, he was a little more awake, but his head spun and he felt like he was going to throw up. His symptoms just wouldn’t quit.

When his parents arrived and learned that their son was fine except for a closed-head injury, Jerome’s head still throbbed. He felt dizzy when doctors described him as having a mild traumatic brain injury (TBI). He threw up when they explained that his brain had bounced against the inside of his skull when he hit the tree, but that the bruising to his brain tissue was minor. Jerome tried to take it all in, but couldn’t. His eyes were open, and he could respond to questions, but he just didn’t feel “all there.”

Phrases like “possible contusion,” “site of impact,” and “no internal bleeding” spun through his head—words he heard but couldn’t make sense of. Other words like “acceleration/deceleration injury” and “concussion” confused him even more. He completely missed the doctors’ descriptions of how the skull and other parts of the head work to protect the brain. His didn’t understand his parents’ jokes about his “hard head” sparing him further injury. He zoned out during the doctors’ lectures on helmets and bicycle safety. He even felt lost during their discussion of “admitting him overnight for observation.” He just didn’t get it. Jerome felt dazed.

Who are all these people? What am I doing here? Why can’t I get this fog out of my head? Though conscious enough to notice his mixed-up thinking, he was too tired to care. Had Jerome been clear-headed enough to understand his doctors’ words, he would have cared, and cared deeply. But he just fell asleep again.

Confusion

Jerome awoke damp with sweat. His head pounded and his eyes ached as he tried to scan the fuzzy room for clues about where he was and what he was doing there. He started to turn his head but stopped when shards of pain pierced his neck and skull. Where am I? his mind screamed in a single moment of clarity. Then clouds of swirling confusion carried him back to his dark slumber.

* * *

“He’s waking up!” Jerome’s mother said almost to herself. Then her tone grew more insistent. “Quick, get the nurse. Your brother’s waking up again!”

Jenny scampered into the hall for a nurse.

“Jerome, it’s me, Mom,” His mother coaxed. “Can you hear me?”

Jerome stirred.

“I’m here, too, son,” his father said. “Over here on your left. If you can hear me, squeeze my hand.”

Every eye in the room dropped to Jerome’s left hand.

“Squeeze my hand, Jerome,” his father urged. “You can do it.”

Nothing. They waited, eyes riveted on the father–son clasp.

* * *

I hear something. What is it? Someone’s calling me. They sound so far away. No. . . . I just want to sleep. Let me sleep. Please just let me sleeee. . . .

* * *

“What’s going on?” Nurse Martin queried as she hurried into the room with Jenny in tow. She checked Jerome’s monitors as his mother rushed to tell her.

“He’s waking up, again. I’m sure of it. I saw his eyes open, just for a second, but they were open.”

The nurse leaned over Jerome’s bed and gently raised his eyelid. The pupil shrunk when it came into contact with the light. She checked the other; it reacted normally, too.

“Wake up, Jerome,” the nurse insisted as she checked the pulse in his right arm. “Open your eyes.”

Jenny nudged her way between the nurse and Jerome’s bed rail. Looking between the stainless steel railings, she spoke into Jerome’s ear.

“Hey Germie, it’s me. You gotta wake up. Please. You promised to take me riding, ’member?”

“Jerome, squeeze my hand,” came his father’s voice.

“He did it! Did you see?” Jenny squealed.

It was the slightest movement but it was there.

“It could just be an involuntary reflex,” the nurse cautioned. “He might still be sleeping. It’s not uncommon for someone with a TBI like his to sleep for long periods of time.”

“No, it was real. He really did squeeze,” Jenny insisted. “I saw it.”

“Squeeze my hand again, son,” his father repeated. “I’m right here.”

* * *

Dad? Jenny? Mom? Why is everybody in my room? Oh, yeah, squeeze his hand. I’m supposed to squeeze somebody’s hand.

“There! See? He’s doing it!”

Jerome could hear Jenny squealing. Where am I? He struggled to open his eyes, but each lid felt like it was sewn shut.

“Jerome, wake up!”

With every ounce of strength he had, Jerome willed his eyes open. The white ceiling, the pastel plaid curtain by his bed, the soft green walls, fluorescent lights: it was all wrong. Nothing looked familiar. Everything looked out-of-kilter and distant. The entire scene seemed blurred, like he was looking through eyeglasses smeared with Vaseline. He blinked once. Then again. Then slowly his mother’s face came into view.

“Mom?” he whispered.

“Yeah, sweetie. It’s me. I love you so much. We’ve been so ­worried.”

“You really scared us,” his father added.

Jerome rolled his eyes slowly toward the direction of the voice.

“Dad?”

“I’m here.” Mr. Johnson said softly, his voice choked with emotion. “It sure is good to see you awake again.”

His father’s voice sounded strained. Why does Dad sound so weird? What happened? Too many thoughts tumbled through his brain. His head hurt.

“Where . . . am I?” Jerome managed to mumble.

Nurse Martin said, “You’re in the hospital, Jerome. You had an accident. Do you remember?”

Accident? What accident?

Jerome barely shook his head, and white flashes went off in his brain. Even the slightest movement caused him blinding pain.

“You were mountain biking with Eric and Tommy yesterday up on the old railroad-bed trail,” his father continued, interrupting the nurse. “They said a dog ran out in front of you, you collided, and then flipped over your handlebars. You hit your head on a tree. Don’t you remember?”

“No,” the teenager mouthed. He wasn’t going to move his head again.

“Eric said the impact knocked you out, but only for a few minutes. Then you seemed to wake up. But you’ve been sleeping an awful lot since they admitted you to the hospital. Almost eighteen hours now. We thought you were in a coma, but the docs assured us that since they could wake you, you were just sleeping. You took quite a bump on the head.”

“Well, what have we here?” a strange voice interrupted. It came from the tall man entering the room. Jerome couldn’t make out the writing on his lab coat, but guessed he was a doctor. He stared at the stranger approaching his bed, trying to bring him into focus.

“I’m Dr. Wilkerson, Jerome. Do you remember meeting me yesterday?”

“I’m a neurologist. Your dad’s right; you took a nasty bump to the head. I’m glad to see you’re awake again. That’s a good sign.”

“What’s . . . wrong . . . with me?”

“Well, your CT scan was clear, but your MRI shows you have more than just a concussion. You also have a mild contusion on the front part of your brain. When your head hit the tree, it stopped, but your brain, which floats inside your skull, kept moving until it collided with the front part of your skull. When your brain impacted the skull, it bruised, just like your arm or leg gets bruised when you bump into something. The bruise on your brain is called a contusion. It’s nothing to be too concerned about. It should clear up on its own in a week or two.”

Jerome couldn’t understand a word the doctor said, but he played along. “Is that why my head hurts?” he asked weakly.

“Your pain is the result of the head trauma you experienced. We can give you something for the pain while you’re here, and I’ll write a script for when you go home. You can expect your head to hurt quite a bit for the next few days, but the pain should subside in a few weeks. Still, I think I’d like to keep you here another day to watch your progress. You took quite a spill.”

“I just want . . . to . . . sleep.” Jerome mumbled, and started to nod off again.

“Should he be sleeping so much?” Jerome’s mother asked while her son slept.

“Sure, it’s pretty normal,” the doctor explained quietly. “He’s been through a lot, and the brain is trying to heal, which itself can be an exhausting process. His Glascow Coma Scale (GCS) score ­indicates that he does have a mild to moderate brain injury, and it’s not uncommon for people with his degree of brain injury to sleep fourteen, sixteen, even twenty hours a day in the days immediately following their injuries.”

“But what about his memory? Why can’t he recall what happened to him?”

“He has what’s called post-traumatic amnesia (PTA). That’s pretty normal following a head injury, too. He’ll probably have little, if any, memory of the accident. He may forget the day or two immediately preceding the trauma and will even have little recall of his time here in the hospital. All of that is standard for a patient with a TBI.”

“So when can he come home?” Jenny cut in.

“Let’s give your big brother another day to rest here. Okay? I’d like to keep an eye on him for another twenty-four hours. Is that all right with you, Jenny?”

Jenny glanced at the big white bed that held her sleeping brother. Then she looked around the room at all the blinking lights and machines. She turned to Dr. Wilkerson, “Okay. I guess. But you’ll take care of him, right?”

“You bet!” The doctor assured her.

“And he can come home tomorrow?”

“As soon as it’s safe for him to go.”

The family felt relieved. They didn’t realize that what the doctor defined as “safe” wouldn’t seem safe to Jerome at all.