Defined by Brain Injury

After being hospitalized for a hemorrhage last year, I'm fully recovered, both mentally and physically—but people still view me differently than they did before.

On March 15, 2014, my head exploded, splattering toxic blood into my brain. In medical terms, I suffered a subarachnoid hemorrhage of the right vertebral artery, an often fatal, usually debilitating, event. I was thrice fortunate: that I was in the hospital at the time, that my hemorrhage was located in a place with less neurological risk, and that I had great doctors. My primary-care physician saved my life by insisting on a CT scan when no one else seemed to think twice about my fierce headache. My neurosurgeon performed an angioplasty, sealing the offending artery with a coil. He told me my brain function held steady throughout the procedure.

After two weeks in Presbyterian Hospital in Pittsburgh—most of it in the neurology intensive-care unit—and about six weeks of home convalescence, recuperating from a persistent headache, sensitivity to glare, a sore neck, fatigue, muscle atrophy, and weight loss, I am as I was. It’s true that I have a Slinky in my cranium, and the blood flow to my head has been rebalanced among the three remaining arteries, and, yes, I spent several months worried that the slightest itch on my forehead foretold doom. But I have returned to my pre-hospitalization work and my pre-hospitalization workout routine. My performance at both tasks has not suffered, nor, sadly, improved. In short, I am neither more nor less dexterous, physically or mentally, than I was before. And my doctors agree.

Yet I have discovered that having recovered from a brain injury is vastly different from having recovered from any other injury. No one thinks that a broken leg or a kidney stone or pneumonia fundamentally changes the essence of who you are. But when you’ve had a brain injury, people don’t believe that you are quite the same, although no one will actually say so. Perhaps it is the expression of a universal personal terror. The brain is who we are in the most fundamental sense. We are what we think, and we think with our brain. Not for nothing does Descartes’ summation endure.

The perceptions of my injury endure as well. Although I have been fully back to normal for close to eight months, “How are you feeling?” continues to supplant “Hello” as the greeting of choice. Sometimes, it seems I hear the question at 15-minute intervals, as I did in the hospital. I half-expect the rest of the ICU script to follow: “Can you smile for me? Can you stick out your tongue? Can you hold up your arms up as if you’re holding a pizza box? Can you tell me what month it is?” When I decline a glass of wine at a holiday party, my host exclaims, “Of course, you have restrictions.” When my parents phoned a few minutes before Yom Kippur because I had forgotten to call them, I could hear the barely-suppressed panic in their voices, their improbable fear of a persistent vegetative state overwhelming the prosaic reality that the day had simply gotten away from me.

Pretty much everyone who has heard tell of my exploding head attends to details that once would have passed unobserved. If I stumble because I’ve hit a seam in the carpet, colleagues will ask me if I’m okay every time they see me for a week. When I develop a headache behind my right eye—the same chronic headache I’ve experienced for years—my wife’s concern trebles. Should I forget something she just mentioned a moment earlier, or should I answer with a non-sequitur because I spaced out during the first half of the question, my wife used to respond, if at all, with mild annoyance. Now, she looks at me quizzically and says “Yiiitz?”, stretching my name into a question that sounds suspiciously like “How about I take you to the emergency room?”

Unfortunately, people’s belief that my mental function has changed generates its own verification. My actual behavior has been altered by the observation. My awareness of symptom-hunting generates more symptoms. Occasional verbal awkwardness becomes less occasional and more awkward; I fall into the habit of over-explaining my mental lapses; when walking accompanied, I attend with greater care to broken sidewalks and black ice. My self-consciousness emulates neurological deterioration.

The hypersensitivity to my smallest tic is understandable. When my head exploded, it plunged my children, my parents, and especially my wife into a trauma that I cannot fully comprehend. I am endlessly grateful to them and to the friends, colleagues, and acquaintances, who supported us through my hospitalization and recovery. But my exploding head has also changed me by changing their perception of me. They think, therefore I am.