Friday, November 11, 2011

Helping a Brain-Injured Person - Part One

About a month ago I was at our local coffee shop ordering a latte when I noticed a book displayed on the counter.  Pieces Missing: A Family's Journey of Recovery from Traumatic Brain Injury was written by Larry C. Kerpelman, Ph.D., a local author who was a regular customer at the Boston Bean House. I liked that Dr. Kerpelman was also a fellow independently-published author like me, and read that he and his wife, Joanie, lived just minutes away in Acton, my home-town. But what really grabbed my attention was the subject-the story of his wife's traumatic brain-injury and how their family coped with this unexpected crisis. I immediately went home and sent Dr. Kerpelman an email introducing myself, describing the parallels in our stories, and inviting him to coffee. To my delight, he accepted my invitation, and I had the opportunity to meet both him and his wife Joanie, read his book, and hear him speak at a recent book-signing.

I could not put this book down...expertly and articulately written, this memoir reads like a gripping, suspenseful novel. Having been through my own significant health crisis, I could easily identify with Joanie's struggle to turn her frustration and disappointment into positive energy more conducive to her recovery, and was inspired by her determination and tenacity. Pieces Missing is not only the story of a family coming together in the midst of a crisis, but a touching account of a spouse being unexpectedly thrown into the emotional role of caregiver and patient advocate.  Dr. Kerpelman also shines a much-needed light on both sides of our health care system: the selfless, committed and most devoted medical professionals who heal and care for us, and the complicated, corporate infrastructure which often interferes. Most of all, this book is a tender love letter from the author to his wife, a true depiction of the wedding vows "...for better or for worse, in sickness and in health..."; a must-read!

After reading Pieces Missing, I thought of how challenging it must be for young children to be coping with a brain-injured parent or relative. In addition to those who suffer falls, auto or other accidents, there must be countless troops returning home from duty in Iraq and Afghanistan with similar injuries. I invited Dr. Kerpelman to write an article for this newsletter, and I was thrilled when he accepted.  This is Part I of a two-part article:

By Larry C. Kerpelman, author of Pieces Missing: A Family’s Journey of Recovery from a Traumatic Brain Injury (Two Harbors Press, 2011)

On a beautiful December day, as my wife and I were returning from our daily walk to our favorite coffee house, she got tangled in her shoelaces and pitched forward onto the asphalt roadway and lay there scratched, bruised, and bleeding. I took her to the emergency room where we were told that she had suffered a subdural hematoma, a traumatic brain injury (TBI).  With that, she became one of 1.7 million Americans each year who sustain a TBI – that’s one every 18-1/2 seconds. Although I had a passing familiarity with brain injury as part of my professional education, over  the course of three emergency room visits, two hospitalizations, and one brain surgery, I became much more acquainted with brain injury than I ever  expected to be.  The book I wrote about her injury and rehabilitation tells the story of how our marriage and family persevered and survived the biggest crisis of our lives and how the human spirit and love helped our family overcome this major health challenge.  
The National Institute of Neurological Disorders and Stroke defines a traumatic brain injury as one where damage to the brain results from a sudden physical assault on the head. That attack to the head may result in either a closed head injury (such as occurred with actress Natasha Richardson in her fatal skiing accident in 2009) or a penetrating head injury (such as occurred from the gunshot wound suffered in 2011 by Congresswoman Gabrielle Giffords). The NINDS further categorizes the damage to the brain as being either focal, that is, confined to one area of the brain, or diffuse, that is, involving more than one area of the brain. My wife’s injury was a focal, closed head TBI.
A traumatic brain injury can cause all kinds of problems—some temporary, some permanent—due to not only the broken blood vessels and accumulation of fluid in and around the brain the injury has caused, but also the damage to the brain’s neurons. Among these problems are head pain, confusion, lethargy, nausea, sleep disturbances, impaired attention, memory loss, speech and hearing deficits, emotional and behavioral problems, and seizures. Having incurred a moderately severe TBI, over the next several months Joanie experienced all of these problems except seizures, which were averted through the use of anti-seizure medication.  Injuries on the left side of the brain, such as Joanie suffered,  can impair a person’s understanding of language, speaking, verbal memory, logic, sequencing of activities and thought, and control over right-sided body movements. Those on the right side of the brain may cause impairment of vision and spatial sense, visual memory deficits, altered creativity and music perception, loss of “big picture” type of thinking, and decreased control over left-sided body movements. Diffuse brain injuries – those that are scattered throughout both sides of the brain -- can lead to slower thinking, confusion, difficulties in attention and concentration, fatigue, and impaired thinking in all areas. At more severe levels, a TBI may cause a person to lapse into a coma, a vegetative state, or even death. 
So what should you do when you encounter a person who may have suffered a head injury.  If he or she is unconscious, try not to move him or her – that may cause more damage.  Call an ambulance, as the EMTs are equipped to handle someone with a head injury, and the emergency room personnel can diagnose what the injury might be.  If the person is conscious and talking, take him or her immediately to a physician’s office or an emergency room so that they can render advice and a diagnosis.  Do not ignore the problem or have the person “walk it off,” as an undiagnosed brain injury can cause worse problems down the road if not treated.  Once a person is released from treatment or hospitalization for a TBI, he or she is unlikely to be back to their “normal” self without some type of further rehabilitation to restore the “pieces missing” that resulted from the initial assault to the brain tissue.
In the next installment, I will review some of the things you can do to help a brain-injured person’s rehabilitation.

Would you like to use this article for your own website or newsletter?  No problem!  But here's what you must include: 
“Larry C. Kerpelman is author of Pieces Missing: A Family’s Journey of Recovery from a Traumatic Brain Injury (Two Harbors Press, 2011). Dr. Kerpelman is a psychologist and award-winning health care communicator who never would have imagined his work would be inspired by experiences in his own family.  When his wife suffered a brain injury from a freak accident, the journey toward recovery took his family through the maze of a less-than-perfect healthcare system.  The book inspired by this experience provides a moving story of the endurance of the human spirit, combined with insights about brain injury and recovery and pointed questions about how our health care system functions. For more book details, please visit him on If you or someone you know would like to buy Pieces Missing, you may order it from ,,, or your local bookseller.”
Dr. Kerpelman will be speaking at Sargent Memorial Library in Boxborough, MA on January 24, 2012 at 7pm.


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