mild traumatic brain injury 2007

[stitchingirl]

I have an MC who was involved in a car accident along with two other friends when a semi hit them when the truck driver fell asleep behind the wheel. Two of the friends in the front seat have minor injuries but my MC got the brunt of the collision as well as the injuries, resulting in traumatic brain injury and other injuries typical in a car accident. I did the best I could to research about traumatic brain injuries but hoped someone here had additional helpful information.

1) If my MC would be unconscious, who would make the medical decisions? He's 27 and not married and doesn't have a POA.

2) With cerebral edema, what was the procedure in 2007 and how was it monitored, and how often were tests done, if any?

3) How long would he be in the ICU?

4) Would family and friends have been allowed to keep vigil by his bedside in shifts?

5) After he wakes up, would he remember anything or just pieces, or nothing at all?

6) How long after he wakes would he remain in the ICU, then in a regular room?

7) Once he's released home, how long would his recovery time be? Would he be able to work?

8) If he had long-term effects, how soon before they became noticeable? Would he need a neurologist for those effects?


Thank you in advance for any and all information.

 

[ChaseJxyz]

1: I'm pretty sure that (in the US at least) the doctors would be making those decisions. Like they're gonna give him blood transfusions because there's no family member to say "wait no he's a Jehovah's Witness you can't do that!" You can refuse medical treatment but once you're unconscious, medical personal will make whatever decision is best to keep you alive/whole. That's why DNR tattoos/orders are a thing.

2: I can't answer that, but there's def people here who could

3: Depends...TBIs can take a really long time to heal, if ever. Plus he probably has other injuries. The more injuries you have, the slower they heal since the "resources" are split among all the injuries. So you can probably have him be in the ICU for however long the plot needs him to be.

4: Maybe? I think it would depend on the hospital, hopefully someone here has personal experience and can give you a better answer (the concept of that is really weird right now w/r/t Covid. You can't even wait at the hospital when someone is in surgery, they make you go away and they only call you when the person is ready to be picked up)

5: Depends...TBIs can be very different, you can bounce back quickly, you can not remember things because of the medicine you were on...you have a lot of leeway here, so do what the plot needs.

6: Again I can't answer that one

7: He might never get better. I have a friend who has a TBI and she's in pain most days and has treatment-resistant depression, but she does have a job as an engineer (so sit at desk all day). There's been a few serial killers that were totally normal kids but got a TBI and they became super aggressive/lost their impulse control. So your character can go back to (mostly) normal after several months or might be permanently disabled...again, lots of leeway, do what the plot requires.

8: Good question. Some things might take some time to discover...like if he now gets triggered by certain noises/smells into having a migraine, he might not encounter those things in the hospital. If his ability to walk is impaired, he really can't know that when he's stuck in a hospital bed for other reasons, he'd only figure that out once he's gone through some physical therapy. He's absolutely going to see a neurologist, a lot, to track his progression as he heals, adjust medications etc. He might even see a specialist for TBIs, which might require going to a fancy hospital.

I did see a neurologist for a bit for ulnar neuropathy. It's one of those doctors offices where all the other patients there are really old. Like some health aid is pushing people around in wheelchairs and they can't even fill out the forms themselves. And the front desk/techs ask you if you're there for another patient or they comment how they thought your birth year on your chart was an error. It makes you feel really bad! It sucks a lot to be a 20/30something and be suffering from "old person problems" and it makes you think about a lot of not-fun things. I imagine your MC is probably younger so this is something they might encounter.

 

[mccardey]

mild traumatic?

 

[stitchingirl]

1: I'm pretty sure that (in the US at least) the doctors would be making those decisions. Like they're gonna give him blood transfusions because there's no family member to say "wait no he's a Jehovah's Witness you can't do that!" You can refuse medical treatment but once you're unconscious, medical personal will make whatever decision is best to keep you alive/whole. That's why DNR tattoos/orders are a thing.

2: I can't answer that, but there's def people here who could

3: Depends...TBIs can take a really long time to heal, if ever. Plus he probably has other injuries. The more injuries you have, the slower they heal since the "resources" are split among all the injuries. So you can probably have him be in the ICU for however long the plot needs him to be.

4: Maybe? I think it would depend on the hospital, hopefully someone here has personal experience and can give you a better answer (the concept of that is really weird right now w/r/t Covid. You can't even wait at the hospital when someone is in surgery, they make you go away and they only call you when the person is ready to be picked up)

5: Depends...TBIs can be very different, you can bounce back quickly, you can not remember things because of the medicine you were on...you have a lot of leeway here, so do what the plot needs.

6: Again I can't answer that one

7: He might never get better. I have a friend who has a TBI and she's in pain most days and has treatment-resistant depression, but she does have a job as an engineer (so sit at desk all day). There's been a few serial killers that were totally normal kids but got a TBI and they became super aggressive/lost their impulse control. So your character can go back to (mostly) normal after several months or might be permanently disabled...again, lots of leeway, do what the plot requires.

8: Good question. Some things might take some time to discover...like if he now gets triggered by certain noises/smells into having a migraine, he might not encounter those things in the hospital. If his ability to walk is impaired, he really can't know that when he's stuck in a hospital bed for other reasons, he'd only figure that out once he's gone through some physical therapy. He's absolutely going to see a neurologist, a lot, to track his progression as he heals, adjust medications etc. He might even see a specialist for TBIs, which might require going to a fancy hospital.

I did see a neurologist for a bit for ulnar neuropathy. It's one of those doctors offices where all the other patients there are really old. Like some health aid is pushing people around in wheelchairs and they can't even fill out the forms themselves. And the front desk/techs ask you if you're there for another patient or they comment how they thought your birth year on your chart was an error. It makes you feel really bad! It sucks a lot to be a 20/30something and be suffering from "old person problems" and it makes you think about a lot of not-fun things. I imagine your MC is probably younger so this is something they might encounter.

I wonder if #5 is age-dependent. Like he'd bounce back a tad faster at 27 than me at 52.

For #8, I was gonna have him still migraines whenever if he's stressed or like not taking enough breaks from working on the computer for work. And also, before the accident, he worked in a steel mill but between the migraines and the bouts of confusion, the Big Bosses decided he was too much of a liability to continue working for them.

 

[stitchingirl]

mild traumatic?

I Googled it up and the symptoms I was picturing is mild TBI. Severe was described as basically having no hope of recovery, not that there's no danger even with mild. But my MC would be put in a medical coma and have cerebral edema

 

[frimble3]

I wonder if #5 is age-dependent. Like he'd bounce back a tad faster at 27 than me at 52.

For #8, I was gonna have him still migraines whenever if he's stressed or like not taking enough breaks from working on the computer for work. And also, before the accident, he worked in a steel mill but between the migraines and the bouts of confusion, the Big Bosses decided he was too much of a liability to continue working for them.

On the upside, if he's working in a steel mill, he likely has a union and disability pay. They should not be just kicking him to the curb.
Because the bosses are right, with the migraines and confusion he'd be a danger to have around heavy equipment.

 

[stitchingirl]

On the upside, if he's working in a steel mill, he likely has a union and disability pay. They should not be just kicking him to the curb.
Because the bosses are right, with the migraines and confusion he'd be a danger to have around heavy equipment.

But would be the mill pay for long-term disability? I thought they just had short-term only.
Plus, the trucking company would be held responsible since it was one of their drivers who caused the accident.

 

[Maryn]

We have our own long-term disability insurance that would kick in, regardless of any responsible party, if one of us were disabled in an accident. (We're retired now, but we started it when employed, completely unrelated to employers.)

The steel industry in the US was not doing terribly well in 2007 due to Chinese steel imports being cheaper, so my guess would be they would feign regret, or express genuine regret, at having to let him go and pay only what is legally required. Do unions have the power to force struggling industries to fork over for long-term disability insurance? I doubt they do.

The rest of this is based on first-hand knowledge following a serious accident involving a family member.

It's very common not to remember the period of time surrounding an accident, or the accident itself. Our family member lost about a half hour of memory (without head injury) and it never came back. The doctor assured us this was normal and fine, the brain protecting its owner.

The guilty party causing an accident rarely/never offers to pay the injured person's major medical bills. Both the injured person's health insurance company sues the trucking company (and possibly its driver, separately) to get compensation. Hoping to settle out of court, the trucking company is likely to make a low-ball offer that might cover expenses already incurred but doesn't cover future medical treatment, loss of income because he can't work at the mill, etc. That's why you have to sue them.

If your guy doesn't know he needs an attorney, he could end up financially screwed.

Maryn, whose family was sued for $20 million

 

[cmhbob]

Re #4: My cardiac ICU experience for my MIL in 2000-ish was that visits were limited to about 15 minutes or so every hour or couple of hours. Typically there's too much equipment in there for family to be close to the bed, and staff often needs to be able to get to the patient right now.

 

[dickson]

I can claim no expertise in these matters but I have known people who have experienced brain injuries of varying severity. As others have noted, the long-term consequences can vary wildly.

The person whose experience most closely fits your MC’s situation was a woman who started the department I hired into in an FFRDC (an American equivalent of a Quango) many years ago. The department’s focus was on image processing for remote sensing. In the mid-late 1970’s it was one of a very small number of organizations on the planet that so much as thought of such matters. (The only other one I can think of as I type is the MIPL at JPL. There were a few research groups in university departments as well; not many.) My impression of her from what I heard is that she was a formidable talent.

She was in a severe auto accident during which her brain was violently torqued. This is a particularly bad thing for a brain to experience.

I did not know her before the accident. When I met her she was still pretty young; about forty. She walked with no apparent difficulties and spoke normally. She seemed to enjoy visiting the department she founded and chatting with us. Later a colleague who knew her better than I told me that, on the matter of how her injury affected her, she simply said “I can no longer do the work I used to.”

The interior experience of traumatic brain injury is necessarily something that those who have not had one will struggle to imagine. If you have the time or interest, I highly recommend “The Man with a Shattered World,” edited by a Soviet psychiatrist named Luria (don’t recall the first name; certainly not Salvador).

It is a first-person account of what it is like to live with the aftermath of a truly appalling brain injury. The author spent thirty years of his life writing it. It is not an easy read. I found his determination to keep on living and to try explaining to the rest of us what existence was like for him breathtakingly courageous. I would also call his account somewhere between spooky and surreal, over and above the pain: For him, one half of existence (I believe it was the right-hand side) vanished totally, a deficit conceptual as well as sensory.

Try to imagine what it must be like to describe a part of your former existence-universe, really-that you can no longer experience, and hardly imagine.

My. It’s been years since I thought about that book. Easily the equal of anything Oliver Sacks wrote on the subject.

I hope the foregoing was not more about elephants than you really wanted to
know, as the small boy said in his class presentation of a book report.

 

[cmhbob]

I highly recommend “The Man with a Shattered World,” edited by a Soviet psychiatrist named Luria

That sounds like a fascinating book. I'd have to think after 20 years of war in SW Asia, something similar has been done.

Man with a Shattered World

Russian psychologist A. R. Luria presents a compelling portrait of a man's heroic struggle to regain his mental faculties. A soldier name...

www.goodreads.com

 

[CMBright]

1) In the US, it would be next of kin if one could be found, the medical staff if no one could be found. Default is to assume patient would want everything to be done, unless there are documents or someone to say otherwise.

2) I'm not a doc, so I'm not sure. If it was bad enough, docs might have drilled holes or removed a small section of bone to relieve pressure. Clots in blood vessels would have been treated with "clot busting" meds.

3) As long as he needed that level of care.

4) In an ICU? Nope. I was not allowed to be with Spouse except for limited visits when Spouse was in ICU after a cardiac event that required stints.

As others have mentioned, if your MC was in the ICU, it was not minor. A concussion is minor.

Don't restrict researching to traumatic brain injury. Look at accounts for stroke, encephalitis, meningitis. How long does it take to recover? How severe was the effect and how much rehab was done. Every individual will be different.

Long term effects would vary based on what area of the brain was affected. I had encephalitis. No way of predicting what would be affected. Deafness was common, my hearing was fine. Cat scans (atually CT scans) would be common, I think I had one in the hospital in the 70's. Pet (PT) scans and MRI might also be used to give detailed imagery. From my experience, lumbar punctures HURT. I was tested for infection, some medical dramas use spinal taps to determine cerebral spinal pressure and test for infection.

I forget the electrode on the scalp test name I had a couple years later, in third grade. I might have had someone who wasn't very good. I needed an epidural in my forties, don't remember it hurting much, but I was distracted by the hospital stay.

Gross and fine motor coordination impairment, did last for years. No rehab that I remember, other than special needs classes while I was in mainstream school classes.

I did learn cursive earlier than my peers, I just could not remember the mnemonics about bats and balls to keep my 'b's and 'd's straight, not to mention my 'p's and 'q's. I was just defiant enough to write my entire name in mirror cursive when told it was to keep me from writing letters backwards.

I have always had the occasional time when I was talking and had the wrong word and had trouble finding the right one. So, some degree of dysphasia. I'm in my fifties, no way of knowing if that was ADHD (genetic) or encephalitis (1st grade, when ADHD was often diagnosed, our kid was diagnosed end of K).

So, if you know where the trauma was, you can predict what the likely effects will be. Maybe difficulty retaining short term memory or accessing long term memories. Maybe your MC can't hear or smell as a result. Maybe it is as blindingly obvious as paralysis or coordination impairment in part of the body.

Once the neurons are damaged, the damage will be apparent, unless it is something your MC isn't doing in the hospital or once (s)he gets home. Confusing some printed letters and randomly flipping others would not be noticed in the hospital unless his name was Brad Smith and he had to print his name on some form. 'S' was one of two letters I was most prone to mirroring.

The inner experience for adults above was interesting. I was young enough I don't remember before. For me, I was my "normal" self. I believe normal is a myth and everyone has a different experience of what normal is.

I am not in health care, but I have personal experience. Effects fade over time, most of the time. Rehab can help to a degree, how much rehab helps depends on the individual and how much rehab he/she gets. It can potentially affect every aspect of who one in including personality, impulsivity, and so on. Or seem to do almost no damage at all.

 

[dickson]

That sounds like a fascinating book. I'd have to think after 20 years of war in SW Asia, something similar has been done.

Man with a Shattered World

Russian psychologist A. R. Luria presents a compelling portrait of a man's heroic struggle to regain his mental faculties. A soldier name...

www.goodreads.com

Good chance of it, one would imagine.

 

[stitchingirl]

We have our own long-term disability insurance that would kick in, regardless of any responsible party, if one of us were disabled in an accident. (We're retired now, but we started it when employed, completely unrelated to employers.)

The steel industry in the US was not doing terribly well in 2007 due to Chinese steel imports being cheaper, so my guess would be they would feign regret, or express genuine regret, at having to let him go and pay only what is legally required. Do unions have the power to force struggling industries to fork over for long-term disability insurance? I doubt they do.

The rest of this is based on first-hand knowledge following a serious accident involving a family member.

It's very common not to remember the period of time surrounding an accident, or the accident itself. Our family member lost about a half hour of memory (without head injury) and it never came back. The doctor assured us this was normal and fine, the brain protecting its owner.

The guilty party causing an accident rarely/never offers to pay the injured person's major medical bills. Both the injured person's health insurance company sues the trucking company (and possibly its driver, separately) to get compensation. Hoping to settle out of court, the trucking company is likely to make a low-ball offer that might cover expenses already incurred but doesn't cover future medical treatment, loss of income because he can't work at the mill, etc. That's why you have to sue them.

If your guy doesn't know he needs an attorney, he could end up financially screwed.

Maryn, whose family was sued for $20 million

$20 MILLION?????

Now since there were two other parties injured but not as seriously, would their cases be all lumped together or individual cases? What if one of the lesser injured cases gets greedy and wants some of the seriously injured's money? Money has a way to turn people greedy.

How long would the case normally take? I always hear justice is slow, but like in a year's time?

 

[Catriona Grace]

Ten years ago, it was a four year wait to get a trial date in some counties in the state due to a large backlog and not enough judges. Even now, I think the average is two to three years if everything goes smoothly. Unfortunately, people invariably expected to make their claim, go to trial, and bank their money within a couple of months.

 

[Maryn]

$20 MILLION?????

Now since there were two other parties injured but not as seriously, would their cases be all lumped together or individual cases? What if one of the lesser injured cases gets greedy and wants some of the seriously injured's money? Money has a way to turn people greedy.

How long would the case normally take? I always hear justice is slow, but like in a year's time?

Yup, twenty million bucks. Money does indeed turn people greedy. The accident in which the family member was at fault--an accident, no excessive speed, alcohol, or drugs involved--involved a death because someone in the vehicle our family member hit, not wearing a seatbelt, was thrown from the vehicle and run over by an oncoming truck that was speeding and could not stop. It got racial fast. (The dead person was black, my family member white.) They hired Johnny Cochran's law firm, Cochran himself being unavailable, and presumed this was not just a tragic loss for which they deserved compensation but a chance for a rich white family to make them rich instead. I remember being astounded, because we went to court in twenty-year old suits or dresses from thrift stores, looking nice, while they wore new Buffalo Bills warmup suits, which cost more. For Christ's sake, I was wearing used shoes I bought for $6.99.

It took about three years for all the legal proceedings to be concluded. Family member's license was suspended for six months and they had to pay to get a new one, which was a financial strain. The lawsuit awarded the plaintiff costs incurred, including lost wages when the surviving driver was unable to work for a few months, to the tune of 20K. The truck driver got nothing. The judge was not an attorney (common in small towns) and he allowed the truck driver to say some vicious things to our family member in open court. The state policeman who had testified hauled him out of the courtroom--but called him by his first name, clearly someone he knew. The judge and bailiff just sat there.

Maryn, unimpressed with small town justice overall

 

[Catriona Grace]

My sympathy, Maryn. I was a certified legal assistant for 12 years, specializing in civil litigation. The tales I could tell about people who thought a law suit was the way to a life of ease...