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Thursday, March 19, 2009

Head Injuries

This is a serious topic, and one that should be discussed;  the fact is, head injuries can be deadly. 

The big news today is about how actress Natasha Richardson died of a head injury received as a result of a ski crash on a beginner's slope. Initially she was fine, they tell us, but the other symptoms appeared.  And that's what happens. One minute someone is fine...the next...they're dead.  

In my first year as a Ski Patroller, I remember that one of our fellow patrollers took a serious spill on the bunny hill. It was a freak thing; he was an amazing skier, he and his wife were actually moving to Europe and were going to be patrolling there, in the Alps. Well, he took a headlong crash and I remember being on was pretty obvious he'd hit hard.  And was a bunny hill.  Never underestimate the force of a fall, even when it doesn't seem to make sense. 

I was also the patroller in charge of a scene on that very same bunny hill a couple years later,  where a little boy had taken quite a creative fall. And although over and over again, he said he hadn't hit his head at it turned out, he DID have a head injury, although in his case it was a slight concussion.

Both of the above people recovered and went on with their lives, but witnessing the damage caused what what was later diagnosed as a "slight concussion" was quite daunting. In the first case, the patroller, "Bill" was bleeding all over the place as a result of a direct hit.  In the latter case, "Andy" had no outward sign of his injury, but he DID go downhill QUICK about 20 minutes later.

One of the scary things with head injuries is that although there are symptoms, they don't always match on every occasion. There are closed and open head injuries. There are direct hits, and hits that involve the brain being "rattled" even though the head has not taken a direct  strike.  There are immediate symptoms, and delayed symptoms.  And sometimes, the patient has to REPORT those symptoms because they can't otherwise be recognized.  (Actually, this would be the difference between Signs and Symptoms:  Signs are objective and can be outwardly recognized, such as an altered mental status, blown pupils, etc.,  Symptoms are subjective and must be reported, although sometimes can be guessed; i.e. someone who is drowsy can report being drowsy, but maybe it can be observed, too. But typically, symptoms MUST be reported due to their subjective nature.)

Personal Experience That Scares Me Now

I've suffered a few concussions; one from a direct hit, a couple others as a "secondary" injury. 

When I was 13, I was in a serious car accident, in which I had not been wearing a seat belt.  We rear ended another car, and I can STILL remember the collision.  As my head struck the windshield at 40 mph or so, my knees hit the dash, and I was thrown back against the seat, dazed, encased in darkness.  I remember shaking it off and looking over at the driver, who was asking me if I was OK. I said I was,  although I was not.  My knees hurt. My head hurt. I remember reaching up and palpating a bump on my head, surprised that was all I seemed to have. I remember trying to peer through a cloud of darkness and trying to grasp what had just happened and what was going on. 

I was really really tired, but got out of the car, wanting to be OK, thinking if I pretended I was, that would effect reality.   

When the ambulance arrived, I told the 'medic, when he asked, that I had not lost consciousness. In my mind, I hadn't. It had just "gotten dark" for awhile.  I didn't tell him even that.  


At the time, I was still a pretty shy person, and he was a stranger; it stood to reason that I wouldn't just blurt out what I was feeling, because I didn't want to be the center of attention.   IN a way, because I wanted to avoid attention, I fled from the treatment I needed, and honestly thought I DIDN'T need. 

But I should have told him the other symptoms; the headache, which WAS severe, in spite of the brave face I tried to put on it.  I didn't tell him how tired I was, and in reality, I don't think I know those were symptoms.  They were just how I felt but meant nothing to me.  I didn't expect to feel GOOD after being involved in a fairly serious car accident.  I didn't expect, that if my noggin had cracked a windshield, that I'd feel good, but I didn't really think I was injured, either. 

On the funny side...the Sheriff himself was at that scene and offered to give me a ride home. I was a little intimidated at the time, and wondered if he'd walk to me to the door (which actually would have been proper).  But no, I said I was fine and would prefer a ride from my friend, thinking that if a cop brought me home, Mom would REALLY freak out!  

Well, as it was, I got a ride home from my friend's brother- in-law,  and Mom's immediate reaction, as I feared, was to overreact and bring me to the ER in a panic. I had a small cut on my head. As we were led back to an examining room, she said, "Oh, I hope she doesn't need stitches!"

I stopped in my tracks. "Stitches?"   (I've never been a fan of needles....)

I didn't need stitches. But somehow they coaxed me back and once I had a bed to lie on, I did so. I wanted to go to sleep. They didn't seem to pick up on that. The doctor asked me everything else, gave me the neurological tests, everything, even as I sat there wanting nothing more than to sleep. 

When we got home, I worked hard to stay awake, and when I finally DID go to bed, Mom spent the night waking me up every two hours to ask me "stupid questions."  I just wanted to sleep.  Of course, you realize that those "stupid questions" were quite necessary and thank God Mom did what she had to do and asked them. (And I got them all right!)  :-D 

(As an aside...I was glad she didn't ask me anything about algebra or geometry...)

At the ER they had given me a sheet of paper that said if the headache was ongoing, we should come back.  I actually put it away and said nothing.  The headache was so horrible that I couldn't do anything for DAYS, but I never told Mom how bad it was. In the afternoons, I would lie down hoping for some relief, and finally the pain would abate enough to allow me to function again. 

That was my first concussion.  Undiagnosed, but I know enough now that there's no doubt that I had one.  Fun.  

The second one happened when I was in the Ski Patrol's candidacy program. 

On a Saturday evening, as an Auxiliary Patroller (IE trained in Outdoor Emergency Care, the equivalent to EMT, had not passed the Hill Test, thus not wearing an identifying jacket), I took a bad fall.  I wasn't a great skier at the time, and was "ripping" down a slope.  At the bottom was a snow machine which caused the slope to go from icy to sticky with new, wet, manufactured snow. I turned to make my hockey-stop, recognizing the conditions, but misjudged the space and the snow, besides the fact my weight was on the wrong ski.  I crashed, hard, and in that crash there was no "slide" to absorb the impact. I think I almost felt my brain hit my skull.  

But I stood up,even in that piercing pain,  brushed myself off, and went on, with a headache that got worse and worse throughout the evening. 

I went home, and the next day got up and returned to the ski area for Hill Training, already fearing that maybe I shouldn't be driving, much less skiing. But I didn't want to say anything because passing the Hill Test was EVERYTHING to me. 

That day I was just "off" in general.  I had no balance. While skiing, I actually had a really creative crash that jammed my skis between  the snow and a little "cliff", causing a friend to have to help me disengage from the "trap".  While standing on flat ground near the lift, I tipped over very suddenly, and later that day, in a store, I quite literally just fell over.  It was the oddest thing; while I've never been a graceful person, it is NOT normal for me to be standing one moment and lying on the ground the next, with no memory as to how I'd gotten there. 

So you see the problem, don't you? 

None of me fellow patrollers recognized the signs because they hadn't seen the crash and had no idea that I had other symptoms, including a headache much like the one I'd had when I was 13.  How could they know? Even though I suspected at the time I might have a closed head injury, I said nothing, choosing to say nothing, thinking maybe if I did, they would pull me from training that day.  (Wisely, in fact.)  

I never experienced nausea, but I did experience a certain confusion, loss of balance, and the piercing headache. 

I should have been in the hospital;  that injury...both injuries, could have killed me.  

And a LOT of people experience this and live to tell about it. But every so often, we get an example of someone who doesn't.  

My heart goes out to Natasha's family, and she herself also remains in my prayers.  What they must be suffering is incomprehensible.  In one moment their dear one is present in their lives, and after something that seems so small...she's gone. 

None of us knows the day or the hour, but there is one thing this tragic accident brings to the forefront; and that is the reality that one doesn't NEED to die of such an injury.  We all need to be vigilant and recognize those things that could cause such an injury. It seems in her case she was given the proper advice and followed it, and really, that's all anyone can do. 

I encourage everyone to become educated in these things, if not to use them professionally then at least to be able to help those you love if they ARE ever injured.  When in doubt, take your friend to Urgent Care or the ER. It's better to be seen than not.  

Even in my case, I suspected an injury, but didn't take the initiative to go;  but had someone insisted, I would have. Of course, they would have had to drive me.  I shudder to think, now, that I was driving a few hours between the ski area and home when I shouldn't have been driving at all!  

Our brains are very sensitive and it doesn't take much to kill us. Please take any kind of head injury very seriously, and know the symptoms, or even the possibility. If one seems likely...get to the doctor.  As soon as possible. And tell them every symptom, even if it doesn't seem important, because at that point, everything is. 

Please keep Natasha Richardson in your prayers, and all of her family, as well as the families that are living out this very same thing right now. 


Karen Williams said...

Thanks for this important reminder ...and as I tell my children; protect your noggin - you only get one of them.

Unknown said...

I believe Dale Earnhardt's death in what was thought a minor accident at Daytona several years ago, was the impetus to mandate the Hahn head restraint devices for NASCAR drivers.

Corie Koskie, former Twin and Milwaukee Brewer 3rd baseman suffered a debilitating concussion on a routine play. He was out of baseball for a couple of years dealing with post-concussion syndrome. He is finally resuming his career with a chance to play with the Cubs this season.

Jennifer said...

Thanks for sharing this. I exeprienced two concussions, both with memory loss, as a child. In the first, I was six and hit my head after falling on a "Slip & Slide", and it was the memory loss that sent my mom outside to ask my friends what happened. She called my dad & they took me to the ER. The second concussion ocurred at school in gym class, and the teacher - a "suck it up and never cry" type - saw me land on my face and never asked how I was. It was a classmate who picked up on the signs (again, memory loss and confusion) and as it was a half-day, the school called my dad then sent me home, where as soon as my dad left for work I laid down and went to sleep. Hopefully this will inspire people to share their stories, and prevent similar tragedies in the future.

Mike T said...

But what IS the proper treatment for a concussion? If you had not put a "brave face" on things, what would have been done differently?

Unknown said...

On a trip home from college I hit my head on a television set (not wearing glasses at the time and misjudged the distance to the corner of the cabinet). It smarted really badly at the time but I thought nothing of it since I didn't black out or anything.

The next day I was walking to class and got very dizzy and nauseous so I went to the Student Health Service. There they did an X-ray and found I indeed had a slight concussion.

Since then I have always been wary of anyone in the family who has any kind of head trauma, no matter how slight.

Adoro said...

Fair Angel ~ Scary!

Mike ~ Well, first it needs to be diagnosed so they can recommend the proper course, depending on the location of the injury, etc. In some cases the brain swells and they have to go through the skull to relieve the pressure. That's what happened to Ms. Richardson.

In less severe concussions, someone has to keep an eye on the injured person in case they go downhill. It can be hours or days, and the brain might continue to swell, so SOMEONE has to know what happened and what to watch for.

And of would be highly recommended that the injured party NOT go skiing! lol

angelmeg ~ Wow, that would have been scary, too! What did they recommend you do in your case?

MJ said...

When my oldest son was playing high school hockey they had a game in Pa. which my husband and I did not drive to because we were tired. It was the only game one of us did not attend. During the game my son got checked into the boards and hit his head against the glass - a very common occurence during a game. He got up cleared the puck and went to the bench ( he remembers none of this). Because he knew his name and where he was, he played the rest of the game. When I went to pick him up when they got back and both his coaches came to tell me what happened and how groggy he was on the bus. Luckily they wouldn't let him fall aseep and I drove him straight to the ER. Scares me to think what might have happened had he taken another hard hit to the head during the game.

owenswain said...

Try telling this to the adult, I don't need to wear a helmet to go cycling crowd. Twice a wearing a helmet made the difference for me and one of those times was said to have saved my life. That time was a very minor fall when cycling with out then very young children.

Melody K said...

Perhaps some people aren't aware that the damage can surface weeks after the original injury. My brother has recovered (thank God!)from recent surgery for bleeding on the brain, which was hidden at first, then gradually got worse, leading to emergency surgery. This came about 2 months after he hit his head in a fall from a tree, where he had been trying to remove a branch with a chainsaw (bad idea!). He was very lucky.
I am so sorry for Natasha Richarson and her family.

Terry Nelson said...

Excellent post - full of good info. I was stunned by Natasha's death - it shows not only how much we have to follow through with medical attention, but how quickly and suddenly our life can end or be radically changed. I'm amazed at the training you have had - I'll bet one day your experience is going to all come together for you to put to use.

Banshee said...

If an adult needs a helmet for biking, we all need a helmet for walking and standing under cabinets. I only got whacked on the head once from falling off a bike, whereas I've hit my head far more often in all sorts of other ways.

But since there's no point in letting kids play outside, making them dress in full armor is a good way of discouraging them from such pointless activities. Let them play videogames inside all day, instead. :)

Adoro said...

Maureen ~ I've known several people who have been seriously injured biking. One was a co-worker who was out West dirtbiking (actual bikes, not motorized), hit a rock or something and went headlong into the ground. A helmet would have prevented a huge portion of her injury (she still probably would have had an injury of some sort, though.)

Several people are hit by cars while biking, whether their fault or the driver's. Helmets are proper and DO save lives.

When I was racing (skiing) I always wore a helmet, or if skiing in certain conditions, but they're recommended all the time and more and more I saw kids wearing their own choice!

Of course, there are some parents who go so overboard with safety've seen them too!