Of the PT Persuasion: Traumatic Brain Injuries
Have you ever wished for a resource that helped writers cut back on hours and hours of researching how to accurately portray injuries and medical conditions? Look no further. In this blog series, I’ll be discussing just that. What makes me qualified to do so? Well, I’m a Physical Therapist! Or, rather, I’m a writer…Of the PT Persuasion.
The key to a good cliffhanger is leaving the reader with that bottomed-out sense of “oh, no…” and sometimes a desperate “what?!” To me, nothing quite says “oh, no” like sustaining a head injury and waking up to find oneself stranded amidst enemies—and a ghost from the past. That’s where Adrienne Young leaves us at the end of Fable, with the repercussions of Fable’s head injury (and all the events that lead up to it) playing out in the sequel, Namesake.
Head injuries have finally been getting their time in the spotlight recently, with more attention paid to education and screening for concussions in sports, particularly. They’re also injuries we see a lot in books, TV, and movies, but I find they’re difficult to portray correctly—mostly because they’re invisible to the naked eye. Our favorite dredger, Fable, gives us a quality look into how head injuries can impact one’s mental condition, as well as having physical effects.
As always, let’s start by taking a look at what head injuries really are. The medical term for head injuries is Traumatic Brain Injury (TBI), which encompasses any number of damages to the brain caused by external forces. You’re probably familiar with the term ‘concussion,’ which is a type of mild TBI. The most common causes of TBIs that patients and your characters may experience are motor vehicle accidents, falls, and sports injuries—or, in Fable’s case, physical assault. Most injuries don’t result in a loss of consciousness (i.e. blacking out).
So, what exactly is a brain injury, and how does a loss of consciousness occur?
First, we have to understand the anatomy, in a nutshell. The brain is made up of neurons that are all tangled up together, forming one semi-gelatinous mass with the consistency of a ripe avocado (surely, those must grow on Jeval?). Now, anyone who’s dredged for a good avocado in the market knows how easy it is to squish one, which is why the brain is suspended in a liquid called cerebrospinal fluid for protection, then encased in bone.
Take it from someone who has sawed a skull in half and scooped out the brain by hand: it’s well-protected. (Disclaimer: cadaver dissections are a required course in Physical Therapy school—this is not my serial killer side coming to light.) However, even with this hard shell and internal cushioning, the brain is susceptible to injury from blows that cause the brain to smash into the inside of the skull. This is referred to as a coup, from the French word ‘blow’ or ‘strike.’ As the squishy brain rebounds, it ricochets into the opposite side of the skull in a contrecoup. Coup and contrecoup cause bruising and brain contusions. When impact causes the brain to wriggle around, it can tug on the nerves threading throughout the brain, causing them to shear, a different mechanism of injury. Penetrating injuries and blood clots can also result in damaging brain bleeds.
Seems like there are a lot of ways to hurt the brain, right? That’s why we classify TBIs into categories of severity for easy understanding:
Mild: the patient does not experience a loss of consciousness longer than a couple of minutes
Moderate: the patient experiences loss of consciousness up to a few hours
Severe: the patient is unconscious for more than a few hours
Considering Fable was delivered a TKO in town and didn’t wake up until she was at sea, it’s safe to assume she sustained a moderate TBI. Oof.
What symptoms are associated with that? Fable is pretty quick to describe a few key symptoms upon awakening: pain, light sensitivity, and blurred vision. Headaches and vision changes are very common with TBI, and they’re probably the ones we’re most familiar with. I mean, how many times have we heard the old “how many fingers am I holding up?” But Fable is also displaying several other mental and behavioral symptoms.
Especially with moderate to severe TBI, your characters may present with longer-term confusion, distress, and even aggression or mood swings. In Fable’s case, she has more than just the concussion to justify her anger and combativeness, but we’ll leave the psychological trauma to the other professionals.
Other symptoms often seen are lethargy, distractedness, memory deficits, impaired balance, weakness, anxiety, depression, and impulsiveness. Just to name a few! If it has to do with brain functioning, then it can be affected by TBI.
It is worth noting that moderate and severe TBIs require medical attention, sometimes for extended periods of time. A single head injury can be enough to change a person’s physical wellbeing and their entire personality permanently! Given that Fable’s symptoms were milder, despite her prolonged loss of consciousness, I think it’s safe to assume she wasn’t in this dangerous territory.
With their intricacies, wide breadth of symptoms, and damage to our most crucial organ, TBI’s recovery is to be taken seriously. Concussions (mild TBIs) are usually resolved with rest and avoiding stimulation. Yes, rest is important, and a person with a concussion should be allowed to sleep! It’s when the patient has a brain bleed (hemorrhaging) that sleep becomes dangerous; signs of hemorrhage include worsening symptoms, pupil dilation, or difficulty walking. (Note: if you suspect you or someone you know has a concussion, you should seek medical attention, not this character injury blog.)
More severe TBIs can require hospitalization and extensive neurorehabilitation, with possible treatments including, but not limited to: medication, intracranial catheterization, intubation and mechanical ventilation, surgery, and rehabilitative measures.
What is the best way to accurately portray head injuries in your characters?
Aside from the symptoms addressed above, know the limitations. The longer your character is blacked out, the more severe and life-threatening their symptoms are. Furthermore, symptoms of concussions rarely resolve quickly. Clinically, I’ve seen symptoms from mild concussions last days to weeks; some moderate concussions can persist for months or longer. Furthermore, the brain becomes much more susceptible to concussions in the future, in both amount and severity.
Many of us haven’t sustained anything greater than mild concussions, and so we find it difficult to relate to this character injury. I hope this article gives you some ideas on how to write accurate concussions and TBIs!
Thank you for reading! I hope you enjoyed this installment to Of the PT Persuasion.
Disclaimer:
If you’re seeking medical advice for yourself or someone you know, you should speak to a medical professional. This blog is not intended for diagnosing or treating real-life medical conditions, only fictional ones.
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