Crash

by Carolyn Roy-Bornstein

  As a doctor I am ashamed of how much I didn’t know about brain injury. I didn’t know fundamental things, like that traumatic brain injury can cause an organic type of depression. I’m embarrassed to say that it was Neil’s lawyer who told me this. We were preparing for trial.

  “We have to be sure the jury understands that Neil’s depression was caused by his brain injury, not by losing Trista.”

  I was a bit taken aback. It was the first time I had considered this. His lawyer was top-notch. I trusted her completely. But surely Neil was grieving for Trista. Was she asking me to lie on the witness stand?

  After that day in court, I went home and did some research. I learned how wrong I was in thinking Neil was simply mourning for his lost love. Of course his lawyer wasn’t asking me to lie. Neil’s depression was organic. All the areas of the brain that regulate emotional stability were areas that were injured in the crash: frontal lobes, right temporal horn, the amygdala. Contusions, hemorrhages, fractures, volume loss. All in the right places to disturb the ability to modulate feelings. To be happy. What a fool I was.

  But I wasn’t the only doctor in the field naïve to the long-term subtle deficits people with traumatic brain injury suffer. When Chuck/Mitch told us, “He’s gonna be just fine,” he believed it. He is an intensivist, geared toward the acute. In his world a patient who knows who he is, can blink on command, and can accurately identify how many fingers are being held up in front of his face is worlds better than the lot he sees every day. Neil didn’t need a stint in a rehab facility. But he did need physical therapy, mental health support, antidepressants, and modified educational plans, none of which were provided for or even suggested at discharge, all of which I subsequently arranged myself. I was not the only one ignorant of what the future could hold for a brain-injured boy.

  I’ve tried to compensate for these deficiencies in my knowledge of brain injury by obsessively reading all that I can on the subject. I subscribe to a cite-tracking news-alert system, receiving almost daily articles about all aspects of head trauma and brain injury:

  “Efficacy and Safety of Dopamine Agonists in Traumatic Brain Injury.”

  “Time and Dose Dependent Neuroprotective Effects of Sex Steroid Hormones on Inflammatory Cytokines after Traumatic Brain Injury.”

  “Is Traumatic Brain Injury a Risk Factor for Schizophrenia?”

  I get them all, trying to become something of an expert in a field I knew so little about until it struck at home.

  I’ve since written articles on various aspects of brain injury for local publications as well as national pediatric newsletters. I edit a column in Heads Up, the Brain Injury Association of Massachusetts’ quarterly newsletter. I’ve blogged about the new concussion guidelines for young athletes.

  I use every available avenue I have to get out the word about traumatic brain injury. It’s the signature wound for our soldiers coming back from Iraq and Afghanistan. The frequency and severity of head trauma in professional sports has prompted new rules for them as well. The nation watches with amazement and respect as Gabby Giffords recovers from her traumatic brain injury. We can only guess what she and her family are going through. I am kindred spirits with all the soldiers and athletes and victims and families who have been through the TBI experience. I am at once their comrade and their advocate.

  I also address audiences about the subtle and not-so-subtle­ effects of brain injury. I am in the Ambassador Program, a speakers’ bureau for the Brain Injury Association of Massachusetts. The program aspires to put a human face on a grim statistic: One and a half million people in the United States suffer from brain injury each year. That’s 2 percent of the population. That’s a brain injury every twenty-three seconds. There are five million children and adults living with long-term disabilities as a result. I speak to Rotary Clubs, Kiwanis Clubs, and Lions Clubs. I’ve spoken to college students and high school classes. I’ve spoken during Alcohol Awareness week and given pre-prom talks. I was the keynote speaker last fall for the Pediatric Brain Injury Conference put on by the Brain Injury Association of Massachusetts (BIA-MA). In just one week, at the end of this month, I will have attended two brain injury conferences, one sponsored by BIA-MA and one at Boston University. I will have lectured at the Trauma Care Symposium at the Lahey Clinic in Boston and spoken to 150 high school students, members of the Students against Destructive Decisions (SADD) chapter in North Attleboro. This has become not just part of my day and part of my work but also part of who I am. In the book world it’s called platform. In my world it’s my passion.

  In the years since the accident, my creative writing has also evolved. The short stories I wrote always had medical themes. That’s my world. “Write what you know,” as they say. But the subjects and motifs have narrowed into sharp focus for me now. My roles as mother, physician, and writer have merged into a life of purpose, passion, and prose. To riff on a phrase of Descartes: I write, therefore I am.

  I will always be a mother: checking in with my sons, helping them move and move on, cheering their successes, shouldering their disappointments. I will continue to work: the doctoring, the taking care of babies, working with families, learning about head injury, lecturing on what I’ve gleaned. And, of course, I will write about it all, putting pen to paper as I try to explore this world and my place in it.

  It has been almost ten years since the crash. Neil has been through a lot. We all have. Although we haven’t come through the ordeal unscathed, we have come through. And we’ve done it together, as a family.

  Five years after the accident, Neil came home from a trip to Israel with a present for me: a necklace engraved with the Hebrew words L’dor Va’dor, which means “from generation to generation.” The words were straight out of our Jewish prayer book and are spoken every Sabbath. Neil knew those words well from his many hours in synagogue.

  “Thank you, Neil. It’s beautiful.”

  Neil beamed, clearly pleased that I liked his gift so well.

  “I read your essay on the computer,” he told me.

  Say what? I was a bit taken aback. I thought Neil had chosen these words to engrave based on the Jewish prayer. I had no idea he’d read my essay. I’d never exactly invited Neil to read my work. Then again, I hadn’t discouraged him either. They were right there on the computer. Saved documents in Microsoft Word. No password required. As personal essays go, the piece Neil had read wasn’t particularly personal. But it also wasn’t something I would normally share with my son. Once again I realized that my son had learned something about me that he wouldn’t have gotten otherwise.

  People ask me all the time, “Does Neil know you’re writing a book?” “Has he read it?” and “What does he think?” The answer is he does know and he has read it. We have supported each other through its writing, submission, publication. He is proud of me, as I am of him.

  The truth is Neil wants to get the word out about brain injuries too. The truth is he understands what it’s like to have problems no one else can see.

  In college Neil had wanted to play soccer. We were told by his neurosurgeon at the time that he should wait at least a year before engaging in contact sports. I was so disappointed for him. Later that year I was attending a Grand Rounds lecture on traumatic brain injury held at Lawrence General Hospital. The speaker was William Meehan, director of the Sports Concussion Clinic at Children’s Hospital Boston. After the lecture I spoke with him, describing Neil’s injuries: subarachnoid hemorrhage, subdural bleeds, frontal lobe contusions, fractured skull. I asked him what he thought about Neil playing soccer in college. He advised against it—not that semester, not that year, not ever. His lecture had been about sports concussions, but his advice applied to any brain injury.

&n
bsp; “The brain doesn’t know how it was injured, Carolyn,” he told me.

  As it turned out, Neil never tried out for the soccer team. While we were worried about his head, he was worried about his leg. He was afraid he would rebreak it if he played soccer. He even worried about playing hacky sack.

  The summer after his first year of college, a year and a half after the accident, he rented a beach house with some friends. One day he called me from his cell phone, all excited.

  “Mom, I jumped!”

  I thought I had misheard him at first.

  “You what?”


  “I jumped!”

  He explained that he and his friends were leapfrogging from rock to rock at the seashore and he suddenly realized that, without thinking, he too was jumping. Not only that, but his leg didn’t hurt to do it. It was holding him up and not rebreaking. This was such a major milestone for Neil.

  For most kids his age, this was a time characteristically marked by a feeling of immortality. I work every day with teenagers who are immune to my messages about seat belts and condoms and designated drivers. This is the mind-set of the teenager and young adult: Other people get into accidents, fall, get hurt. This cannot happen to me. In their minds they will live forever. But here was my son who came so close to losing his life that he’s afraid of having a seizure, he’s afraid to jump, for God’s sake. He felt none of the invincibility that usually defines this stage in life.

  Neil also wanted to help other people avoid what he had suffered, but he did it on his own terms. He didn’t join the SADD group at his high school, newly formed after his accident. He didn’t want to drop the first puck at a hockey game raising funds for a scholarship in Trista’s name. The Newburyport Police would all be there. Neil was certainly not ready to face the detective from the accident reconstruction team who wanted twenty-five hairs from his head.

  He did help put together a video on underage drinking and drunk driving with his friend and mentor, Anna Smulowitz, to be used in the high schools and by local police to discourage those practices. He showed up in court infrequently but as much as he could, seeking just sentencing for the drunk driver from the judge. Even when he wasn’t physically there, he wrote his own victim impact statements for the judge. And he still wants to learn about other people with brain injuries.

  One night Neil was visiting us and we all were watching a biopic on Mohammed Ali. At a commercial during the show, Neil said, “I hope Scal retires.” He was referring to Brian Scalabrine, the Boston Celtics forward who, that year, was sitting on the bench after suffering three concussions in one season. Neil understood the risk he would be taking if he returned to play: the risk that another concussion might be life-threatening. He was afraid for this player. He didn’t want him to take that risk. He can relate to people with traumatic brain injuries.

  Neil has a friend named Emily whom he has known since the third grade. She was diagnosed with a brain tumor when she was a little girl. She was told at her local hospital that her tumor was inoperable, but her parents took her to Mount Sinai Hospital in New York, where they treated her despite all the risks. She survived. She is legally blind and walks with a limp and suffers crippling headaches at times, but she is Neil’s age and is alive.

  Neil and Emily had lost touch with each other for a number of years until, a few years back, Neil heard Emily being interviewed on WBUR about her amazing story of survival. She was a freshman at Harvard University, majoring in mathematics. Neil called her up right away.

  “I heard you on the radio,” he told her.

  “I read all about you in the newspapers last year,” she said.

  Since that telephone reunion, they have become good friends again. They share a love of music. Neil plays piano and guitar. Emily’s father is a professional musician. Emily sometimes played on stage with her parents, a popular local band called The Crocketts. Neil and Emily both love higher education and mathematics. When Neil fell in love with the book Flatland, a novel of mathematical fiction, he described it enthusiastically to Emily, who, of course, could not see to read it. Not finding it on books on tape, Neil spent an entire summer recording himself reading the book. He recently gave the CD he’d recorded to his friend.

  They also share their experience of brain injury. Emily has suffered longer and harder than Neil, but Neil understands her in a way few others can.

  Though he isn’t the same person he was before the crash, the “new Neil” is well on his way. He is enrolled in a PhD program in mathematics education and hopes the advanced degree will help him land a job teaching at another private high school or maybe even college. He has all kinds of hopes and dreams for his life and talents to offer. He is looking forward to tutoring during graduate school. He wants to be a teaching assistant. He would like to be active coaching high school athletes or helping out with theater productions.

  I’ve thought a lot about how to end this book. How do I end a book about one of the dearest people in the world to me? How do I end what has at times taken every ounce of my strength to simply show up at the page? The writer Red Smith once said, “Writing is easy. All you do is sit down at the typewriter and open up a vein.” Obviously Red was writing in another era: an era of Royals and Remingtons and Underwoods. But the sentiment is timeless. Writing and bleeding have at times felt very much the same to me.

  But Neil’s story, in many ways, is just beginning. His future, though informed by a very arduous and obstacle-filled past, is brightening. It is a new start for us all.

  Book Group Discussion Points

  •Guilt is a major theme in Crash. Under what circumstances does guilt emerge in the author? Is the guilt justified?

  •In “The Offender” what is the importance of the distinction between anger and hatred? Why is one acceptable and the other not?

  •In the prologue the crash is identified as a dividing line, separating the before and after. What other dividing lines emerge as the story moves on?

  •In “Please, Please, Please” the author makes a distinction between faith and fatalism. What is the difference between these two concepts, and why is that difference important?

  •Grief is another overarching motif in the book. Is grief the same thing as bereavement? Or is grief in the eye of the beholder, so to speak? Is there any grief that is not valid?

  •In “POV” Neil’s learning of Trista’s death is seen from two different points of view: mother and son. How does our point of view color our perception of events? Consider age, timing, event, and circumstances.

  •How does the way each parent learned of the events shape his or her ultimate interpretation of outcomes?

  •How is Dr. Roy-Bornstein supported by and failed by her medical community?

  •The family struggles with its interactions with the media. What role do modern media play in private tragedy?

  •What role does the author’s medical background play in how she reacts to her son’s accident?

  •Define grace. What role does grace play in the family’s healing?

  Acknowledgments

  I have to thank the members of my writing group—Lisa Mahoney, Shelley Carpenter, and Margaret Flaherty—for their tireless willingness to read essay after essay, chapter after chapter, and rewrite after rewrite, offering feedback on everything from the placement of a comma to the impact of a word. Ladies, this was truly a group effort.

  To my husband, Saul, and my son Dan: Thank you for being my shared memory in this journey and my eye to the details that escaped me in my fear and angst.

  To my agent, Daniel Bial, and my editor, Mary Norris, this book would not have been possible without your confidence, dedication, and work on my behalf. Thanks for believing in me.

  To Shannon Berning, I am gratef
ul to you for seeing the book that was trying to emerge from the one I was originally writing.

  To Mary Zinck, the “other mother” in this story. We’ve been in this together from the beginning. I have learned much from your brave, no-holds-barred attitude.

  Most of all, to Neil: You are the hero of this book and of my life. Your ability to grow, to learn, to adapt, and to teach has been an inspiration to me. I am not a good enough writer to put into words my love for you. Just know that it is there, constant, certain, everlasting.

  About the Author

  Dr. Carolyn Roy-Bornstein is an award-winning writer who is also a practicing pediatrician. She writes a monthly health column, “Pediatric Points,” in the national newsletter Pediatrics for Parents. She is also an ambassador with the Brain Injury Association of Massachusetts (BIA-MA), giving speeches to civic groups, schools, and businesses. She lives in Massachusetts.