My concussion

Some friends have asked what it’s like to have a concussion, and how my recovery is going. I think it’s hard for them to understand why, almost six weeks after the accident, I’m still having so many problems. Since this is my first concussion I don’t really know what to expect, but having consulted with a neurologist last week I feel assured that my recovery is on the right track. As a reminder, on Saturday 21 May 2016 I was in a head-on collision; two days later I was diagnosed with a concussion. The CT scan showed no brain swelling or bleeding.

I decided to address the “What is it like?” questions by listing the common symptoms of concussion and describing how I am experiencing them.

Symptom 1 — Loss of consciousness. I did not lose consciousness at any time after the accident. I remember quite a lot of the accident itself, the arrival of the EMTs and ambulances, getting my vitals checked in the ambulance, and getting ourselves to the ER.

Symptom 2 — Headache. After the accident the worst pain I had was around my ribcage. Actually, everything hurt. I didn’t notice the headache as a separate pain until Sunday when I tried to grade my final exams. Since then the headache has been a more or less constant companion. It gets a lot worse when my brain has been overtaxed or overstimulated (more on that below). The headache doesn’t feel like a tension headache and it isn’t localized. It’s a dull diffuse pain that feels like my entire head is being squeezed under the skin. The best thing to do when the headache gets bad is to lie down and close my eyes. Looking at computer screens is very taxing on the brain, which is why it is taking me three days to write this post.

Symptom 3 — Amnesia, confusion. I didn’t have any amnesia right after the accident, and I passed all of the cognitive evaluation questions the EMTs asked me (“What day is it?” “Who is the President of the U.S.?” “How old are you?” etc.). I knew where I was and how I had gotten there.

Symptom 4 — Dizziness, vertigo, nausea. This has been strange. On Monday, two days after the accident, I started experiencing a bit of vertigo. I would move my head and it felt like the world was taking a while to catch up. Also, I could read printed words on paper, but when I tried to read my students’ hand-written answers on their final exams the words swam around on the page. I gave that up as a lost cause and went back to the ER. This general wooziness resulted in some mild nausea.

There was a very early morning almost four weeks after the accident when I woke up feeling seasick. I took an anti-nausea pill and went back to sleep, and when I woke up for real a few hours later I felt no seasickness at all.

Symptom 5 — Cognitive deficits. I have these in spades, although I don’t know if anybody else can tell. For the first couple of weeks after the accident my head felt very foggy and it was difficult to process information. I’d walk around with a nectarine in my hand wondering what I was supposed to do with it. Oh yeah, those want to be eaten. I couldn’t really type, either. I could, but letters would come out in strange orders, as though my typing were dyslexic. That has gotten better recently.

I’m still having trouble carrying on detailed conversations. I can think of the words I want to say but they don’t make it to my mouth. And it feels like it takes me a very long time to process an answer when somebody asks me a question. What do I want to eat for dinner? Um. . . .

And yet, occasionally I can act with my usual decisiveness. Sometimes I feel as though I have my act together, and at other times. . . I don’t even know what my act is supposed to be.

My internal clock, which normally does a pretty good job of keeping track of elapsed time, is all out of whack. As is my ability to judge how long it will take to do a given task. This is rather a drag, as I’m used to my brain acting as a clock I don’t have to look at to tell the time. I suppose part of this deficit is due to the fact that I’m not spending as much time outdoors as I normally would in the summer, so I’m missing time cues that I should be catching.

Symptom 6 — Sensitivity to light and sound. As of now, six weeks post-accident, this is the most severe of my symptoms. It takes surprisingly little visual or aural stimulus to completely overwhelm my brain. Crowds, movement, the clinking of silverware on plates in a crowded restaurant, loud music, children playing (I think it’s their high-pitched voices that do it)–all are hell to me right now. There is no such thing as background noise to a concussed brain. Every sound pushes to front and center, demanding attention and energy that my brain simply cannot give. My brain reacts by hurting and trying to withdraw my consciousness from my surroundings. I can cope in the short-term by closing my eyes to shut out all visual stimuli, but I can’t close my ears and there are some sounds that dig their way into my brain. A massive headache ensues.

Right now there are two major construction projects going on at the marine lab, which makes the lab a very unhealthy place for me to be during the week. Fortunately there’s no construction work on weekends, so I can retreat down there for an hour of peaceful time with my critters. But even the running water through the seawater system makes a lot of noise; I’d never paid much attention to it before, except to notice when it was suspiciously quiet in the wet labs, but now it can get to me. I find that I need to minimize my time at the marine lab, period.

Driving remains extremely difficult for me. I can drive myself to and from the marine lab, but that’s about it. And even doing that little amount of driving causes a headache and wipes me out for the rest of the day. I’m not having flashbacks any more (more about that below) but my heart jumps every time a white car unexpectedly catches my eye. Driving takes so much concentration that my brain just isn’t up to it. I’m also fairly certain that my brain function is compromised enough to have slowed my reaction time. All in all, I don’t feel anywhere near competent to get behind the wheel of a car and drive any longer than 10 minutes.

Symptom 7 — Sleep disturbances. Dealing with these has been very strange. I’ve been sleeping a lot. At the beginning of my recovery I was taking 3-5 short naps every day, as lying down and closing my eyes was the only way to rest my brain. As the recovery continues I’m now a teensy bit more able to deal with sight and sound, and am down to 1-2 naps a day. But I also sleep late in the morning, which is extremely unusual for me. The past few mornings I have been sleeping past 07:00; usually in mid-summer I’m up at first light, or earlier if there’s a low tide to be had. I assume all this sleep is what my brain needs to heal.

Every night since the accident I have had crazy, vivid dreams. Some of them are borderline lucid dreams, in which I know I’m dreaming. And then things get sort of meta, when I think “This is a really strange dream I’m having right now.”

Symptom 8 — Changes in appetite. I am constantly hungry. All the time.

Symptom 9 — Psychological difficulties. I am definitely more irritable than I was before the accident. The niceties of polite conversation feel like such a chore that they just don’t seem worthwhile. I never was good at making small talk; now I find that having to do so really taxes my brain and gives me a headache. In this particular regard it seems that my natural introversion has been augmented by the concussion.

I’ve also noticed that my language filter has deteriorated quite badly. It is much easier these days for f-bombs to escape before I can hold them back. Then again, maybe it has nothing to do with the concussion but is because I’ve been watching “Game of Thrones” and “Orange is the New Black.” Those shows will definitely increase one’s tolerance for f-bombs and c-bombs.

For about a week after the accident I had flashbacks that occurred randomly throughout the day. I’d feel my body tense up for no apparent reason, then expect to hear the sounds of the collision and explosion of the air bags. I still get that momentary tensing when a white car suddenly appears out of the left side of my field of vision (the car that hit us was a white Honda sedan). And I really don’t like being in a car. The flashbacks aren’t happening nearly as frequently now, though, and that’s a good thing.

Symptom 10 — Hallucinations. I don’t have either visual or auditory hallucinations, per se, but there is almost constantly a snippet of music running through my head. This isn’t all that unusual for me; I seem to be very susceptible to infection by earworms. Since the accident one piece that my subconsciousness is obsessed with is Tchaikovsky’s Capriccio Italien. Why? Who knows. It happens to be the first piece of classical music that I remember from childhood, and maybe that’s significant. Other random bits of music running through my head at any given moment are Christmas carols (“Good King Wenceslas”; “Il est né, le divin enfant”; “In dulci jubilo”), old folk tunes (“My darlin’ Clementine”), the “Et in terra pax” movement from Vivaldi’s Gloria, and lately the opening riff from The Fixx’s “Saved by Zero.” Is there rhyme or reason to any of this? Not that I can see.

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One interesting thing that the neurologist told me was that with concussions, the severity of the symptoms doesn’t typically correlate with the prognosis for full recovery or the time it takes to reach full recovery. Very often, he said, patients who report very mild symptoms either take a long time to heal or don’t reach 100% recovery. Of course, this led me to ask whether my symptoms would be considered mild, moderate, or severe. He smiled and said that my symptoms are congruent with a full recovery, then warned that it will be a slow process. I shouldn’t be surprised if it takes several months or a year not to have any symptoms.

One good sign is that my condition has improved quite a bit since the accident. Now that it’s July I need to start working on my class for the fall semester. I’m going to be taking things very slowly and resting/napping as necessary. I will continue to minimize my social activities and very gradually re-enter the world as my brain allows. Although I miss the field activities I had planned to do this summer, I’m learning how to do nothing, which can be sort of rewarding in its own way.