Skull Fracture

Coming home from the hospital that night in '93, something was terribly wrong. It wasn't just the pain or the crushing mental fatigue, not just the room spinning around, and not just the sick feeling in my gut. It was that I couldn't think straight.

The next morning, I found my hairbrush in the refrigerator.

I headed for my doctor's office first thing. I'd been to the same doctor, three days earlier, and sat in his office, skirt-suited and ready with a medical article I'd edited. But on this Monday after the accident, I was sick. His office was a straight shot from my house and I'd been seeing him for years. On this day, I got lost driving 15 miles per hour.

My scalp was tender, I'd said. He felt around my head and said there was no "egg" bump, that the best thing to do would be to rest.

He asked about the CT-scan. I repeated what they told me in Mt. Auburn's ER: No hematoma. A contusion. You can go home.

In other words, I wasn't bleeding to death; I just had a contusion, a bruise. A bruise of the skull or of the brain?

In the ER, I'd been half asleep. My only comment was when they bandaged my leg from where I kicked one leg with the other when I fell to the floor. "Bubbly water." I said, meaning, hydrogen peroxide.

I'd fallen in Star Market, while holding my daughter, aged 2 and 3/4 years. We were walking in the produce area. She was in the cart, but for some reason, she started to climb out. As she leaned into my arms, I grabbed her, and as I grabbed her, I felt myself becoming airborne, and realized I had to grab her around the waist and then lock my arms together so she would stay in my arms. I had nothing to break my fall.

Neither she nor I knew why she climbed out of the cart and into my arms, but I think she saw the inches of sloppy water on the shiny linoleum floor. I never saw that water. There were no safety cones to cordon off the area and nothing to forewarn me.

I was airborne, and then I crashed.

Thud, groan.

When I came to, people were all around me. Someone helped me up. I did not know where I was. My daughter was crying, but I didn't hear her. Only as I was getting to my feet, did I hear and see her. She was standing and crying. I didn't know if she fell. I was wet, lying in the water. 

As a mother, the rest my doctor wanted me to have was impossible. My head throbbed, my neck and back ached and I could not function more than an hour after being awake. My son was in kindergarten, my daughter in nursery school. By the time I'd gotten everybody dressed and fed, it was time for sleep. I slept the entire day they were in school. For years.

I made an appointment at Spaulding Rehabilitation. The appointment was four months away.

Somehow I muddled through those weeks. The back of my head where I fell was still too tender to be touched. No doctor touched the area of the impact, nor looked at the CT-scan.

Typing was nearly impossible. I'm a touch typist, yet when I pressed the keys with my left hand, it was the fingers on my right hand that did the typing.  There was brain damage. I could not type; I could not write. Words would not push out of my brain, and I could not find words to express my thoughts or my soul. Every area in my brain was affected except music.

There was an MRI of the brain taken at Spaulding just before Christmas. I was coughing a lot during this MRI. I was brought up very stoical about pain - to inure, not feel. That is the ticket. This has since proved to be my bane.

I decided to drive the kids to Montreal to visit my sister and her kids. Not a problem. I'd driven to Montreal and her house many times.

One block from my sister's house and I got lost. Called my brother-in-law and he walked me through the directions from catty corner to the front door. Once at my sister's house, I realized the error of my ways. I was sick and needed to return to Boston. My lungs  filled up with fluid as I lay down. I did nothing but sleep while at my sister's house. In two days, I was back on the road to Boston.

Back at my house, I looked deathly pale. I called the doctor and said I might have pneumonia. He said to go to the hospital. I drove to the hospital, forgetting my glasses. Once in the ER, doctors peppered me with questions for six hours, and then admitted me. For two weeks.

Do you have AIDS? Do you smoke? Your white count is abnormally high. You are very low on blood. Your oxygen saturation is low. You have hypoxia. You have bilateral pneumonia. We have a bed in intensive care, but we want to see how you do in a regular bed, first.

In was during this time I felt the dent in my skull. A depressed skull fracture.  A skull fracture.  I mentioned it to my sister, who'd heard that that was serious and needed surgery. I mentioned it to my doctor, who said nothing. 

It was around this time that MRI report came back.

It read: A buildup of water pressure on the right side of the brain, blood clots throughout the brain, weakening of the protective nerve shaft and injuries to the vertebrae in the upper neck region. Two of the vertebrae were broken.  The pupil of my right eye is enlarged.

At least the Spaulding doctor had an appropriate response: My God. 

At least, she was worried. And not concerned that my medical case was inevitably, unfortunately part of a legal case. Spaulding was a rehab hospital. They specialized in accident cases.

At the first sign of legal trouble, my primary care doctor turned tail and ran. By refusing to look at the CT-scan, by refusing to properly examine my skull, by refusing to believe that he might be outside his expertise, he damned me to years of chronic, debilitating injury with life-threatening risks.

Appointments were made at Spaulding. Twice a week, I drove to Spaulding from Storrow Drive, at 15 miles per hour. I slept 16 hours a day. I took prescription Aleve and developed an ulcer. Only sleep temporarily relieved the water pressure on my brain, and only sleep relieved the pain from the broken vertebras.

No one suggested surgery. They said it was risky. Riskier than what? Certainly not riskier than the complications I was developing and would develop for several years more.

By this time, it was getting late. Four months post injury. The doctors knew they were in hot water, and, instead of trying to fix the vertebras, instead of trying to install a shunt or do surgery to fix the water on the brain, they did nothing, hoping I would not complain. They did not confess their mistakes. They  claimed nothing could be done. Doctors hate lawyers and legal cases so much they will usually try to avoid any confrontation with a lawyer. They were just making matters worse.

Ringo's daughter had water on the brain and was in surgery at Brigham & Women's hospital, I'd read during this time. During the early 1990s, it was common for a person to get a CT-scan at a hospital and be told everything was all right, only to discover months later that everything was all wrong. CT-scans were so imperfect, so poor at pinpointing the true risks from head injury that using them at all is just bad medicine. I hope conditions have improved since then; I'm not hopeful.

You can watch nearly any medical show on TV these days to discover routine brain surgery on cases less serious than mine was.

The visits to doctors continued. One doctor, a neurologist, flatly denied I had water on the brain and suggested I was schizophrenic. I hit the roof. Just how bald doctors' lies were to avoid being named in a lawsuit was an eye opener. Once home, I told my husband of the visit with this neurologist. A quack! My husband said. My husband is a psychologist and knew this doctor was so far out in left field that he could be sued for malpractice.

Had I been mentally stronger and had I been able to coherently explain my problems with the doctors, I would have stuck another claim on the grocery store lawsuit. But I was in such a fog from the water pressure on the brain, that problem solving was difficult.

I had to stay cool. In the summer, I kept the air conditioning at 55 degrees, day and night. I spent time in the town pool. I drank milkshakes and applied ice packs to my forehead. The pain was too much for me to be up and about for more than six hours out of 24, and so my discipline, athleticism and daily living skills were shot to hell.  Before the accident, I was 41, 117 pounds and still running an 8-minute mile, just like I did when I was 30.

I tried to study for the Law School Admission Test that I had been planning to take before the accident. I took the Kaplan Test Prep Course four times in one year. I finally took the LSAT over a six-hour period. I got  9 percent right.

I endured batteries of neuropsychological tests. On the tests, just as with the MRIs, the results all said the same thing: the injury is more severe than one would normally expect from a fall in a grocery store.

People who fall in a grocery store are not usually holding their baby in their arms as they fall. Doctors ignored this key point. 

Some hapless secretaries made the mistake of writing my report as a motor vehicle accident, instead of a slip and fall. Legally, my case was called a closed-head trauma, which is difficult to litigate because the problems are invisible.

People suffer with invisible cognitive disabilities, only to add insult to injury because incompetent or negligent doctors refused to get involved, and no one bothered to lead the way for genuine treatment.

I was on disability for a year when I had to stop freelancing as a computer business journalist, because I failed every assignment. I couldn't understand the assignments and couldn't understand what was said to me. My confidence was shaken, and so was my health.

Eventually, I climbed out of the morass that brain damage caused. It was a long, painful journey marked by years of baby-steps and missteps, by worries I'd never have a day where my symptoms wouldn't show, by years of walking around as a sad, little porcelain doll, invisible cracks on the inside, masquerading as whole.

But I'll never say that everything worked out okay, that the doctors tried their best. They didn't try at all. They hid behind their mistakes and it is only by a sheer miracle that I'm alive to tell the story. I'll never forgive them their arrogance, their refusal to participate, their hypocrisy and their failure to adhere to the Hippocratic oath.

Everything I am now is because of me. The doctors had nothing to do with it.

And, yes, I still have the dent in my skull.

Copyright 2006 Kathryn Esplin