Lara Newson was involved in a near-fatal road traffic accident when she was 21-years old and sustained a traumatic brain injury as a result. Since then, she has written the following piece of creative non-fiction entitled Head Smash.
Disclaimer: This is based on a true story, although some parts have been fictionalised in varying degrees.
In a pot in my bedside cabinet are fragments of skull.
Shards of off-white bone, too many and too shattered to ever fit back together. Many have been lost, either on the road where my head landed, or rinsed into washing machine filters. Some have been claimed by lovers along the way, a new twist on wanting a piece of me.
For years people have asked what happened to my head. The answer is both simple and complicated. There are many different versions depending on who is asking and what I want them to know. Here’s one.
In the moment of impact everything slowed down, just like they say it does. As the leering grill of the Merc slammed into my right thigh my body flowed sweetly up around the bonnet and through a windscreen which melted around me.
Once I’d got a close up of the two faces in the car, I floated back out to land on my back on the road. That’s when my vulnerability finally registered and, using the badge on the bonnet for leverage, I pulled myself upright. In doing so the logo came loose so I threw it to one side in disgust and hobbled to the pavement.
A crowd gathered. Someone handed me a white towel.
“Get my bike,” I said, gesturing to the L-shape machine lying mid-lane. “Don’t want it getting damaged.” The crowd seemed rooted, staring at me. My return glare was obscured by gunk; the impact must have split the oil sump. I wiped whatever it was away with the towel. With one eye I saw the whiteness smeared with the same red and grey gunge I’d seen inside the car. More red this time, more vivid, more liquid. The car. I looked up at the crossroads where the Merc had been. It had gone.
“My bike,” I repeated, though there was no traffic. This was Pershore Road, a major arterial from the city centre, it was always busy. Time must be stuck on go-slow. Surely any moment the lights would change and send a three-lane stream over my sad bent scrambler.
People tried to move the bike but she wouldn’t cooperate. There she lay, the rounded headlight pointing towards me, her face the only thing intact. The rest of her was beyond broken. I watched others join those trying to hoist the bike to an upright she no longer had.
I don’t remember it arriving but an ambulance was parked beside me and two medics laid an unnecessary stretcher on the ground.
“I don’t need you,” I said. “It’s just a scratch.” Whatever was on my face would wash off. I was 21 and immortal.
“You’re going to need that head seeing to,” insisted a paramedic.
Birmingham Accident Hospital, crowded with post-Christmas casualties. I accepted the indignity of arriving in a wheelchair and being pushed straight through to intensive care. My neck felt gummy, the collar of my greatcoat a soaked sheepskin sponge. I stank, engine oil and iron over stale baccy and the sweat of last night’s curry. If I could smell this so could everyone else.
Then it hit. A delayed response, one impact to another. I wasn’t immortal. I wasn’t even tough. I was a fragile flower and I was broken.
I remember my grandmother’s expression seeing the mangled body she had nurtured. Her stunned pallor as she struggled to take in tubes sinking into flesh, machines bleeping in confirmation of life on the edge.
“Why did you do it?” she attempted through tears. Nurses were more accustomed to this scene.
“Don’t tire her; it’s enough for her to know that you’re here.”
But that doesn’t happen yet. My family didn’t even know. Staff asked for my next-of-kin but I insisted I had no-one. Plenty of people are alone in this world.
I needed to pee and insisted on taking myself. A nurse accompanied me in case I lost consciousness. They warned me not to look in the mirror but it wasn’t my appearance I cared about. I needed to soak up some solitude from the safety of the grey cubicle. From there I sat and took stock. I’d done it this time. I’d smashed myself up and had no idea if I was even fixable. My life was no longer in my hands. It was completely in theirs.
Staff insisted on going through my injuries as a way of keeping me still. An X-ray confirmed a fractured hip. They didn’t need an X-ray to show the broken skull, everyone could see that. What used to be forehead was now lacerated brain matter, strewn with shards of thin white bone, lightly sprinkled with grit and bits of glass. There was pain in the room and logic suggested it was mine yet I felt nothing, simply a softness at being forced to a stop.
The fracture at the head of the femur would heal with rest, prediction two months. The mulched brain was more complex. Faces around me suggested recovery was unlikely. I was an incomprehensible zombie whose being alive made no sense. My being conscious made even less.
I wasn’t a patient any of them would forget in a hurry.
The hip injury had cut off circulation to my leg. As if on cue of diagnosis my whole pelvis started to throb. My body has always been obedient, about the only thing about me that is. Dance, I tell it, and it does. Get up. Run.
“You won’t be riding a motorbike again,” stated a nurse in a slightly lilting accent. “Though I don’t suppose you’ll want to after this.” What did she bloody know? I forgave her though as soon as I saw her. Tall and golden, an easy smile. I could just about read her name badge with my one eye. Aurora. Fancy name for a nurse. The only one not tiptoeing around me. I was suddenly awash with childish gratitude and desperately wanted to hold her hand.
Later I didn’t much care what was happening. Despite my repeated requests they refused me morphine but the brew of pain killers and anti-seizure drugs they did allow made me slide into an anesthetised coma, a smooth one.
That night they attempted to patch my skull with plastic and hid their makeshift repair under bandages. I was a Mummy, en route to the afterlife. Maybe I had been for ages, I just hadn’t realised.
Though the term ‘brain damage’ explains the obliteration there’s no way of knowing exactly when it occurred. The moment of impact, of course. And gradually, during the weekend, while heavily sedated. Despite lapsing in and out of consciousness I knew we were in limbo. I was waiting for clues as to whether I had a future or not. Medics waited for a decline in my vital signs to force the choice between life-support and a spare bed.
Inside my head something else was happening. Surgical attempts to suture the shattered edges hadn’t worked and the skull was bleeding profusely. Trapped behind freshly inserted plastic the blood built into a sizeable clot, hardening as it expanded into the damaged brain.
As I waited to see if I could be saved my body worked slowly but surely to euthanize itself.
During this time I had an intense dream which seemed to go on for ages. I was inside a cave on the side of a mountain, its yawning mouth a distinct sidelong oval. I stared out onto a Dali-esque landscape of smooth desert and Moorish palaces beneath a blue sky swirled with candyfloss clouds, deliberating whether or not to jump. I felt peaceful making that decision, as if I knew whatever choice I made would be right.
Days later I got a jolt on being shown the X-rays of my skull. The outline of the hole in my forehead was the exact shape of that cave mouth, the irregularity confirming I’d been looking out from inside my own head.
During that first weekend in hospital, Nurse Aurora was with her Doctor boyfriend, a researcher into brain injury based at the much more modern Queen Elizabeth Hospital. As a direct result of their pillow talk I was transferred, late that Sunday night, to the immense critical care unit of the QEH, with one of the UK’s first Magnetic Resonance Imaging scanners. It makes me smile that such a cliché of medical romance helped save my life.
Monday morning everything brightened. My medication had been reduced to assess the brain damage and my environment gave me new hope. I had a private room in yellow with windows onto car parks and the world beyond. Best of all, we got cards with options for each day’s meals. Food in a tube for coma patients wasn’t appetising; I’d missed real grub and was suddenly starving. If I thought hard enough I’d probably remember what I’d ticked.
I barely remember the MRI scan, trapped inside a slow moving tube of incomprehensible solidity. The prolonged enclosure gave me a what-if-I-need-to-sit-up panic, forcing me to clench my jaw while the machine did its thing.
I remember events later that morning much more keenly. Everything seemed to change colour, from warm gold to pale, ice blue. One minute I was sauntering along a corridor, leaning on the side rail to support my hip, on a mission to make friends with patients on other wards. The next I was surrounded by a fluster of nurses, urging me back to bed. I’d expected a telling off for walking but not this. Back in my room I was hurriedly reattached to monitors.
“Just relax,” nurses said through gritted teeth as the bicep winch of the blood pressure cuff bit more tightly. More staff arrived to watch. It crossed my mind I was being sectioned. Why else the change of hue?
I don’t remember the doctor, but I do recall his voice. It had a measured calm, as if rehearsed. The MRI had revealed the blood clot, a biconvex extradural hematoma, which was significant and still growing. The doctor held up computer printouts of two lateral slices of heads. One was a neat oval of undamaged skull, a dappled mass of tissue enclosed in a continuous outer layer of white bone. In contrast the dark brain matter in the other was squashed around an invasive looking lighter blob and the surrounding bone thinned to nothing across the front. If I read it right the blood clot took up more than a quarter of the cranial cavity.
Several nurses remained with me from this point on. One held my hand in a gesture I took as comfort but was to test for weakness in the extremities opposite the injury. Another peered into my open eye with a torch, asking repeatedly what I could see. A sturdy machine with a breathing funnel arrived at my bedside.
I needed to be put into another induced coma and onto a ventilator before medullary damage risked respiratory arrest. They planned a craniotomy to reduce blood mass and ease pressure on my brain. My current consciousness was termed a lucid interval and would drop out at any moment. Everything around me had speed up. The faster they induced a vegetative state the better my odds.
I couldn’t help but ask.
“What are my chances?” The small group of doctors glanced at each other whilst nurses avoided my gaze.
“I’m afraid they aren’t good. We estimate a 50/50 chance of you surviving surgery.”
At least half then? This was a statistic I could latch on to.
The faceless doctor continued.
“But of the 50% there’s only around a 20% chance of you fully recovering speech and mobility.”
My survival now relied entirely on the medical team. Other surgeons were en route and the operating theatre was being prepped. Before all that there were a couple of administrative issues to resolve. Who was my next of kin. Did I carry a donor card.
I’ve always had a weird relationship with my father. What girl hasn’t? The split family, the odd weekend with him every now and then, me slotting in with whatever foreign students he had lodging and hoped to bed. Some friendly, some indifferent, but all of us, without fail, he called mate. His lack of emotional connection made him ideal. It didn’t occur to me that notifying him would mean the rest of my family finding out. He’d been estranged from them for as long as I could remember.
All I had was his name and last place of work and nurses did the rest. By the time I was being trollied to surgery my father was on his way. I briefly wondered why but mainly focused on myself. With those odds, would these be my last moments? If so what would be the last thing I saw? Shouldn’t it be fine art, beautiful landscapes, a wonder of the world? Not the inside of an industrial lift surrounded by strangers. As if she had read my mind the nearest nurse brushed my upper arm with what felt like real tenderness.
“That’s a beautiful tattoo,” she said. “I’ve never seen anything like it.” I glanced down at the inch-wide horse, galloping one way while looking in the other. The image of my stone-still body with its jewelled inks became the last thing in my mind’s eye as I again began the anaesthetic count back from 100.
My first awakening after the surgery was to a darkened antechamber lit with an electronic gleam. A change in monitor activity confirmed my status as an unexpected guest. Within seconds bodies bustled around me in echoes of the mechanical whirring and a sharp scratch to my upper arm despatched me back into the void.
The second awakening was to a vaulted boiler room ward, the walls running with industrial pipe work instead of windows. Basement neurological Intensive Care, hiding place for head shaved droolers. Intense light and crackling radio sound ricocheted pain into my pulped brain. If the first place was Purgatory this was Hell. I had to do something about the noise but I couldn’t move. My body had pooled into a stone mattress, my mouth arid and immovable. Above me floated the image of a word, blurring in and out, which I knew I’d have to focus on, as soon as I made the noise stop.
In response to my eye movement nurses flickered around me.
“She’s vocalising,” they called, peering into my eyes. I kept trying to speak but my throat was too serrated to turn it into voice. But it was me doing it and something was working. The floating word came into view. Paralysis. I was there and I wasn’t paralysed. Or not completely. My jaw wouldn’t move and neither would my lips but with my heart I could move air to make sound. A nurse leant in closer, recognising my efforts. I was trying to say off.
“Yes?” I was swimming beneath the pain, had to hold on, my hands grasped, I could feel my fingers, if I could feel my fingers I could be here.
“Off,” I repeated. “Off. Radio.” My words were heard, I was compos mentis, and the nurse angels twirled to silence the ward, reducing my agony to a deep and dull pain overlaid with a sense of surprise and celebration that I was still alive and very much me.
There were doctors and then more doctors and all sorts of people gawping but I was busy doing my own thing, sussing out where I had feeling, when a familiar face came into view. My Dad. He looked like he’d been crying but had now found whatever it was that he’d lost.
“You really upset that boy with the radio you know,” he said.
I went back to investigating what moved and what didn’t. These weren’t phantom movements. Rippling my fingers meant my hands worked and I could even push from my shoulders, though the slightest shift from neck up created an intense pull above my ears. Though painful, any feeling was reassurance against sensory loss.
“Try to stay still,” said the nurse at my shoulder. “Mustn’t disturb the drains.” Coming out from each side of my head were plastic tubes, siphoning an opaque pinkish liquid into glass specimen jars. Was this my brain fluid? I was determined to monitor the gory contents of these jars despite difficulty with my peripheral vision.
As well as these there were numerous other tubes. One came out of somewhere on the top of my head to analyse intracranial pressure, another went God knows where down my nose, there was an IV in each arm for medicine, blood and fluids, a tube into my bladder which I was thrilled to be able to feel, and another in my ankle monitoring blood pressure. Counting tubes became a preoccupation of mine but I kept forgetting where they were, which I’d included, or what number came next. Only as they were removed did I realise the significance in having eight. I was one of those sea creatures with a weird name. I just couldn’t remember what it was.
For days following the final surgery I was kept stationary and monitored constantly. With water the tubal damage to my throat healed and I could talk to anyone. Even my Dad. The story of his harrowing journey to the hospital somehow took precedence over anything I’d been through. His panic at the thought of never seeing me alive again. How he’d alternated between speeding up the fast lane in the hope of catching me before I went under, and having to pull onto the hard shoulder in tears at the thought of losing his only child. How he’d prayed for a second chance to be a father, vowing if I survived he’d take care of me from now on. And how, if he told me all this now, it would all become true.
Eventually the levels of cerebrospinal fluid within my brain stabilised, reducing the risk of hydrocephalus and enabling medics to remove the tubes, which they did by gently but insistently tugging until they slid through the newly stitched sinews around my head. No pain before or since has ever been quite as excruciating. Once my shaven head was free I felt more viable as a human, albeit a new build androgynous model.
Days in the Neuro ICU dungeon become weeks in an airy ward and I settled into a routine of healing and care. I’m tempted to call this time out of mind yet my sole focus was on rediscovering and rebuilding the brain remnants I had left in order to activate a body I could barely understand how to use. Nothing mattered other than my making as full a recovery as possible.
I had no idea if I was relearning or remembering but it all felt magical. After a week I could count to a hundred. Two and I could annunciate clearly enough to hold basic conversations, though with the vocabulary of a sweary toddler. Three and I almost had the alphabet down. Four weeks in I took my first steps unaided and managed to cross a small room without dizziness, overcoming the dual challenges of my neurological deficit and the healing femur. As star patient my inner child lapped up praise as if I’d never had any before.
During this phase I could almost feel my brain expanding as each day brought new people, new information, new movement, new memories. Neurosurgeons advised friends and relatives to look out for changes in my personality yet my emerging self wasn’t a variation, I was new. And gifted. Someone donated a Scrabble set and at roughly five weeks I won my first game. Though I suspected my opponent of deliberate self-sacrifice, my euphoria was as much at being able to place my own tiles as getting the winning score.
Eventually doctors started talking about releasing me into a supervised environment and my father volunteered his latest place. It was almost April and between washout rainy days, colour was returning to the world. I kept watch from my window with my one hawk eye, the other still blocked by swelling. I routinely forced that eyelid open to reassure myself I still had sight underneath but the shock of distortion and sting at its inability to adjust to light kept this brief.
When doctors confirmed I could go my nursing team held a leaving party with sweets in kidney bowls, and even brought those blowy streamers, though I was still unable to inflate one. By the time the party was over and I’d given away all the books and games I’d amassed, it was evening and I realised I was terrified of going outside. Months of incarceration will do that in any circumstance and I knew I wasn’t in charge of mine.
As we swapped the artificial light of the hospital for the dark outside the rain-sharp cold cut into my softened skin. The steps to ground level glinted wet black and I accepted Dad’s offer of support, posting an arm around his thick neck. At the bottom of the steps we paused as I realised I didn’t know what kind of car my Dad had. He pointed ahead.
“Not far now.” Another step and a nearby engine snarled into life. I jumped. I hadn’t been near the metal monsters of my near destruction for months and this was too close.
A car slid from its position on the end of a nearby row to stop in front of us. The sleek sidelong profile revealed its make. A long low black Merc. I was suddenly all heart but no breath. Dad went to walk around it but was distracted seeing a row of nurses watching from the ward above.
“Ah look,” Dad said. “Give them a wave.” He lifted his hand in cheery acknowledgement as I stared at the car. The rear window slid down a few inches and stopped. I had no idea what was happening. Was this the car which had smashed into me, newly repaired? As some kind of macabre joke? Were they here to finish the job, right in front of the nurses, the very people who had worked so hard to bring me back to life?
Once again I was completely powerless, there was nothing to help me now, not Dad, or a retreat, or even pleading. I squared my jaw in readiness for whatever was to come next, keeping up my one-eyed stare for I don’t know how long. Finally the window rolled up and the car slid away, sleeking through the car park and out into the wider world. As it did so my breathing resumed, but it felt like my heart had stopped.
“Come on,” said Dad. “That was weird.”