Scars

I've been struggling for two weeks now to write this post. I've given you the details of the accident and the details of the injuries, and I was planning next to write about the emotional experience of that night and the aftermath. There was a lot to get used to; a lot to mourn. My daily life and foreseeable future, my body, my mind, my physical appearance had all been changed against my will in a blind, violating moment. 

How did that feel, I keep asking myself. How did that feel? 

I'd been very nearly killed, for one thing. At 19, the height of my adolescence, I'd lost my youthful sense of immortality. I'd been given firm proof that bad things can happen to people even when they're following the rules, even when they're doing everything right. I could die; my friends could die, my family. We had no say in the matter. Not one of us. How did that feel?

I was incapacitated for months. I had to quit my job, drop out of school. My beloved car, of course, did not survive the event-- not that I could have driven anyway, at that stage. I couldn't move well, couldn't see, didn't know how long any of it would last.

Also, there were two huge scars on my face.

They were dark, angry, reddish purple. They were visible from across the room. One ran along my jawline, and although it was less visible unless I raised my chin, it was thick, raised, and twisted. My mother had insisted that a plastic surgeon perform the closure to lessen the impact of the scars, but it had been a rough-cut wound and it wasn't smoothly repaired.

The other scar began at the bridge of my nose and arced upward across the center of my forehead, ending just below my hairline. My skull had been pieced back together by a neurosurgeon, and his closure had been expertly done. It was as minimal a scar as could be expected. It was still a dark red line through the middle of my face. It was the first thing I saw when I looked in the mirror. I assumed it was the first thing everyone else saw, too.

How did that feel?

With a diminished vocabulary, a ruined face, no mobility or independence, there was nothing left of who I'd been before. My life-- my face-- was unrecognizable to me. How did that feel?

Here is the truth, and the reason this post has been so difficult and confusing to write: it didn't feel like anything. 

Or rather, it felt like something antithetical to emotion. It felt like floating. It felt like watching a vaguely interesting movie about someone else's life from a great distance. It was just a calm acceptance-- a zen state, of sorts. No tears or grief over what had happened, no rage against the drunk driver who hit me, no nightmares, no terror or joy or gratitude. I just woke up from that surgery and went back to my shattered life without a second thought, and I seemed to those around me to be fine. 

It didn't feel strange to do this. It felt almost like nothing at all.

The only response I do remember during that time, in fact, was the very strong sense of the loss of feeling. When I compared myself to how I'd been before the crash, the difference was striking. 

I remember describing myself as "monotone." It was as if someone had turned down the volume and evened out the treble and bass; as if everything in my emotional register had faded to a single, mellow, mid-range hum. The upper and lower ranges were wiped out, and nothing moved me much beyond a raised eyebrow or a puzzled frown. "Fine" became more than a placeholder; it was the way of this strange new life I led.

Looking back, I have two reactions to this. My rational mind now knows what science has discovered since then about trauma and PTSD and dissociation, and I understand very clearly, from an intellectual standpoint, what neurological medicine hadn't yet learned to watch for:  that this was a disturbing response to what had happened to me and a sign that something was very, very wrong.

My emotional self, though, sees nothing wrong or surprising about this blank response at all. In fact, I can't imagine reacting any other way. Twenty years on, my emotional self no longer operates on that level; no longer even feels the loss of what came before; no longer mourns who I was, pre-monotone. 

I don't remember what it felt like to really feel, anymore. I only remember remembering, and there's not much feeling in that.

_____

This brings me, I suppose, to the reason for this blog. Neuroscience has caught up with me, and Post Traumatic Stress is no longer thought of as a Disorder, but as a biologically normal and even advantageous Response, and one that can be completely resolved with the right work.

I am doing that work. I want back what's left of the life I lost.

I've been immersed in this process for the past 6 months, and have already seen many changes in myself for which I had never even dared to hope. I'm writing this all out to give you the back story and set the stage for what's coming. Eventually, I'll be able to blog about what's happening to me in real time. 

And it's happening. It's happening. Finally, after all these years, I am coming back to life.

Next

The memories:

I remember waking up in the ambulance, strapped to a board, and all I wanted to do was bend my knees and relieve the pain in my back. I couldn't move my head. I was in a cervical collar and it hurt and I wanted it off, but I couldn't move my arms or legs because of the restraints. There was a paramedic sitting next to me, staring. I asked him to unstrap my legs so I could bend my knees, and he shook his head. No.

He didn't say anything else. I thought it was strange that he wasn't answering me, but I learned much later that this wasn't the first thing I had said to him; it was just the first thing I remembered. I'd been screaming like an animal since they removed me from the car.

_____

I remember rocking my body back and forth, back and forth, trying to wriggle my legs free of the straps. Eventually, I did. I looked up at the paramedic in triumph. He stared back. We didn't speak.

_____

I remember throwing up in the ambulance, lying flat on my back and unable to turn my head. The paramedic flipped the whole board sideways so I could throw up on the floor. I don't remember how that scene ended.

_____

I remember waking in a hospital bed. I opened my eyes and saw my dad. Staring at me. His face was chalk white. My mother's voice came from beside me: "Honey, do you need to go outside?" 

"I just need to sit down," my dad said, his voice faint and shaky. "I just need to sit down."

_____

I remember there was a man in the room, a nurse. He was cheerful, loud, asking a lot of questions. "Have you had anything to drink tonight?" he said.

"Yes," I said. "Hot chocolate."

He laughed. My parents laughed. I thought, why is that funny?

_____

I remember throwing up again, still flat on my back and strapped to a board in the ambulance. Someone tipped me to the opposite side from before. I thought, I must be in a second ambulance. They wouldn't want me to barf on both sides. 

This was true. It had been determined that my neck wasn't broken and my life not in immediate danger, so I was being sent to a different hospital for surgery.

_____

I remember waking up deep inside an MRI machine. There were loud, crashing noises and I opened my eyes and saw that I was lying in a tight tunnel, the ceiling a few inches above my nose, the entrance somewhere down beyond my feet, and I thought, It's a good thing I'm unconscious right now or I would be freaking out. I closed my eyes and surrendered back to the darkness.

_____

I remember waking up in another hospital room and hearing my friends Matt, John, and Chris talking nearby. My eyes were closed. They were speaking in hushed voices. Suddenly, Matt's voice rose above the others: "Dude, look at her chin! I can see her throat moving through her chin!"

I heard him move closer to me. He wanted a better look. "Stop it," someone said. "Stop it."

"That's so cool, look at that," said Matt, and he let out an amazed, frantic laugh. It sounded cool.

_____

I remember waking up again, sometime later, and the guys were gone and my parents were there. The head of my bed was propped up and the cervical collar was gone. I was chatting with my mother, about what, I don't remember. Every time I moved my head, it would fall to one side like my neck was made of string and I would have to lift it back up with my hands. I didn't stop to think about how strange this was; I just tried to keep my head still so it wouldn't tip off my shoulders.

Another strange thing was that every time my head lolled to the side, I felt something warm and wet wash across my forehead. I kept wiping it away with my hand. We kept chatting.

At some point, after another head-tip and another wipe of the forehead, I looked at my hands. I was covered in blood. "I'm bleeding," I said, surprised.

"Yes, dear," said my mother. She actually smiled. "You've been bleeding for about ten hours now."

Interesting. I went back to our conversation.

_____

I remember they came to take me into surgery. It had been 11 hours since the accident. They would be closing up the rent in my chin and pulling the shards of bone out of my forehead and trying to piece them back together in the hole over my brain. 

As they were rolling me out the door, I looked at my mother and was shocked to see she was crying. "Don't worry, mom," I said. "I'm fine! I'm fine!" Why is everybody so upset? Everything is fine!

_____

I remember waking up some time later, coming slowly into awareness in the dark. Voices. There were voices speaking softly all around me. I couldn't open my eyes. I listened. People were talking. They were drinking coffee. My mom. My dad. Matt. John. Chris. I couldn't see them. 

"Mmmuuhhh." I tried to speak and a croak came out. There was immediate silence, and then they all began hushing each other in loud whispers. "Shhh! Shhh! She's waking up, she's awake, she's awake!"

After a moment, someone spoke. "Katie, do you know who this is?"

What a strange question. "Matt," I said, my voice strangely soft and slurred. It was hard to move my mouth. I heard him draw in his breath.

I said, "Do you know who this is?"

Everyone burst out laughing. Matt's voice again, louder than the rest: "She made a joke! She doesn't have brain damage! She doesn't have brain damage!"

Sudden silence in the room. Then a nervous chuckle. A cleared throat. 

Oh, I thought. Oh. He just answered a question.

First

The injuries:

I woke up in the ambulance, wearing a cervical collar and strapped to a board. I was bleeding heavily from two massive head wounds, and my body was in terrible pain. 

I had a compound complex depressed skull fracture the size of a silver dollar in the center of my forehead. The end of the towbar in my trunk (in the front, under the hood of my '71 VW Beetle) had come up through the dashboard and bashed a hole in my head, partially collapsing my right eye socket and lacerating the dura mater in several places. I was leaking cranial fluid. The paramedics didn't know if I would live or die.

I also had a large, three-cornered tear along my jawline. My skin was hanging open far enough that you could see inside and watch the muscles of my throat working when I swallowed. 

I had a severe concussion and Grade 3 whiplash-- it would be months before I could move my neck on its own without using my hands to position my head.

My knees had been embedded into the steel of the dashboard, leaving dents 2 inches deep. I had no feeling in my kneecaps. I still don't.

Every inch of my body was covered with bruises. It looked as if someone had dipped their fingertips in paint and played piano on my skin. Red, green, yellow, purple, blue. Everywhere. It seemed that no blood vessel had gone unscathed.

The seat belt bruise was really something. A wide, deep red band ran from my left shoulder to my right hip, with tendrils radiating outward across my chest. On my hip was an enormous black medallion, eight inches across and striated with impossible colors. Black. So black. And then burgundy, purple, green. It took well over a month to fade.

At first, after the surgery, I couldn't see at all, because my eyes had swollen to the size of a man's closed fist and I could not open them. This lasted for about four days.

After that, when I could open my eyes again, I still couldn't see much. My right optical nerve had been damaged by the shards of bone from the break in my skull, and had left my field of vision drastically reduced. 

Do this: press the heels of your hands together, and then your fingertips, forming a circle. Hold the circle up in front of your right eye and bring it toward you until your hand touches your nose, keeping your eye in the center of the circle.

Now imagine that everything outside of that circle is just gone. Black. Like you're wearing a mask or trapped behind a locked door with only a peephole to look through. Only the locked door is your own head.

That was my first real sense of claustrophobia-- being trapped inside my own body with no escape. I began to panic during those first few weeks. The panic lasted a long, long time. I don't think it ever went away, in fact. I just got used to its presence over time, and stopped consciously noticing it was there. 

In the coming months, my field of vision would expand somewhat, even more than I was told was possible by my doctors, although it would never go back to normal. I have double vision around the edges of the field now, not correctable by glasses. My right eye is no longer synchronized with my left and can wander independently to alarming angles. My peripheral vision is impaired, especially on my left side. Depth perception is sometimes difficult. At first, I had to hold my head awkwardly to the side in order to see where I was going. Stairs were a nightmare. I still have a noticeable tilt to my head that often makes people think I am looking quizzically at them. 

The truth is that I do it to mitigate my double vision, and have been doing it for so long that I can no longer tell that my head isn't straight up and down. Sometimes I only realize it when my ear touches my shoulder. My world is canted permanently to the left.

Many other symptoms came to light in the weeks after the accident. For instance, I had lost my sense of taste and smell. Or rather, everything tasted and smelled the same. It wasn't certain whether this would be permanent or not. It ended up fading after a few months.

My extremities went numb and fell asleep very easily, as if I were an old woman. My circulation had been compromised in the impact, and again, it wasn't certain whether I'd regain normal function or not. I didn't. I fidget a lot now, cross and recross my legs, switching sides frequently, toss and turn in my sleep, because if I don't I'm all pins and needles. It's difficult to be physically comfortable, even now, after all these years.

Worst of all, in those early weeks, it slowly became clear I had sustained brain damage that affected my vocabulary.

As you might imagine, especially if you know me well, this was a significant discovery that was very, very difficult to accept. I had been a gifted student, an excellent communicator, a lover of words, a lifelong reader. And I wanted to be a writer.

All of a sudden, my vocabulary was diminished. I hadn't lost the ability to speak, or even enough words that the loss was immediately noticeable. But it soon became clear that I had little of my extended vocabulary at my immediate disposal. I'd lost all my ten-dollar words, my mother said. They were just gone.

No one could tell me whether it would be permanent or not. "Time will tell," my doctors told me. "Time will tell." 

In the meantime, I found myself rephrasing sentences to get around strange gaps in my inner lexicon. I spoke very simply. I often had that "it's right on the tip of my tongue" sensation, knowing I knew the word but unable to summon it when I needed it. Like a victim of stroke or aphasia, I could describe the word I wanted, but couldn't recall it on my own. Once again, I felt trapped within myself, locked away from the very thing that made me me. 

Many months later, I began to realize that once someone suggested the word I was looking for or I found it in my thesaurus, I'd have that word back for good. I imagined that I could actually feel my brain rewiring itself, sending a little spark down each darkened hallway and lighting it up. Word by word, I found what I had lost and made it mine again.

It took about four years.

The other significant "soft" symptom that took a long time to realize but has ended up being the most insidious of all (and will be a major theme in this blog) was the disconnection that happened, in that moment of impact, between my thinking brain and my emotions.  Before the accident, I had been a rather exceptionally sensitive girl. I cried often, felt deeply, and wrote and spoke with a passion driven by a profound emotional awareness.

After the accident, I didn't cry for more than three years.