Wednesday, September 14, 2011

Pieces Missing

Some of you may know Larry—either from a writing group or as a regular at the Boston Bean Coffee House. After the publication of his book I asked him to send me something to post. He sent the following piece.

In his book, Pieces Missing: A Family’s Journey of Recovery from Traumatic Brain Injury, published by Two Harbors Press, Larry Kerpelman gives a first-hand account of his wife’s traumatic brain injury and its aftermath over the course of a year as she is hospitalized, faces dysfunction and possibly death, undergoes emergency brain surgery, and fights to recover the pieces missing from her memory, speech, and joy of life. “This book is at once both inspiring and informative” writes Jo M. Solet, PhD, OTR/L, of Harvard Medical School in an advance review of the book.

Although the book has just been published, Larry is already scheduled to give two talks about it.  On October 16 at 2pm in the Acton (Massachusetts) Memorial Library, he will give a talk at the meeting of the Acton Historical Society. On October 24 at 7pm at Emerson Hospital’s Cheney Conference Room in Concord, Massachusetts, he will be participating in the annual Concord Festival of Authors, where he will be part of a program titled Life After Brain Injury: Havoc, Hope, and Healing, along with two other authors of similar books Concord Festival of Authors . The program will be moderated by Henry Vaillant, M.D. Both events are free and open to the public. In addition, an excerpt from his book has appeared in the September 2011 edition of Physicians News Digest.

Here is a short excerpt from an early chapter of the book; a short while earlier, Larry’s wife Joanie had tripped and fallen on the roadway
while returning from their daily walk to the Boston Bean House in nearby Maynard, Massachusett.
Joan sits in the dim, cramped office of the triage nurse in the Emergency Room as the nurse asks her to describe what happened so she can determine what to do with her next. I wait a few yards away in one of two chairs in the hallway outside the office while the nurse questions her and records the information she gives her. I manage to catch snippets of sentences as Joanie describes her symptoms: “achy all over from the fall,” “sore wrists,” “chest hurts,” and “my head aches badly.” The nurse records Joanie’s recitation and then directs us to wait in the hospital’s Urgent Care Unit across the hall.

​In contrast to the old Emergency Department, the Urgent Care Unit is bright and relatively quiet. It is a new addition to Emerson’s facility, having been put in only a year before to afford more space for the hospital’s overall emergency operations. After giving the receptionist there identifying information and data about Joanie’s insurance coverage, we wait on a couch in the Urgent Care waiting room to be called to be seen.

I tell Joanie how bad I feel for her, suffering an injury while engaging in something that was meant to contribute to her health and well-being.
She expresses the same to me, and we commiserate about the irony of it all. After close to an hour of waiting, we are directed to go to a treatment room. The blood on Joanie’s face has begun to clot, but her lip and eye are still noticeably swollen. As I help her get to her feet, she cries out “Larry!” and then crumples. I catch her before she lands on the floor, and, seeing that she is unable to stand on her own, I hold
her up and yell, “Somebody get a wheelchair. We need help here!” She seems to be conscious, but she can’t stand. I begin to think this may be getting serious.

​A young patient care technician appears and, between the two of us, we maneuver my wife onto a wheelchair and into a room where she transfers, with the help of the technician, to the bed. A nurse wearing a multi-floral tunic top comes in.
“I’m going to take your vital signs—blood pressure, pulse rate, temperature,” she says in a warm, caring tone. “Then one of our doctors will be in to see you.”

She records Joanie’s vital signs and leaves us alone in the room again. We hold hands and, to try to get her mind off her pain, chit-chat idly about inconsequential things we notice about the new Urgent Care center.

Presently, an emergency room physician strides in. He introduces himself as Dr. Gert Walter and asks Joan about the circumstances of her accident.

“I was jogging, my foot got caught up in my shoelaces, and I couldn’t move. I didn’t have any other place to go and fell over and hit my face on the road.” She relates this in a clear, even voice, the quaver of a few hours ago now gone.

​On the basis of her description of her fall, her symptoms, the triage nurse’s note, and a brief medical history and examination, Dr. Walter orders a chest X-ray and a computer tomography (CT) scan of her head. She is wheeled to the Radiology Department to have these done and then wheeled back to the room in Urgent Care. While we wait alone in the treatment room for the results of these imaging tests, Dr. Quentin Eliason, a physician from Acton Medical Associates who is covering at the hospital for Joanie’s primary care physician this weekend, comes in and asks about the circumstances of her fall, how she is feeling, and what has happened to her thus far in the hospital. Joan’s answers are much the same as she gave to the previous physician a short time before. Dr. Eliason makes a few notes and then departs, leaving Joan and me to wonder what the CT scan and X-rays are going to show, what the physicians are going to conclude, and what the next steps are going to be. Meanwhile, my mind is ping-ponging back and forth between wanting to believe that this is just a matter of a few facial cuts and bruises and fearing that it may be something more serious.

​“The chest X-ray doesn’t show any obvious damage,” Dr. Walter says when he returns a short while later. “You may have cracked a rib, but
small rib fractures may not show up on X-rays. In any event, the treatment would be the same whether or not the rib has a small crack in it, or even if it were just bruised. Right now, let's just leave it alone; if the pain gets worse, then we'll decide what to do about that rib.”

He leaves, and Joan and I are both relieved that her chest pain doesn’t seem to be anything grave. We engage in more small talk as we wait for whatever is to happen next. In half an hour, Dr. Walter comes back again and announces, “Well, now I know why you have such a bad headache. Your CT scan shows a subdural hematoma on the left side of your brain. We’ll admit you tonight and keep an eye on you.”
Read further excerpts from Pieces Missing: A Family’s Journey of Recovery from Traumatic Brain Injury at Larry’s Web site, (L.C.Kerpelman ), where you may also order the book itself.

1 comment:

  1. Well done, although my head hurts just reading this short intro. Suspenseful, but after two brain concussions and skull fractures (my horse threw me and later my bike threw me). And a more recent mini-concussion, again on pavement when I slipped on ice a few years ago. I feel lucky— yet anxious about reading more, Larry. I hope your book leads to more research about and study of the brain and injuries to it as it swells.
    — Jan