headaches

I find myself thinking a lot about head injuries at this time of year.

Yes, it’s partly driven by the fact that IHAD falls around this time every year, but it’s more strongly driven by the fact that the transition into autumn (at least in the Northern Hemisphere) brings me closer to another anniversary—the mark of another year that I’ve been living with the consequences of a riding accident that left me with what the doctors in the emergency room at the time referred to as a “mild” concussion.

(Did you know that concussions are initially graded based on a few factors, such as whether you were knocked unconscious at the time of the injury and how long your symptoms last, and not necessarily on the severity of the actual damage caused by the injury?)

It was a freak accident that gave me a traumatic brain injury, much like most riding accidents are. I was in my lesson on a Thursday evening, just like I always was during the school year, riding the classic spiraling circle at the trot, when my horse’s front legs just… gave out. He went down and I went down too, headfirst over his right shoulder—at least, that’s what I’m told. My trainer was with me near-instantly, so if I did get knocked unconscious, it was only for a moment, but I have absolutely no recollection of the accident, even now. I remember nothing from a few minutes before we fell to, oh, probably half an hour or so afterward, when I came out of the shock in the car on the way to the emergency room. That part of the whole affair is seared into my brain—the headache that was only made worse by all of the stoplights reflecting in the raindrops on the windshield, the confusion, the fear because I didn’t know what happened, I didn’t know if my horse was hurt, I needed to know if he was okay, did he break his leg, did they have to put him down.

(He’s fine. He now belongs to a long-time boarder at that barn and is living out his 20s being spoiled entirely rotten, as he should be. I cried out of happiness when I first found out a couple of years ago, because I’d spent so long wondering what had happened to him.)

At the emergency room, after a doctor initially gave me an exam, they told me I could sleep until they could take me in for a CT scan. I was so out of it that my brain just defaulted to remembering the one thing that I’d always heard about concussions—don’t sleep, because if you sleep you might never wake up. As one might expect, this absolutely terrified me at thirteen years old, to the point that I literally threw up due to the amount of fear that I was experiencing at the thought. The doctors blamed it on the shock and the concussion that I definitely had (since nausea is a common symptom), and when all was said and done, after they did the CT scan (and some x-rays, to make sure that I hadn’t fucked up my spine or the shoulder that I also landed on), they called it a mild concussion. I had no visible trauma, no fractures, nothing to indicate that there was anything wrong with my head other than the fact that I had literally landed on it and absolutely wrecked my helmet in the process, so they told my parents to schedule an appointment at sports medicine a couple of weeks later so that I could get the all-clear to resume my normal activities, and sent me home.

I didn’t go to school for a week and a half (ended up being more like two and a half weeks between in-service days and Thanksgiving, but actual school days missed were a week and a half). I tried, once, the week after I fell, but my head was pounding so much that I couldn’t focus in class and had to go home early, so I wound up spending most of that time lying on our couch, staring at the ceiling or sleeping. I couldn’t read, I couldn’t watch anything, I couldn’t do anything that required that I actually pay attention to it because it made my head hurt so much trying to focus, so I just… didn’t. I’d listen to whatever was playing in the background on television, but for the most part I just sat there. No music, no art, no books, nothing. Definitely not horses.

It took more than two weeks to get me into sports medicine, because what was the point of going to an appointment two weeks after the accident when I was clearly still not okay then? The symptoms weren’t gone. The headache was still there. It was somewhere around a month after that I went in, not long before winter break, when I was back at school and the most obvious symptoms had mostly faded. I went into the concussion lab and they did what hardly anyone was doing at that point—at least, not for anyone other than professional athletes (and this was prior to Sidney Crosby’s concussion saga in 2011 and the shift that that brought to the whole discussion, so honestly, how much they were doing it for the athletes at that point is also a question in and of itself). They made me stand on a sandbag—two feet, one foot, eyes open, eyes closed (balance test, not all that exciting)—and they sat me down and had me take the ImPACT test (immediate post-concussion assessment and cognitive testing).

Technically speaking, you should take the ImPACT test before you ever get hurt, to establish a baseline of your normal brain function so that there’s something to compare a post-concussion test to if you ever happen to suffer a TBI. It’s something that my high school makes all of the student athletes do, which is basically the entire student body there courtesy of athletic requirements, which is something that started when I was a student there. Unfortunately for me, that came after my accident, so I had no baseline. There was no way to really know what “normal” was for me, but… when the scores came back, it was easy enough to fill in the gaps.

The ImPACT test looks at a whole bunch of things—your verbal and visual memory (both short- and long-term), brain processing speed, reaction time—and everything about my scores was perfectly normal, except for one thing: my short-term visual memory was absolutely fucked. If we’re talking scores out of 100 here, all of my scores in other areas were in the high 80s or 90s. My short-term visual memory score was a 29 or something like that. There’s obviously no way to truly know without the baseline test, but the doctors at sports medicine had seen enough tests already to know what the trends should look like—my short-term visual memory scores should be in range of everything else. That they weren’t meant one legitimately-likely possibility: the fall had damaged that part of my memory. It made sense. I’d fallen head-first on the right side of my head, right in the area of the occipital lobe where the visual cortex is located, and the visual cortex on the left side just couldn’t pick up all the slack. I was missing half the signals.

It was too soon to tell if it was permanent or not—it had only been a month. That it hadn’t repaired itself yet didn’t mean that it never would, so… they also sent me home, told us to come back in a few months but that I shouldn’t ride, that I shouldn’t really do anything that would put my head at risk until they checked my brain out again. I couldn’t ride anyway—between the recession and some other things relating to my accident, I didn’t really have a barn to go back to—but for a thirteen-year-old whose entire life was horses… ha. Good luck with that one.

(That’s its own story. I’ve alluded to it here and there, but I’ll tell it all one of these days.)

One week ran into the next, and then the next, and then it was, oh, March or so, somewhere around four months after the accident, and I went back to sports medicine and took another ImPACT test, and, well… Nothing had changed.

Nothing had changed. Almost all of my scores were really high, but my short-term visual memory score was incredibly low, indistinguishable from the score from December, and that was when the doctors told us that there was a real possibility that it would stay that way—that if my brain hadn’t shown any signs of repairing itself four months after an injury like that, especially when I was so young, there was a strong likelihood that it never would repair itself, and I would just have to get used to it. Everything was fine, except I no longer had the ability to look at a flash card and remember what was on it. I couldn’t remember things that I’d seen five seconds before. This part of my brain function that I had so taken for granted up til that point just wasn’t there anymore, and now I was being told at thirteen years old that I might never get it back. Of course, being the horse-crazy thirteen year old that I was, I sort of wrote that off at the time, because all I really cared about then was one thing: could I ride again?

They wanted to say no—of course they did, they told me that, they told me that truly, the best thing that I could possibly do for my brain was never get on a horse again—but they also knew that I wouldn’t listen, because athletes are athletes and unless it’s truly career-ending, you’re not keeping any of us away from what we love to do, so they told me that I could, but that I should go slow, that I should be careful, that I shouldn’t jump (at least not for a while, that was another battle they knew they wouldn’t actually win), and that I should never, never, ever get on a horse without a helmet from that point forward (not that I’d really made a habit of it before then, but the point was still taken).

I tried riding again that spring, but it didn’t go well, and so began the first of my three significant hiatuses from horses, and dealing with the psychological consequences of everything that had happened (again, a story for another time—long story short, I wonder to this day if the family tendency toward anxiety and depression would’ve remained dormant in me had I never hit my head).

It’s been almost twelve years since that night. In a month and a half, we’ll reach yet another anniversary, and yet another year of me not really knowing what’s going on with my brain. I haven’t taken another ImPACT test since that day in March of 2010. I could have—my high school wanted me to—but if I’m being honest, I’m too scared. I don’t want to know, even though I’m fairly sure I already know what the answer is, and even though I’ve come as far as I have and learned my workarounds (my apologies to every one of my auditing colleagues who had to listen to me talk to myself for hours on end in the audit room during busy season when I was copying data over by hand, because my verbal memory works fine even if I still can’t remember shit just by looking at it) and managed to be really, really fucking successful in my academics and my career thus far. I should do it, to get another baseline, to know where twenty-five-year-old me’s brain is at compared to thirteen-year-old me, just in case I get another concussion, but… is potentially (probably) finding out that you truly do have permanent brain damage something that anyone looks forward to?

I bought myself a new helmet this week (along with so many other things for Cooper that I shouldn’t have spent money on, why do I do this). MIPS technology is finally starting to hit the equestrian market in a significant way, and I’ve had my helmet for going on three years now, and I have fallen off in it once (even though I genuinely didn’t hit my head—my ribs and stomach paid the price for that one), so it seemed like a good time, especially with the sales going on. I don’t mess around with these things anymore. Not after all of this. Not after experiencing what the after-effects of a so-called “mild” concussion can be. I’ve got one brain and I already messed it up enough doing this thing that I love so much. There’s not a chance in hell that I’m going to risk it any more than I already have.

At the end of all of this, I suppose that’s my plea for everyone: please take these things seriously. Please wear your helmet. Please make sure that you’re replacing it after you fall. Please don’t think “I’m just going out for a hack, I’ll be fine,” because all I was doing was flatting my horse, and look at the price that I’ve paid and continue to pay. Please take your brain seriously if you do fall, and don’t just listen to the “Rest for two weeks and you’ll be fine” adage that I still hear from people way too often if you show even the slightest sign of a concussion. Get your brain checked out. Go get a baseline ImPACT test done (don’t be a coward like me) so that you have something to compare to if you do hit your head. I’m incredibly spoiled by the sports medicine group here (shoutout to them for fixing my legs so that I can run without crying, also), and incredibly lucky that I have access to arguably the foremost concussion program in North America and to the same sports medicine doctors as every athlete on every professional sports team in this city. That may not be true for you, but please seek out whatever resources you have available to you to handle these things, and, please… I know helmets are expensive, but you’ve got one brain. Please protect it.

This is something that truly can happen to anyone, no matter how skilled you are, no matter how much you trust your horse—I did and do still trust the horse I had my accident on with my life, just like I trust Cooper—and it’s just not worth the risk. There was no way I would’ve been in my lesson without a helmet on, but sometimes I wonder… what if I was? How much worse would the damage have been? Would I even be here to type this? I walked away with a scraped-up shoulder, what seems to be some permanent memory damage, an absolutely wrecked helmet, insomnia, a heck of a lot of other long-term psychological consequences, and the ability to go out to the barn and see my horse and ride every damn day if I so choose. That’s getting off easy. I’m eternally grateful that I avoided the alternatives. Do yourself a favor and give yourself the best chance of doing the same.

(Rest in peace to Dr. Freddie Fu, who started the sports medicine program here, and passed away from cancer yesterday. A lot of us in this city, and elsewhere in the world, professional athletes and normal human beings alike, owe him for a lot of things, but I owe him for starting the program that turned in part into the concussion lab that arguably saved my brain for all that it terrified me, and I’ll keep wearing my helmet in honor of that and in the hopes that I never have to wind up in that lab again.)