Brain MRI.

Neurorehabilitation and Recovery: Going Through Hell

This article is adapted slightly from remarks the author delivered at the 2022 International Neuroethics Society annual meeting on a panel about neurorehabilitation moderated by Dr. Joseph Fins.

By Leslie C. Griffin

I’m a tenured law professor at UNLV. This semester I’m teaching Bioethics and Constitutional Law.

I am healthy, happy, working, and working out.

But I went through hell to be here.

Why? Because twice, doctors told members of my family that due to brain injury, I was about to die. Or if I lived, I would probably live in rehab the rest of my life because I would not be able to work again.

Two good things to say about both those situations, which everyone should know. One, I had health insurance, or I would still be paying thousands of dollars in expenses. And, two, following Cruzan, I had a durable power of attorney identifying who would make my medical decisions for me when I could not. Everyone needs one. My students always resist me on this, but I keep telling them you never know when you are going to wake up in a hospital bed, fighting for your life, and unable to make your own decisions.

In 1993, I had just graduated from Stanford Law School, was clerking for a federal appeals court judge, and had just won a fellowship to Harvard University. Next thing I remember I woke up in a hospital, where for six days I had been unconscious.

What happened? I went out early one Tuesday morning for a walk, pre-work. I crossed the street with the walk sign, but the car turning behind me hit me. I fell down and clipped the back of my head. Tuesday morning, one brain surgery, and Wednesday morning, another.

I have no memory of any of that. I woke up Sunday. I remember what happened for years after that. My surgeon had great confidence in me and I think is still proud to this day of my recovery. The other doctors and therapists told me I was brain damaged, and that everyone knows the brain cannot heal. They told me because I had a brain injury, I would never be aware of my deficiencies, my family would not have the courage to point them out to me, and I needed to stay in rehab with the doctors in Arizona, and not go to Harvard, because of my permanent injuries.

I am the most stubborn person you might ever meet. It’s not a great personality trait, but I stubbornly fought through the original physical and emotional pain of proving to everyone that I was okay. You don’t help your patients heal if you tell them they cannot recover, or they can’t do as much as they used to, or they have to rest all the time. You’ll undermine their confidence.

To get through the hell of brain injury, you need to have confidence. Why? Because in my view the best thing you can do is keep your brain working, not accepting that its prime is past. You’ve got to believe your brain is working and keep using it to show it can work. Otherwise, it will just rest until it gets worn out from not working at all. It matters if you keep telling patients they can and should use their brains.

Your advice has to match your patient. My friends and family knew a lot more about what was right or wrong with me because they knew me before the accident, and were not just trying to match me to book descriptions of what people are like.

This is something that was confirmed by what I learned from athletes, and from the athlete who has trained me for the last ten years to stay healthy. The athletes who recover know what their injury is, know what they can do to heal it, and patiently go through the ups and downs of recovery because they know, over time, they will heal. They take failure as a lesson, not as a reason to stop working. Many brain injured people stop because people keep telling them they are brain injured and cannot get better. That discouragement takes recovery away from people.

There are ups and downs, so one has to be patient. Rehab takes place over time because people react differently to brain injury. Recovery doesn’t happen overnight. Rehab and recovery workers must always stay positive, because that’s the only way someone can heal. A lot of so-called “healers” don’t even realize how negative they are. If negative rehabbers tell you all the time you can’t do things, you won’t learn how to do them.

I went back to my clerkship, went to Harvard, went on the job market, started teaching law, got tenure, got a chair, went to another law school.

What did I learn from that first rehab and recovery? I was successful, but it was hell. Why? Because if people know you have a brain injury, they question everything you do. And nothing undermines your confidence like being told your brain is sick and unhealable. Fortunately, at Harvard, I had a different doctor who told me she had seen brain patients heal. And that gave me hope.

By 2016, I had 23 years of a legal career behind me, even though those original therapists warned me not to aim too high because my achievements would always be low.

That fall, I was out for a Friday afternoon walk in Henderson, Nevada. A stranger, who had some past domestic violence complaints against him, came from behind me, pushed me down on the ground, kicked me, told the others who walked up that I was dying, and then tried to steal the car of one of the Good Samaritans who stopped to help me. I lay in the street, bleeding from my head. The attacker was arrested.

My brother in Philadelphia was contacted and flew in immediately. He still remembers the Nevada doctors telling him I would probably die. And the numerous people who supported me, my friends, colleagues, and students, tell me it was just an awful sight, seeing me lying in that hospital bed, with everyone wondering if I would live.

That was October 7. I don’t remember anything until I woke up in a Houston brain injury hospital in November. I was awake by presidential election day but don’t even remember being flown to Houston. I was disappointed that I didn’t get to vote.

Second time? Everybody had some doubts. But not me when I woke up. In a way the second time is easier, because nobody was going to convince me my life was over and I couldn’t work again. It may be because in my generation, girls were told we could never be as smart as boys. I took control of my brain then and now and insisted I could use it. No one’s better at recovery than someone who already learned about it the first time.

I am not pretending that recovery happened all at once. People wondered when I first came to if I was quite the person I used to be. I seemed slower than I had been before. But that’s rehabilitation. Slow and patient work aids recovery.

And you’re not the same person. Why? Terror and fear are one reason. I had been attacked by a car driver and by a murderer, and I think that is similar to someone who is attacked by a disease like a stroke or another brain injury.

After accident one, my friends and I would kinda joke about me. I always said you could be telling me in a crosswalk I won the Nobel Prize and I wouldn’t have noticed because my eyes are always on the cars.

After the second incident, I went back to teaching and living in Nevada for a year and a half, but got out of Nevada for two years, and looked for jobs elsewhere. Why? It is frightening to live in a city where someone has tried to murder you, even if he is in prison. No one wants criminals in jail more than I do.

Everyone knew about the murder attempt. It was in the Vegas newspapers, on Facebook, Twitter, other places. The Nevada hospital told me everyone was calling in to see how I was.

I did have to prove to everyone that I was okay. I gave lectures I had agreed to pre-attack. I went on leave. I then taught my classes and published articles, textbooks, and briefs. And I’ve kept doing that up to today.

Brain injury is not something you want to go through. Not once, or twice. The physical and mental cost of surgeries or brain illnesses, joined with whatever fear a patient might have, can easily undermine her strength or confidence. That’s why everyone needs to give the patient a positive message that gives her confidence to work through the illness with strength, coming out with the best she can on the other side of the illness. Recovery is a long term process, and it is a very hard fight when the world has lost confidence that you have a brain. Rehab and recovery should be about encouraging the patient to be strong, confident, stubborn, and to keep using her brain.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.