Reconstructing Identity After Brain Injury

A Search for Hope and Optimism After Maxillofacial and Neurosurgery

Stijn Geerinck

• Publisher: Routledge
• Year: 2022
• Print ISBN: 9781032036496
• eBook ISBN: 9781000555974
• Topic: Psychology
• Subtopic: Social Science Biographies
• Index: Psychology

Reconstructing Identity After Brain Injury tells the remarkable story of Stijn Geerinck and his journey from road traffic accident to recovery. After he was hit by a drunk driver whilst cycling, Stijn suffered a traumatic brain injury and had to undergo drastic maxillofacial and neurosurgery.

In his own words, this book narrates Stijn's difficult recovery, focusing on the physical, medical, mental, social and financial changes he had to endure. It lays the groundwork for coping with permanent impairment resulting from TBI, including lifelong lesions and the irreversible physical changes. The testimonial narrative is complemented with philosophical insights, providing key philosopher's reflections on the experience of brain injury. Stijn also explores the essential human characteristics of resilience, fighting spirit, emotionality, despair, vulnerability, hope, depression, optimism, anxiety, rationality, focus, anger and love, as he looks at the impact of his brain injury and resulting disfigurement on his masculine identity.

It is essential reading for any professional involved in neuropsychological rehabilitation, and all those touched by this condition.

Chapter 1

A Radical Change

The End of a Lucky Duck

DOI: 10.4324/9781003205142-2

I used to be the happy-go-lucky sort of person, the man for whom every day was Sunday both as a child and as an adult. I had a wonderful family, a meaningful job and fantastic hobbies that gave me great joy. I was a father of two children with a lovely wife, a teacher of philosophy in secondary education, a bass player in a groovy band and a long-distance runner. Add to that a group of the finest friends one could wish for and it is fair to say that life was good to me. The fact that all this was set in an affluent region such as Flanders¹ at the beginning of the 21st century undoubtedly contributed to that feeling of prosperity. The world I lived in knew no major problems such as war, poverty or rampant inequality. Of course, it would be an exaggeration to say everything just fell into my lap. Even under the most favourable conditions chances do not take themselves. However, although some days came easier than others, there were no insurmountable obstacles and I was always one to count my blessings.

Apart from any possible personal merits, my prosperity was mostly a matter of extremely beneficial circumstances. I was no stranger to happy coincidence: it was my faithful ally. My imagination turned ‘Every day is like Sunday, every day is silent and grey’ into ‘Every day is like Sunday, every day is vibrant and gay’.

I don’t know Morrissey (the writer of the original soundbite) personally but he has always struck me as a witty and enjoyable representative of a rather gloomy view on life. In my opinion, he shows that seemingly contrasting views of life are not necessarily irreconcilable.

And then I turned 40, a transition that would have been trite and uneventful if it weren’t for the life-changing incident that shook my world. It was my first encounter with bad luck, a common fact of life but in this case nonetheless a blow of massive proportions. I became a traffic accident victim, pure and simple, a split second with drastic consequences. In the blink of an eye, in a jiffy, I was left with a confusing mess of dramatic and far-reaching outcomes. It was the beginning of the greatest challenge of my life.

The accident was the start of what would turn out to be a radical confrontation with my own personality. Willpower and perseverance were put to the test to see whether they were only empty words, hollow theoretical shells, or would actually live up to their name and withstand the hostility of reality. Was my talent for optimism just an unfounded attribute or actually a useful weapon for life? How far did my ability to make life worth living reach, to make a positive difference to those close to me (family, students, friends) even in moments of hardship?

What happened? Spring 2017: as I was riding my bike on a nightly trip, a drunk driver, who had fallen asleep behind the wheel, mercilessly crashed into me. The police were called and the perpetrator would later have to stand trial. I was taken to the nearest clinic, which was Ghent University Hospital, a place that specialised in the sort of care my situation required. It literally saved my life. Their neurosurgeon was (and still is) a star at lonely heights in his line of work. Even though calling the fact a ‘lucky break’ would be a bit inappropriate given the severity of my situation, it was most certainly a silver lining to a very dark cloud. The fact I was transferred to this hospital very fast is the only reason I survived. I became a statistic, not as a casualty but as a survivor of a traffic accident by merits of medical technology and positive science. I got to see what it means to be human in the Modern Era from up close and in the most radical way. The achievements of our exceptional cognitive abilities were what kept me alive. On the flipside, however, I had become a victim of one of the many disadvantages of modern public infrastructure.

Public spaces are mostly regarded as functional environments, meant to bring us from one place to another in fast and dangerous vehicles. Within this domain, any contact with others is to be avoided due to its inherent dangers. This leads to human alienation. The person who ran me over apparently no longer considered the road a place where one is to take responsibility towards others. By boxing ourselves in moving cans called cars we have significantly increased the distance between one another. Although most of the available means of transportation are efficient and have massive advantages, one could argue they don’t really fit our bodily nature. Neither our senses nor our psychological abilities are adapted to high speeds and a complex interplay of events in the modern functional ‘pseudo-open space’.

The challenge was to preserve the connection to what’s positive and valuable in life. I reckoned it would become a long struggle. Luckily, I nonetheless felt determined to write a second chapter to my story, one that would be worthwhile.

The accident left me with an acquired brain injury (ABI). For three months, my skull had to stay open after surgery to give room to my severely injured and swollen brain. At the same time, I suffered from the issues that come with ‘sinking skin flap syndrome’. The gravity of the situation called for an urgent replacement of my bone flap in spite of a hospital bug I had caught and which made surgery particularly risky. Luckily, I came out without further damage. The next step was to install a permanent shunt to drain any superfluous cerebrospinal fluid, which had been heaping up in my ventricles since I fell out of bed. It was supposed to remain there for the rest of my life. Adjusting the shunt, however, proved to be difficult and initially, too much fluid was being drained. As a result, I had to spend the next couple of weeks lying head-down on an inclined bed. To make things worse, I suffered from double pneumonia. My fall from the bed convinced the medical staff to take no further risks and strap me to the bed every single night for four months.

I had broken my cervical vertebrae column, so it was decided it would be best to stabilise my neck with something called a Halo vest – a metal brace attached from my middle body to the top of my head that was supposed to keep my cervical vertebrae in place. I spent the next three months with this brace around my upper body, with only a ‘sheepskin’ to support the construction and make things more comfortable – although this proved to be a burden rather than a blessing, especially during summer, as I soon found out. The entire left side of my body was paralysed. My face had taken the worst blows and was severely disfigured, which also had an impact on my heavily injured eyes. The damage was said to be irreversible and situated in the right temporal lobe.

It was impossible to assess the outcome of these events, especially at the early stage of the revalidation process. As I was unable to take in food for a long time, I lost more than 20 kg. My consciousness was too impaired to eat without assistance and I found myself continuously at risk of choking. It was much more likely than not that I would come out a different person and / or severely mentally impaired – if I survived the ordeal at all, that is. I did survive, albeit with many complementary and simultaneous complications. My future perspectives were grim and short-lived.

Neurosurgeon Prof. Dr. Kalala made an important announcement to my parents and my wife: ‘Once we’ve replaced the bone flap, Stijn will be able to reach the same level as right after the incident and to live a life worth living.’ This meant a lot, because my situation had only deteriorated the first months after the accident.

The food intake issue was resolved soon after said announcement by continuously having a feeding tube in place, first via the nose and later via the abdomen. Also, I was transferred back to Ghent after a short relocation to Oostende due to the fact that I had ‘run out of bed-days’,² a bureaucratic disaster that all but cost me my life had it not been for the impressive prowess of the nursing staff in Oostende (shout-out to Sabine and her colleagues).

I hold no conscious memories of this time after the accident. Everything I know was told to me by my wife and parents. I hardly spoke a word at the time and it stayed that way until after my skull was reattached and my speech gradually improved. In all, I had to go through the cycle of ‘intensive care – high care – hospital – revalidation’ three times.

The life that gently drifted on the flow of seemingly unstoppable progress came to an abrupt and irreversible end in a matter of seconds. It was replaced by an existence of insecurity and a dubious future with only one certainty: I would be dependent on others for an indefinite amount of time and unsuited for work for a long while. The intensity and duration of this period was impossible to predict, so I could only hope that whatever form of bodily resilience I possessed would not fail me now. The first weeks I was in mortal danger without conscious thoughts or feelings. I had to undergo my situation passively: the feeble faith in a life-worthy outcome was reserved for the surgeons. My parents, wife and kids were dependent on their assessment and decisions while I spent my time in the waiting room of unconscious existence.

Having stayed by my side for the first three weeks all by herself, my wife decided to bring my two daughters to the intensive care department. My oldest daughter had prepared a speech but couldn’t read it out loud. Mom had to read it for her, while we all listened, hand in hand. At the end of the visit, I waved to them, the first sign of demonstrable consciousness, save for the way I had been holding hands with my wife for some days by then. I made contact, I communicated at last.

The accident and the recovery had made one thing painfully clear to me: my mental identity and its bodily vessel, the brain, are one and the same. My conscious experience is rooted in the functioning of my brain. I went into an identity crisis, embarked on a life-long journey in search of new equilibria, driven by the obligation to reinvent myself.

What is commonly considered the essence of humanity was suddenly endangered in an overwhelming fashion. My ideas, memories, convictions, fantasies, emotions, ‘tools for thinking’, … they were all under threat. I was about to lose myself irrevocably. In the course of many months, I became more and more aware of the complexity of the human brain.

The fact that the human organism is powered by a rich variety of processes has become clear to me through the lens of my ‘extreme situation’. Unsurprisingly, there is a multitude of brain-related possibilities and difficulties alike. Listing them all here would simply take too many pages, as my experience soon made me realise. The way I process stimuli has drastically changed, the pieces of my thinking abilities have to be put back together from scratch and I am facing a long, capricious and untrodden trajectory learning how to come to terms with my new reality. It will take most of my energy for a long time.

I had to trust in the remarkable plasticity of the brain for my recovery. A significant area was affected and I could only hope that the neighbouring regions would take over the tasks of the damaged tissue. I had learned from a reliable source that neurons are not like skin or blood cells. Neurons that are destroyed are generally not replaced, so it was up to the survivors to fill the functional gap. I soon came to see the utility of ‘brain training’ and was constantly trying to stimulate cooperation and healthy competition among the remaining brain cells, relying on the neurotherapy provided by the K7 rehabilitation centre of Ghent University Hospital. I often joked that I had become the rare owner of a brain going through puberty for a second time (although my limited consciousness prevented me from riding the wave of my black humour). It only came to me relatively late in the recovery process, an afterthought in every sense of the word.

Notes

1    The northernmost, Dutch-speaking region of Belgium.

2    The number of days a patient stays overnight at the hospital.

Chapter 2

The Mental Resilience Reflex

DOI: 10.4324/9781003205142-3

Perseverance was key, as was claiming all conscious moments that had become so precious to me. For months, I lived in the well-nigh hermetically sealed bubble of the here and now.

As time progressed, I slowly developed the mental resilience to ward off relapse, the ability to embrace bad luck and the feeling of injustice that comes with it. I called it ‘the mental resilience reflex’. It took me months to develop it before I could call it as such during a conversation with my friend Wouter (the drummer of my band). All it took was for him to ask me how I was doing. I had a challenging and busy day ahead of me: seeing my lawyer, a final revalidation session in preparation of the facial reconstruction surgery, having over a film crew shooting a documentary on facial surgery at Ghent University Hospital – a tough combination for an ABI patient. I told him it was hard, but that I ‘tried to develop an almost spontaneous reaction to stop apathy or depression from getting the best of me.’

Giving it a name and honing the skill was my way of shaping my willpower. It had to be a more or less spontaneous reaction, a stubborn, powerful and positive reflex to bad luck, fear and physical or mental decline. At times, it proved to be almost impossible, but that only further encouraged me to resort to what had kept me going: my family, running, music, reading, writing, friends, going out and talking, carrying on slowly but surely at a sensible pace … All these things helped me a lot and lie at the heart of the reflex. Although I realised that the form these lights in the darkness take differs from person to person, I nonetheless had the feeling that my mental resilience reflex could have universal value, because it was based on human nature and shaped by natural selection. That basis was (at least in theory, in my opinion) available to all. It became my main objective to develop and learn this ability.

I worked hard to cope with difficult circumstances as rationally as possible. I wanted to see results, whatever it took. This was clearly a break with my easy-going style before the accident. My mental outlook was thoroughly analysed in an attempt to root out all thoughts and actions that stood in the way of my recovery. For example: I made no allowances for lashing out at other people (although lifeless objects often had to suffer for it). Drinking was too risky and would have conflicted with the principles of recovery, so I stopped completely and indefinitely. Instead, I set strict priorities into which I put all my available energy. I found out that without any theoretical background in cognitive behavioural therapy, I nonetheless had come to similar ...

Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Table of Contents
• List of figures
• About the Book
• Preface: Life, Survival and Personal Identity
• Introduction
• 1. A Radical Change: The End of a Lucky Duck
• 2. The Mental Resilience Reflex
• 3. Physical Recovery
• 4. Mental Recovery
• 5. Social Recovery
• 6. Financial Recovery
• 7. Two Years and Counting
• Afterword
• Epilogue
• Appendix 1
• Appendix 2
• Appendix 3
• Index