If you had asked me about concussion a couple of months ago, I would probably have scratched my head and muttered about headaches. Now I am living with it, but I still find it hard to describe.
What led up to the concussion? I am dependent on the observations of others, because in effect I wasn’t there. I remember riding up a leafy lane leading onto Dartmoor on a lovely late-September day. The next thing I recall is lying on a hospital trolley feeling a hard collar with holes in it around my neck, and being told that I had fallen off the horse and injured my head six hours ago but that I’d had a normal CTS, but was going to be kept in hospital overnight for observation. I recall the regular disturbance to have my BP taken and a light shone in my eyes, the kind efficiency of the A&E staff, the NHS toast and tea next morning.
As we drove home, my husband told me what had happened. Nothing impressive: we had left the lane and were up on the moor, my horse was restive and started to canter, I lost a stirrup and slipped off. Not onto granite, onto a gorse bush. No obvious head injury, and yes, I was wearing a helmet, but there must have been enough of a wallop for me to be unconscious for several minutes and to have no memory of the fall (just as well if I were ever going to get on a horse again). I have no picture of being in the Land Rover, the drive over the moor to the cottage hospital, the ambulance trip to Exeter and the CT scan. During that time I had tried persistently to understand what had happened – asking endlessly where I was and why I was there. For a while I thought John Major was the Prime Minister, but by the time I reached the cottage hospital I am told I was able to recall the names of my current colleagues, though still perseverating with a litany of repetitive questions as I tried to anchor events in time and space.
For the first few days I couldn’t read comfortably, or use a computer, and I couldn’t bear music playing – it overloaded my brain. I didn’t know that I try to deconstruct Bach fugues when I listen, but apparently so. I just slept. After a few days I picked up ‘A Short History of Tractors in the Ukraine’. Taken in short doses, just the thing for the bruised brain to practise on (those of you who haven’t read it will be very puzzled).
After a couple of weeks I went back to practice for two days a week. I was safe enough – so much of what we do is embedded so deep that the blow had not shaken it out, and there are always people around should I get stuck. But for a while I was clumsy on the computer, and I am still slow. After a couple of sessions in which I ran 40 minutes late , I now have 20 minute appointments, a luxury both I and the patients will find it hard to relinquish.
Though the old knowledge is still intact and accessible, newer information tends to bob out of reach when I try to grasp it. Irregular Spanish subjunctives and QOF codes for example. And I haven’t gone to any educational events; there doesn’t seem any point in going through the ritual. Mental multitasking is still difficult, too. I am not up to driving round Camden on a wet, dark evening looking for blocks of flats. Could I cope if a patient were collapsed, or psychotic, or waving a knife at me? And I still tire easily and sleep badly – apparently a not uncommon sequel to a head injury.
Speaking to a neurologist was reassuring – six hours of amnesia is quite a long time compared with most knocks on the head, and, as they say in Cornwall, ‘the age is there’, so I can expect it to take three months for my mental processing to return to its normal speed and complexity. And if I do too much I will only set myself back. I am learning that ‘doing nothing’ does not mean picking up the newspaper or fiddling on the computer. It means sitting with my eyes shut, doing . . . nothing.
I am told that during the hours of amnesia, I kept asking ‘Is this real?’. For me, of course, it still isn’t. No images have ever come back to fill in the black hole. I suppose that I realised that I was not forming memories. Neurologically, what processes were involved? When I am recovered I shall try and find out.
First published in NASP Newsletter 'The Sessional GP' December-January 2007
Judith Harvey was a research scientist, ran the VSO programme in Papua New Guinea and taught in a Liverpool comprehensive school before going to medical school. She has been a partner, a salaried GP and a locum, an LMC chair and a long-time supporter NASGP. Her charity, Cuba Medical Link, enables medical students to go to Cuba for their electives.
Judith has now published all her articles from the NASGP website as a new book Perspectives: A GP reflects on medical practice and, well, just about everything…