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Episode 1

The early days after a brain injury

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In episode one, we share an introduction to the series and discuss the immediate aftermath of trauma and sustaining a brain injury, particularly Brooke's collision and his family's experience.

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Information and other content provided in this Podcast should not be taken as providing medical advice or recommendations. Please always consult your doctor or treating team for medical advice.

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Ashwini 00:00:02 - 00:00:38

Hello and welcome to brain injury bites, a series of bite-sized podcasts helping brain injury survivors and their families and friends. 

My name is Ashwini, and I'm a senior associate solicitor at CFG Law. I act on behalf of clients who have sustained catastrophic injuries, including traumatic brain injuries. I'm also a chair and trustee of Headway Warrington, which is part of the National Headway UK charity that helps support survivors of brain injuries and their families, friends, and carers. 

I'm joined here by Brooke Trotter. Brooke, would you? Like to introduce yourself.

Brooke 00:00:38 - 00:00:54

Hi, my name is Brooke Trotter. I was run over in Manchester when I was a student in 2007, on the 15th of May at 2 a.m., to be precise. And I've lived with the residual effects of the traumatic brain injury ever since.

Ashwini 00:00:54 - 00:02:46

This is a series of podcasts based on the experiences of sustaining a traumatic brain injury. Brooke and I will be talking about his specific experiences and the advice he can give to other people who might be going through a similar thing. We'll also be looking at what support can be given to those who are suffering the effects of a brain injury, as well as helpful hints and tips for family members. 

We'll be looking at the basic needs that someone has immediately after a brain injury and how we can progress them in their recovery. A lot of our discussions will be centred around a concept known as Maslow's Hierarchy of Needs. For those of you who aren't necessarily aware of what this is, Maslow was a psychologist who devised a pyramid structure of a Hierarchy of Needs—starting at the very bottom with what a human being absolutely needs to survive and then moving up through the different levels of this pyramid to achieve their full potential. So, your basic needs, for example, could be physiological; they could be the need for food, rest, and shelter. But then also add on financial issues, love, belonging, esteem and self-actualisation. 

I'd like to start really by talking about Brooke's experiences and particularly looking at the first few days and weeks of your brain injury, Brooke. Could you perhaps share with us what happened to you, what your story is?

Brooke 00:02:46 - 00:04:19

It was a night out in Manchester. I was a student at the time, and it was just basically just a normal student Monday night out. We'd actually been to see a band. My friend was mate with these lads that were in a band called the Courteeners – they've since become a lot more famous, but they were just a lads band at the time. So we'd been to see them at the Deansgate Locks area of Manchester if you know that. I was walking home; I was walking down a street called Oxford Road, and I crossed over Chepstow Street, and I obviously don't know, I don't remember, I have no memory of this; there was a car coming towards us from the left-hand side - witnesses say being driven of up to speeds of up to 50 miles an hour. He slammed his brakes on and lost control of the car under braking, and the car had skidded. I'd made it over the road and I'd made it to the pavement but it had skidded onto the pavement. He hit me from my left-hand side and my head went straight through the windscreen. I was then obviously unconscious. I find this quite lucky really because he had driven off, but somebody had obviously seen me and phoned the ambulance, and they picked me up. Credit to North West Ambulance Service because they picked me up, they took me to Manchester Royal Infirmary Hospital and I was stabilised.

Ashwini 00:04:19 - 00:04:50

I think that it's important to note how quickly you were treated at the scene. Thinking about what we call the golden hour, in terms of addressing a traumatic brain injury and just talk us through that; I appreciate you won't necessarily have any memory yourself, but from what you've been told of that first hour. What happened to you?

Brooke 00:04:50 - 00:05:45

Yeah, it's pretty critical is the first hour. Something that was famous at the time was from a guy called Richard Hammond, who used to present Top Gear. He was filming driving a jet car on a runway in York, and he actually crashed the car, and he had a severe brain injury like me. But I think the difference is that if you actually watch that video, the ambulance is there within seconds. 

What happened to me was that my brain had been rattled about inside my skull, and your brain is like any other part of your body; if it's injured, it starts to swell, and you get something that's called intracranial pressure, which is the pressure inside your head building up. Then the race is on to get that treated.

Ashwini 00:05:45- 00:05:46

Because there's nowhere for it to go either.

Brooke 00:05:4600:06:02

Yes, because there's nowhere for it to go, and it crushes itself inside. Credit and kudos to the paramedics that treated me. They're called Luther and Jonathan, and I've met them, which was really nice for me.

Ashwini 00:06:02 - 00:06:03

Shout out to Luther and Jonathan!

Brooke 00:06:03 - 00:06:17

Yeah, it was really nice for me because of their professionalism. I don't know how long I was there, but obviously, I was taken to the hospital pretty quickly, judging by the state of what I've been able to recover to now.

Ashwini 00:06:17 - 00:06:35

And I hate to use the term lucky because it really isn't, but in a sense, you were lucky that where your collision happened was actually relatively close to Manchester Royal, so you were able to get to the hospital within a fairly short time.

Brooke 00:06:35 - 00:06:46

Yeah, I was. It's a funny word, lucky, isn't it? It's something that people who have got a brain injury get told a lot; that they're lucky.

Ashwini 00:06:46 - 00:06:47

But it's not luck.

Brooke 00:06:47 - 00:07:18

It's not, but it's fortunate that I was in that situation and in Manchester really, where they have such good hospitals. I was then passed on to what is now Salford Royal but was then Hope Hospital, one of the country's leading neuro units. If I were in my hometown in Scarborough, I would have had to have been airlifted to the nearest neuro unit, which is in Leeds or Hull, and that would have been the golden hour gone.

Ashwini 00:07:18 - 00:07:28

Yeah, it's time lost, so the fact that you were able to get to the nearest major trauma centre pretty quickly has probably improved your outcomes.

Brooke 00:07:28 - 00:07:50

Yeah, what they did with me was, they had to let the pressure out and it involves drilling a hole in your skull and I had what's called a shunt in my head. It's like a little like a little valve in my head, and that's the nearest to brain surgery that I've had.

Ashwini 00:07:50 - 00:08:03

Am I right in thinking that after that, you were managed quite conservatively? As in, they didn't perform any surgery on you; they just monitored you to see how you got on?

Brooke 00:08:03 - 00:08:25

Yeah, yeah, I didn't have any surgery. You see some people with massive scars on their heads because they've had a large section of their skull removed. I don't have that, I just have a little scar under my hairline, and it's been an excuse to shave my head in the past, but yeah, that's all I've got.

Ashwini 00:08:25 - 00:08:43

Obviously, when the collision occurred, you have no recollection of the collision or what happened. There's something called the Glasgow Coma Scale, which monitors somebody's responses. Do you know what your Glasgow Coma Scale was?

Brooke 00:08:43 - 00:08:54

So the Glasgow Coma Scale is a scale of three to 15, I think. It's scored on three different things. 

Ashwini 00:08:54 - 00:09:04

It's whether your eyes are open and whether you're reacting to any sort of visual prompts.

Brooke 00:09:04 - 00:09:14

And for each one of those, the lowest you can get is one point.  I was a three on the Glasgow Coma Scale, which is actually as low as you can go.

Ashwini 00:09:14 - 00:09:18

Gosh, so that's no response to really anything.

Brooke 00:09:18 - 00:09:19

No response to anything at all, no.

Ashwini 00:09:19 - 00:09:35

Which is very serious, and I know that that's often used as an indicator of the severity of a brain injury. So you were three, and do you know if that rose and how long it took for that to rise?

Brooke 00:09:35 - 00:09:36

I don't know how long it took to rise.

Ashwini 00:09:36 - 00:09:38

You don't know.

Brooke 00:09:38 - 00:09:45

No, I'm just aware that the paramedics got me there really quickly, and I had really good care.

Ashwini 00:09:45 - 00:09:49

And talk to us about how your family found out.

Brooke 00:09:49 - 00:12:03

My mum was at home in Scarborough, which is 100-115 miles away, I think, and she got a knock on the door at about 3 a.m., I believe. My dad used to work away in the Middle East, so she was alone in the house, and she was pretty terrified to see the police at the door. He said, your son's been involved in a really serious accident, and he'd got the nurse that was caring for me on the phone. She spoke to my mum, and she'd said you just need to get here as quickly as possible. Ever since, something that's traumatised my mum is she said, 'He is still going be alive when I get there, isn't he?' and she said 'I can't promise you that, just get here as quickly as you can.' So she drove to Manchester, which was a pretty traumatic experience for my mum.

My dad was in Azerbaijan at the time and he said he got a call from my sister, and he knew from what the time would be in England it was something important. She said, ‘Brooke has been seriously injured, you need to come home, you need to come home now, dad’, and he'd got on the nearest available plane. It's like a 5-hour journey back home, so one thing that was quite poignant to me was that he had a mobile phone and you obviously have to turn your mobile phone off on the plane. He was kind of reluctant to turn his phone off because he didn't know when he turned it back on again if he'd still have a son. So it was a pretty traumatic experience for both of them.

My mum, when she got there, they took her in to see me, and she said she would have walked straight past me. My head was swollen; I was told it was like a watermelon – it had just been through a windscreen, so I wasn't looking my best at the time!

Ashwini 00:12:0300:12:07

Did anyone prepare her for that?

Brooke - 00:12:07 - 00:12:32

I don't know, but how can you prepare anyone for that, I suppose. I have this thing of guilt, really, which is stupid, but you do you don't you? My mum lost massive amounts of weight when I was in the hospital; she was really traumatised by it, and you take that guilt on yourself, don't you.

Ashwini 00:12:3200:12:57

Yes, and although it's easy to say you have nothing to feel guilty for, I guess you know that what happened to you has had a wider impact on those around you who love and care for you.

So you started off in Manchester Royal, and then you were transferred to Salford.

Brooke 00:12:57 - 00:13:02

Yeah, Hope Hospital at the time, but yes, what is now Salford Royal Hospital.

Ashwini 00:13:02 - 00:13:08

Yes, so can you talk to us about the sort of treatment that you were having there?

Brooke 00:13:08 - 00:15:48

I mean, this was within a few hours really, it wasn't a long stay. I was transferred to Salford Royal when I was still in a coma, and I went into ICU, intensive care unit. I don't know what the time scales are, but I think it was day 16. There were people going in who could sit with me, you know, you were allowed one at a time, and people would hold my hand and stuff like that. My sister actually kept a diary of this time, and my dad actually came in one morning. He says, you know, come and look at your son with those beautiful blue eyes because he'd gone in one morning to see me, as he usually did, and I had ever so slightly opened my eyes and could see you could see the blue of my eyes. It was quite a moment for them because I was waking up out of the coma, and that was day number 16. From there, I'd got moved into HDU, which is the high dependency unit, and then onto another ward called B8, and then finally a ward called C2 in Salford Royal Hospital. That's the neuro recovery unit, and that's actually where my memory picks up.

I remember walking down the middle of the ward and seeing my bed and my family had put all familiar pictures, of you know, family and friends and stuff, out there all around. I'd actually been in hospital in Scarborough about a year before for some drunken injury;  I'd broken my ankle and had to have an operation, and that's where I thought I was for the duration of the stay. I even knew what room I was in, and I was convinced of this. Eventually, it took somebody to take me outside in a wheelchair to prove that I was not into Scarborough hospital.

Ashwini 00:15:48 - 00:16:15

And you mentioned that quite a while later that you woke up from your coma, and then it was quite a while before you can remember anything specific. In a later episode, we'll talk about post-traumatic amnesia. I know you don't necessarily remember yourself, but what were your first words from what people have told you?

Brooke 00:16:15 - 00:17:12

Yeah, well, everything from here is from what people have told me. My first words I'm actually incredibly proud of; I don't know if you should be, but I am! So there used to be a health care assistant who would walk around making hot drinks for the family or whoever was sitting with me at the time, and they’d say do you want a tea, coffee or hot chocolate and I used to have a hot chocolate. My sister was about to order a hot chocolate, and bear in mind I hadn't said anything up to this point; they didn't know if I was going to be mute for the rest of my life. But before my sister had had a chance to say hot chocolate, I'd said, 'Can I have half a Stella, please love!' I don't know why it was half a Stella; I can only assume because it was in hospital and drinking pints is not the done thing in hospitals, is it?

Ashwini 00:17:12 - 00:17:19

Excellent, well I'm sure that, funny as it is, it was also of great comfort to your sister and your family.

Brooke 00:17:19 - 00:17:19

I think my family were like, yeah, he's back kind of thing.

Ashwini 00:17:19 - 00:18:26

That's our boy!

So I think at this point, it would be helpful to share some help and advice for our listeners, and I'm thinking particularly for listeners who may be supporting a family member or a loved one through brain injury, and particularly in those early days.

You'd mentioned, for example, that your mum didn't recognise you; she could have quite easily walked past you because you just didn't look like you. So I suppose, what our message might be is, when you're visiting somebody in the hospital who's just sustained a brain injury to be prepared for the fact that they may not look like they should, that there will be tubes, it will be quite distressing to see. And perhaps it's also one for clinicians, police, etc., to prepare the family for that, that what they're about to see is going to be quite shocking for them.

Brooke 00:18:26 - 00:18:43

I mean, there's only a certain amount you can prepare people for what they're about to see, especially if it was a trauma. But also just how they are as well because you think you're going in to see that same person, but if they've had a brain injury, that person's changed.

Ashwini 00:18:43 - 00:19:23

You also mentioned how your mum had lost a lot of weight, and I suppose that was with the trauma of everything that was happening and obviously spending a lot of time, I imagine, by your bedside. But I think it's important for family members to remember the importance of self-care is as well. To be strong for the person you're supporting, it's OK to take time out and look after yourself. It's important, in fact, that you take time out to make sure you're eating properly, to make sure you're getting enough sleep and rest so that you can be strong for the person that you're supporting.

Brooke 00:19:23 - 00:19:49

Yeah, I don't know if they'll get as much sleep and rest as they could do, but it's just certainly to look after yourself as much as you can and make sure you’re eating; there's another thing because although you don't feel like food, make sure you eat something because if you're not strong yourself, you're not going to be able to give them the best care in the world.

Ashwini 00:19:49 - 00:19:54

Did your family take turns when it came to sitting at your bedside?

Brooke 00:19:54 - 00:20:28

I think my mum and my immediate family were pretty much there all the time. I had friends that came in to see me as well. 

I think one thing we were quite lucky with that only applies to us specifically as a family because we're from Scarborough, but my sister actually lives in Manchester, so my mum just basically moved into my sister's house for about six months. They had that as a base, and they were going to the hospital from the start of visiting time to the end of visiting time every day.

Ashwini 00:20:28 - 00:20:49

Yeah, and that can also have quite a big impact if you have to visit in a completely different town or city to where you live and travel; you could be travelling and spending a lot of time travelling in and out or spending a lot of money on accommodation nearby.  I'm sure there's support available.

Brooke 00:20:49 - 00:21:02

I believe Salford Royal had accommodation there; I don't know how nice it was, though! I know they stayed in that accommodation sometimes.

Ashwini 00:21:02 - 00:21:34

Yeah, and I think it's also important to ask for help from people you know in addition to family. Of course, they'll be friends and wider members of the family that would be concerned and wondering how they can help to support you and your family, and it's being able to say, you know what I need some help, please can you put my bins out or bring me food or something else.

Brooke 00:21:34 - 00:21:49

It's the one time, I guess, you'll get offered more help than you know what to deal with, and it's that's time to say yes and let people help. It'll make them feel better that they're doing something, and it's going to help you because they're helping you!

Ashwini 00:21:49 - 00:22:49

Yeah, and there's no shame in asking for that support at all. 

But as well, and this is something that I've come across quite recently - the importance of asking questions of the clinical team. Obviously, the clinical team's top priority is getting you back on track and trying to do everything they can to promote your recovery. But it's also important that they take the time to communicate what's going on with somebody who's been injured and that the family understand what's going on, what to expect, what's going to happen next. I know recently I've been working with a client and his family, and the mother had no idea as to what was going on; I'm sure COVID restrictions possibly played into that a little bit, but nevertheless, she just had no contact with the clinical team for quite some time.

Brooke 00:22:49 - 00:23:00

I guess it's something they're going to be dealing with every day, and they know it like the back of their hand. But it's the families who don't necessarily have a clue, so they would have to start again with every new family.

Ashwini 00:23:00 - 00:24:21

And it's also just that acceptance of, well, they're in the hospital, they must be in the best possible hands, which is fine. But it's important to understand that you know this is where we're up to, and this is what's going to happen next just to prepare.  Coming back to that point we made earlier about being prepared for what's happening, so don't be afraid to ask questions. Don't be afraid to go up to nurses or doctors and say, 'Can you just tell me what's going on? What does this mean?' Because it will put you in a better position to understand how you can support your loved one. 

Thanks for that, Brooke; that was really helpful. I'm really interested to hear more about your story.

In the next episode, we'll be looking more in-depth at the initial treatment that you had in the hospital and your experiences whilst you were in the hospital. We'll also be looking at post-traumatic amnesia and the fake environment that you've described whilst in the hospital and the sort of memories in inverted comments that were being formed.

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