Crash (18 page)

41

The Three White Envelopes

Because we were victims in a criminal case, the district attorney’s office assigned us a victim/witness advocate. We have had seven or eight different ones over the years, changing as they retire or move on to other jobs. We were also assigned a new advocate each time the drunk driver changed correction facilities.

I have always appreciated the advocates. They accompanied us to every hearing, trial, and sentencing. The court can be a very intimidating place. While waiting for our case to be called, we have been witnesses to all manner of tragedy. We unwittingly were at the trial of an elderly man accused of poisoning a toddler at a barbecue at his home. We witnessed part of the trial of a doctor who allegedly walked into his wife’s hospital room and shot her dead along with her lover. Prisoners in orange jumpsuits, their wrists manacled, shuffled within inches of us, their shackles clanging with each step. Although our advocates couldn’t really do anything about who was in court with us, I was grateful for their experienced presence.

They weren’t just hand-holders though. They explained the system to us as we went along: the role of the grand jury in the indictment of the drunk driver; the array of possible charges that could be brought against him and the advantages and limitations of each; the range of sentences possible. The learning curve was very steep, and the district attorney did not always have the time to explain all the details to us himself. There was also an endless number of Latin terms to puzzle through. The
voir dire
: a fancy phrase for jury selection. The
colloquy
: the process by which the judge ensures that the person charged understands the rights he is giving up if he changes his plea to guilty.
Ex parte
: the sidebars in which the lawyers conferred with the judge, hands over microphone to mask their words. It was a bewildering new world to be mastered quickly. The advocates helped us cram.

They tried not to let anything surprise us. They didn’t want us reading about developments in the case with the rest of the region in the
Boston Globe
. They called us on the phone whenever the drunk driver’s lawyer made any motions. Whether he asked for a parole hearing or requested to be moved to a different corrective facility, the advocates made sure we knew first.

They are always happy to answer any questions we have about the drunk driver. From their answers we learned what classes he took in jail, what infractions he committed while there, and who came to visit him. Sometimes it felt voyeuristic. But I guess he surrendered certain rights when he took a life, left the scene, violated his probation.

Now, eight years after the crash, our contacts with the victim/witness advocates are few and far between. Often it seems that just when our lives are getting back on track and back to normal, the envelopes appear. Always three: one for Saul, one for me, one for Neil (even though he hasn’t lived at this address for years). All with the same telltale blue coat of arms of the Commonwealth of Massachusetts in the upper left-hand corner. All with Victim Service Unit typed in the return address. My heart always drops when I see them. Those three white envelopes, all the same. I worry that he’s been let out of jail—proclaimed free and innocent. Or out on some technicality.

The most recent letter informed us that inmate W92140 had been approved for transfer from minimum security to a prerelease program in Boston. My heart skipped a beat. Were they letting him go? I called and spoke with my latest advocate. I have never met him. We had never spoken before. But he knew all the facts of the case and assured me that the earliest the drunk driver would be released was more than a year away; that he could still serve his entire sentence until 2014.

We will know when his parole hearing comes. The advocates will make sure of that. We’ve done this before many times. We’ll argue for continued incarceration in front of the parole board. We’ll write our victim impact statements and read them to the board. I have a drawer full of them now, including the one I wrote from Neil’s hospital room at Anna Jaques.

After all these years I am quite used to this roller coaster of a judicial ride. But the predictable is still painful. The prosaic still smarts. Try as I might not to allow the drunk driver to rule my emotions, the sight of those three white envelopes showing up in my mailbox, all the same, brings me to my knees every time.

42

Of Grief and Gratitude

“The road to recovery after a traumatic brain injury is not linear.” Those words were spoken by Marilyn Lash, a publisher of books on brain injury, at a conference put on by the Brain Injury Association of Massachusetts a few years ago. Truer words were never spoken.

When I first learned of the accident …

“Where are the kids?”

“They should have gotten to your house by now.”

“Two kids were hit on Ferry Road,”

… I was stunned into disbelief. I ran all the way to the crash scene, praying that Mary was wrong. That it wasn’t our kids. That Neil was all right.

And he was all right. Or so I thought. In the span of one breath I went from gratitude to grief. Breathe in. He’s alive. Breathe out. He’s confused. Breathe in. Thank God. Breathe out. Oh no. Breathe in. “He’s gonna be just fine.” Breathe out. But will he still be Neil?

As glad as I was that Neil had survived the crash, I was still, even that very first night, worried about his future. His personality. His IQ. As grateful as I was, I still grieved for his losses. And with good reason. Those are the very aspects of his life that are affected to this day.

But with that grief came guilt. For even as I stood over my shivering son in the emergency room at Brigham and Women’s Hospital, wishing I could warm him with my coat, my body, I thought of Mary—of how she would love to feel Trista cold and shivering instead of just plain cold.

And later, when Neil was screaming at me, I thought of Mary. Of how she’d give anything to hear Trista’s voice again. Even if she were yelling; even if she were angry or confused.

The road is not linear, indeed.

It can take a very long time to realize all the effects of a traumatic brain injury. It can be a very long time before you realize that your son, who looks so perfectly fine on the outside, isn’t really so perfectly fine.

It was easy to feel gratitude when Neil opened his eyes and said, “Hi, Mom.” It was harder to feel grateful five years later when he’s still seeing a therapist and taking Lexapro and smoking cigarettes.

For years I felt like I was standing in the shadow of the other mother: the one whose child was killed in the same accident that injured mine. To even use the word
grief
when talking about Neil’s losses felt fraudulent, like I was hijacking the very word from someone who knew true loss. Whose loss was terminal.

But as time has passed—as Neil has continued with his memory loss, learning disabilities, and personality changes—I have owned my grief. Spread out in it and made myself at home. Year after year I attend the Brain Injury Association’s conferences. I am comfortable there. I feel like people understand me there. We get one another in this disenfranchised grief. I always learn something new at the conference. Every year I feel like I understand Neil and his injury a little bit more.

For years after the accident, Mary and I went to court, over and over. We stood side by side before judge after judge, telling our respective stories, chronicling our individual loss. Our parallel if uneven tragedies were held up for display over and over. I stated my disclaimer up front. I haven’t suffered like she has. The whole time I was writing my impact statement, I was making comparisons. Myself to Mary. Neil to Trista. Every time, my own losses came up short.

Sometimes Mary and David spoke ahead of me. Occasionally I went first. Sometimes they read from prepared statements, but often they just spoke from the heart. They told of memories: shopping trips and Girl Scout camps, school plays and holding hands—all the things they would miss about their daughter.

“What yardstick do we use to measure that?” they asked.

But I need a yardstick too. It may be different from Mary’s. With tinier notches perhaps. Or at least spaced more widely apart. But I have things to measure, too. Neil’s pain from fractures and blood. From stitches and metal and scars. His slow progress through physical therapy. His struggles with memory loss, depression, anxiety, and learning difficulties. His pain from the loss of his girlfriend and having his whole world shattered in an instant. Neil wonders too what is a result of the accident and what is just his personality. But he’s coming to grips with the fact that it doesn’t really matter. It’s just who he is now.

I believe now that grief has many faces. There is no one right way to behave in the face of it. No correct approach. There is no one set of circumstances that warrants it as a reaction and no specific set of behaviors that qualifies as appropriate in response to it. It just is. Mary’s rawness. My reserve. Her guts and grit. My reticence and guilt. I have come to understand that the whole gamut of human emotion is legitimate when it comes to coping with loss. Even how we define our loss is personal and valid, different as it may be for each of us. I’m not sure where I stand in this hierarchy of grief. I may not be on the top rung, but I’m not on the bottom either. I just know that I belong on the ladder.

For years I bounced around between grief and gratitude and guilt. But over time, all three of these “Gs” have given way to another “G” on this very nonlinear road, and that is grace. We’ve had our struggles as a family, but we’re here. We are survivors. Neil may not be the same person he was before the accident, but who really is the same person he or she was at seventeen? Neil has his limitations, but don’t we all? I don’t want to focus on what Neil might have accomplished without his brain injury. Instead I want to celebrate everything he has accomplished with it. Despite it. That is grace.

I also choose not to make my life all about the drunk driver’s punishment. I had to show up. I had to voice my opinion to the judge about what I thought that punishment should be. But I can’t make my peace depend on justice. I can’t make my happiness be about that. Again, there is grace.

I don’t believe in fate. I believe we deal with the hand we are given. We make our own meaning. We find our own grace. Grace as a kind of acceptance. Grace as thankfulness. Grace as new meaning for a changed life.

Afterword

The accident has become a defining part of our family’s narrative. Tragedies can break families. Ours is not broken. I am proud of the way we came together. I am proud that Dan’s immediate reaction to the news of the crash was “get me home.” There was no question that I would take time off from my job at the community health center. The vastness of staff led to many frustrations with my job there, but it also meant that there were many hands to take over caring for my patients while I cared for Neil. Saul’s role, after those precarious first days in the ICU, went back to being chief provider for us. Our rock.

As a doctor I am ashamed of how much I didn’t know about brain injury. I didn’t know fundamental things, like that traumatic brain injury can cause an organic type of depression. I’m embarrassed to say that it was Neil’s lawyer who told me this. We were preparing for trial.

“We have to be sure the jury understands that Neil’s depression was caused by his brain injury, not by losing Trista.”

I was a bit taken aback. It was the first time I had considered this. His lawyer was top-notch. I trusted her completely. But surely Neil
was
grieving for Trista. Was she asking me to lie on the witness stand?

After that day in court, I went home and did some research. I learned how wrong I was in thinking Neil was simply mourning for his lost love. Of course his lawyer wasn’t asking me to lie. Neil’s depression
was
organic. All the areas of the brain that regulate emotional stability were areas that were injured in the crash: frontal lobes, right temporal horn, the amygdala. Contusions, hemorrhages, fractures, volume loss. All in the right places to disturb the ability to modulate feelings. To be happy. What a fool I was.

But I wasn’t the only doctor in the field naïve to the long-term subtle deficits people with traumatic brain injury suffer. When Chuck/Mitch told us, “He’s gonna be just fine,” he believed it. He is an intensivist, geared toward the acute. In his world a patient who knows who he is, can blink on command, and can accurately identify how many fingers are being held up in front of his face is worlds better than the lot he sees every day. Neil didn’t need a stint in a rehab facility. But he did need physical therapy, mental health support, antidepressants, and modified educational plans, none of which were provided for or even suggested at discharge, all of which I subsequently arranged myself. I was not the only one ignorant of what the future could hold for a brain-injured boy.

I’ve tried to compensate for these deficiencies in my knowledge of brain injury by obsessively reading all that I can on the subject. I subscribe to a cite-tracking news-alert system, receiving almost daily articles about all aspects of head trauma and brain injury:

“Efficacy and Safety of Dopamine Agonists in Traumatic Brain Injury.”

“Time and Dose Dependent Neuroprotective Effects of Sex Steroid Hormones on Inflammatory Cytokines after Traumatic Brain Injury.”

“Is Traumatic Brain Injury a Risk Factor for Schizophrenia?”

I get them all, trying to become something of an expert in a field I knew so little about until it struck at home.

I’ve since written articles on various aspects of brain injury for local publications as well as national pediatric newsletters. I edit a column in
Heads Up,
the Brain Injury Association of Massachusetts’ quarterly newsletter. I’ve blogged about the new concussion guidelines for young athletes.

I use every available avenue I have to get out the word about traumatic brain injury. It’s the signature wound for our soldiers coming back from Iraq and Afghanistan. The frequency and severity of head trauma in professional sports has prompted new rules for them as well. The nation watches with amazement and respect as Gabby Giffords recovers from her traumatic brain injury. We can only guess what she and her family are going through. I am kindred spirits with all the soldiers and athletes and victims and families who have been through the TBI experience. I am at once their comrade and their advocate.

I also address audiences about the subtle and not-so-subtle effects of brain injury. I am in the Ambassador Program, a speakers’ bureau for the Brain Injury Association of Massachusetts. The program aspires to put a human face on a grim statistic: One and a half million people in the United States suffer from brain injury each year. That’s 2 percent of the population. That’s a brain injury every twenty-three seconds. There are five million children and adults living with long-term disabilities as a result. I speak to Rotary Clubs, Kiwanis Clubs, and Lions Clubs. I’ve spoken to college students and high school classes. I’ve spoken during Alcohol Awareness week and given pre-prom talks. I was the keynote speaker last fall for the Pediatric Brain Injury Conference put on by the Brain Injury Association of Massachusetts (BIA-MA). In just one week, at the end of this month, I will have attended two brain injury conferences, one sponsored by BIA-MA and one at Boston University. I will have lectured at the Trauma Care Symposium at the Lahey Clinic in Boston and spoken to 150 high school students, members of the Students against Destructive Decisions (SADD) chapter in North Attleboro. This has become not just part of my day and part of my work but also part of who I am. In the book world it’s called platform. In my world it’s my passion.

In the years since the accident, my creative writing has also evolved. The short stories I wrote always had medical themes. That’s my world. “Write what you know,” as they say. But the subjects and motifs have narrowed into sharp focus for me now. My roles as mother, physician, and writer have merged into a life of purpose, passion, and prose. To riff on a phrase of Descartes: I write, therefore I am.

I will always be a mother: checking in with my sons, helping them move and move on, cheering their successes, shouldering their disappointments. I will continue to work: the doctoring, the taking care of babies, working with families, learning about head injury, lecturing on what I’ve gleaned. And, of course, I will write about it all, putting pen to paper as I try to explore this world and my place in it.

It has been almost ten years since the crash. Neil has been through a lot. We all have. Although we haven’t come through the ordeal unscathed, we have come through. And we’ve done it together, as a family.

Five years after the accident, Neil came home from a trip to Israel with a present for me: a necklace engraved with the Hebrew words
L’dor Va’dor,
which means “from generation to generation.” The words were straight out of our Jewish prayer book and are spoken every Sabbath. Neil knew those words well from his many hours in synagogue.

“Thank you, Neil. It’s beautiful.”

Neil beamed, clearly pleased that I liked his gift so well.

“I read your essay on the computer,” he told me.

Say what? I was a bit taken aback. I thought Neil had chosen these words to engrave based on the Jewish prayer. I had no idea he’d read my essay. I’d never exactly invited Neil to read my work. Then again, I hadn’t discouraged him either. They were right there on the computer. Saved documents in Microsoft Word. No password required. As personal essays go, the piece Neil had read wasn’t particularly personal. But it also wasn’t something I would normally share with my son. Once again I realized that my son had learned something about me that he wouldn’t have gotten otherwise.

People ask me all the time, “Does Neil know you’re writing a book?” “Has he read it?” and “What does he think?” The answer is he does know and he has read it. We have supported each other through its writing, submission, publication. He is proud of me, as I am of him.

The truth is Neil wants to get the word out about brain injuries too. The truth is he understands what it’s like to have problems no one else can see.

In college Neil had wanted to play soccer. We were told by his neurosurgeon at the time that he should wait at least a year before engaging in contact sports. I was so disappointed for him. Later that year I was attending a Grand Rounds lecture on traumatic brain injury held at Lawrence General Hospital. The speaker was William Meehan, director of the Sports Concussion Clinic at Children’s Hospital Boston. After the lecture I spoke with him, describing Neil’s injuries: subarachnoid hemorrhage, subdural bleeds, frontal lobe contusions, fractured skull. I asked him what he thought about Neil playing soccer in college. He advised against it—not that semester, not that year, not ever. His lecture had been about sports concussions, but his advice applied to any brain injury.

“The brain doesn’t know how it was injured, Carolyn,” he told me.

As it turned out, Neil never tried out for the soccer team. While we were worried about his head, he was worried about his leg. He was afraid he would rebreak it if he played soccer. He even worried about playing hacky sack.

The summer after his first year of college, a year and a half after the accident, he rented a beach house with some friends. One day he called me from his cell phone, all excited.

“Mom, I jumped!”

I thought I had misheard him at first.

“You what?”


“I jumped!”

He explained that he and his friends were leapfrogging from rock to rock at the seashore and he suddenly realized that, without thinking, he too was jumping. Not only that, but his leg didn’t hurt to do it. It was holding him up and not rebreaking. This was such a major milestone for Neil.

For most kids his age, this was a time characteristically marked by a feeling of immortality. I work every day with teenagers who are immune to my messages about seat belts and condoms and designated drivers. This is the mind-set of the teenager and young adult: Other people get into accidents, fall, get hurt. This cannot happen to me. In their minds they will live forever. But here was my son who came so close to losing his life that he’s afraid of having a seizure, he’s afraid to
jump,
for God’s sake. He felt none of the invincibility that usually defines this stage in life.

Neil also wanted to help other people avoid what he had suffered, but he did it on his own terms. He didn’t join the SADD group at his high school, newly formed after his accident. He didn’t want to drop the first puck at a hockey game raising funds for a scholarship in Trista’s name. The Newburyport Police would all be there. Neil was certainly not ready to face the detective from the accident reconstruction team who wanted twenty-five hairs from his head.

He did help put together a video on underage drinking and drunk driving with his friend and mentor, Anna Smulowitz, to be used in the high schools and by local police to discourage those practices. He showed up in court infrequently but as much as he could, seeking just sentencing for the drunk driver from the judge. Even when he wasn’t physically there, he wrote his own victim impact statements for the judge. And he still wants to learn about other people with brain injuries.

One night Neil was visiting us and we all were watching a biopic on Mohammed Ali. At a commercial during the show, Neil said, “I hope Scal retires.” He was referring to Brian Scalabrine, the Boston Celtics forward who, that year, was sitting on the bench after suffering three concussions in one season. Neil understood the risk he would be taking if he returned to play: the risk that another concussion might be life-threatening. He was afraid for this player. He didn’t want him to take that risk. He can relate to people with traumatic brain injuries.

Neil has a friend named Emily whom he has known since the third grade. She was diagnosed with a brain tumor when she was a little girl. She was told at her local hospital that her tumor was inoperable, but her parents took her to Mount Sinai Hospital in New York, where they treated her despite all the risks. She survived. She is legally blind and walks with a limp and suffers crippling headaches at times, but she is Neil’s age and is alive.

Neil and Emily had lost touch with each other for a number of years until, a few years back, Neil heard Emily being interviewed on WBUR about her amazing story of survival. She was a freshman at Harvard University, majoring in mathematics. Neil called her up right away.

“I heard you on the radio,” he told her.

“I read all about you in the newspapers last year,” she said.

Since that telephone reunion, they have become good friends again. They share a love of music. Neil plays piano and guitar. Emily’s father is a professional musician. Emily sometimes played on stage with her parents, a popular local band called The Crocketts. Neil and Emily both love higher education and mathematics. When Neil fell in love with the book
Flatland,
a novel of mathematical fiction, he described it enthusiastically to Emily, who, of course, could not see to read it. Not finding it on books on tape, Neil spent an entire summer recording himself reading the book. He recently gave the CD he’d recorded to his friend.

They also share their experience of brain injury. Emily has suffered longer and harder than Neil, but Neil understands her in a way few others can.

Though he isn’t the same person he was before the crash, the “new Neil” is well on his way. He is enrolled in a PhD program in mathematics education and hopes the advanced degree will help him land a job teaching at another private high school or maybe even college. He has all kinds of hopes and dreams for his life
and talents to offer. He is looking forward to tutoring during graduate school. He wants to be a teaching assistant. He would like to be active coaching high school athletes or helping out with theater productions.