Impact (50 page)

Ryan nodded. “I'll be as clear as I can. Three things happened to Mr. Donahue. First, he received a blow to the head severe enough to cause brain shift, that is, movement of the brain within its protective membranes and the cerebralspinal fluid. A portion of the frontal lobes became crushed against the skull, causing lesions and hemorrhaging.”

“What was the long-term result of that event, if any, Doctor?”

“There are two. Damage to the cerebral cortex has resulted in a degree of physical impairment, particularly on his right side. For a time Mr. Donahue couldn't move
any
of his limbs without assistance. Now he can use his left arm and leg and rotate his torso to some extent.”

“Is he confined to a wheelchair?”

“Yes.”

“Will he be so confined forever?”

“Possibly. The most optimistic forecast is that he will have to employ crutches and leg braces for life.”

“What is the second product of the damage to the frontal lobes?”

“That is more ephemeral. Through studies of the effects of stimulating or damaging various sections of animal brains, it has been learned that certain personality traits are governed, at least in part, by the frontal lobes. When damage occurs in that area, a person experiences what we call ‘frontal lobishness'—his behavior may be drastically altered, although the specific symptoms vary from injury to injury.”

“Does Jack Donahue display any such symptoms?”

The doctor nodded. “He is unmotivated and lacking in initiation, which is to say he doesn't start things on his own; he waits to be told to do something. He speaks only when spoken to. He is generally apathetic and prone to drowsiness, but he is also occasionally euphoric.”

“How do you mean?”

“He tends to overestimate his well-being. He also demonstrates a lack of inhibition from time to time. He perseverates, that is he tends to repeat what people have said to him; similarly, he suffers from echolalia—he repeats the last thing he heard. Also, he has emotional lability—mood swings, if you will—and there is always a chance that he will experience a catastrophe reaction, that is, a severe depression brought on by his realization of the dimensions of his disability. This is very common with head injuries.”

Ryan shifted in his chair. “At this point I should say that nothing about the brain is simple, which means diagnosis cannot be precise. Often the full consequences of a head injury are not apparent for many years. Brain functions are complex and interrelated, so the conditions Mr. Donahue has experienced may also result, in whole or in part, not from the damage to the frontal lobes but from the more permanent damage that was done to his brain.”

“Which was?”

“As I mentioned, Mr. Donahue's skull was pierced by a knitting needle, which passed through the frontal lobe and penetrated to the portions of the limbic system known as the hippocampus and the amygdala.”

“That's in the interior of the brain.”

“Yes. About three inches from here, in the direction my finger is pointing.” Dr. Ryan pressed a finger against his head.

“What is the consequence of that injury?”

“The primary consequence is that Mr. Donahue suffers from global anterograde amnesia. That is, he has lost the ability to store and recall newly acquired information for any length of time. The technical term is postencoding consolidation deficit. In practical terms, it means that Mr. Donahue's ability to form long-term memories has been destroyed.”

“You mean he can't remember anything at all? Who he is? Where he is? Nothing?”

“That's not quite it. He simply can't remember anything that occurred after the crash. I should note that he suffers a slight retrograde amnesia as well—his memories of approximately two years before the crash have disappeared, too. Basically, anything that happened before 1985, Mr. Donahue remembers. He knows his wife, his old friends, his address, things like that; but anything that happened to him after that year has vanished. And anything that happens to him now, he retains no memory of for even as long as an hour.”

“Will this condition last forever?”

“I'm afraid so. The damage to those portions of the brain was extreme. All cases on record of similar injuries show them being permanent.”

“You mentioned a third result from the crash.”

“Yes. Because of the fire that broke out in the cabin, Mr. Donahue was deprived of a requisite amount of oxygen for a time. That anoxia very likely contributed to both his memory and emotional problems, by damaging the hippocampus. As I said, the brain is vastly complex, and our understanding of it is partial, at best. I could talk for days about what I think has happened to Mr. Donahue, but it wouldn't be particularly helpful. All his problems are interrelated. And all of them are a result of the crash.”

“You say, Doctor, that Mr. Donahue has lost his memory. That has psychological aspects as well, does it not?”

“Indeed. Anterograde amnesia makes the victim in some respects like a ghost. He has consciousness without content—he can't remember what he has just done, who he has just seen, why he is where he is, what he was doing five minutes earlier. He can't watch TV, because he forgets the plot before the show is over. He can't make new friends, because he never remembers having seen the people before. Victims of this dysfunction often lapse into a leaden state, to the point that they do virtually nothing without stimulus.”

“It seems impossible that a person like that could hold a job.
Any
job.”

“I think that would be fair to say.”

“It also seems it would be very painful to look on someone you love who was put in that state.”

“I would agree. Unquestionably.”

As Tollison nodded and consulted his notes, Hawthorne looked at Brenda. The last comment had been noted and filed for future reference.

“Earlier you mentioned the Glasgow Coma Scale,” Tollison went on, unaware of the fury at his back. “Please tell us about that.”

“The Glasgow scale is a standard tool of neurological evaluation. It measures the level of unconsciousness based on stimulus and response.”

“What was Mr. Donahue's score on the scale?”

“When he arrived at the hospital, we put him at five—he failed to open his eyes, exhibited decerebrate posturing, and uttered incomprehensible speech.”

“What's the significance of that finding?”

“A GCS of less than six carries a high likelihood, over sixty percent, of early death. In that respect, Mr. Donahue beat the odds. However, a GCS of less than nine carries a similarly high risk of long-term cognitive sequelae.”

“He will suffer long-term impairment to his mental capacities?”

“Yes.”

“Are there no therapies available to help him?”

“Fortunately, there are. He has already begun speech and physical therapy and has undergone preliminary levels of evaluation such as the Galveston Orientation and Amnesia Test, the Wechsler Memory Scale, the Purdue Pegboard, and the Peabody Individual Achievement Test. Mr. Donahue will improve from his current levels of cognition, undoubtedly. With new computer programs such as the Einstein Memory Trainer and REACT—which stimulate basic skills such as visual tracking, information processing, and pattern recognition—he can be expected to advance further. But it will be a slow process at best and will not be accomplished without a great deal of sacrifice and effort by Mr. Donahue and by those who love him.”

With the final phrase, all eyes turned to Laura. From his place in the crowd, Hawthorne winced. Laura's love for her husband was best unmentioned, yet Tollison and his witness had just done so for a second time.

“What is Jack's current level of development, Doctor?” Tollison asked

“On the Levels of Cognitive Functioning Scale, I put Jack at level five—confused/inappropriate/nonagitated.”

“Can you define that more specifically?”

“Yes. Mr. Donahue responds to simple commands, but in nonstructured environments he is random and fragmented. He is easily distracted and lacks ability to focus. Verbalization is often inappropriate and confabulatory, his memory is severely impaired, and he can't learn new information.”

“Thank you, Doctor. I have one last point.” Tollison drew himself to full height. “I ask you now what you believe, to a reasonable medical certainty, was the cause of the injury to Jack Donahue's brain.”

Chambers hurtled to his feet, objecting as he unbent. “We offered to stipulate to the doctor's medical prowess, Your Honor, but we did not stipulate to his powers of clairvoyance. Dr. Ryan was not on the plane and he was not at the crash site. There is no foundation for such testimony from this witness.”

Tollison approached the witness box. “If I may, Your Honor, perhaps I can provide a basis for the testimony.”

Judge Powell nodded.

“Dr. Ryan, you are called upon in your work to assess the etiology of injury all the time, are you not? The cause of a medical problem?”

“Of course.”

“The genesis of an injury is one of the considerations that goes into the formulation of a program to
treat
that injury, is it not?”

“Often. Yes.”

“Your Honor, I submit Dr. Ryan's testimony is within the bounds of professional diagnosis and treatment.”

Judge Powell nodded. “I concur.”

Hawthorne suppressed a grin. Chambers hated to lose such exchanges. When he did he got mad, and when he got mad he made mistakes. What had bought Hawthorne his mansion in Belvedere was the fact that in aviation litigation, mistakes can cost millions.

Tollison clasped his hands at his waist. “Dr. Ryan, what caused Mr. Donahue's brain injury? If you know.”

“As I mentioned, my examination indicated that Mr. Donahue had been subject to severe stresses, substantial forces impacting his body both front and back. That is, his head and shoulders seemed to have both struck and been struck by solid objects, with tremendous force. The arms were extended to cushion the blow, as though he knew it was coming, but the momentum was so strong the bones fractured in the effort. His foot was crushed. Consistent with this pattern, I conclude that in the course of the crash Mr. Donahue was thrown into an immovable mass, that he both struck and was struck by various solid objects, and that among the objects he struck was the knitting needle, which, because of the forces involved and the angle of the needle at impact, was able to pierce his skull.”

Tollison nodded. “Is your interpretation of the cause of Mr. Donahue's injuries consistent with the suggestion that his seat came loose from its anchors at the time the plane struck the trees, and he was hurtled forward like a missile at a speed of one hundred miles an hour until he struck and was struck by other seats and baggage and debris that were simultaneously being flung against the forward bulkhead of the plane?”

Chambers was livid. “Your Honor, this is the purest fantasy, quite obviously a vain attempt to fill the gaps in the plaintiff's crumbling case.”

Judge Powell seemed to think this one over. Tollison held his breath. “I'm going to allow it, counsel, though it's close,” Powell concluded finally. “Once again, I remind the jury that they are not bound by any opinion given in this case and are free to give opinions what weight they deem they deserve. You may answer, Doctor.”

When Ryan hesitated, Tollison prompted him. “I ask again, Doctor. Were your observations and diagnosis consistent with the event I just described?”

“Yes.”

Tollison did not quite suppress a smile. “Thank you, Doctor. No further questions.”

Judge Powell glanced at his watch, then peered across the bench. “Cross-examine, Mr. Chambers.”

As Hawthorne smiled inwardly, Tollison sagged into his seat, clearly exhausted by his effort and relieved that he had established all he'd hoped. In the next instant, Hawley Chambers donned a carnivorous smile and marched to the center of the courtroom. “Doctor, you've given a rather apocalyptic view of Mr. Donahue's condition. But it's really not that bad, is it? For example, you said there would be no residual harm from the broken arms, but there might be residual disability from the broken foot. It's possible, isn't it, that all Mr. Donahue might have is a limp?”

“It's possible.”

“And even that—with the help of exercises to strengthen and retrain certain muscles—might disappear in time?”

“Perhaps.”

“As for the lungs, Mr. Donahue won't be able to run a marathon, right?”

“Right.”

“Has he
ever
run a marathon, to your knowledge?”

“Not to my knowledge.”

“Is there
anything
he did on a regular basis prior to the crash that he won't be able to do now because of the damage to his lungs?”

“I'm not that familiar with his former routine. He will be more prone to pulmonary stress, certainly.”

“Did Mr. Donahue smoke prior to the crash?”

“I believe he did.”

“So his lungs were already less than perfect.”

“Yes, but there's no doubt there was damage beyond any existing disease.”

“Let's get to the brain, Doctor,” Chambers continued. “It's quite an amazing organ, is it not?”

“That's putting it mildly.”

“You've devoted your professional life to its study and repair, if that's the right word.”

“Yes, I have.”

“Tell me, Doctor. There are instances on record, are there not, where extensive brain damage has occurred and the victim has gone on to lead a perfectly normal life?”

“That depends on what you mean by extensive. And normal.”

“Let me be more precise. There are cases on record where a hemispherectomy has been performed—
half the brain was removed
—yet the victim lived and functioned. Is that not correct?”

Ryan nodded slowly. “Thanks to the new lumbar puncture and shunting techniques, hemispherectomies are starting to be performed to relieve progressive seizure disorders. But this is done only on younger persons, whose powers of recovery are substantial. Adults who suffer strokes that destroy half their brain invariably die or are impaired significantly.”