On December 9 1987, an event occurred which permanently altered my life. I was twenty-seven years old, engaged to be married soon and two days shy of moving into an apartment with my fiancée, Denise. We had given two months rent and security, a substantial outlay of funds, which caused me to postpone joining the union at my job and getting full medical/hospital insurance. This proved to be an unfortunate and costly choice.

While bicycling home from work, I was struck by a small pick-up truck, which dragged me at full speed for approximately 100 yards. I sustained a basal skull fracture, bilateral temporal fractures, and the majority of my facial bones were broken. The EMS paramedics took great care of me, and saved my life. They inserted an endotracheal tube and breathed for me. I was taken to Kings County Hospital in critical condition. I had sustained a coupe contra coupe injury, a shearing brain injury; I had an intraventricullar bleed on one side and an intracerebral bleed on the other. I was comatose and the doctors were telling my family they did not know if I lived, how functional I would be. One of my friends clearly recalls a male, Indian doctor weeping in the emergency room when he realized that the severely damaged person before him was someone he knew as a young boy. My intracranial pressure was dangerously high and was compressing my brain. The doctors wanted to lower the pressure by inserting an intracranial catheter, and if that did not significantly reduce the pressure, they would have to operate. I was in intensive care at Kings County Hospital for about two weeks. When I was hemodynamically stable, I was transferred by ambulance to Montefiore Hospital where my sister, Lauren, was on staff as an anesthesiologist and able to provide extra care. My family was grateful for the way the trauma center had saved my life, but was upset with Kings County Hospital’s lack of cleanliness and good daily medical care.

When accidents such as mine occur, there are many casualties. There is, first off, the one who is directly injured, but the family and significant others are also injured in a myriad of ways. Families are interdependent, cooperative units in which the needs and wants of one are affected by the needs and available resources of another. The importance families place on different needs varies with time, age of the members, and change of the familial constellation. Different families assign varying levels of importance to different needs, as does a change in circumstances. In meeting the challenge of disability or chronic illness, there are eight basic areas of needs that can be categorized: 1) economic, 2) health and security, 3) physical care taking, 4) social, 5) recreational, 6) affectional, 7) self-definitional, and 8) educational requirements. Having a member with a disability, or dealing with a traumatic event or accident, intensifies some needs and minimizes others. At these times some needs of the caregiver tend to be either ignored, or not accorded the same importance as before; we triage needs. Needs change over time, and likewise change according to the circumstance. This was clearly illustrated in the circumstances and the reactions this accident caused in all our lives then, and now. Grappling with and finally accepting my disabilities was an arduous process for my family and myself. It surely changed, in many ways, the way we look at life.

I was comatose for approximately six weeks. Awakening from a coma is a slow sequential process, a continuum of events. I progressed from showing no response to any stimuli - to only a quickening of heart rate to painful stimuli - to eye opening in response to pain - to eye opening in response to verbal stimuli - to making guttural verbal utterances - to speaking partial, albeit confused or incoherent sentences. It is a rather difficult, tiring and taxing thing to observe and be a part of. My sister dealt with it by retaining her professional detachment and hiding behind this; my mom by fully immersing herself in her son's care. My fiancée had a difficult time seeing the man she loved and was to marry reduced to a dependent, disabled person. The uncertainty of whether I would have a complete recovery was frustrating. She did not do well with the hospital routine or this sudden change in our relationship to each other. "With one phone call, everything changed, my whole world was turned topsy-turvy. All our dreams and plans were erased", said Denise.

My memory of this whole experience does not really begin until two months later, in February. I have wisps of memory of being in a hospital room in a bed; then of being tied in a wheelchair so I would not fall; then more concrete images. Both friends and family members have told me that it was frightening to see me like this: a once intense, intelligent, curious individual who had regressed to a quiet, unsure, confused person with little sense of self. The most unsettling thing for me was the complete emptiness in my mind. It was as quiet as the attic room in an old deserted house, with the window open and a slight breeze blowing through the curtains. It was not physically painful, but was quite unsettling - all the more so because of the magnitude of emptiness. Disturbing, because I knew somewhere deep down that this was not right, that it should not, and had not been this empty before.

I recall, upon awakening more clearly, people sharing anecdotes about things we had done and relating stories regarding experiences we had shared. "I remember the time we did..." or "Bob, recall when you did..?!" I'd nod and smile and perhaps get this vague recollection. Not that I'd recall the actual event, more often than not, I wouldn't; most likely it was gone forever, as if it had never taken place. I did, however, recollect the role of the individual being described. I was beginning to recognize that I was this being: Bob Plante. Now, all I had to do was be him again. Except, I hadn't the faintest clue as to how to begin doing that. The clear-cut definition of self that I had lived with for years, no longer existed. A poignant illustration of the change in definition of self can be seen in the following incident. My sister relates that I began pointing to myself and saying "Bib." My family would smile and say, "yes honey but not BIB, it's Bob." They were relieved that I had some sense of self. They thought that I was just not saying my name correctly, but they were happy that it was damn close, and it was the idea that was important. This went on for some time and despite the constant corrections, I kept addressing myself as BIB. Eventually, my sister, having decided that this had gone on too long, said to me, very patiently:" no little brother you're Bob not BIB." She says I looked her square in the eye and with a composed look, said "Bib: Brain Injured Bob."

My sister was extremely encouraged because my attempt at self-depreciating humor, while showing my anger, sadness and frustration was an indication of good cognitive function, as humor requires a high cortical capacity. My ability to construct an acronym and my self-depreciation involved very high cognitive function. An interesting response to the brain injury sustained in the accident was that I created an intense personality "split". I had a very close and platonic friendship with a woman named Andrea at the time I was engaged to marry Denise. My name, Robert, was used in official documents while my friends and family called me Bob. What I did was to set up a unique situation in my mind where Robert was engaged to Denise and Bob was engaged to Andrea. This, I think, is a fascinating study in adaptation. It is a marvelous illustration of an individual coming to terms with a perceived change in definition of self. An individual's definition of self has many strata. There is the innate nature of the person, but their beliefs and self-image change constantly in response to changing situations. These may not be grave swings, but there are changes. When faced with traumatic circumstances we adapt by changing our perceptions of, or definition of ourselves and/or the world. The Bib/Bob - Bob/Robert episodes are examples of adaptive mechanisms to a changed definition of self. It was so hard for me to accept what had happened and what disabilities I had incurred that I separated into two people as a protective mechanism. What it means as to why I assigned which woman to which part, I do not know, and any deep analysis is better left to someone more qualified.

For me, my definition of self was greatly affected. I was the golden boy. `I was invincible, and my prior experiences verified this. I had fallen from a third floor window straight to the floor and had only broken three ribs; I had dived into shallow water in Martinique and sustained a C5 fracture without any lasting side effects. Well this accident woke me up to reality. No longer was I the golden boy. I was blind in one eye, had lost my sense of smell, had a left hemiparesis with extremely limited ROM, my speech was severely compromised and often, especially if I was excited, it was difficult to understand me. My memory was affected, at times it was hard to concentrate, and learning was difficult. Because of cognitive difficulties, I have to study much harder now than I ever had to in the past to understand simple concepts. No longer was I this glib, self-assured articulate bright wunderkind. I was not Bob I had become BIB.

I have mentioned self-definition regarding myself, but what of the family - how was their definition of self-affected by the circumstances, and by their relationship to me. Self-definition in relationships is a two-way street. Our definition of self affects how we act and therefore how others respond to us, which in turn affects how we act in response to them and a cycle is created. For my mother, her sense of self predicated upon taking care of me. Her sense of self and her needs became secondary to mine. No longer was she an active and social person. She was preoccupied with visiting and caring for me, even when my needs were fully taken care of by the medical staff at the facility where I was recovering. Her definition of herself as a caring parent dictated that she be there constantly. Lauren became the champion and fierce protector of her little brother. The medical field was her ballpark and she warmed to the task. She used her contacts in the hospital and medical community to get the best care. Her sense of self worth was also caught up in being thoroughly involved; if decisions were to be made about her little brothers care, by God she'd make them so the right ones would be made. She traveled out of state to visit many rehab centers before choosing Mediplex in Camden, NJ, a location difficult and expensive to reach for my family and friends who visited as often as possible. My mother, an RN and my sister, an MD, channeled their anxiety about my condition and the powerlessness they felt into networking medically, and to some extent, this empowered them. Denise was not a medical professional, did not share this commonality with them and did not have this as an outlet. Emotionally this brought up some old feelings and remembrances of when her father, also named Bob, was hit by a car and had to have his leg amputated. He had a speech impediment, and now my speech articulation difficulties because of my trigeminal nerve damage, were quite reminiscent. Once again she was faced with the lack of control and the accompanying familial distress over the health of a loved one, and the resemblances were frightening.

My adaptations and constantly changing definition of self also affected her. The whole Robert/Bob episode was upsetting, and she relates that with my head injury the accompanying changes in my mental status were often quick, and didn't leave her time to react "My life was turned upside down and I couldn't find the floor, it was hard to get my bearings." When family members face the challenge of dealing with the illness of a loved one, the helplessness they feel is partly derived from their lack of control over the situation and their inability to alter the circumstances. If they could, they would trade places with their loved one to take their pain or disability away, and take it upon themselves. But of course they cannot. All they can do is be with them, love them, pray for the best, and wait. Yet somehow that never seems enough.

In my family, hopes and expectations were not limited. The love and support were amazing. They did endeavor to view me as a person first and a disabled person with special needs second. But to totally separate the person from the disability is difficult, especially if the disability is acquired in mid life. They often may unconsciously compare you with the "you" you were before. I did not feel them do this, but I know I did. I constantly struggled with seeing myself as a disabled person first and a person second. My mom states, "Honey, you were dead and you came back to us, we compared having you to the absence created when you left." The health, economic and security needs of this family were absolutely affected. The emotional and physical toll on our family was extensive. As I previously mentioned, I had delayed joining the union at my job and receiving full medical insurance so that Denise and I could put rent and security down on an apartment. This proved costly. The medical bills were staggering. I was able to qualify for Medicaid to defray the costs. Denise had just started a new job and so was not given much freedom to juggle her schedule and was not allotted much time off to visit me. My sister was told that the anesthesia residency she was doing could not accommodate her lack of available time and she would have to be available more often or give up the residency until a later date. The choice was hers. There was no choice. She gave up the residency. Fortunately the hospital worked with her and she managed to accomplish both the residency and take care of, as she affectionately called me, her "roadkill" brother.

In the aftermath of this accident, I went from acute care hospitals, to an inpatient rehabilitation center that specialized in head trauma, to an outpatient cognitive rehabilitation center. In my long trek through the health care system the staff at the institutions addressed many of my needs. A family's interaction with health-care workers is an integral facet of an individual’s care. My situation is anything but ordinary owing to the status of my family as health professionals, and specifically my sister being an MD on staff at the facility where I was hospitalized. Here, my situation differs from the norm because in addition to my sister being on staff, my mother is an RN and professional courtesy was granted. I’m sure the hospital staff extended more consideration and time to us as a result. However, the consistently unpredictable nature of my condition made life for the family difficult.

One of the areas of basic needs categorized in meeting the challenge of an illness or disability is the need for recreation. There doesn’t seem to be much opportunity for it when dealing with an illness or disability. Some needs of the client and the caregiver are ignored or not given the same importance as before. But the need for recreation for both the client and the caregivers must not be ignored. For us to work at our best levels we all need time off, we need to recharge. The clients often have recreation built in to their schedule. The caregivers need to recognize the importance of taking some time for themselves. This will translate in them having more to give their loved one. Honoring your needs empowers you.

In my case, with regard to recreation, there was not very much of it - between juggling jobs and hospital visits everyone was very busy. Undergoing a determined recovery and physical therapy program, my recreation was postponed for a very long time. When I finally came home from the rehab center, my mobility was so reduced that although I was ambulatory with a walker, it would take me a long time to get anywhere. Also, I would tire very quickly and this strongly hampered any socialization plans I had. This was in great contrast to someone who, pre-accident, was very athletic and always moving. All the biking and sporting Denise and I did would have to be postponed. Worse yet, due to my limited mobility, I was mostly confined to my mother's home. Once again, definition of self is affected.

Our close relationship got my family through this grueling two-year period. My family has never had any problem showing or asking for affection. And I thank God for this. For if I ever needed affection it was at this time. And if my family ever needed affection and shoulders to cry on or someone to scream to, they found it. We are incredibly fortunate to have each other and our friends, who were there for us and who shared our rage and pain.

Any sexual needs Denise or I had went beyond the need for the sexual act. Yes that need was present, but also present was the need for closeness that had vanished in the clinical rehab process. We needed time to be alone together, to hold one another and to dream together again. On her part, she needed to have me close, to keep me safe, for her to feel safe – to feel that everything is okay. I too had the need to believe that everything was okay, and I also had the difficult task of dealing with losses and changes incurred. Denise also had to deal with the changes that had occurred to me and to her and to our relationship. The sexual act was a way to break through all the layers and to be together - just she and I. For me, the need for acceptance, support and affirmation were at times channeled into a sexual need, because this represented attractiveness, worth, acceptance. Again we see the manifestation of definition of self. And some of my behavior may have been due to some damage that suppressed my inhibition and societal restraint.

As for education, my sister completed her residency and continued pursuing her career goals with more determination. For me, after being at Mediplex for three months and completing the six-month cognitive rehabilitation program at ICD, I decided to continue with my education at Brooklyn College. After not having been in school for ten years, since 1980, I took two classes -Abnormal Psychology two days a week & Sociology on weekends. This was interesting because I was an EMT who had planned to study for my paramedic license, before the accident. But now with my reduced mobility, and blindness in one eye, I felt that I would be better off with additional education. After going to college for a while, I realized that through my firsthand experience and personal insight regarding disability, I could make a very valuable contribution in helping others regain function and deal with their disability. What a marvelous way to give back to those who helped me. This spurred my desire to be a physical therapist.

After years of hard work and the assistance of several people, I graduated from Long Island University with my MS in Physical Therapy. It may have been harder and taken longer than it would have had I not had the head injury, but that is unimportant. The same drive and determination I employed in my rehabilitation, I utilized in my scholastic endeavor. It was just one more goal. Presently I am a physical therapist working in the TBI Unit at Jamaica Hospital and I consider this a marvelous forum for the utilization of my experience as a TBI survivor. I use this as a means to make an impact in the treatment and rehabilitation of persons who have sustained a traumatic brain injury, and in the communication, insight, and the hope this can give them and their families. I consider myself fortunate to have this opportunity to fully utilize my experience.

My experience as a TBI survivor imbues me with a unique perspective with regard to traumatic brain injury, and the accompanying hospitalization and rehabilitation. I have a greater understanding of the changes that accompany their injury from the alteration in how they see themselves, in what they can and can no longer do, the frustrations and grief that accompany these experiences. I understand the sudden jump from tolerant understanding to irritated intolerance an individual develops because I’ve been there. It’s wonderful being able to share with a patient and their family that yes, I truly do understand; I am no stranger to the frustrations and the challenges they face. The patient’s physical therapist being a TBI survivor also forges a bond between us that can assist with their therapy. Because I’ve had this kind of experience, I can understand if not the specific difficulty, the larger aspect of having undergone a traumatic life-changing event. I can share with them some of the compensatory strategies I’ve developed and aid them in developing their own. In my situation, with my disabilities, I needed to squarely face any cognitive and physical difficulties I possessed to find ways to compensate. This aspect was particularly important with regard to schooling. It wasn’t as easy to learn. I found myself becoming more creative because I had to learn to think outside the box to discover how to do things differently because the standard ways no longer worked. At times I still struggle in dealing with my disabilities.

Personally, since my TBI, while I’m the same person, I’m not the same. I’m different. Not better or worse, but most assuredly different in many ways. I don’t just refer to the disabilities I’ve incurred; I've gained a better understanding of myself. I’ve learned volumes about my strength, my resilience and tenacity. My experience has shown me so much about my family, my friends and myself; and about how much love surrounds me. These are priceless revelations. I assist my patients in recognizing those aspects in their own experience.

The needs individuals and families have varies according to many factors: socioeconomic status, race, religious beliefs, and cultural factors, to name a few. The type of disability and the age acquired also impact on the type and amount of needs. I've mentioned before that needs change in response to various circumstances, a traumatic accident being one. The type of injury also dictates which needs are emphasized. In respect to my accident, owing to the head injury, the neurological trauma, and the age of onset, the overwhelming need for me seems to have been that of definition of self.

Families are interdependent units in which the needs of one influence the other members. The conditions of one member affect the behavior, the way members view the world, and influences what they find important. Some families are brought closer together in how they adapt to and provide for the member with the disability. Other families may be split apart by the anger, pain, guilt, sadness and helplessness they feel regarding the plight of the individual. All these factors come into play and affect all family members. Very often, both of these outcomes may occur. At different times, members may find themselves going from one issue to the other, but usually they will resolve into one outcome.

In my case, you see how both of these scenarios occurred. Denise and I found that the pressure of the situation and the accompanying problems, such as the disruption in our plans, and the roles that we played with each other were overwhelming, so we split up. This experience, while I refrain from saying broke us up, showed us many things about the other that were hard to deal with. It was a grueling situation that put us both under a lot of pressure. We remain friends, acknowledge how dramatically the experience affected us and also showed us our differing and incompatible needs, wants and abilities. On the other hand, the relationship between my mother, sister and myself deepened. We were all brought closer together and became more conscious of how much we love one another and how valuable we all were to each other.