Sometimes the stories we cover at ABILITY Magazine hit a little too close to home. In this interview with ABILITY editor David Radcliff, and ABILITY health editor, neurosurgeon Thomas Chappell gets to the heart of an accident that nearly cost Radcliff his life.
Dr. Thomas Chappell: Tell me about this head injury you recently sustained. How did it happen?
David Radcliff: Pretty quickly, actually. It was a Friday night and I was walking to a house where a bunch of my friends live together. I crossed a street I had crossed countless times before—and then, all of a sudden, I wasn’t walking anymore. I was on my back. I had been hit by a car.
Chappell: Do you remember being hit?
Radcliff: Not really. I must’ve gone unconscious immediately, because the next thing I remember, after I’d regained consciousness, is that I was lying in the street and there was a total stranger kneeling over me. I assume he was the driver of the car, though we still haven’t spoken because I was carted away and all of this paperwork stuff takes forever.
Anyway, I woke up and realized I wasn’t in any pain, which I found really surprising. It felt a little like being in one of those war movies in which a bomb goes off and you can’t really hear or make sense of what’s going on around you. There’s just a lot of stimuli, and you’re dazed. I was kind of disoriented.
Chappell: You had good reason.
Radcliff: I have cerebral palsy and use crutches to walk and, after the accident, I was surprised to find that my crutches were fine and were still near me. I got up on my feet again and, although everything felt kind of vague, I wasn’t hurting. I remember telling the ambulance medic, sort of stupidly, I guess, “I think I’m fine.” The medic said, “You’re bleeding from the side of your head. We should probably check you out.” So he led me over to the ambulance, and soon after that I was put in a neckbrace and onto a little stretcher thing and I realized they were taking me off to the hospital. One of my friends had tried to get into the ambulance with me, I think, and was not allowed.
As I was being driven to the hospital, the medics started asking me questions about, I don’t know, “What day of the week is it? What is your name?” And I could come up with some answers but not most of them. I had forgotten a lot of basic information, which was pretty spooky to me. Would I get it back?
My dad had died of brain cancer, which I remember telling them. It’ll be four years ago this week, actually, and so I’m very hyper-aware of brain injury stuff. Obviously I was concerned. I was bleeding from my left temple, and I knew that was a pretty bad place to bleed. I remember telling the medic that I have cerebral palsy, and I remember asking where my crutches were. For some reason I’d thought maybe they’d get left behind.
I also asked the medic, “Is this like what happened to Liam Neeson’s wife?” Because for some reason, one of the things I did remember was that Natasha Richardson hit her head while skiing, felt fine, and then died the next day. And when I asked the medic about that situation, I could kind of see him give me a funny look. I don’t even remember what his response was. I do remember I asked him if I was going to be okay, and he sort of gave me a generic, noncommittal response, just in case I wasn’t. (laughs)
Chappell: That’s a fairly typical story. I imagine he just looked at you quizzically because he wasn’t aware of the story of Natasha Richardson.
What happened in her case is actually a well-understood medical phenomenon. In that scenario, there was a substantial blow to the head, sufficient to fracture a thin bone on the side of the skull. This bone, found just in front of the ear, is called the temporal bone, and beneath it lies the temporal lobe of the brain. A major artery, called the meningeal artery, runs just under the surface of the temporal bone and can be torn when the bone is fractured. Often in situations such as these (as occurred with Ms. Richardson), the victim is initially knocked unconscious for a brief period but awakens looking just fine, or may even laugh and joke with the ABILITY 15 ambulance driver. Unfortunately, during this “lucid interval”, the torn middle meningeal artery is bleeding inside the victim’s head and is pushing the temporal lobe against the vital structures of the brainstem. If the blood clot is not immediately removed, the pressure it causes can rapidly lead to coma and death. In numerous cases, however, rapid ambulance transport to a facility where a quick diagnosis by CT scan can be done, an emergency surgery often results in the patient’s life being saved.
Radcliff: I realize it was kind of obscure that I pulled out that information about Natasha Richardson. I mean, I couldn’t remember how old I was—I think I told the medic I was 24 and I’m actually 27—but somehow I could remember Liam Neeson’s family history.
Anyway, I remember telling the medics that I felt nauseous on the drive—I think that was the last thing I’d said, actually—and I passed out. I don’t have much memory of anything for the next day and a half or two days. When my friends showed up at the hospital that first night, apparently I was really out of it. One my friends kind of jostled my leg to see if I was responsive, and I mumbled something to him, but neither one of us knew what I had said. I have no memory of these moments, but I’ve been told about them after the fact.
Apparently, I also had to be restrained to the bed with straps because I was struggling with the hospital staff. I’m pretty physically strong, I guess, and I broke the restraints, so they had to get different ones and try again. I really don’t like being in hospitals, and obviously was anxious to get out of there. But I don’t remember much until at least a day, maybe two days later, when my mom and my grandpa and my sister all came in.
Initially, when doctors in the emergency room called Nebraska and got my mom on the phone the night of the accident, they held the phone up to my head, apparently to see if her voice would trigger some kind of response. I couldn’t respond in anything but a moan. I don’t know if that was from sedation or what, because my memory of those initial days still hasn’t returned.
Chappell: That’s a fairly typical story as well. The reason you were straining against the restraints is also fairly common. People in your situation are often what we call “agitated,” and you had probably been sedated by the doctors and nurses when you spoke to your mother because you were agitated. But that’s a fairly typical story. How long do you think you might have been knocked out, initially?
Radcliff: When I got hit by the car? That’s still hard to say. At the time I came to, the ambulance had gotten there, so I was out for at least as long as it had taken for it to arrive. My friends actually didn’t know I was outside their house until ambulance lights had filled their living room and they thought something must’ve happened outside. It was a very odd experience for me, though, because there was no intervening time for me at all between my injury and the arrival of the ambulance. I remember I was walking across the street and then— boom—the ambulance was there. It was very immediate for me.
Chappell: You mentioned you remember the driver standing over you. That probably would have been after a few seconds. He would have gotten out of his car and probably would have run over to you within a few seconds.
Radcliff: I’d hope so. I don’t know how long he was over me waiting to see if I’d come to. I’m glad that he waited with me, though.
Chappell: He had probably used his cell phone to call the ambulance, I would presume. I’m guessing on all of this, of course.
Radcliff: Yeah, I’m just glad it wasn’t a hit-and-run, because then I’d have really been screwed. But he, aside from hitting me, apparently did everything he was supposed to do. (laughs)
Chappell: Were you on a sidewalk? Did he manage to hit you on a sidewalk?
Radcliff: No, I was crossing the street. I guess I just happened to have been there at the wrong time. (laughs) It was just a fluke thing. Really bad luck. Or, considering how quickly I recovered, good luck. I turned around a lot faster than the doctors had anticipated.
Chappell: Timelines are very interesting when it comes to memory after an injury. Which Friday night was this?
Radcliff: It was two Fridays ago.
Chappell: And when do you think after that you began to remember a lot of what you’ve just told me? Because you’ve just actually recounted a lot of details that I’m guessing you didn’t remember, certainly within those first couple of days. When do you think you started to recall some of that stuff?
Radcliff: Monday is probably when I first started to— it’s hard to say, actually, because some of the stuff I’ve recounted was told to me by friends, or was told to friends by people at the scene, so then it kind of feels like—
Chappell: —you remember it, but really you were told.
Radcliff: Yeah, in some cases. And some of the images are so vivid that it’s kind of hard to shake them, anyway. For example, all of the stuff about me having been strapped to the bed is stuff I don’t remember at all, but it’s striking. I don’t remember it, but that’s what I was told by the doctors.
Chappell: So that would have been within the first day or two. When did you go home from the hospital?
Radcliff: I was let go on Monday, I think.
Chappell: It’s a little unusual, in your case, that you actually remember a lot of the things immediately after the event. Those are usually the last things to return. And then you seem to have a little bit of gap between when you passed out again in the ambulance and when the weekend was over. How long did you say you were in the hospital?
Radcliff: I’m not absolutely sure, but I think I was let out on Monday.
Chappell: So you were there a few days. It’s a little scary in the sense that much of this is exactly what happened to Natasha Richardson. What you experienced is called a “lucid interval,” in which you’re initially knocked out, you wake up for a little while, and then, within the next hour, you lapse into a coma.
Radcliff: I dodged a bullet.
Chappell: What did the doctors tell you about your CT scan?
Radcliff: I don’t remember actually going through the scans, except for the one I did shortly before dismissal from the hospital. I think I did four or five CT scans during my stay, and my friends remember seeing me being wheeled off to do one. I had subdural and subarachnoid bleeding and, according to the doctors, there was a lot of progress in my brain’s ability to reabsorb the bleeding. I never actually saw the CT scan, which I thought was unusual. I figured they would have shown me that.
Memory after a head injury has a typical pattern. Most people never recall the details of the event and what happened immediately afterward. Also, the amount of memory loss is roughly proportional to the amount of time one spends unconscious. Typically, memory of events after the injury will come back gradually and incompletely, beginning with more recent events and moving to events which were closer to the time of the injury.
Few people ever recall the actual events around the time of the injury. In many cases, memory is not the only brain function affected by the injury. Depending upon the severity of the injury, patients may experience cognitive, sensory, or motor problems. Cognitive issues may include difficulty concentrating or accomplishing tasks that require complex thought (such as calculations). Sensory deficits may encompass problems with vision, hearing, taste, or even balance, as balance depends on sensation from the feet and inner ear. Motor dysfunctions may involve speech problems, or difficulty with various tasks that require the use of the arms or legs.
Other symptoms that frequently manifest after a concussion include dizziness, ringing in the ears (tinnitus), nausea, poor appetite, fatigue, and headaches. Most of these symptoms eventually resolve themselves, and there is no specific treatment for them other than to rest, drink plenty of fluids and take headache medication. These symptoms are not indicators
that something dangerous is going on inside the head.
Chappell: I always show the scans to the patients and the families, but not all doctors do. It’s a little easier to do now because we can bring computers into the room, so sometimes I bring my laptop in and show patients their scans. You can actually get a copy of your scan on a CD-ROM. All you have to do is call the radiology department at the hospital and tell someone there that you’d like to come pick up a copy of your CT scan on CD. They’ll prepare it for you.
Radcliff: I’m going back into the hospital in a few days for a check-up. I don’t know if they’re planning to do another CT scan then.
Chappell: They probably won’t.
Radcliff: I was treated at the LA County hospital at USC. That just happened to be the one I was closest to when I had the accident. They were really good. I was actually wearing my USC sweatshirt the night of the accident, which is kind of funny. Maybe that’s why they treated me so well.
Chappell: It would have been funny as long as the ambulance hadn’t taken you to UCLA!
Radcliff: Yeah! (laughs)
Chappell: So it’s been a little over a month now, not quite a month, since the accident. What’s gone on since you left the hospital?
Radcliff: When I left the hospital, the doctors had me on Keppra, which my dad was also on when he had brain cancer, to prevent seizures. I never had a seizure, but I was on Keppra for, I think, four days, and I was getting headaches pretty frequently—every morning for maybe a week. The headaches were rough. I don’t get migraines, but these were about as close as I’d like to get to one. The Keppra also affected my appetite, so I wasn’t eating much.
Chappell: Actually, the head injury was probably what was affecting your appetite.
Radcliff: Oh, really? I was just blaming the medicine. Anyway, I’m not getting headaches anymore, I’m not on the Keppra anymore, I’m eating fine. I was a little concerned that driving might make me dizzy. It didn’t.
Chappell: What about work? Are you able to do that?
Radcliff: Well, as you know, I write stories for ABILITY magazine, do interviews and edits, and I’m back to that now. Usually what I also do is come down to the office in Costa Mesa every two months, just before we put an issue out, so I can do page edits there. This time around, though, I’ve been talking with the publisher about whether or not I’d be able to drive down after my accident. Costa Mesa is about an hour’s drive from where I live. But I think I can manage it, and the doctors are fine with it.
I do a lot of writing and editing work, mostly freelance, and after my injury I was very concerned about whether I’d be able to continue to write at all. In the few weeks following my accident, I wanted to let all of my loved ones and friends know I was okay, and I was getting so many heartfelt messages and phone calls and e-mails, but I just didn’t have the energy to write everybody back. So I figured the best way to let people know my status was to put it up on my Facebook, and in that way reach hundreds at once. In a Facebook status line, you just get, what, maybe 100 characters? So that’s how I was keeping people informed. It was manageable. And now, thankfully, I’m back to a place where I’m writing just like I ever did, and I’m able to edit and go out and be productive.
Chappell: That’s where my questioning was going. I was trying to see if you feel this event has impacted your cognitive abilities at all. But you’re back to writing with your same level of creativity and sharpness?
Radcliff: That’s assuming it was creative to begin with (laughs). Actually, regaining my ability to write fluidly was one of the best developments in my recovery. I think in part because of my physical disability, which I’ve had all my life, my ability to write and express myself is extremely important to me. I’ve written, and have been encouraged to write, ever since I was young. If suddenly I no longer have that ability, that’s a big strike against me. If you can’t walk and you can’t write and you can’t form cogent thoughts—well, I’d rather not think about it.
Chappell: Given the extent of your injuries, you’ve actually made a fairly rapid recovery. I’d say it’s a very rapid recovery, overall. You said you’re 27, so your youth is in your favor. Do you feel that there’s anything about you that is still affected by this accident? Are you having any type of symptoms at all?
Radcliff: No, not anymore, although getting back to feeling truly like myself was gradual, even psychologically. It’s bizarre to think about how close I came to something really horrible.
After the accident, I was having muscle aches, and I had a lot of bruising on my elbows and shoulders and tailbone. No broken bones, though, amazingly. For about a week after coming home, I was walking at about half the speed as I usually do—which, granted, is rarely an impressive speed to begin with. So it took a while for everything to kind of ease back to normalcy.
But yes, everything works now. I had been taking it really easy for a while and was consciously trying not to push myself too hard. I’m not the kind of person to just lie around, and I get bored very easily, so it was difficult for me to adjust to just letting my body heal itself. I was feeling a little home-bound and stir-crazy. According to the doctors, my non-displaced temporal lobe skull fracture is apparently stitching itself back together, in a sense. That’s what I’ve been told.
Chappell: It’ll heal on its own, yes. It’s like any broken bone. If you break a long bone—like one in your arm— you have to splint that because it won’t stay still very well, but when you fracture your skull and it’s not badly displaced, typically nothing needs to be done about it. It’ll heal up on its own.
It’ll always be noticeable, though, in the sense that if you ever got a CT scan for any other reason, doctors would be able to see that a fracture was there and that it has healed. But it’ll just heal in place, so to speak. The interesting thing about all this is, again, is that this is exactly what happened to Liam Neeson’s wife. She had a fracture of the temporal bone, and you alluded to knowing that the temporal area is an area in which you don’t want to be badly injured. You were exactly right. When you fracture the temporal bone, it can actually tear an artery there. So you’ve been very lucky, because if that artery is torn, as it was in Natasha Richardon’s case, you can develop a blood clot that can be fatal. Fortunately, it didn’t happen that way in your case. You’ve made a pretty amazing recovery. Typically, somebody with subarachnoid hemorrhaging and subdural hemorrhaging on their CT scans has symptoms for as long as a year, sometimes longer. So the fact that you’re virtually perfect again is very good news.
Radcliff: I know. I’m kind of amazed, and I’m very grateful. So many people at the hospital were saying things like, “You don’t know how unusual this is, to see you come around so fast from circumstances like these.”
Around the same time that I had my accident—you’re probably aware of this—Bret Michaels, the lead singer of Poison, had a brain hemorrhage. I saw him talk to Oprah about it, talking about how he felt this little explosion inside his head. When he went to the hospital, the doctors said he had something like a twenty-percent chance of living. He’s apparently fine now.
Chappell: If I’m not mistaken, Bret Michaels ruptured an aneurism, which is a different situation from yours, but can be fatal as well. But I’m very glad to hear you’re doing so well.
Radcliff: I spoke to the neurosurgeon who had operated on my dad during his cancer treatment—this is a doctor back in Omaha, where I’m from—and he was able to answer some of my questions. He essentially said that the fact that I was able to have the conversation that he and I were having on the phone indicated to him that if anything were going to happen to me, it would have happened already. So I guess I’m kind of in the clear.
Chappell: Yeah, the big problems are typically right after the injury. From there, it becomes a question of how well someone can recover, and of course you’ve made a rapid and full recovery. Just so you know, these injuries are variable, and CT scans don’t necessarily predict much, in and of themselves. Often the biggest ct is how you do initially. In other words, it’s a question of whether you come into the hospital in a coma versus coming in mostly awake and agitated.
Radcliff: Thanks a lot for talking about this with me. It’s kind of interesting to hear about what’s happening to my brain from the outside, from someone who knows how it all works.
Chappell: No problem. Be careful out there.