School of hard knocks: How to cope with the aftermath of a head injury

by Gareth Eyres / 05 July, 2018
Remy Grosso head knock during the first All Blacks France test in June.

France's Remy Grosso had a double face fracture after this tackle during the first test against the All Blacks in June. Screengrab / World Rugby

A chance encounter with clocks led Gareth Eyres to question the seriousness of several head knocks he'd had over his lifetime. He looks at the issue of concussion, whether Kiwis are doing enough to protect themselves and how to cope if you're unfortunate enough to experience a head injury.

It was the first All Blacks test of the year. The lounge at home was full. People were on the edge of their seats, as at the end of the first half we were behind on the scoreboard. Fingernails were being chewed, while delicious desserts were ignored.

Then, a dodgy call by the English ref left the French with 14 men, and characteristically, the ABs pounced. The speed of the already-fast game went up a notch.

Soon into the second half came the tackle that made rugby-hating Linda nearly spill her drink. Remy Grosso was wrapped up by All Blacks Sam Cane and Ofa Tu'ungafasi-one from the front, one from behind. Three heads cracked. It was a sound that could be heard in the kitchen. It was the sickening crunch of bone on bone that makes you wince - you know someone is going to be hurt. Linda reeled back on her chair, clasping her drink. Sam Cane staggered sideways, hand on head saying, ”I’m okay, I’m okay”. 

Grosso was not. He was rushed to hospital and found to have a double fracture to his face. Swelling on the brain left him unable to fly to home to France. Cane was unconvincing with his "I’m okay” and taken off for a Head Injury Assessment shortly afterwards. It was an ugly scene, with no apparent malicious intent, just the awful crunching effect of three big men travelling at high speed and colliding.

Sadly it happens quite regularly. And it’s not just rugby. These players are part of the 35,000 New Zealanders who experience a brain injury of some sort every year. It’s not just sports that injures Kiwi brains.  There are car and bike accidents, baby shaking, and - especially for toddlers and older folks - falls around the home.

For whom the clock ticks

I was on a photo assignment for North & South magazine when I was first made aware that perhaps I too, had experienced a head injury.

It hadn't been obvious to me until then that the three serious bangs on the head I'd experienced in my life had affected me, even in a small way. My friends may say different of course, some simply say I've been a pain in the arse for quite some time.
 
I was staying in a small cottage on a farm. It was a book-a-bach type situation. I was ushered in by the owner, shown where all the important things were, then she said, “Make yourself at home, I’ll be back in about an hour with your breakfast bits and pieces”.

I unpacked my computer, sorted through my camera data cards and sat at the Kitchen bench to edit the work I’d done that day. The farm-like surroundings were peaceful and warm.

It was then I noticed the ticking. Tick-tock, tick tock, tick bloody tock. There were two clocks in the living/dining area and one in the bedroom. The ticks from all three were not in sync, and in that late afternoon quiet became an earworm that I just couldn’t ignore. It was driving me nuts.

The lady of the house returned to find me working with two clocks lying on their fronts with their batteries removed and one buried under a pillow in the bedroom.

She asked, "What’s with the clocks - were all the batteries flat?”

I explained how their ticking was driving me mad and I’d just disarmed them. 

She cocked her head to one side and looked me in the eye. ”When did you get your head injury then?” 

It made me stop and think. Head injury? Sure, I’d been knocked senseless a few times when I was young and about 15 years previous had a really bad boot between the eyes playing soccer that had left me in a dark room for nearly a week because I couldn’t stand the light - but head injury? Nahhhh.

She went on to say her son had been in a car crash. He was okay physically, but he'd taken a bad bang on the head. He wasn’t rendered unconscious. ”He’s never been the same since", she said. "He used to be a top student – now he can’t concentrate on his work. His grades are failing. And he gets moody - he snaps at me like you wouldn’t believe. He has lost a lot of his friends. He just sits in the house on his own. And he can’t stand clocks ticking..."

We went on to discuss this at length, as the afternoon was pleasant and the woman was also.

She said something that was quite illuminating for me later. “I look at him and he physically looks the same. But he isn’t. He is a completely different person. He used to be sunny and outgoing, always active, always doing things.

"Now he complains of headaches, has no energy, and is really short with me and the rest of the family. He only seems to like the cat.”

I asked the question, somewhat optimistically. "Do you think he’ll get over it? I mean how long has it been?” She replied, “it’s been nearly three years now. If anything it’s getting worse…I just don’t know what to do.”

It sounded serious. And it set me to thinking.

There must be hundreds - perhaps thousands - of young New Zealanders who, in the national spirit of sport, adventure activities and, sadly, speeding in motor vehicles that must be in the same boat. Young people left broken and misunderstood.

The woman left me to carry on with my work, and I stowed the conversation away in my memory, for it was quite disturbing.

What if I was a different person after those bumps on the head? Would I know? Would I care? How much of a bang does it take to affect someone?

I’d soon get to know.

How a movie shone a spotlight on the issue

Say the words "head injury” in 2018 and it’s pretty much front of mind. Search "All Blacks. Head knocks." See how many hits you get.

Even actor Will Smith took the subject seriously. Smith eschewed his loose "Jiggy with it” persona and tackled the subject full on in his NFL-damning movie Concussion. (It’s currently screening on TVNZ OnDemand.)

If you haven’t seen the movie it tells of the true story of Dr Bennet Omalu, the Nigerian neuropathologist who inadvertently found himself in conflict with the American National Football League over his findings of players who had died after experiencing repetitive concussions. Omalu went on to discover the link between football players who had suffered repeated blows to the head and chronic traumatic encephalopathy (CTE). The big thing for me about the film is the obvious loss of self for the players. The classic statement ”What the hell is happening to me - am I going crazy?”

Dr Bennet Omalu.

This “lost” state was enough to make a number of them commit suicide.

The personal loss and repeated denials about the seriousness of the issue by the NFL – in effect trying to sweep the problem under the table - makes the story so poignant. Omalu had a tough time with the NFL and its standover tactics. After all, millions of dollars were at stake. In the end, Omalu’s findings were validated.

In a study conducted by Dr Ann McKee of 111 NFL players' brains (they were all deceased at the time) it was found 110 had C.T.E - all due to repeated blows to the head.

Compare that with the All Blacks in 2018. There have been well-publicised head knocks to important key players. Stars like Ben Smith, Ryan Crotty, Sam Cane and Beauden Barrett have all taken bad head blows over the last few seasons. Some more than once.

Wise words for young players 

The Rugby Coaching Toolbox Facebook page has some wise words to say about head injury.

“When a player has to miss rugby through injury, it is often one of the most difficult, and loneliest, periods to go through, but the modern game is a vastly changed landscape and sitting on the sidelines recovering is now part and parcel of the environment.

The old attitudes, like “you will be right tough guy, get back on the field” and the personal now defunct mantra “my team needs me, I can’t let a small injury let them down” have no place in the modern rugby environment.

The coach and captain need to be the principal drivers from the team perspective.

No longer should the doctor do anything possible to try and get a potentially concussed player back onto the field, it is now the responsibility of the medical team to remove any injured or concussed individuals immediately.

Senior members of the group must support this; there can be no dim view that players are ‘soft’ if they need time to recover.

Most important is that players need to put themselves first, for all of the talk of rugby being a team game, when it comes to injuries, there are plenty of I’s.

- I must recover
- I cannot play to my full ability while injured
- Concussions or injuries won’t affect my team, it will affect my family and friends
- I must look after my long-term health

Could you imagine those words being said 30 years ago on the rugby pitch?

Back then being a “tough bastard” was all part of the game.

There was the eye-watering event during The All Blacks versus France in Nantes in 1985 where Number 8 Buck Shelford had his testicles ripped open, sewn up and carried on with the game.

This seems to capture the mindset of the players of the time. It eventually took a knockout blow later in the match to finally remove Shelford from the game. “I was knocked out cold, lost a few teeth and had a few stitches down below. It's a game I still can't remember... I don't really want to, either," Shelford once said of the 3-16 loss.

Graham Charles was immobilized for six weeks after he was hit by a car while out riding. Photo / supplied

From dead on the road - to a full recovery

One day while training for the Lake Taupo Cycle Challenge, three friends were out riding along the highway close to Tokaanu in the central North Island. It was just coming on dusk. A good friend, Graham Charles, has limited vision in low light conditions. He doesn’t go anywhere without his Petzl headlight. The three guys were going for it and riding briskly. Graham didn’t see the grey car he rode into in the fading light. He flew over the top of the car and landed, spear-like, onto the tarmac. His helmet split first, followed microseconds later by his skull. He was dead on the road.

Luckily for Graham, he was riding with two ski patrollers who were also top Emergency Medical Technicians. They were also carrying a cell phone. One called up the Rescue Helicopter from Taupo (it pays to know folks in high places when it comes to getting hurt), while the other commenced CPR the on the seriously injured rider. The helicopter was guided into landing on the road and Graham was whisked away to Waikato Hospital inside the magical Golden Hour, the important 60 minutes post-trauma when the chances of the best recovery are possible.

I saw him on the ward a day later. The ever-busy outdoorsman was bed-bound, his head cradled in fine steel bars that were screwed into his skull, the ends of which were resting in a collar on his shoulders. His shaved scalp was sewn back together in a Y cut. He had two black eyes and some broken vertebrae in his neck. Not being rude, but he did look like a stand-in for Bela Lugosi in the old black and white movie Frankenstein. All he needed was a bolt through his neck and he was there.

As I walked in he rolled his eyes towards me. I expected the worse…was he going to be a vegetable? Could he talk? He sure as heck didn’t look that great. He spoke….“Hey - how you doing, thanks for dropping in”. Incredible, I thought. He talks! I cautiously sat beside him and he told me clearly what his prognosis was, how long he had to be immobilized for (6 weeks minimum) how nice his nurse was, and how much fun it was to be given morphine regularly.  He was normal! Graham was only cranky about not being able to move about - and how much daytime TV he could stomach.

Maybe time would tell, he could recover or go downhill. Luckily it was the latter.

His was an incredible recovery.

Graham Charles made a remarkable recovery after his skull was split. Photo / supplied

From the outside, he seems fine. I asked him if he noticed any changes in his life since the accident. He replied in the vein of “Not so’s you’d notice”. He’s gone on to be an accomplished author, photographer, polar explorer and family man.

How can a head injury be so different?

Here we had the young student in a car crash that had a knock and remained conscious - but his life was changed. Then another who recovered back from the dead, Lazarus-like, and went on to have a full adventurous life.

It’s complicated, obviously. Sometimes it’s all in the way the brain moves about inside the skull during collision. There’s front to back impact (in Graham’s case, straight vertical) where the brain is better-protected. It’s side to side where it can get really troublesome.

Physio Kevin McQuoid says the most common cause of serious concussions he sees is downhill mountain biking. Photo / Richard Spranger Photography

A sports physio with his own head injury experience

Kevin MCQuoid is a physio based in Pukekohe. For the past 25 years he has been involved with many NZ teams – All Blacks, Māori All Blacks, NZ juniors, Colts, Sevens (13 years including 3 Commonwealth Games) Hurricanes and recently the Chiefs.

What we are seeing now on the rugby field is not a new phenomenon. Head injuries have always been prevalent; it’s just the reporting, both at sporting body level and in the media, that has increased.

Kevin himself understands head injury.  As a rugby player he had a series of concussions. He can’t even remember his first senior game at age 19.

In 1995 things got worse. By then, he was aged 30. Kevin was T-boned whilst driving. The car that hit him was travelling over 100kph.

Kevin received a serious head injury, was placed in an induced coma for five days and was discharged after 10 days with no real post-injury care programme. Being the bloke he is, he returned to work six weeks after he was hurt. He ended up with over three months of post-event amnesia. Not only was his memory shot but so was his state of mind. He became moody, impatient, aggressive, and in his words ”I was a total arsehole for over two years - poor Kate!" (That's his wife).

He states his recovery up to now is due to his physical fitness, a drive to get back to work, and the support of his wife.

Through his clinic he has seen many head injuries over the years. It’s downhill mountain biking that he sees most of these days with serious concussions. Just think what those patients would be like if they weren’t wearing helmets.

Gareth Eyres.

The author, in good health. Photo / supplied

The case for a helmet

This winter thousands of us will take to the ski fields to make some turns and enjoy what New Zealand's snow scene has to offer. But how many of us will be wearing helmets? It seems ludicrous not to, seeing as high speeds, large rocks and slippery snow can lead to nasty accidents.

Recent medical studies have shown that wearing a helmet can prevent between 15 to 66 per cent of snow sport injuries. Helmets are no longer the unfashionable clunky items they once were, so there’s no real reason not to wear one unless you’re particularly vain about helmet-hair. A quick survey conducted at Ruapehu in 2013 showed that over 60 per cent of skiers and boarders were wearing head protection. The survey, which was published in the New Zealand Medical Journal, is a discussion about making helmet-wearing on the ski slopes mandatory, which would potentially reduce the number of winter sports injuries at little cost or discomfort to the user.

As one who had a very close friend injured while skiing, I’d highly recommend it. Your life could change in a bad way if you don’t.

Tips for coping after a head injury

So what can you do if you have a serious bang on the head? Answer – get help, and fast. Don’t ignore it. There are robust, fast, professional head injury assessments that will work out what level of injury you’re experiencing, and guide you to where to go next.

If it comes to a fight with your insurance provider, get support and good documentation from health professionals who know what they are talking about when it comes to head injury.

If you are in a bad way, and you have someone who can work as your advocate,  take them on. Don’t try to stagger through with a “she’ll be right!” attitude. I’ll tell you now - she won’t.

The road to recovery is fraught with hurdles that in a head-injured state are hard to negotiate. You will need someone to guide you through, be it a partner, parent or a trusted friend. Warning. It won't be easy for them or for you - so be kind to each other. Find yourself a team of health professionals that can look after you. It’s unlikely one medical practioner can cater to your every need. Find someone like Kevin who is a specialist in his field, and has a quiver of people at his fingertips who can help. 

And you can help yourself. Look to your lifestyle. Everything from diet, alcohol and caffeine consumption, screen time, continued sports activities and relaxation can affect your healing processes. Supplements like quality Omega 3 have been recommended to help.  Early intervention is important. Gentle exercise such as walking and brain training (contact your health professionals to find who can help with this) often show good results.

Don’t think, “It won’t happen to me, I’m big and tough. I’m careful”.

Trust me. It can.

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