Head Lines: Rebuilding a Brain

By Pheasant Orpen Reid and Susan Orpen

Pheasant describes in an immediate way the experience of being in a coma and out of her body. She learns how everything in life is her choice, whether to live or to die, when she chooses to live, and that everything in her life has to be relearned and rebuilt. Join her and her mother, Susan, an accomplished artist, in the story of how she had to begin again. Read about the challenges and triumphs of recovering from, and living after, a traumatic brain injury.

• Language: English
• Publisher: Balboa Press
• Release date: Dec 21, 2018
• ISBN: 9781982215088

Pheasant Orpen Reid

Pheasant is nineteen years old and is studying a diploma in Equine Sciences in Pretoria, South Africa. During the practical year of her studies she has a near- fatal fall from a horse. Written ten years after the accident, Pheasant involves the reader in each moment of her recovery, the highs and lows, and ultimately shows us what we can all overcome.

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Copyright © 2018 Pheasant Orpen Reid and Susan Orpen.

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The author of this book does not dispense medical advice or prescribe the use of any technique as a form of treatment for physical, emotional, or medical problems without the advice of a physician, either directly or indirectly. The intent of the author is only to offer information of a general nature to help you in your quest for emotional and spiritual well-being. In the event you use any of the information in this book for yourself, which is your constitutional right, the author and the publisher assume no responsibility for your actions.

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ISBN: 978-1-9822-1507-1 (sc)

ISBN: 978-1-9822-1506-4 (hc)

ISBN: 978-1-9822-1508-8 (e)

Library of Congress Control Number: 2018912944

Balboa Press rev. date: 12/18/2018

Contents

Preface

I

II

III

IV

V

VI

VII

VIII

IX

X

XI

XII

XIII

XIV

XV

XVI

XVII

XVIII

XIX

XX

XXI

XXII

XXIII

XXIV

XXV

XXVI

XXVII

XXVIII

XXIX

XXX

XXXI

XXXII

XXXIII

XXXIV

XXXV

XXXVI

XXXVII

XXXVIII

XXXIX

XL

XLI

XLII

XLIII

XLIV

XLV

XLVI

XLVII

XLVIII

XLIX

L

LI

LII

LIII

LIV

LV

LVI

Afterword

Dedicated to my Dad and dearest friend, Redmond Orpen. 1927-2018

With all Mum’s and my love

Preface

In February 1999, when my daughter was lying unconscious in a Johannesburg state hospital with a brain injury, I started writing a daily letter to her so that, when recovered, she would be able to read what happened. The daily writing became a coping mechanism for me as our family groped for hand-holds in the trauma of her crisis and recovery.

Eight years after her accident, I read these letters to her. She had been writing a diary herself since June 1999 as a way to stimulate and retrain her short-term memory. She and I decided that she would reconstruct memories of her experiences in hospital and of her recovery, and that these could be interspersed in appropriate places between my letters, and that I would write short pieces to provide a larger context.

This is how the book emerged. Pheasant has always wanted to ‘help people’ and we hope that this account of her fight back to normality after Traumatic Brain Injury will help others who are living through this horrible experience.

I

We sat in a corridor for a long time. It was not very clean. Nurses walked back and forth talking loudly. I closed my eyes, and the image of her was there; white, waxy, remote, responding to nothing. Like a marble effigy in St Paul’s, I thought. Smell of cold stone, and echoes of whispers in the great domed space.

I comforted myself for the hundredth time. Nothing is broken. There’s no blood except from the ear. Her face only has bruising. She’ll soon wake up.

Then I wondered, why the helicopter?

It was hot. My stomach felt nauseous from sipping warm Coke from a tin. I looked at Redmond sitting next to me. We could not talk. Only, we could search each other’s faces, but there were no answers.

Too impatient to sit, I began pacing. Someone said, Here comes the doctor. I looked down the corridor. A large dark man approached. He was young. His black hair, cut short, was low on his brow. I thought, Oh God. He’s foreign! I remembered our government’s shopping expedition for third world doctors.

Mr Orpen? Mrs Orpen?

Yes, I was right. Hispanic accent.

He ushered us in to a small room with an X-ray light box. You must sit down. The news is not good. My stomach contracted on the warm coke as he clipped the acetate under the holding pins against the light. The pattern of grey shapes was indecipherable, even when he pointed out four bleeding areas in the brain.

We would like to relieve the pressure, but we cannot. The bleeds are too deep to operate. We nodded.

When will she wake up?

We don’t know.

Pulling Out

I feel a strong force pulling me up. I have a strange sensation of being taken out, or being separated from myself.

I feel quite panicky, yet as soon as the feeling of separation has passed, I calm.

So much becomes clear. I can see all around me. There are bright lights and movement everywhere. People in blue are scurrying up and down, with beds all around.

The light is so bright.

II

Diary Letter 1

19 February 1999 10.30pm

Phezzie, this is your second night in the Neurological ICU in hospital. You are hooked up to a great bank of machines which blink and sigh and sometimes suddenly go silent, making my heart nearly stop. I don’t know what the machines do, or mean. I don’t know what any of this means. Dad and I watch you lying there so white and swollen, with your mouth twisted out of shape by huge tubes, and sticking tape and gauze making a patchwork of your cheeks and skin. There is cottonwool stuck in your ear tonight.

When Adam held your hand and talked to you, you became very agitated, stopped breathing, and thrashed your legs about trying to draw your knees up to your chest. I was very frightened. Adam tried to calm you with tears streaming down his face. So we have decided to be very quiet when we visit you, so as not to upset you. We are very grateful, of course, that you are responding, but you seemed terribly distressed and it probably made you aware that there are restraints on your wrists to prevent you pulling out your tubes and wires.

Darling, you will not remember anything about it when you read this. You were taken by John Rolfe helicopter from Gailie’s farm to the State hospital yesterday at noon, after being attended to by a large team of paramedics and ambulance doctors. It will be a long time before I forget the sight of you lying in the farm road on your back, naked from the waist up because the paramedics had cut your shirt and bra away. Dad was cradling your head in his hands. How he crouched there for so long on his bad knee, I don’t know. The farm people were holding a duvet aloft like a tent to give you and the paramedics some shade. It was terribly hot. Gailie was sitting on the wall looking very old and defeated. I kept thinking you’d soon be okay and get up and be normal. Then they carried you to the helicopter, and I watched you go high up into the blazing sky, and then speed away to the East. The ambulances roared off. We followed in the car. It’s funny that I wasn’t really worried. I even argued with Dad about the quickest way to the hospital!

Tonight I know we are on a long road to goodness knows where. Rest peacefully my darling. Everyone is praying for you, and we all love you.

Bodies in a Haze

I know that I am just beside a bed with my body in it, and see a man in blue with a mask over his mouth leaning over me. What is he doing? Another man is standing at the foot of the bed, with a person in white moving at the side. I see something like a plug-hole in the wall above my head. I am drawn to it. What is it for? What are these people doing? The sounds are very dim so I cannot hear them speak, but I do hear a constant beeping in the background.

III

The Flat Baby

The missus must come. There is trouble.

A still frosty morning, sunlight just touching the rough grass as I followed the child to the cottages used by the farm workers. There was a knot of women around a door I recognised as belonging to a tall thin woman, no longer young, called Miriam. She was an indifferent worker, often drunk, and had recently surprised us by giving birth to a baby.

My heart sank as I approached. The women looked at me wordlessly, expecting me to enter, so I pushed the door open and went in. The room was very dark, and rank with strong odours. Stale drink. Unwashed bodies. Smoke. Dry mieliemeal pots. As my eyes grew accustomed to the dark, I saw the room was almost entirely filled by a big bed. Miriam sat up straight in its midst. I could see no expression on her face. She made not a sound. At the foot of her bed was her tiny baby, half naked. I put out my hand to feel for life, but there was none. The baby was cold, and the baby was squashed flat. I knew she had rolled on it in her drunken sleep.

I stumbled out, shocked at what I had seen. My anger at her carelessness obliterated any compassion for the regret or fear or sorrow that the woman may have been feeling.

We buried the baby on the farm. The women came to the grave and wailed. The children played quietly in the dust. There was some subdued singing. Still, Miriam was expressionless. And I? I was filled with self-righteous outrage at the waste of this small life.

Many years have passed, and Miriam’s story comes again before me because I am now the careless mother. I was often too rushed, too distracted, too self-absorbed to keep saying, Phez, remember your hard hat. Phez, don’t forget to ride with your hat.

Now I wish I could sit with Miriam on that dark evil-smelling bed, and touch her hand, and share her sad guilt.

IV

DIARY LETTER II

21 February - Sunday

We are taking it one day at a time, looking for little improvements to encourage us.

Yesterday was not a good day. We had to come to terms with the chaos of your Intensive Care ward. It is noisy and bustling; some nurses are rough and careless; the doctor adjusting your windpipe made Daddy very upset. There are nice nurses, though, who try to explain to us all the complex charts pinned up around your bed. Temperature graphs, blood-pressure, drug records, the all-important Glasgow scale which measures your level of consciousness – or lack of it. There are others which I cannot understand at all. Your doctor’s name is Mario. He is Cuban. I was very doubtful about him at first, but we had a good long talk with him tonight. He is OK – just a bit difficult to understand as his Spanish accent is very strong. He has been at the State hospital for five or six years, and is busy with his final exams for Specialist Brain Surgery.

They do horrible things to you to get you to react to pain so they can measure your unconsciousness. Last night Mario pinched your breast to make you thrash out with your arm. I just stood and wept. I feel so hopeless just standing and looking at you. I long to take you in my arms and comfort you, but cannot even hold your hand properly.

Today was a better day and they seemed pleased with your progress. You are moving your legs and your jaw and your tongue, and Adam says your eyes flickered open when he was with you. Mario told us tonight that he expects you to be unconscious for between one and two weeks. He says you will have no short-term memory for six months, along with headaches and irritability. After that you will improve, and in a year you will be back to normal. When we read this in a year’s time, I wonder how things will have panned out.

Goodnight my darling love. You have so many people willing you better that I’m sure you cannot fail. Everyone we know will be thinking/praying/meditating/visualising at 2pm every day now until you wake up. God bless, sleep peacefully. I’ll see you tomorrow.

A Force

What is happening? I know that this is me right here, but something is awry. I want to get away, but should I leave? Will I be able to return to my body? I go up higher, and it is tempting to move further up as there is so much to see. Can I go back down? I immediately find myself beside the plug-hole again, and grasp that I move exactly to where I think.

I am starting to feel quite at ease here. Although I cannot hear the people, I rather know what they are saying. I am ill, and they seem to be putting me on drips and machines, but I’m not really interested with what’s happening here. I want to see beyond.

This force pulling me fascinates me.

V

The Lonely Child

As I stood in that hospital looking at her prone figure, I thought often of her childhood. Taking stock I suppose you could call it; spinning out memory pictures of her life.

Her birth! The happy day – a daughter after five sons! The off-duty nurses in the labour ward staying behind in the corridor to wait for the arrival – girl or boy? The champagne in the ward later, and the general air of festivity in the hospital because Maggie Thatcher had just won the General Election in England. Why was that so important to us? It seems like so much stale water under the bridge now.

The plump little child with bright auburn curls and red cheeks. She had to fit into the chaos of our lives. She crawled in the puddles of cement when we made bricks, she made hidey-holes in the huge stacks of bottled pickles in the farm factory. She pulled on my skirt for attention while I tried to do the bookkeeping, or to study and write Unisa assignments.

I see her picking cosmos with Granny Orpen, dwarfed by the seeding veld grass and the bobbing pink and white blooms, the wind kaleidoscoping them into brilliant sunlit fragments, Granny’s soft Irish voice drifting away from me.

From an early age she had a mind of her own. Often there were battles getting dressed in the morning. I longed to dress her in pretty feminine clothes but she would not have it, and spurned all my dressmaking efforts, and all dolls. She was happy in old dungarees with straw in her tangled red hair, riding on the back of the tractor. One day, in a fury, she packed her little nursery school case with some clothes and left home. I found her, small and determined striding far down the dusty road. Sometimes, when she was a little older, I would find her bed empty when I went to give her a goodnight kiss. We would find her in the stable, curled up in a blanket fast asleep, with her precious Bambi standing over her, breathing steamily into the anxious beam of our torch.

I see now she was a lonely child, absorbed in her own world, while the complicated, boisterous life of the older boys and the larger family spun around her. Her horse became the centre of her life, her love and her passion, and the first step in a progression of events leading to this reverie at her hospital bed.

VI

Diary Letter

23 Feb 1999

I saw you this afternoon Phez, and you were battling. You were very flushed, and you groaned a lot having just had a pummeling from the physiotherapist, for you now have pneumonia. When I held your hand and said hello, you opened your right eye a slit and tried to look at me, so you are having moments of consciousness.

Adam is wonderful; he saw you this morning and again tonight. He has seen you twice a day, every day. I know how important this would be to you.

Hang in there, darling. We are all with you in prayers and thoughts.

Height

It is quiet up here.

And light.

I feel a sense of knowing. And a sense of complete control. Although this is all new and strange, I do not feel afraid. I know that this is all of my choosing, and that I have a choice to make.

I am high up. It feels as though I am just beneath the ceiling, yet I am definitely higher than that. I see all these people below me, many moving with extreme urgency. Most of them are dressed in light blue around what I know is my bed. There are monitors and stands with drips on, and Oh! so many people. So many other beds too; it’s like a menagerie of connecting rooms, joining beds and people. It’s almost like an ant’s nest, with ants marching from room to room with a programmed task. The doctors and nurses similarly seem to be on an automotive drive, in a sense of never-ending motion…bending up and down, moving, talking, examining slides on the wall. They are surrounded by a constant stream of other people; some just standing, while others seem in such a hurry.

VII

Fragments

We tried to piece together what had happened. We needed a mind picture, an explanation. We needed to understand.

From Gailie at the stables we learnt that Pheasant had spent the morning exercising a difficult horse in the ménage. When she was finished, she walked the horse to cool him down – away from the stables and down the farm road. A short while later the horse galloped back to the stableyard alone.

We could find no-one who saw what had happened. The farm children, alerted by insistent dog barking, found her lying deeply unconscious in the road close to a heavy wooden fence.

There were few signs on her face or head to help us. The curved bruising on her left jaw we thought was hoof-shaped, and there was bleeding from the ear itself. The doctors told us that several teeth were missing from the same side. I was anxious that her jaw looked crooked, pulled out of position by the forest of tubes in her mouth, but in the Neurological Ward they were worried only about her brain, and we were told that the jaw could be fixed later. She seemed a creature suspended in a delicate balance with which we did not dare interfere. So we looked, and whispered and touched gently.

Much later we discovered the base and the side of her skull was fractured. Nobody told us that at the time, nor was it explained how haemorrhages occur deep in the brain. We pieced together information over subsequent months and years, and later understood that the brain is a jelly-like substance within the cranium. When the head receives a strong blow, the brain wobbles violently, pulling away from its moorings; veins, arteries and nerves can be torn, and the brain swells from bleeding and from the insult itself, causing pressure inside the skull. If the haemorrhage is close to the skull, it can be drained to relieve the situation.

But in that first week we knew little, and asked little. We understood nothing of brain injury and its implications, naively thinking she was just unconscious and would be home in a week or two.

The accident, we concluded, was probably caused by the farm dogs frightening the horse, causing him to rear unexpectedly, tossing Pheasant backwards and kicking out at her as she fell.

Order

It is completely quiet here. I can see the clamour below, but I don’t hear it. It feels to me as though everything is in perfect order. Although there is obvious urgency about, I feel completely calm.

I’m starting to be aware that I understand everything. I know I have brought myself to this place to kind of re-evaluate; to see if I want to carry on with this path, my life. I’d been unhappy. I’d been alone, and felt that apart from my folks, not a soul gave a damn.

So I’m drawn to the people….I need to see them – I need to see their reactions.

VIII

4th Diary Entry

24 February/Wednesday

It is really sinking in, Phez, what a very long and rocky road we have to walk. Mario says another two to three weeks in ICU, and then you should be conscious. This seems an impossible age to me. I am dying to wash your hair – it is so matted and bloody and sweaty. I’m dying to make you special titbits to eat, and to feed you peeled grapes. I’m longing to spoil you and nurse you and love you back to health.

They had you sitting up today but you looked very uncomfortable. You raised one eyelid when I said hello, and looked accusingly at me before you slumped back into wherever you are.

Byron keeps looking in the car for you. He runs up whenever we drive in, ears pricked, tail wagging. He sniffs inside eagerly, and then his tail goes down and he ambles off. It breaks my heart. I am making a big fuss of him and feeding him special treats so my shares with him are quite high.

Six and a half days have gone now. Keep strong, keep struggling on my darling. I wish you could see your flowers – they are brightening up the main desk outside your room.

My Choice

I’m not really interested in all the doctors, nurses and hum-drum of strangers about. I know that in this bed just below, it is me they are tending to, but I have no desire to see. I’m not interested in the view of my body, only the other people; those standing around and in a group quite nearby. I know these people, and I can’t believe they are here. In contrast to the doctors, they stand in a group with nothing to do. They look lost, bunched in a cluster, shoulder to shoulder, with similarly pale faces. There’s Adam; well at least he’s here. Goodness, he’s even got his girlfriend with him. Well I suppose that’s not surprising, because she’s always been a very warm, kind person. And there are my dear parents- poor people; they’ve had so many struggles. I can’t really do this to them, can I? If it wasn’t for them, I don’t think I’d even be considering remaining on this earth. It’s so beautiful out here. And there is this pull….a force, trying to pull me out. I wonder; does it get even better?

IX

5th DIARY ENTRY

Thursday 25 February

This has been the worst day. The phone rang at 6.00 this morning. It was Mario. He said the crisis was over for the time being, but he asked us to come to you. He had been with you all night fighting the pneumonia that was spreading in your lungs like wildfire. We flew in through the morning traffic, but when we arrived you were stable and quiet, and your temperature was down. You are back on the respirator, and you are getting three antibiotics as well as all the other stuff. Eleven drugs in all I think I counted on your chart. We stayed with you all morning. When we left at 12.30 your temperature was rising again. They put a wet sheet on you and blew a fan across the sheet. When we returned at 7, your temp was down again, but we could see on your chart that it had been over 40 degrees. Your feet were freezing cold. I longed to try and warm them, but knew that would be stupid. You were peaceful and breathing nicely.

I am so grateful tonight that you are still with us. That sounds ridiculous and melodramatic, but it is true. I am grateful with every fibre of my being. This time last night you were in septic shock. Please God you don’t have another crisis like that, and you can get better peacefully now.

Darling I’m going to cut your hair off tomorrow. Please forgive me but it is so smelly and matted, and it will be another week or two before we can wash it. It will grow again….

Sleep peacefully, my dear love.

Unity

It is so light, and easy and high here. I feel overwhelmed; I’ve made a new discovery; I have friends! All of these people who’ve come to visit me must mean something. I move around the hospital with the speed of thought, and with the joy of understanding. I don’t feel so separate anymore. I seem to feel them, and am even aware of their thoughts. I am suddenly able to realise in people