Over My Head: A Doctor's Own Story of Head Injury from the Inside Looking Out

By Claudia L. Osborn

This physician’s “inspiring” account of overcoming a devastating brain injury “will assist patients, families, and friends enduring the same difficulties” (Library Journal).
 
Locked inside a brain-injured head looking out at a challenging world is the premise of this extraordinary memoir chronicling the long process of adjustment and rehabilitation after a fateful, helmetless bike ride. In Over My Head, Claudia Osborn, a doctor and clinical professor of medicine, recounts coming to terms with the loss of her identity and the courageous steps (and hilarious missteps) she took while learning to rebuild her life.
 
For years, Osborn was deprived of the career she loved and the intellectual companionship of her professional colleagues—and the ability to handle the simplest undertakings like shopping for groceries or sorting the mail. Her progression from confusion, dysfunction, and alienation to a full, happy life is told here with restraint, great style, and considerable humor.
 
“Exceptionally well-written and engaging.” —Publishers Weekly

• Language: English
• Publisher: Open Road Integrated Media
• Release date: Jan 1, 2009
• ISBN: 9780740786631

Book preview

March 8, 1989

New York

Hello . . . I’m in a phone booth at the corner of Walk and Don’t Walk.

ANONYMOUS

A blast of music from WABC-FM blew my eyes open. I lay still, fully awake if not informed by what I saw. My eyes surveyed the room searching for a hint of something familiar. 

Nothing.

I struggled upright, my protesting back announcing the quality of my sofa hide-a-bed, reached out, and tapped the clock radio into silence. Traffic noises wafted in through the open window, so I knew I was in a city.

If I had thought about it at all, I would have been surprised at how someone as curious as I am by nature could feel so little interest in waking up in a clearly alien place. Yet I sat quietly, devoid of wonder, serene in my disorientation. The most familiar part of waking up was its unfamiliarity. I was accustomed to it. I had become one of the fortunate few who could be catapulted through a time warp and arrive unruffled in Never-Never-Land in the twenty-third century. I wouldn’t know it wasn’t a typical day.

Rustling noises behind me caught my attention. A sleepy face appeared over the back of the sofa and mumbled, Good morning. 

Lori. I knew Lori. We had been roommates at Vassar years ago. Apparently, we were again.

Drawn by the noise of traffic and the billowing curtains, I struggled free of the covers and went to the open window, leaning far enough out to make Lori gasp. Forty-three floors below, tiny people scurried and toy cars multiplied to jell traffic. Manhattan, I said. I’m in Manhattan.

Right, she said. It’s not Tuesday; this can’t be Belgium. How about closing that window.

I realized I was shivering. This must be wintertime, I informed her.

Whatever, Lori said absently as she headed for the bathroom.

I returned to the sofa and snuggled under the covers, seeking warmth, not wanting Lori to feel hurried to free up the shower. I lounged contentedly while she moved briskly about the large, airy studio apartment. Notes on the end table by my sofabed spelled out the directions to 24th Street under big block letters:

BE THERE AT 9:45 A.M.!!!

I should start to get ready. It was almost six-thirty.

You have your keys? Lori said. Remember, I won’t be home till late this evening, I have a long deposition today, but the doorman knows you if you have a problem.

Is it with a doctor? 

No. Are you listening? You’re sure you’re set for the day? Money? Directions? My phone number, in case?

I’m set, I said. I have everything written down. 

It wasn’t like I didn’t know my way around. I’d stayed in this city many times . . . maybe years. I was adept at navigating the streets and subway system.

She was cramming files into an already bulging leather briefcase. All right then, as long as you’re sure.

I’m glad it’s not a doctor, I said. You’ll win the case, Lori.

From your lips to God’s ear. See ya. And she was out the door.

I arose and began my own preparations, striving to imitate the efficient routine I had just witnessed.

I put my suitcase on Lori’s bed and opened it. Nice. Marcia would have packed everything I needed. Blouses were neatly folded on top. I put one on. Underneath were little piles of underwear. Deodorant, shampoo, miscellaneous toilet articles were tucked in on the side.

Shampoo. I needed to shower. I closed the case, put it under the bed, went into the bathroom, took my blouse off, turned on the water, and stepped into the shower. Damn. No shampoo. I stepped out of the shower, dripping wet, returned to the main room, but couldn’t spot the suitcase.

It was okay, I’d use Lori’s shampoo.

I lathered and rinsed my hair several times before I felt assured I’d remembered to use the shampoo, but as I towel-dried my tangled hair, I realized I had missed the conditioner.

From the bathroom doorway, I spotted the suitcase sticking out from under the bed. I opened it and took out underwear, stockings, and another blouse and dressed myself, putting on the shoes I had worn yesterday. Then I took a pair of wool slacks out of the suitcase and, after some difficulty getting them on over my shoes, removed my shoes and finished my dressing.

As I dressed, I checked then rechecked the notes on the end table so I could remember why I was alone in this strange apartment in this strange city. They also reminded me about food. A note from Lori suggested I have a bagel and orange juice. I went into the tiny kitchenette, buttered a bagel, and poured some juice. Then, satisfied that I had done everything I was supposed to do, I locked the door and left.

I had allowed almost two hours to make the two-and-a-half-mile trip to 24th Street and First Avenue. I hoped it was enough. Time, I had learned, tended to evaporate inexplicably. Best to build extra minutes—even hours—into any plan.

The needle-sharp March wind whipping down the street stung my eyes. I shivered, pulled up the collar of my coat, and realized my scalp felt like ice. I must not have blow-dried my hair. Too late now. I’d write it down for tomorrow.

I immediately pulled a scrap of paper from my pocket and wrote a reminder to myself while standing in the middle of the sidewalk. For the most part, I was oblivious to the buffeting of passersby hurrying to their jobs, but I responded courteously to a shabby man who touched my arm and asked with a putrid, alcoholic breath for assistance.

Poor old man. I supposed he thought he knew me. Maybe he did, but for the life of me I couldn’t place his face. He asked for help several times while I tried to figure out what kind of help he needed; then he gave up and abandoned me to speak to someone else.

Just as well. I wouldn’t have wanted to misdirect him, although I had no trouble following my own directions to the bus stop, where I stood, shivering, in line. As we moved forward for boarding, I reached into my coin purse for my bus money.

Damn! I said.

There was only the solitary quarter I kept for an emergency phone call. I needed a dollar in change or a token to ride the bus.

I stood stiffly at the curb, struggling to find a solution to my problem, barely aware of the drunk who had apparently followed me until he stepped right into my face and said, I need money.

I promptly put my quarter into his outstretched hand.

He turned away in disgust. You need it worse than me, he said, but he didn’t give it back.

What did I do now about change for the bus? I was numb with cold and bewilderment. There had to be an easier way to fix my trivial thinking problems than subjecting myself to living for months in New York City.

I comforted myself that many of my friends back in Detroit wouldn’t have a clue about how to maneuver their way around Manhattan either. It was a condition I now shared with them. Temporarily, that is.

In the old days, I would have hopped into a cab, or gone into a store and gotten change, or even walked to 24th Street. None of those answers occurred to me.

When I calmed down, my thinking cleared and one idea emerged—return to the apartment and get change. It seemed a reasonable choice. More to the point, it seemed to be my only choice.

I walked back into the warm apartment building. Which was good. Now I could dry my hair and put myself together to look professional.

When I used the mirror to style my hair, I realized I’d never combed it that morning. A tangled mass of brown curls stuck out in every direction—as though I’d stuck my wet finger in a live socket, my grandmother would have said. The mirror also revealed the fact that I wore just one earring and had forgotten a belt.

I searched my luggage for ten minutes for a belt and discovered the mate to my sapphire earring, all by itself in the middle of the bathroom counter. I was definitely going to have to remember to look carefully in a mirror. Still, I left the apartment feeling much more in charge.

The bus change still sat on the dresser.

Fifteen minutes later, after a third trip to the apartment, I deposited my change in a crosstown bus farebox and clung to the pole, swaying with the motion of the bus, rigidly attentive to street signs. It was only a mile to Second Avenue, where I would transfer to a downtown bus. I was not going to miss that stop. Second Avenue, I whispered fiercely to myself. You want Second Avenue.

I made the transfer seamlessly and settled into my new bus seat, now relaxed. I watched the teenager across the aisle apply another coat of mascara. Her face was a kaleidoscope of color, buried under layers of beige pancake; cheeks of an improbable pink and eyes ringed with a violet that matched her jacket. The lipstick was a harmonizing fuchsia.

I licked my own lips, which were chapped. I wasn’t much on makeup, but surely I must be wearing some. I wanted to look attractive. My fingers assessed the dryness of my face. No moisturizer. I felt a trickle of sweat roll down my side. Could I have actually forgotten deodorant? No makeup, maybe, but deodorant? It was part of showering. Still, this situation was vaguely familiar.

I ran over my notes again. After shower and dress came bagel and juice. My stomach growled. I was starving, so I must not have eaten the bagel. What if it was still in the kitchen, attracting roaches? Lori would kill me. I pushed my way toward the door and jumped off at the next stop.

The street signs read 14TH ST. and SECOND AVENUE. Whoa, I was no-where near that bagel. I sat down against a store wall and tried to collect myself. When my thoughts began to clear, I read my notes again. I was supposed to have gotten off the bus back at 24th Street and then walked a block east to First Avenue.

I still had enough time if I forgot about that bagel. Maybe it was still in the refrigerator. Maybe it never existed despite what the note said. Notes in my experience were often wrong. I didn’t know why, but nothing in my life could be taken for granted anymore. I knew I was doing everything as usual, yet here I was hungry and probably stinking as much as the old man dozing next to me. Go figure.

I rose and headed back up Second Avenue at a brisk pace. I should have skipped the buses and walked the whole route that morning. Exercise always made me feel better.

The traffic lights that decorated each Manhattan intersection frustrated me at every block. I would barely reach my stride before I had to stop at a crossing. As I reached 20th Street the light turned red against me. Again!

Ah, but the Walk sign lit up across Second Avenue and the person next to me turned quickly and headed toward Third. I followed, obeying the command—WALK. I swiftly overtook fellow pedestrians and made good progress till I caught a red light at Park Avenue.

Wait, what was I doing? I had faithfully read all the street signs, but their clear message that I was heading in the wrong direction hadn’t registered. Somewhere I had forgotten that the point of this trip was not continuous motion, but reaching a destination. I was no longer early. I would have to hurry while maintaining course. That should be easy.

But would it? Success had such a random quality.

I was flushed, sweaty, and ragged when I arrived at the beige brick dental school on 24th Street, one of many undistinguished-looking buildings accommodating a sprawling New York University. I threaded my way through the crowded lobby to the elevator bank. When I stepped off at the eighth floor, I was a tad disheveled to be sure and, at a mile-per-hour speed, not your average marathon walker, but as I pushed open the door labeled HEAD TRAUMA PROGRAM, NEW YORK UNIVERSITY, I glanced at my watch with grim satisfaction.

I was right on time.

Friday, July 8, 1988

DETROIT

The practice of medicine is an art, not a trade; a calling, not a business.

SIR WILLIAM OSLER

The hospital where I practiced was an old one with new trappings. Indirect lamplight made the most of featureless beige wallpaper picked to complement newly carpeted halls. Most patient rooms now had pastel walls and updated lighting. VIP rooms were papered and furnished with blond, painted-metal furniture meant to create a hotel-like ambiance. The administrators deserved high marks for effort, but on the whole, the redecoration of this old inner-city institution was more ambitious than successful. The elevators were still slow, which dictated that I run up and down staircases to save time, and there was no central air-conditioning. 

It was only six-thirty in the morning when I whipped down the corridor leading to Three East enjoying the relative calm between the hospital’s night and day. I had seen my ICU patients already and it would be an hour before my house staff tracked me down for morning rounds, time enough to review the charts of two new patients admitted during the night. I was actually ahead of schedule. For the moment.

My lead vanished when I arrived at the nurses’ station, which sat like a NASA command post, dead-center of the intersection. There Ms. Rollins nailed me, wearing that smarmy nurse smile which heralds the transfer of burden from nurse to physician.

Dr. Osborn, she said. Mrs. Jones, your patient in 301-A? She’s refusing her surgery prep. 

Because getting to the point was my usual style, I couldn’t resist saying, Whatever happened to ‘Good morning’?

It hasn’t started yet. I get off in an hour. She suppressed a grin that quickly turned into a frown. Now, Dr. Osborn, I don’t know what’s gotten into Mrs. Jones.  She accepted everything yesterday.

What did the night intern have to say about her change of mind? I suspected the answer.

I didn’t tell him.  She folded her arms across her starchy chest. He has an attitude. That young man couldn’t convince a starving man to eat free food. Besides, I knew you’d be along.

Give the new interns a chance, Ms. Rollins. They’ve only been doctors for a week. They’re insecure. Some of them cover it by being a bit assertive. 

Despite my defense, I was relieved the intern hadn’t spoken to Mrs. Jones. Her surgery was essential, and an impatient, exhausted intern still flushed with his new authority wasn’t what an anxious, frightened patient needed.

I’ll see Mrs. Jones now.

I tried to inch by Ms. Rollins, but she reeled me back.

That’s not all, doctor, she said. Here are the lab results for 309, and I wish you’d do something about Mr. Samuels. Last night, he was hopelessly confused and drove the nurses crazy and . . .

Ms. Rollins’s list was long, especially since I interrupted her recitation to answer overhead and beeper pages from Five South, the wife of a patient, the Urgent Care Center, and two interns. It was seven o’clock before she and I were satisfied that everything was in hand and I could sprint to Mrs. Jones’s room.

I hesitated a moment outside the door so I could appear to stroll in. It’s counterproductive for patients to feel their doctors don’t have enough time for them.

When I emerged from her room twenty minutes later, Mrs. Jones was still apprehensive but once again understood her critical need for the surgery, and I was half an hour behind schedule. My entourage was lounging against the far wall engaged in desultory conversation punctuated with a lot of yawns, waiting for me to start rounds. They were a good group who seemed to get along with each other. Jeff, a short redhead with a down-home accent, was a second-year resident in internal medicine. My two interns, Susan and Brian, had joined my house staff a week ago at the same time as the two medical students, Paul and Madeline.

Brian had a chart in his hand.

What have you got? I said.

Mrs. Wilson. I’ve written out her discharge instructions. I knew you’d want to see them.

Sure. I quickly reviewed his directives and medication list on the sixty-six-year-old newly diagnosed diabetic. You did a good job with her diet and insulin. I think she really understands what she needs to know.

He straightened. Thank you.

But your discharge instructions? Especially this line about swimming or taking walks in her neighborhood every day?

She’s fat. You said exercise is the best way to lose weight.

Brian, she lives on social security in an area so dangerous she’s scared to go to her clinic appointments. She can’t afford to join a club to swim, and a stroll in her neighborhood poses a greater risk than her disease.

I can only tell her what to do. I can’t help it if she doesn’t do it.

Stop a moment. I stretched out my arms, stopping the group in the middle of the hall. The art of medicine is as essential as the science. You’re not helping her if you suggest something she can’t do. How about talking to her about walking in the mall? Her transportation can be taken care of through a car pool, maybe through her church or the diabetic classes or our Cardiac Rehab Program. Or maybe she could buy a secondhand stationary bike.

I don’t want to get that involved. 

Well, you’ll have to for the month you’re on my service. It’s a central ingredient of internal medicine. And even more in my practice, which was composed largely of the medically disenfranchised—especially the elderly poor and the foreign-born.

His face flushed. That’s my point. Internal medicine requires too much interaction with patients. That’s why I want to be an anesthesiologist. 

He looked so serious, I had to suppress my grin. It’s true we internists tend to be pleased when our patients stay conscious.

Look, Dr. Osborn, he said, I know what you’re saying, but medicine isn’t in my blood like it’s in yours. It’s exciting when we’re saving someone’s life or solving a diagnostic problem or even doing rounds—you liven things up. But most of the time, it’s just me and the patients, and they bore me.

I think—

Dr. Osborn to the ICU, stat. Dr. Osborn, stat, ICU.

At the sound of the overhead stat page, the six of us sprang to life. My emergency was also their emergency. I felt the familiar rush of adrenaline. No time to preview the other charts. It didn’t matter. The day was in full swing.

Brian had me dead right. The patient care that irked him charged my life. I didn’t ask my house staff to follow in my footsteps, but I wanted them to be enthralled with medicine, the stimulation of diagnosing, the challenge of helping a patient attain a better quality of life, the sheer joy of nurturing. It was possible to become disenchanted with medicine in a poor, inner-city hospital. Our patients’ stays were seldom uncomplicated, and rarely elective. Nor did our patients look like the ones in TV commercials who leave the hospital smiling, loaded down with flowers, a doting family at their side, everything put to rights.

Our patients were usually the chronically ill. Most were elderly with precious little money. Many had end-stage diseases—cancer, failed kidneys, heart, lungs, or liver. Often, their suffering was compounded with alcoholism, drug abuse, and AIDS.

The day whizzed along at its usual dizzying speed. At five o’clock, I was in the outpatient department with my resident, Jeff, and it seemed possible to predict when I would be leaving the hospital. My housemate, Marcia, and I had dinner plans that evening.

I dialed her clinic number, balancing the receiver between ear and shoulder while I added the finishing touches to my recommendations on a consultation.

It looks like I can get out of here by six tonight, I told her when she answered. I’ll be home in time to go to Stephen’s with you so we don’t end up with two cars.

Great, Marcia said. I can’t remember the last time we both made an evening event on time.

I nodded to the EKG technician to go ahead and do my patient’s graph and took the blood gas results from the respiratory therapist at my elbow.

Are we supposed to bring anything? I said into the phone, handing back the results to the therapist and adding, Three liters, nasal canula, please. 

No, Marcia said. Got to run. See you at six-thirty.

My beeper went off, paging me to a number outside the hospital, one I didn’t recognize. I hate mystery numbers.

Especially at five on a Friday night, Jeff said. It could be another hospital wanting to transfer a patient.

I’m leaving here in an hour, I said. Think positively. 

I walked over to a cubicle where I would be less accessible to disruptions and punched the number into the phone. I was relieved to hear my cousin Nancy’s voice.

 How are you? I said. It’s nice to hear from you.

Listen, is this a bad time or do you have a minute?

All the time you need. What’s up?

Do you remember my friend Jenny Langton, she said, from high school days?

Sure do, I said, dredging up a sixteen-year-old memory of a petite blonde girl.

Well, she’s sick, really sick. I saw her two weeks ago and she looked bad. I saw her again today and I’m really frightened at how much she’s changed.

I’m very sorry, Nancy. Who’s her doctor?

Nobody, that’s the problem. She’s handling it with prayer at home. Her religion doesn’t go along with much medical intervention. Her mother told me it’s liver failure. The situation is pretty hopeless—short of a miracle—and she’s suffering terribly. She’s bright yellow, she can’t eat, she can barely breathe. Nancy’s voice began to crack. We have to do something. Help her, will you? Please.

I will if she’ll let me, I said gently. I can’t force her to get help, but if you can get her to agree to see me, I’ll try to persuade her to at least let me make her comfortable.

She already said she’ll come see you as a favor to me. I told her you wouldn’t make her do anything she didn’t think was right. When should she come?

Well, the way you describe her condition, someone better bring her to the hospital now. I hung up the phone knowing that Marcia and I would be taking two cars to Stephen’s tonight. Emergencies are never convenient; it would be nice if you could schedule them.

Half an hour later, I confirmed how gravely ill Jenny Langton was. She allowed me to examine her thoroughly and do a chest X ray, but what she needed was aggressive medical intervention or she would soon die.

My natural desire was always to jump in and lead the charge to save a life. Holding back was hard and I detested being shackled. So did Jeff.

Why aren’t we doing anything? Jeff punched his fist into his other hand. Do we just stand by and watch her die? How the hell can we respect her wishes at a time like this?

If I break her trust, I said, how long do you think I could keep her alive? She has liver failure. She has the right to make her own choices. I walked away but called back over my shoulder, Wish me luck. 

I entered the examining room and sat down on the cushioned stool next to the bed where Jenny was propped up to keep her from drowning in the fluid that filled her lungs. The small, quiet room magnified the sound of her raspy breathing and involuntary cough. In the light streaming from the wall fixture behind her, her saffron-yellow skin was startling, as though she had been dipped in a dye bath. Her medium-length, ash-colored hair hung limply, her eyes were half closed and dull, the whites yellow.

Numerous open sores, most of them on her legs and abdomen, oozed fluid, the body’s response to the enormous pressure of fifty pounds of excess water that had collected in her tissues, swelling her malnourished frame to a huge size. She looked nine months pregnant. All water.