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Bombs, war and the mysteries of the brain: How The Post's TBI story came to be

The question last year, from a long-time source, seemed simple enough: Did I want to meet some patients from Bethesda with TBI? Unlike so many military acronyms beyond my ken, I knew what TBI stood for: Traumatic Brain Injury. But until that night, at Oriole Park at Camden Yards, where I met several wounded warriors who were the guest of the governor of Maryland, I realized I didn't really know what TBI was.

The Marines, all patients at the new TBI unit at National Naval Medical Center in Bethesda, were tough and tattooed, and, at first, didn't seem all that different from other infantryman I had met. But the more I talked to them, the more I got caught in conversations that meandered from one subject to another, sometimes mid-sentence, the more I realized their brains weren't functioning quite right.

Although they all looked fine, their speech was sloppy and their memories were flawed. One showed me a notebook he kept to write down all the things he knew his brain would not be able to recall: when to take his medications, when his doctor appointment were--and where.

After a few months, I was able to visit 7 East, the TBI unit at Bethesda Naval, where I met an amazing staff of nurses and doctors led by David Williamson, a neuropsychiatrist. Over the next few months, he would introduce me, photographer Marvin Joseph, and video journalist Whitney Shefte to many of his patients, teach us about the mysteries of the mind and help us understand what it is to have a TBI. The result is this multimedia report.

Early on in the reporting, Dr. Williamson gave me what I took to be a challenge. In order to capture what it really means to have a brain injury, he said, I was going to have to somehow demonstrate that his patients suffered far more than a physical wound.
When the brain is injured, he said, it affects our humanity.

He sounded more like a philosopher than a doctor. I had no idea what he was talking about.

Look, he said. You're listening to what I'm saying. You're processing the language, understanding it, storing the information away. At the same time, you can hear other conversations in the background (the hospital was a bit noisy at that point), but subconsciously you can filter that out, just like you feel the chair beneath you without really thinking about it. Meanwhile, he went on, you also know that later today you have to pick up the dry cleaning or run certain errands. You can, if needed, pull memories from childhood that have been stored in your long-term memory. Look, he said pointing, you just scratched your head. You had an itch--that information was conveyed to your brain, which sent a message to your arm to scratch.

All of this is going on in your brain in real time, he said. So when some of the neurological connections are disrupted, either by a blast wave or a piece of shrapnel, it changes how people experience life. And that, he said, makes them different people. Some come home from the wars with scars and missing limbs. Others come home acting strange: extroverts can become introverted. Others become impulsive. Some can't recognize faces.

A brain injury, then, affects their humanity.

"That," he said, "is what your article should be about."

By Christian Davenport  | October 4, 2010; 8:46 AM ET
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I'm glad to see this article in the Post. I got out of the Army 30 years ago and have a service-connected TBI. The VA (and other health care systems) had little in the way of cognitive rehab then.

Fast forward to now and the VA is virtually the only game in town if one needs cognitive rehab. Most private insurance doesn't cover it.

The VA may not be perfect but at least at the VA hospital in DC (where I go for my cognitive rehab) the TBI clinic is very professional and coordinates cognitive, physical, occupational, driving, and recreational rehabilitation in one center. They also do a lot with cognitive prostheses - artificial intelligence to help your brain work around problem areas - and they have the staff to help you use them.

Before I began cognitive rehab, I was very isolated socially. Now I'm more confident about being around other people. To the extent that a TBI affects one's humanity, the VA do the best they can to restore it.

Posted by: konig2 | October 4, 2010 5:37 PM | Report abuse

Christian, thank you for this series and this article in particular. Most people with TBI could use more services and care. It's shameful that not only veterans but so many other people with brain injury can't get the outpatient care and rehab that could make the difference because insurance companies don't believe it's necessary and so don't cover it.

Posted by: barbara28 | October 4, 2010 7:54 PM | Report abuse

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