My 27-year Journey with Traumatic Brain Injury

Brain Scans
by John W. Sharpe, FACHE, VHA-CM, Inspirational Healthcare Management Analyst, VA-DoD Liaison, Veterans Health Administration
November 1, 2017

The following article is a first-hand account by John Wayne Sharpe, a service-connected veteran who sustained a severe traumatic brain injury (TBI) while in the Air Force 27 years ago. His experiences, understanding, views and accounts of events are personal. Therefore, this article is not endorsed by and does not necessarily reflect the views of the Department of Veterans Affairs or Department of Defense. This is the first of a two-part series on living with TBI. His story begins when he arrived at the Virginia Commonwealth University Medical Center of Virginia (VCU/MCV) Level I Trauma Center in Richmond, Va. VCU/MCV also happens to be the Hunter H. McGuire Veterans Affairs Medical Center’s (McGuire VAMC) academic affiliate. His journey is shared through his own eyes and incorporates his own fears, feelings, frustrations, challenges and lessons learned, mainly from hindsight. Some of his successes are provided in multiple parts during his recovery and reintegration back into the community. The later parts of his journey tie into his feelings about the importance of the Department of Veterans Affairs’ academic mission as seen through his eyes, and why he believes VA Healthcare is the best, anywhere.

 

My First Memories

It was the first week of September 1990 when I woke to a dimly lit room with a television mounted in the center of the wall. An empty hospital bed was across the room. A nurse walked by, but she didn’t realize I was awake – my eyes open, searching around the room for some meaning. I tried to speak but couldn’t. I tried to move but my arms were restrained to the hospital bed. Monitors “beep, beep, beeped” around me and a tube was coming from my stomach, which I later learned was a feeding tube. Another tube was going to my throat so I could breathe – the result of a tracheotomy for an oxygen line.  I even had a tube coming from my genitals. My tongue was sticking out, rolling left and right searching for my teeth, before I realized I was missing my two front ones.

Eventually, I recognized the strange place as a hospital room, but I had no recollection of why I would be here. My mind racing to perceive the unperceivable, I was confused and couldn’t understand what could have possibly happened. My initial thought was, “I must have really pissed someone off for them to beat me up like this!” With my memory not working, I needed someone to talk to but no one was around. I was confused, afraid and alone, but I soon quickly fell back asleep. Later I learned that I had recently been transferred to the Hunter H. McGuire Veterans Affairs Medical Center (McGuire VAMC) in Richmond, Va., from the Virginia Commonwealth University Medical Center of Virginia (VCU/MCV), also in Richmond.

 

The Accident

On a dark night July 22, 1990, on a winding back road in King George, Va., I was returning from a recent Air Force Temporary Duty Assignment (TDY). I had spent the day at the Pentagon Waterski Club before driving toward my parent’s home in Stafford. According to reports, I fell asleep at the wheel, ran off the road and hit a tree. My truck was thrown down an embankment, making it impossible to see my vehicle from the road. However, the tree I hit fell back across the road, thankfully stopping the next oncoming car. King George rescue personnel were the first on the scene, where I was initially unresponsive. They say I later became aggressive and fought their attempts to remove me from my vehicle. Due to breathing difficulty, I was given a cricothyroidotomy, which is an incision made through the skin and cricothyroid membrane to establish an airway. I was paralyzed and, due to profound polytrauma, put into a medically induced coma before being immediately evacuated by Med Flight helicopter to the closest Level 1 Trauma Center, VCU/MCV.

Physical exam on admission was notable for facial and head injuries, left eye and facial bruising, a laceration of my lower lip and two missing front teeth. My neck was immobilized and a tracheostomy put in place. On neurological exam, I had a 5 on the Glasgow Coma Scale, which is based on a 15-point scale for estimating and categorizing outcomes of brain injury. My left pupil was dilated and nonreactive. A CT scan of my head showed a right subdural hematoma with a small left frontal subdural hematoma as well. My lip and face lacerations were seen and repaired by Plastic Surgery and my fractured left ankle was treated by Orthopedics via a left posterior splint. While in the Intensive Care Unit (ICU), I developed increased intracranial pressures – increased pressures inside the skull of 17-26 – which required release or, in medical terms, “popping via ventriculostomy 2-4 times per hour.”

I was diagnosed with a Grade III, which is the most severe, closed head injury and remained in a comatose state in ICU for about 28 days. On Aug. 19, 1990, my skull pressures dropped to 10, showing signs that the blood clot (hematoma) was subsiding, and the hospital began weaning me off paralytics. I was eventually transferred to the MCV rehabilitation floor. Although I had physical and occupational therapy while in rehab, I have no memory of these events. Aug. 27, 1990, I was stable enough to be transferred to McGuire VAMC. My left ankle was now in a short leg cast, and I still had the feeding tube, tracheostomy and missing front teeth. I still have no recollection of the incidents immediately before, during or after the accident, or any recall of the 35 days in the hospital at VCU/MCV.

 

Before the Accident

I joined the Air Force on March 15, 1984, as a 19-year-old and 11 days later celebrated my 20th birthday in Air Force Basic Training at Lackland Air Force Base (AFB). As an E-4 Sergeant stationed at Maryland’s Andrews AFB, I was an Instrument Control Systems technician, maintaining and servicing all electronic intrusion alarm and fire alarm systems for all buildings and aircraft hangars on the Base. I was athletic and loved to play flag football and softball for Andrews’ team. An avid water skier, I was also a member of the Pentagon Waterski Club where I maintained the ski boats and loved to teach others how to waterski. I was outgoing, loved helping others and was known to lead by example, displaying leadership qualities with every interaction on a daily basis.

May 1990, I received orders for reassignment to Hickam AFB, Hawaii, and was to report to Hickam on Sep. 20, 1990. The week of July 15, 1990, the Andrews AFB Softball team traveled to McGuire AFB in New Jersey to play in the Military Airlift Command (MAC) softball tournament. My last memories before my accident were of playing in the MAC tournament Monday through Thursday before losing the second game and being eliminated from the tournament. I don’t remember traveling back to Andrews on July 20, nor do I remember traveling to the Pentagon Water Ski Club the following day for the weekend.  Friends tell me I was skiing most of that last day before leaving later that night for my parents.

 

Life after Awakening

As the days in the hospital passed by, I remembered the faces of some of my best friends from Andrews who came to visit me. But, I kept addressing them by the wrong names. I also remember being awake and talking to my parents, other friends and visitors for about five minutes, before I turned away and fell asleep. I was still in a confused state and had no idea what day or month it was. However, I vividly remember one weekend when my parents came to see me. I overheard the doctor speaking with them about not being sure how well I would progress with therapy. The doctor said I could possibly require around-the-clock care, 24-hours per day. An extremely independent person, I was devastated when I heard what he said to my parents.

Little by little, as I was able to comprehend the information, my parents and friends told me about the accident and what had happened. They explained how black and blue, and swollen my face was, and how they had me on a bed that looked like a “Ginger Bread Man” that rocked side-to-side. They also explained the tubes coming from the back of my head, which were relieving the pressure from around my brain.

One of friends said, “Your mother made the trip to Richmond every day to spend time with you while you were in ICU. You better make sure you thank her!” When I asked my mom about visiting me every day, she said, “I wanted you to know that I was there praying for you; I didn’t want you to suffer alone.” When I asked my mother what she would have done if I had to be kept alive by life support indefinitely, she said, “As difficult as it would be, your father and I would have taken you off life support because we know you wouldn’t want anything taking care of you.” After hearing her words, I welled up with emotion and immediately said “thank you, mom.”

As I continued to progress, I had an enormous amount of therapy:  physical therapy (PT), occupational therapy (OT), speech therapy (ST) and kinesiotherapy (KT), to name just a few. I even vaguely remember something called “education therapy.” To this day, I still don’t remember what I did while in education therapy. However, I do remember the kinesiotherapist coming to my room and moving my legs, feet, arms and hands. I also remember the physical therapist working with me on how to roll side-to-side in bed and how to go from lying on my back to sitting up on the edge of my bed.

Although I could easily sit up on the edge of my bed, my balance wasn’t good enough to remain sitting without support. Yes, I had to relearn how to sit and maintain my balance. I also began working on lateral transfers from the bed to a wheelchair since I couldn’t yet stand with the short leg cast on my left leg. One of my many challenges was learning how to operate and navigate a wheelchair. It may seem easy, but I always kept running into objects or walls on my left side when trying to propel the wheelchair. I initially had this feeling that my entire left side was much weaker than my right side. Although I was left-handed, my right side became my dominant side. I thought I was becoming ambidextrous, but, in reality, I later learned that my weaker left arm couldn’t keep up with my stronger right arm. That was the reason I kept going toward the left.

During this time, I was receiving in-patient rehabilitation at McGuire VAMC. Although I was making progress – slow progress, mind you – I continued to feel less than a whole person. I was ashamed at the loss of my bowel and bladder control. At points I actually felt like a newborn child with my being awake one minute and asleep the next, and my lack of bowel and bladder control. I had a hard time accepting these limitations. Like many military men and women, I was always in control of myself and my actions, and couldn’t understand how I could be so out of control – how something else could get the best of me. The worst part is this shattered my self-esteem.

But after thinking about my condition more, including what the doctor told my parents about possibly needing 24-hour per day care, I made a commitment to myself. Somewhere along the way during this dreadful time, I made the following statement to myself, “The rest of my life is only going to be as good as I make it.” Something made me make this statement – a stronger power above, perhaps. Although the therapists could help me learn new functional abilities, I knew it was up to me to put forth the effort and to give 100 percent, if I really wanted to improve and get my life back.

Part 2, which will be in Issue 5 of Health21 magazine (online at www.health21magazine.com and via its emailed e-magazine), will include more on my rehabilitation, as well as therapeutic and community challenges.