"Head Cases: Stories of Brain Injury and Its Aftermath": Trying to restore beautiful minds

"Head Cases: Stories of Brain Injury and Its Aftermath"

by Michael Paul Mason

Farrar, Straus and Giroux,

310 pp., $25

"Ounce for ounce," observes brain-injury case manager Michael Paul Mason in his fascinating book "Head Cases," "a walnut enjoys more protection than the human brain." It's no wonder, then, that huge numbers of people sustain damage from falls, strokes, neurological diseases, accidents, suffocation, assault, poisoning, war wounds or other causes. In fact, the Centers for Disease Control and Prevention report 1.4 million cases annually, resulting in 50,000 fatalities. As many as 5.3 million Americans live with permanent disabilities resulting from brain injury. Almost a quarter million people are hospitalized, yet antiquated legislation and massive cutbacks mean "few states are capable of providing even the most minimal level of specialized care" for traumatic brain injury (TBI) patients.

Mason should know. One of only about 200 brain-injury case managers serving roughly 5 million survivors, he travels around the country trying to arrange patient care. Usually, he knows he'll fail. At least 90,000 Americans have brain injuries requiring extended care, but only a few thousand beds are available. A limited number of psychiatric facilities have neurologists on staff and even fewer have brain-injury rehabilitation programs.

Far more money is spent on pharmacology, technology and preventing deaths — particularly in Iraq, where the U.S. military is "proud of its production-line styled medevac capabilities." Such success has significant costs, however. Increasingly severe injuries in a system unprepared to offer extended care and/or rehabilitation means "we are no longer asking most soldiers to die in service; we are asking them to accept a lifetime of severe disability." The average lifetime cost per veteran? More than $10 million.

Mason visited Iraq, so his experiences will give readers information they've been sheltered from too long. But no less vivid, heartbreaking or movingly written are other cases. In "The Hermit of Hollywood Boulevard," for instance, a snowboard crash left a young man with more than 120 seizures monthly. After exhausting his options as well as his family's finances, he committed himself to a psychiatric crisis unit, his only venue for free care.

"The Resurrection of Doug Beardon" describes herpes encephalitis, which left the patient believing he's dead. Again, Mason chronicles the nightmares affecting both patient and family; again, those nightmares include difficulty finding and affording care.

In "Pony Soldier," a construction worker suffers blackouts and winds up in prison for a crime he can't recall committing; in "Wood of the Suicides," a man who hanged himself yet survived suffered anoxic brain injury that made him unable to form new memories.

Mason chronicles better outcomes for those who received the expensive, time-consuming care TBI patients need. Rehabilitation "occurs at a snail's pace," he reiterates. In "Rob Rabe Cannot Cry," a brain stem injury required "a now unheard-of forty months of inpatient care" during the early '80s. Rabe, who currently works for a TBI residential rehabilitation program, has no doubt he would have died if he sustained these auto injuries today, when the bottom line rules.

"Brain injury is a quiet crisis," Mason demonstrates. Inevitably, his stories will be compared with those of neurologist Oliver Sacks. While both admirably explore the mysterious workings of human brains, Mason is less the formal clinician, more the literary writer.