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Interview with Ross McGowan

"Mornings on Two," KTVU-TV, San Francisco, February, 1999

An excerpt from Dateline:

"I, Claudia", an interview originally broadcast in April, 1998, on NBC: Dateline

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This Up Close and Personal interview of Dr. Osborn was published on The Cooper Institute website, January 14, 2000.

Traumatic Brain Injury: The Invisible Thief

 Out of sight, out of mind. But even when the signs of brain injury are apparent¾short-term memory loss, inability to perform certain tasks, behavioral problems¾its victims (who are known as ‘survivors’) or their families may not connect their problems to the injury.

“Survivors consider their neurological symptoms unimportant or they blame other factors for their difficulties,” says Dr. Claudia L. Osborn, author of Over My Head: A Doctor’s Own Story of Head Injury from the Inside Looking Out.

“The survivor ‘recovers’ and returns to work or school, the family rejoices in the fact that their loved one survived and¾beyond scrapes or fractures received in the accident¾everyone believes no real harm was done.“

Over time, the brain injury may be forgotten and the patient and family unlikely to attach further significance to the event.  Survivors may not tell their doctors later that they once had a brain injury, not even when those TBI symptoms produce problems for them.

“They do not make the connection,” she says, “between that injury and their worsened performance. People say, ‘I got knocked out, but no damage was done. I’m fine.’ How would they know? It is the brain that gives us our information. If the brain is injured, it cannot be a reliable reporter.

“Nor can close friends and family always judge what is ‘fine’. It’s easy to notice when the brain injury has paralyzed a limb, but the injury often causes changes in behavior, memory, attention, judgement, and organization. Families commonly attribute these changes to a lack of motivation, a stage of life (adolescence, menopause) or to depression.”

The Need for Objective Evaluation

Dr. Osborn, who lectures throughout the US and Canada on TBI rehabilitation says it takes a neuropsychological exam to determine if the brain trauma has caused significant injury and if that injury would benefit from rehabilitation.

She believes such assessment is critical. “Not addressing a traumatic brain injury is a missed opportunity that will impact that person’s future. It spells the difference between just getting by and living a happy, productive life.” 

She speaks from personal experience.

She is a survivor of a TBI. Her brain injury, sustained when her bicycle was struck head-on by a carelessly driven automobile, was minimized by others and particularly by herself. Determined to return to her medical practice, she was oblivious to her injury.

“Despite the changes in my behavior, my loss of short-term memory, and my poor language skills, I could still insist I was fit to return to work.  Even those—doctors included--who thought I needed more time to rest and recover assumed that I would be myself again soon.”

It was in trying to return to her medical practice that her problems became manifest and she sought help. That included an eighteen-month rehabilitation program at the Brain Trauma Day Program of Rusk Institute of Rehabilitation Medicine, a division of New York University in Manhattan .

Would she have eventually overcome her problems without professional rehabilitation? 

“Absolutely not,” she says.

The Overlooked Diagnosis

She offers another example, this one from her role as a consultant to a case-manager. “The patient is a 20-year-old who was injured at age 15 when she fell off her skateboard. She was comatose for just a few hours and had no other injuries. That was in May. In September, she seemed fine and returned to high school.

However, this formerly high-achiever began falling behind. Her teachers complained she didn’t pay attention and she had disciplinary problems, using poor judgment, impulsive behavior, and fits of anger. She couldn’t get a handle on the practical side of her life. She couldn’t organize, prioritize or manage what is called “executive function,” a problem associated with frontal lobe damage.

“Her parents knew of the TBI diagnosis,” Dr. Osborn says, “but no one had ever given her a neuropsychological examination  to evaluate the significance of this teenager’s deficits, or directed her to a formal program. Her problems were attributed to ‘adolescence’ and she drifted unhappily along. That she graduated at all and stayed out of serious trouble is due to her high intelligence and family environment.  

“While trying for college entrance, the fact of her TBI was resurrected. She was evaluated and directed into a rehabilitation program and is doing very well. She can be thankful that all she lost was a few years, as opposed to a good future.”

The Missed Diagnosis

Can brain injury occur and not be diagnosed?

“It is not uncommon,” says Dr. Osborn.

“Patients don’t always know what happened during an injury, especially if they are alone when they strike their head. They may be unaware that they lost consciousness or may not even recall hitting their head. Yes, they had an accident, but they appeared to be uninjured and so they never consult a doctor. 

“I had a patient in her fifties, living alone, who tripped and fell down her basement stairs. She told her daughter about it later that day saying she had been only slightly dazed and bruised her shoulder. I saw her three days later when her neighbor brought her in for a routine appointment. She was dragging her right foot. She denied this was a problem and wanted me to concentrate on helping her lose weight although she wasn’t heavy.

 “I did a neuro exam and ordered a CAT scan. She had a sub-dural hematoma—a blood clot pushing on her brain—from her fall, which required surgery. When she recovered from the surgery, by the way, she no longer wanted a weight-loss diet.”

Frequently, a brain injury is simply overlooked or deemed irrelevant to the person’s problems. Or attributed to other causes.

“Sometimes symptoms overlap,” says Dr. Osborn, “or masquerade as other entities¾adolescent malaise, post-partum depression, emotional breakdown, substance abuse, work-related stress, or menopause.

“Athletes may assume they’ve never had a brain injury although they have been knocked unconsciousness on the football field.

“All primary care doctors should have a high index of suspicion for TBI when a patient has behavioral changes.”  It is a point she emphasizes in her lectures to physicians.

“They should consider whether the patient may have an unevaluated TBI or if a previous injury was misdiagnosed or overlooked. 

It is Never Too Late

While seeking treatment early is the best course, good rehabilitation offers benefits at any time. “It is almost always possible to benefit if only through understanding the implications of one’s deficits and learning some strategies and techniques to compensate for them.”

The TBI Disabled Physician Returning to Practice

Because Dr. Osborn returned to her hospital duties¾teaching medical residents and interns and seeing patients¾she knows it is possible for a brain-injured physician to reenter the system unchallenged.

“If a doctor shows up for work, the assumption is that the doctor is fit to work.”

She denies this is an example of ‘good ol’ boys’ sticking together. “It’s more a matter of doctors being taken at their own word. Sometimes we forget that having expert knowledge doesn’t mean you can treat yourself. Thus the axiom, ‘an attorney who represents himself has a fool for a lawyer.’

What does Dr. Osborn recommend?

“Every hospital should have a written code,” she says, “dictating the conditions under which a doctor with a TBI may return to work. This should include nothing less that a full neuropsychological examination.”

Such a code would have benefited her. But that is another story and it is already told in her book.

                        ¾Jeanne Findlater