Gatekeepers

In the world of concussions, a huge hurdle exists for adolescents in particular with regards to health care response. My own journey became much more trying as the only “medical professional” who treated me following my concussion was a high school athletic trainer. We had one meeting, and then I was on my own. His advice, to “give it a week and you’ll be fine,” is a common refrain for youths with concussions. While the world is slowly establishing the true extent of concussion symptoms and fallout, adolescents suffering mTBI face perhaps the hardest challenge in retaining their own mental health. The following is a section of my memoir Gravity in which I discuss the importance of this particular issue:

Gatekeepers

The sad reality for many adolescents sustaining concussions or mTBI is that the gatekeeper to their response team is a high school athletic trainer. I don’t mean to knock the profession: one of my best friends in the world is a phenomenal trainer at the school where I taught. These professionals, however good at their job they may be, are not mental health experts though. Moreover, I can say from experience as a teacher that concussion training in academia is woefully inadequate. Depression, a well-researched and surprisingly common symptom of mTBI isn’t even tacked on to the list of symptoms in the training I took for being a baseball coach. The scientific literature at least does that much.

For me, as with many, the trainer was my psychiatrist, neurologist, and therapist rolled into one. Scary, given the all-too-common diagnosis of give it a week and you’ll be fine. It’s a message that greets millions into the bowels of mental illness.

I yearn for an answer.

The pragmatist in me understands that schools aren’t likely, capable even, to fund neurologists. The athletic trainer is the gatekeeper, whether we like it or not, for most of the half a million high school sports related concussions occurring annually each year in the United States. Imagining underrepresentation is not difficult either, particularly in my Southern city where football is worshipped only marginally less fervently but considerably more frequently than the gospel.

The problem is one of education, though. Until we begin teaching about the true severity of even mild TBI symptoms, millions of people will continue to lack the knowledge of how respond to their own injuries. In my first year back to teaching after a two-year health leave, I told my students about my TBI. I told them what happened to me and how my life had been so dramatically derailed. In the process, I learned that an alarming percentage of my students already had sustained concussions, but a few of them even confided in me their long term psychiatric, behavioral, and intellectual consequences. None of them reported any significant help from the adults in their lives.

The sad reality of the situation is that Western medicine is startlingly behind the concussion science curve. Give the MD’s a moderate or severe TBI (in which one loses consciousness for more than an hour), and they piece together some effective care. Limit the injury to a standard concussion, the most common form of the injury, and you are likely never to receive the help you need. The advice that I received from the moment I got my first concussion was the worst advice that could have possibly been given. Sleep is the answer that unites the perspectives of my alternative medicine doctors. In many ways, they are far more advanced in holistic recovery from TBI than their Western peers. Sleep, they contend, was my express ticket to recovery from my concussion, yet the science of 2004 kept me awake for the first full night following my concussion. It is a scary fact, given the numerous studies that have come out since about the impact of the night’s sleep before and after a concussion. According to most of these studies, sleep has an outsized effect on both initial concussion severity and concussion recovery. Even more widespread studies highlight the ways that concussions make the act of getting sound sleep more difficult. When you combine this data with the fact that I attended a private high school with one foot remaining in the Old South and a pedagogical approach to match (overburdening students with homework, mandating appearance down to hair length and style, pushing the concept of a Southern gentleman even onto their underrepresented minority students, etc.), the result was a maximum of six hours of sleep per school night. The average was probably closer to four or four and a half hours per night. I never had a chance.

It’s a Sisyphean tragedy in which I play the great sinner rolling the boulder. My twist on the myth is that the boulder never rolls uphill. All I can do is dig my heels in and hope it doesn’t crush me on its way down.

The realization occurs thirteen years too late:

We did everything wrong.