My name is Stephen Shortall and I hale from Durrow in Co. Laois. I attended secondary school in Kilkenny and then UCC where I studied English and Psychology in a BA, staying on to do an MA in English. I graduated in 2010 during the recession and stayed on working in UCC part time, returning to Laois at the end of my contract. I moved to Dublin in 2011 and studied IT and management in DCU through distance learning while working part time. My injury caused me to have to drop out of the degree part of the course. I am the youngest of ten, with seven brothers and two sisters. My father passed away in 1994.
While a story of much and serious injury, I assure you that what follows is not a tale of woe, nor a tale aimed at urging you to live a different life, nor a better life. It is merely a story that some of your circle of friends or family, more than you might think, will live through as well. It is a story that exemplifies the power of rehabilitation and the worth of the many who help with the path to recovery.
Unfortunately, I was not present for my injury. I have no memory of it or the time leading up to it. I have however heard many stories. I fell at approximately 11am on 31st December 2014, down a flight of stairs outside my apartment in Rathmines, Dublin. I was knocked unconscious by the concrete steps. My friends tell of how they found me in a pool of blood at the bottom and how they tried to wake me. They called the ambulance and waited with me, before accompanying me to James’s Hospital and then to Beaumont Hospital for the emergency brain surgery that followed. If one is to have a traumatic incident like this, new year’s eve on the point of midnight is not a good time. It proved difficult to get hold of a family member, made no easier by my friends not knowing any of them, but eventually my sister was found and arrived promptly. She remembers the coldness of my skin and its whiteness. I will not inundate you with stories of how each member of my large family was informed and the course of events regarding each that ensued, but they all made it to the ICU of Beaumont within a few hours.
I was kept in an induced coma, following my surgery, for six days. I had incredible swelling, so much so that my eye lids could not cover my eyes. They used to keep my eyeballs moisturised. I was intubated in case the brain swelling would cause me to stop breathing and to give the brain more of a chance to heal. My family stayed in shifts over the six days. I do not remember the seven days after the coma, but I was barely conscious.
My family were told that I may never speak, walk or even move again. Therefore, each limb that I managed to move brought celebration. Even when I scratched my nose it was noteworthy. I have been told that ‘howerya ma’ were my first words as I turned over and went back to sleep. I came back to speaking, but often there was little sense. They would have the same conversation with me several times. I could never remember or even understand why I was in hospital, why these people were keeping me here.
I also did a couple of embarrassing things. I am told that I told the nurses to “f” off. In response to someone else in my ward who was shouting, I once pleaded with the nurses loudly that they get him whatever the hell he wanted. I told my brother that the woman that he had with him was lovely, that he should marry her. He had known the woman in question for many years and I had attended their wedding two years before my fall. I asked ridiculous questions such as, ‘what is religion’ and enquired why people marry.
My first memory is on the twelfth when the doctor took out the last of the staples in my head. I remember wanting to leave all the time. I was not allowed out of the ward for a few days more. I had no idea why these people were keeping me against my will. I would be told repeatedly, but I could not remember. At least once I packed a bag and tried to leave. I was told that if I could tell them where I was, then I could leave. Apparently ‘here’ is not a satisfactory answer. Eventually I was allowed to be brought to the café by my family. They were told to ask me questions about what I had done during the day, thereby helping my short term memory return. Once I could clearly walk, clean and feed myself, I was discharged. Beaumont is an acute hospital and my bed was needed. They had done their job. I was sent to James’s for three days and then discharged home. If my mother had not been in a place to look after me at home, the hospital would have had no choice but to keep me.
This is when my rehabilitation began, though I was convinced that it was nearly complete. I planned on being back to work in a month, maybe two. I think the swelling on the side of my head did me good. It reminded me that I was not okay and that I should at least wait until it had gone. I would sleep ten hours or more every night, napping often twice a day for two hours each. I missed being able to effectively read.
While in hospital I asked for a favourite book of mine to be brought in, thinking I would use my time with it. While I knew the words, I could not hold the beginning of the sentence in memory long enough to reach the end. I set this as my goal. I would read for an hour or two each day, Stephen Fry’s More Fool Me. In the beginning, rereading sentences until some of the meaning stuck. Though a minor task to accomplish, it was extremely tiring.
I wasn’t allowed to be alone or to cross the road unaided. I walked slowly now, all strength gone. But I was nearly back to normal, nothing that would take too long to fix. My sister in law was a nurse and she advised that I apply to Headway and to Acquired Brain Injury Ireland. In the cover letter to one of these applications the word ‘disability’ was used and I did not take the implication well. I did not want to apply. The process was also demeaning. There is something about rating the bad areas of one’s life to an anonymous party, frequently quite personal in nature, that made me quite angry. Even in asking certain questions there is an implication that the answer will confirm the presence of the issue or problem. I was incredibly enthusiastic about the assumption that all was going very smoothly and that I needed little if any help. My sister filled it all out, asking me the questions.
A case manager from ABI Ireland contacted us, as initial contact is given to the caregiver, again assuming, often quite rightly, that the patient is unable to correspond. She arranged a time to visit and I was gearing myself up to convince her that most things were well. She answered a huge amount of questions, many of which I had not thought to ask, allaying so many of my fear, putting me at ease.
I remember meeting with my consultant. My brother came with me so that I would remember everything. The consultant was really friendly. He was surprised at my progress. He showed me some brain scans taken from the night. I could see the swelling and the fractures in the skull. I had a list of questions and he answered every one. More than once he had to shrug.
For instance, when asked if the headaches would go away, he said that they might, but they might not. He went through my prescription and got rid of much of it. Apparently he visited with me every day after waking from the coma and we would speak, but I don’t remember.
The next few weeks were given to ticking boxes. Medically, visiting with referrals. ENT and rehabilitation in James’s. I performed well. My GP, whom I had to meet first weekly and then monthly, was of great help. He would talk to me and tell me stories. Oddly, an acupuncturist who my mother was visiting, asked me to take an appointment. I went with incredible scepticism, but she obviously gave me what I needed. She also practiced very ‘airy-fairy’ areas, but the talking was incredibly beneficial. She gave me books to read to which I also owe a lot. Some just on positive thinking, others on souls before birth deciding to be born to life a certain life. I love fantasy literature, maybe that is why it was restorative. Likely, now I wouldn’t engage with the subject matter, but it was what I needed at the time.
I was, with incredible luck, brought in to the National Rehabilitation Hospital for an assessment and asked to bring a bag to stay. I was not only lucky that I was given a bed in the NRH, but I was also lucky in being placed in St Patrick’s Ward, the ICU area of the brain injury section. It offered more privacy and more space than was available in the other wards They had many who were high dependency and I believe I fit in as requiring less attention. I would also be short term, only six weeks. The NRH changed everything, in ways that I did not realise they needed changing.
They tested me for everything, asking me what areas I felt I was lacking in. I said that I was afraid I would fall again, that perhaps I had fallen down the stairs because there was something lacking in my balance. They tested me and found that my balance was just fine, nothing to worry about. I was getting dizzy now and again, the room swirling around me. A vestibular physio fixed that for me. I berated myself over lapses in memory and concentration so, probably as natural protocol, I was tested for the different types of memory. There only seemed a deficiency in facial memory, planning and in concentration. It put my mind at ease.
Most of the help came in the form of talking. My occupational therapist and my social worker were incredibly important. So often it was about focusing on the future, planning and taking into account the areas that would be most difficult.
Most importantly, they got me to see that those areas of difficulty were not an example of weakness or failing, but were the natural ramifications of a traumatic injury. I met so many fellow patients in the NRH and we would talk at lunch times and around the quadrangle in between our appointments. We would trade symptoms and stories, showing each other again and again that we were not deficient or odd, simply all experiencing recuperation. There was little to do in the NRH but the wifi was good and there were some great characters there. They showed me that any difficulties I was having were perfectly normal.
An art teacher visited out ward once a week for two hours. I never considered drawing since my ill-fated junior cert art result. She taught me how to draw and I discovered that I enjoyed it. I’d like to say that I remembered that I enjoyed it, but I don’t remember enjoying it so much. It gave me a boost in confidence and did not require concentration or strength.
Some Stephen’s drawings during his rehabilitation
When I left the hospital I took a sculpture class. Though the three hour classes were exhausting, having a project and the social interactions that came with the others in the class were exactly what I needed.
On being discharged from the NRH I stayed in contact with my occupational therapist and social worker. I was also given outpatient appointments with another occupational therapist. They assessed me for driving and was finally able to return to drive. I now attend counselling in Headway and am a member of a support group there.
Life is good now, but the support I receive is still essential. So often life seems to be about proving I am okay, proving that there is nothing wrong, nothing to see here. I made a list of goals when in NRH that I wished and felt I needed to achieve. The list became steps back to normality and to restoring self-confidence. As the year anniversary of my accident approached, the recent new year, I was focused on completing them all. It was as if, should I complete each one, then I would no longer be ‘that guy who had the brain injury’, no longer the man that needed to be cared for or seen as less than normal. So much of this existed purely in my own mind, but I have learned that it is quite common. It is something that still comes to the surface in my day to day life.
I have mentioned luck so often in this piece. Some of that is simply that there exists knowledge in the area of neuro-rehabilitation, that it is available in Ireland. But I was also lucky in that I was one of the blessed few who would avail of these services. Some never even know that they exist. I am now self-sufficient again, independent and okay. My employer is to be commended for his help during the long months during which I could not work. I owe them much I do not exaggerate when I say that I might not be here if it was not for the people who helped me to recover. I skipped a few things, you see. I sidestepped the breaking down in tears in the early days at home, wondering if it was worth proceeding. I also left out the sleep deprivation in the NRH that led to me breaking down, the psychiatrist seeing me and sleeping tablets being prescribed. There were other episodes I will continue to leave unsaid. I could give you a list of professionals who came at the right time, knew what was needed, helped me sometimes beyond the letter of their job descriptions, but that list is too long for here.
As wonderful as the NRH is, it is far too small and underfunded to serve the needs of the whole country. There is no private option available to patients with insurance. There are two main charities who deal with people in the community, Headway and Acquired Brain Injury Ireland. Though partly funded by the HSE, not all will be able to avail of their services.
There are few families that will not be touched by brain injuries at some point, be they brought on by encephalitis, stroke, accident or cancer. As important as families are in rehabilitation, as mine surely was, there are areas that they cannot cover. Many patients feel burdensome and will not complain in case it is seen as being ungrateful. As nurturing as a family member can be, it cannot be understated how beneficial a professional is, as they with a weight of experience look you in the eye and tell you that something is okay. It is somehow more acceptable to express your natural frustrations and fear to a professional than to a loved one. Many will go without these therapies that are not expensive and are cost-effective, in part due to lack of availability, in part because so many who experience a brain injury may not be able to speak up, perhaps not able to speak at all.
It’s okay, I am nearly finished. I will clamber down off my soapbox, survivor’s guilt scrawled across, and go on my way. I hope your brain remains healthy and untroubled, but now at least you are aware of what services are available, and hopefully you receive what you need if the time comes.