After Skull Fracture: Day to Day Routine

After Skull Fracture: Nancy Part Eleven

I continued my interview with Nancy’s Mom, focusing on the day to day life after skull fracture in her first few months after returning home from UW Hospital.

She doesn’t go back to school or fourth grade, but she has a tutor, what’s the daily routine after skull fracture like the rest of that school year?

Well, we get her up.  We try to keep it scheduled.  Get her up, her brother’s up and gone to school and I get her up and get her dressed, get her something for breakfast and every day I put up a different activity out on the kitchen table.  Because at this point in time she’s pacing.

This is where the pacing starts.  I don’t know why.  In my feeble little mind I thought that once we got home everything would go back to normal, or things will click into place.  That’s not the case.  So, she starts pacing and I think in a day she probably put on ten miles of pacing in the house.  I’d have to actually physically ask her and ask her to sit down.  And it was very difficult for her to do that.

Did she do that in the hospital as well?

No.  In the hospital she did a lot of tapping, just always with her hands.  Something with her hand.

Has the doctor given you any, doctor given you any explanation for the pacing or this need to move after skull fracture?

I hate to say it.  I know that they did but I think in my, because I never left the hospital when I was down there so, I think I was on overload myself or maybe just a little bit of mental fatigue, and even though I understood it because of what he was saying that things are reconnecting.   But I guess I didn’t realize until I got home and I didn’t have that support system that was there to help me to make sure that I was doing things right.

Both the pacing and tapping is probably a mild form of agitation, which is a normal consequence of severe brain injury after skull fracture. See Park, Soohyun, Effect of Preferred Music on Agitation after Traumatic Brain Injury at  deepblue.lib.umich.edu/bitstream/2027.42/77884/3/soohyunp_3.pdf  page 21: “Agitated behaviors range from more mild behaviors, normally inhibited motions, including nail-biting, foot-tapping, hand wringing, the inability to sit still, or pacing, to more severe behaviors”

There’s a term they call elopement, meaning that she basically wants to escape or wander off.  Did she ever do that when she got home?

She, no.  She paced and everything like that but the first time she ever walked away from us we were camping, went to a campsite to see all of our old friends at the campsite and everything and she said she was going to go for a walk and she went for a walk.  Like a dummy I thought, well she’ll know her way back.  But she didn’t, and we had to go find her.

How old was she then?

Oh, she had just turned 10 so it was probably in May.  Open fishing, fishing season is when we usually start our camping season.

Is she wearing a helmet after skull fracture when she comes home?

No.

Did they give her any protective head gear until they fixed her skull after skull fracture?

No.  And they said that she wouldn’t need it.  The injuries were the  size of her, the holes in her forehead.  They didn’t remove the whole forehead, per se at that time.  They just had the open holes, with the skin covering it.  And, they said that she wouldn’t need it but she couldn’t be on a surface higher than four feet.  They wanted her lower than that.  They didn’t want her going faster than her feet could carry her so no bikes, no scooters, roller blades, you know, of course all that was off limits.

Did her skull grow back together after skull fracture?

No.  She had to put in a prosthesis.

So they did ultimately go back in and put in something in to fill the holes after skull fracture?

Yeah, six months later.

So tell me about the second surgery after skull fracture.

Oh my gosh, I think it was worse than the first.  Saw her come out with that bandaged head and she was a little swollen.  Her eyes were a little puffy but they were open.  At this time she knew what was happening and she was like, why did we do this again Mom?  Why did you let them do this to me?

Now she’s more concerned about how she looks?

Yeah, she was thinking about that.  I just think it’s the pain level too.  She was aware of it.  Before, this nice lady the beautician when she first got out of surgery it was, and put on the pediatric rehab unit, was pulling and tugging on her scalp so hard with her hair that had been matted with blood and whatever else, that, the beautician, she goes oh I feel terrible pulling it like this, and she never yelped or spoke about anything.  She didn’t feel it.

And the beautician you are talking about, this was a week or two after her injury and after skull fracture?

Yeah, about a good week after.

And how is she in contrast after the second surgery after skull fracture?

Her scalp sensation, her scalp sensation obviously recovered, and it took a couple of the weeks for the forehead, you know, but she can’t raise her eyebrow.  One of her eyebrows, her left one, I don’t think she can raise.

What were they able to do in terms of repairing the orbit bone around the left eye after skull fracture?

They left it.  We weren’t going to touch it.  They took care of the front but they didn’t want to invade the space, the orbital roof of her eye socket because they said that the millimeters that she’s off between the horizontal vision, they didn’t want to mess with for fear that if it builds scar tissue up it might really mess with things.  But they were hoping that scar tissue wouldn’t fill that area and it seems like it’s been fine.

Where is she at in terms of her cognitive function at what would be the end of  May or what would have been fourth grade?  Is she seeming to get back to normal?

No.

What’s abnormal?

She would ever finish a project – couldn’t, never, even though I have activities in on the table she’d start coloring.  First she just held the crayon and looked at the page and then it got better where she started coloring but then it stopped.  It would only be one object or a half of an object or not even a half of an object.  And then she got to the point where she was destructive where she would draw, because she was really good at coloring and drawing and she’s pretty fussy about it, that if she went outside the line or because she knew, I think it was how it wasn’t looking like before, she’d rip it all up.

Next in Part Twelve – Becoming Aware of Nancy’s Residual Deficits After Severe Brain Injury

Attorney Gordon Johnson

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