Challenges Identifying Amnesia: Otto Part Five
There was some challenges identifying amnesia when it came to Otto. As important as amnesia is in assessing the potential severity of a severe brain injury, it is absolutely critical element to diagnosing a mild traumatic brain injury. There are four acute events which define the occurrence of MTBI:
- • a loss of consciousness,
- • a change in mental state,
- • amnesia or
- • focal neurological deficits.
See American Congress of Rehabilitation Medicine, definition of MTBI, https://tbilaw.com/RehabDefinitionPage.php
Focal neurological deficits are rarely seen and a loss of consciousness or change in mental state may be difficult to determine if there is no eye witness to the injury is one of the challenges identifying amnesia. On the other hand, the right inquiry within the first few hours and days after the brain trauma, should be able to identify evidence of amnesia. See Concussion Clinic.
Otto’s Wife’s explanation of his failure to remember the conversations they were having, is clear evidence of amnesia and reduce the challenges identifying amnesia.
There were challenges identifying amnesia with Otto and never formally assessed despite your efforts to have somebody look at it?
That’s what I understand.
You would tell him something and he wouldn’t remember it.
He might remember it for a minute or two but he wouldn’t remember it an hour or the next day.
I wouldn’t even say it was minutes. It was talking to a Alzheimer’s or dementia patient that was repeating. Well how is she today? She’s doing really good. Well how is she today? Well she’s doing really good. I mean it was that instantaneous that he wasn’t even cognitive that he was saying, making a question to me.
If we were going to prioritize memories, the most important thing would be that your daughter has been in an accident and she has had brain surgery and is in Madison, that is a 10 on a 10 point scale. He remembered that almost from the beginning which would present challenges identifying amnesia ?
But when you get less significant memories he had more and more difficulty?
Correct. Conversation was nonexistent and there wasn’t any because it just was too much repetition.
Throughout this whole time though he did remember his daughter was in Madison with a brain injury?
Elaborate on what he did and didn’t remember and the challenges identifying amnesia.
When he came to see Nancy, he had talked to me about the accident and what had happened and it was very little. He remembers pulling off to the side of the road. Other than that I don’t think he remembers anything after that. I don’t know how much retention he actually had but he had talked to the in our truck who had told him and filled in the blanks. Then they were trying to do as best they could trying to get the story straight, in his own mind I think and it was Chris our passenger that actually filled in the blanks.
How long did it take him to be able to even keep the reconstructed story straight?
I would say a good three, three weeks when pieces were falling into place where he could actually repeat it and it would come out in the same sequence or, you know, it was fluid as far as what Chris had filled him in on.
Other than that his daughter was in Madison was he able to grasp any of the other details of what happened to her?
No, not until actually until he came to the hospital and saw her, I think was where he could put it all together. I know he wanted to come instantly when he got released from the hospital but I didn’t think he was anywhere near ready to see this, to deal with it, to, you know, to come and participate.
When does he get released?
I think it was about six days after the accident.
And again he is hospitalized just because of the broken bone?
Broken bone and then they did a surgical ear repair.
Talk to me about the ear.
When he came down he actually had a piece of foam, yellow foam that was sutured in place to keep the ear in its shape and try to get a similar structure, you know, like to it. Then his foot was up in a cast and he was quite fun. He was quite fun because I had two, two kids on my hands. You know, it was kind – he felt bad. I think he really did. I think that’s what ate him up the most and what ate me up the most was I think he’s like come on, get up and do something but you know you can’t. You’re supposed to have your foot up 24/7, you know – that was hard.
Now what makes challenges identifying amnesia difficult with his situation is one, he’s got all these other pain issues and drug issues and other things that might mask what is significant amnesia, significant cognitive problems but he’s also got a reason that he can’t really do the kind of things that you would expect him to do when he comes home because of the injured foot. Convalescing is not very demanding of the brain. So other than this memory issue, when do you start to realize that there are some changes that he’s going through as well and the challenges identifying amnesia?
I think it was when – it was the home component. Like I expected that my husband will be there now and everything will be good. But it, it wasn’t there wasn’t a lot of help from him because he couldn’t and I had to get him things as well as watch her plus try to spend some time with my son.
I also addressed the challenges identifying amnesia and tried to determine the extent of Otto’s amnesia by asking him about it.
What do you know of what happened on February 1, 2003?
I know the morning that we went and on the ride home and the phone call that I gave my wife.
You remember making that phone call?
I do remember making that phone call and then from that point I remember nothing. I don’t remember where the accident took place. The only, I guess, the last memory I have I saw the truck that hit us do spins, and I just saw headlights, taillights, headlights, taillights, that’s it.
So that would mean that you really probably have some memory right up to the moment of collision.
Probably is accurate.
What’s the next thing you remember? Do you remember being in the hospital with a broken foot?
I have, uh, very faded memories of that, foggy, very foggy.
But you remember your daughter was hurt?
Do you remember being told that? Or just knowing it?
I just knew it.
Do you remember talking to your wife at all while you’re in the hospital?
I do not.
Do you remember going to Madison to seeing, see her in the hospital?
Very vaguely I do. I remember going down. I remember with my son for my daughter’s birthday.
So she would have still had her eyes closed?
No she had her eyes open then.
Was that the first time you saw her?
I think so.
You didn’t go down right after you got out of the hospital the first time?
I don’t think I did.
Do you remember talking to your son before you saw her about well she’s not going to look different.
I remembered most of that, you know. I remember that it’s going to be tough. She doesn’t look the same as she did before and just try to prepare him for it.