In 1999, Professor Clark Elliott is rear-ended by a stranger at a stoplight. He’s shaken but figures he’s fine, and drives to work. Spoiler: Clark Elliott is not fine.
Elliott is severely concussed, and this fact will dictate the next ten years of his life. Elliott’s memoir is based on notes he took while concussed. Reading it is like watching someone try to troubleshoot their broken laptop using the broken laptop.
In the opening chapter, Elliott describes walking from his office to his car after a long winter workday:
“At this point my world had collapsed inward on itself… I looked down at my feet and shouted at myself to walk, but I knew it was hopeless. I had lost the mysterious initiative that impels us all forward when we walk, and I knew that without brain rest I wouldn’t be getting it back. I considered lying down in the snow.”
Over an hour later, Elliott finally manages to cross the parking lot and begins the second phase of his trial: getting into the car.
“I’d lost the concept of center. I had no internal representation, or visual understanding of circle, target, middle, inside. Without these concepts I couldn’t get my hand to move toward the lock, or put the key in the slot.” So he just stands next to the door for another hour and a half.
Around 2 a.m., a suspicious police officer asks why Elliott is loitering in the parking lot, but the officer is too cold to get out of his car and drives away. At 3:30 a.m., four and a half hours after he left his office, Elliott finally arrives home.
The book’s first mystery is how a person can remain conscious, verbal, employed, and yet so damaged that he can’t get into a car or recognize his own house. The second mystery is: why did he apparently recover through treatments that sound, at first pass, like boutique neuro-quackery?
A disclosure is in order before we continue. I am pretty personally invested in the answers here. About a year and a half ago, I got seriously concussed. Milder than Elliott’s, but bad enough to substantially rearrange my life. On some level, I read this book in hope of a cheap fix, or at least an obvious one. Instead I found myself in the weird borderlands of modern medicine.
What’s it like to be a human with severe brain damage? Elliott offers a metaphor:
To simulate concussion damage to a human brain then, we’ll need to gather together […] 50 million desktop computers, a 500,000-mile-high stack of paper, and the almost inconceivable amount of information it takes to construct a human mind, then loose a hurricane on the system, ripping out network lines, laying waste to vast sections of memory, and sending landslides to smash hundreds of thousands of computers.
A bit sensational, but you get the picture. One classic model of what’s happening during severe concussions is “diffuse axonal injury”: rapid acceleration and deceleration stretch axons, the neuron projections that send electrical signals, causing micro-tears and disrupting cellular metabolism.