Seldom does one find a “travelogue” of a journey back from catastrophic traumatic brain injury that is so well written and compelling as the memoir by Cathy Crimmins, Where Is the Mango Princess: A Journey Back from Brain Injury. Ms. Crimmins, whose husband, Alan Foreman, survived a severe head injury while on a family vacation, crafted this book with an intellectual's command of language and a comedienne's sense of timing.
In the process, she obviously experienced a steep learning curve of concepts of neurology and brain injury – from the time of her husband's injury in a boating accident, through intensive care, neurological recovery, rehabilitation, and ultimate re-entry into the family and community. This book powerfully points out the fact that when brain injury happens to one member of a family, it affects all other members of the family, as well.
The story begins on the family's vacation in Canada, a getaway won at a raffle that brought its own bad luck. While boating on a lake, Alan is struck in the head by a boat which collides with and flies over his own. His seven-year-old daughter, Kelly, and family friends in the boat sustain minor physical injuries, but there are considerable psychological ramifications. After witnessing her father's injury, Kelly leaves the scene to direct another adult back to her cottage to announce the news of her father's injury to her mother. The terrifying events of the collision and his injury are complicated by the possibility of losing him during his coma and the need for Kelly to tolerate her father's abusive language and behavior through a stormy recovery process.
Alan's emergence from a coma of five days' duration finds him asking the question, “Where is the Mango Princess?” – a question for which his wife, the author, has no clear answer. She later offers the explanation provided by their young daughter: “Daddy got hit on the head and went up to heaven. And the Mango Princess was there, and she was real nice to him, and she said come back to us. And he did come back and he remembered her, just for a little while.”
Ms. Crimmins depicts the “hidden disability” of traumatic brain injury, its suddenness and catastrophic dimensions, with all the twists and turns of a roller coater ride of problems and emotions. She points out that her husband's injury is not apparent to those who see him, but the hidden neurological damage has dramatically altered his personality and cognitive functions in ways that require the help of health care professionals, friends, and family in reorganizing the life of a man who appears physically intact.
Along the way, this story serves as an indictment of the managed care systems in the United States and argues for a rational and uniform health care system such as the emergency trauma care they experienced in Canada prior to returning to Philadelphia for inpatient and follow-up rehabilitation services. With the exception of one difficult neurosurgeon, the Canadian paramedic and acute care teams were perceived as competent and caring about Alan's human condition, while the transfer back home to the US system began with arguments about who would pay for transportation and deteriorated from there.
The new relationship Ms. Crimmins must develop with her husband during his recovery acknowledges the “incredible imbalance” of his need for supervision as a result of the diminished self-awareness, which is so characteristic of severe traumatic brain injury (TBI). Ms. Crimmins aptly describes the existential dilemma of brain injury when she writes: “TBI is like an incomplete death: you've lost a person or parts of that person, but he's still here.”
This touching and intense real-life drama is, at times, tedious in its details but clever in its humor and profound in its insights. The author makes effective use of excerpted notes from her husband's hospital chart, injury rating scales, National Institutes of Health consensus statements on TBI, and comments of caregivers in the beginning of each chapter.
Ms. Crimmins engages in truth telling that is often harsh and hard to read, even as she confesses to her own insensitive remarks and exposes her own limitations as a wife and mother. As we learn about her husband's journey of recovery from TBI, so too does the reader observe the author's transformation from wife to crisis worker, to therapist-extender, to case manager, and back to wife again – but in a relationship with a much changed man.
PROFILE OF A SURVIVOR
This gripping story concludes with Alan returning to work as an attorney in a modified capacity at a new law firm, leaving the reader saddened but more settled. Alan is left with cognitive deficits and is prone to uninhibited, vulgar language and diminished insight – all traits that paint the typical profile of the survivor of severe TBI.
Ms. Crimmins wraps up with a classy and lengthy acknowledgment of relatives, friends, and health care professionals and supporters, which is equally well written, sincere, and gracious. This book should be required reading for all who are touched in any way by TBI in their personal or professional lives.
Most of us will never experience the inside view of the TBI experience of our patients and their family members, so this vicarious experience provided us by Ms. Crimmins is more than merely entertainment. Neurologists will gain insight and understanding through the real life experiences of Alan Foreman and his family, which would be applicable to a broad spectrum of brain disorders and which call upon the physician to be as empathic regarding the effects of brain dysfunction as they are knowledgeable regarding its causes and treatment.