I wrote this essay in response to the shock and dismay I felt when I learned that helmet laws in America are being systematically challenged and rescinded through the work of (fill-in-expletive-here) who utilize the internet to spread disinformation claiming, among other things, that helmets are dangerous.
I learned about traumatic head injuries in the usual way—by watching Saturday morning cartoons. I learned from Tom and Jerry that, if an anvil drops on your head, a tall bump will immediately emerge and little chirping birds will circle about your head until the next scene, when you will be fully recovered and ready to chase that mouse again. I learned more from watching movies. I learned that a blow to the head could cause amnesia—which could only be reversed by another blow to the head. And, as any fan of action flicks knows, a sharp thump to the back of the head will knock the hero out, but he’ll awaken 30 to 60 minutes later (whatever the plot demands) ruefully rubbing his head and muttering, “What happened?”
I didn’t learn much more about head injuries until I went to physical therapy school. I learned even more by working with head-injured patients over the next thirty years. Now I live in Vietnam, where traumatic head injury is one of the leading causes of death and disability. This is because, in Vietnam, motorbikes comprise 90 percent of road traffic and helmet use is rare. Thirty-eight people die everyday in Vietnam in traffic accidents—mostly head injuries from motorbike mishaps. But many, many more suffer head injuries and survive. Those survivors fill the hospitals and rehabilitation centers in Vietnam.
Phuong was a bright high school student--one of the few in Da Nang who was fluent in English and confident enough to speak to American and Australian visitors. One day she slipped off the back of her boyfriend’s bike and struck her head against the pavement. Now, a year and a half later, she can walk again and her hair has grown in enough to camouflage the deep depression in her head where her scalp lies directly over the right half of her brain. She even recalls a few words of English. If she concentrates really hard, she can stand at the sink and wash dishes under her mother’s supervision. But her bright academic and professional future is gone now and her mother has grown to accept the idea that her once brilliant daughter will always remain an impulsive child.
Dr. Lam has spent the three years since his motorbike accident searching for the Holy Grail—a therapy that would give him back the use of his left hand so that he could resume his work as a surgeon. Ours was the third rehab center he had tried. He arrived with his youngest son in attendance and was delighted to find a foreign-trained therapist. He offered me his wizened left hand to examine. “I’m so sorry,” I said, “but when we see no evidence of muscle return after all this time, I have to say that I see no hope that you can regain enough use of your hand to do surgery again.” I talked to him, instead, about teaching medical students those skills that he could no longer perform himself.
Mr. Cuong was an engineer and the father of three until a van made a right turn from a left lane and knocked him from his motorbike. His younger sister has been by his side for the three months he’s been hospitalized, while his wife cares for their children at home. His sister spoon-feeds him soup between his chokes and sputters. His progress in therapy has been slowed by recurrent bouts of pneumonia, caused by his inability to consistently direct food into his stomach instead of his lungs. Mr. Cuong can’t speak and can’t understand verbal commands either, which makes teaching him exercises and understanding his concerns difficult. One day last month, his sister, his therapist, a student therapist, my translator and I encircled him as he sat in a straight-backed chair and tried to puzzle out why he appeared to be so agitated. Failing that, we elected to go on to the most basic non-verbal exercise I know: Stand Up! With his therapist on one side and me on the other, we hollered, “MOT, HAI, BA!” and hoisted him up onto his feet. Mr. Cuong grimaced and grunted and stood up--and dropped a steaming load of shit from his shorts onto the floor. Nervous giggles all around. Oh. That’s what he wanted to say.