When the brain breaks

Mark Ostow

Anne Forrest ’79 at her home in Virginia. "I was a PhD economist," she says, but after the accident, "I couldn't add up my time sheet." View full image

In 1997, a minor car accident left Anne Forrest '79 with what the doctors called a "mild traumatic brain injury"—a term that did not prepare her for 13 years of struggle with cognitive impairment. David Zax '06 interviewed Forrest at a café near her home in Arlington, Virginia.

Y: You were highly functional before the accident.

F: I was a PhD economist. I was working at an environmental think tank. I played competitive volleyball and coached youth soccer. I drove, I had an active social life, I did everything that I wanted to do. Life was good.

Y: Could you describe the accident resulting in your brain injury?

F: It was June 14, 1997, a Saturday. I was hit from behind. I was looking left in order to merge into traffic, and my head swung from side to side and backwards and forwards. It was a slow-speed accident, a seemingly insignificant accident. There was some damage to my bumper.

Y: Was there any visible outward injury to your head?

F: I didn't hit anything—it was the shaking of the head. At the time I was just thinking, "Now I have to get my bumper repaired." It didn't seem like it would be something that would still be affecting me 13 years later.

Y: What symptoms began to develop?

F: I woke up the next day with a very severe headache, nausea, and chills. The doctor told me not to play volleyball and to take aspirin for the headaches. I went back to my job and had a hard time focusing. I couldn't carry ten-digit telephone numbers in my head anymore, and I couldn't add up my time sheet. Our CFO said, "Wait a second, we can't have an economist who can't do numbers." That's when I went out on short-term disability.

Y: What, biologically, had happened to you?

F: The belief is your brain is a bunch of telephone wires, and that the connections between the neurons are either stretched or broken. I went to see a neurologist, who said I had a mild traumatic brain injury. I thought, "How bad could a mild injury be? I have a bruise to my head. It'll go away." I had no idea.

Y: Can you define "mild" traumatic brain injury? What makes it "mild"?

F: "Mild" TBI is no-coma. It's a description of the acute injury [as opposed to long-term effects]. It can be a brief loss of consciousness, but there's no coma.

Y: It sounds like a misnomer.

F: It's a huge misnomer, and it really creates problems. Part of the problem with the name was people weren't believing me. People were just not getting me where I needed to go. There are times—and this is unbelievable to me—you almost wish you'd had a coma. A comedian friend said to me, "Just tell them you're gonna knock your head against the wall until they give you help."

Y: In the following months and years, what symptoms did you or your friends become aware of?

F: People noticed how slow my reactions were. My bills were stacking up. I was unaware that life was continuing on and I wasn't able to keep up with it. I would leave the gas stove on, and eventually I quit using the gas stove. Michael [then her boyfriend, now her husband] bought me a rice cooker, since it turns off by itself. There was concern about my safety, so we figured out a system where I called a Yale classmate in Boston, Kathy Rabin, every day at 12.

Y: How did you finally start to get better?

F: I've had four different rounds of cognitive therapy, which has gotten me tremendously better. I've managed to reduce my fatigue a lot. I still use compensatory strategies to get me through the day.

Y: Are you using any right now in this interview?

F: I had to write them down because people always ask and I can't remember. [Takes a written list from her bag.] I keep nothing in my head, everything is on paper, so all my brain is used only for problem solving. I use a routine; I use cues; I use other people's brains to help me think. You lose procedural memory as well, so I have to re-figure out how to do things. I have to work that through on paper beforehand.

Y: A Washingtonian profile of you says your therapist retrained you by breaking tasks down: "Paying the bill might involve ten steps, including, ‘Get a pen.’"

F: Right, right. God. [Laughs.] Thank goodness that's a while ago! The pen is now automatic, OK? That's an automatic thought that somebody like yourself doesn't even realize that you're doing. For me, my head was just silent—there wasn't that automatic thought—and everything had to be at a conscious level.

Y: In 2007 you started doing some advocacy work.

F: I started volunteering a couple of hours a week at the Brain Injury Association of America. My speech and language therapist wanted me to write a speech about my injury. I think everybody and his dog helped me write that first speech. I was just reading—every word had to be written out. [Someone] said, "That was a great speech," and I was like, "Why? What did I say?" You can imagine anyone saying that as a joke, but I was like, "No, you don't get it—I don't know what I said."

Y: What else are you doing now?

F: I'm a mom. So that represents a huge amount of work, to actually be able to take care of someone else. That was a huge step. It's really fun, because I understand so much more of what my son's brain is doing. He's learning about attention, and I'm learning about attention with him.