Rebecca Butterworth

More than 500,000 Australians have an acquired brain injury, many caused by trauma. Rebecca Butterworth meets three men who have had to rebuild their lives - and even their personalities - after accidents.
WHEN Brian Scanlon left the office one wet night in 1988, he drove away as the much liked and respected managing director of canning giant SPC.
 
Within minutes, that life was gone.
 
''I was coming from Shepparton to Benalla. The motorcycle was coming from Benalla to Shepparton. We hit,'' he says, smacking his hands together lightly, like he's telling a bedtime story. He points up, indicating that the biker was launched into the air. ''And I don't remember. Because something switched off in my head. But he came over and smashed into me, then - dead, dead, dead.''
 
Brian's elder sister, Shirley, remembers the night all too well.
 
''I had a call in the middle of the night to say that there had been a shocking accident and that Brian wouldn't make it, that he was too badly injured,'' she says. ''It was a bad night, and one of the motorcyclists had veered off and drove straight into Brian's car. He came through the window, with his helmet on, and crashed into Brian's head. Broke his head into a million pieces. The motorcyclist was killed.''
 
Apart from the damage to his skull, Brian was left without a mark on him. His head now resembles a fault line, running from his crown to the top of his eyebrow, a crack in the tectonic plates. He no longer looks like the man in the picture that Shirley keeps on her living room table, a treasured image of the siblings together before the accident.
 
''They sent a helicopter. Apparently, when [it] was above them, [they] were there trying to get him out of the car.'' Shirley's throat begins to close up, and she sobs. ''Oh, isn't it awful? I always break up here. So they said, 'No, we can't get him. He'll be dead.'''
 
She said the helicopter left to attend another accident, but returned several hours later, by which time emergency crews had been able to free Brian from the wreckage. The helicopter intercepted the road ambulance and flew Brian to Melbourne.
 
It would be months before he recognised his sister. Brian had become one of some 500,000 Australians with an acquired brain injury, or an ABI. He would never return to paid work; his new job was to rebuild his life.
 
Brian had been top of his class at school, but joined SPC at 15, chopping wood for the then director, Sir Andrew Fairley. Sir Andrew noticed something in the clever young lad, who was also a keen sportsman. When Brian received an offer from a prominent VFL club, Sir Andrew convinced him not to go - to instead make a career at SPC. At 31, Brian was appointed managing director. ''I started to travel around the world,'' he says. ''And we ran the fruit industry in Australia.''
 
''The first thing that [ABI victims] lose is their personality,'' says Shirley. ''He had the greatest sense of humour; he'd tell you a story and you'd be really rolling around, laughing. That's all gone now.''
 
According to the Australian Institute of Health and Welfare, one in 45 Australians have an ABI. While strokes account for the majority of acquired brain injuries, accidents (including falls, sporting injuries and vehicle collisions) are the second most common cause. Of these traumatic ABIs, a third occur on the road. Three-quarters of ABI victims are male, and two-thirds are aged under 25 when they acquire their injury.
 
Brian, who was 48 at the time of the accident, falls late in the bell curve.
 
Brian's sentences are filled with long, slow gaps, as he struggles to remember each word correctly. Occasionally he loses his way, pauses, and gives an apologetic look. ''It's …'' he crosses his eyes and makes a nasal sound, points to his temple, laughs, and pushes on.
Stilted communication is common among sufferers of ABI. Distinct from those with an intellectual disability, ABI can steal memory, executive function control, impulse control and pockets of intelligence - but often intellect can remain relatively undamaged, while what's lost is the ability to express it. Thought is not easily converted to words.
 
ABI is seemingly arbitrary in whom it affects and in what ways. The resulting frustration can often overflow into physical violence. Often, ABI sufferers know they lived differently once, but cannot remember how. Brian is able to remember a lot about his history, and although his memory lapses, he speaks with relative precision. Despite everything, it is his optimism that stands out.
 
AARON Gaunt was 13 when he acquired his brain injury in November 1996. Big for his age and a bit of an athlete, there weren't many sports he didn't play. At eight, he had won the state championships in high-jump. Five years later, he was a promising basketballer. He was also fascinated by yo-yos, as were many kids his age in the mid-1990s. As he stepped off a bus on the way to basketball training one afternoon, his mind was on his latest yo-yo trick.
 
''My yo-yo wrecked up. My focus was in on it - being 13, and that. And then I wasn't looking on the road. And I stepped out into the middle of the road,'' he says.
 
The car that hit Aaron knocked him unconscious. Aaron's basketball coach rushed to his side. A passing doctor also came to his aid, eventually bringing him round.
 
''I had this massive headache. I took a couple of steps, and then I collapsed.'' Aaron was rushed to hospital in a coma.
 
''They told my mum, 'He's got no chance of living. Pretty much, no chance.' But my mum wouldn't give up for quids. Plus she never did. Except for the time that she left my room to go have a shower, and then freshen up, then come back. And then that's when I decided to wake up. Just to be a smarty.''
 
That was nine weeks after he had collapsed. It was dark, and Aaron was confused - he couldn't call out, because he had a tube in his throat.
 
Aaron spent the next 23 months in hospital while his mother arranged his new life, largely funded by the Transport Accident Commission, which also funds Brian's part-time carers. From 13 to 15, Aaron was in a hospital bed or a wheelchair.
 
''They were very sympathetic, a little bit too sympathetic, you know?
 
''I would wake up, and the nurses would shower me, and that, and just wheel me out. And then it's a big move to my wheelchair. I hated my wheelchair. Because I never had full control in my right hand, yeah?'' Aaron's eyes widen when he remembers the frustration. ''Yes! Yes. I felt like kicking the walls down, you know? I had fisticuffs with the nurses, and that. And my mum. At times, I felt like killing my mum. You know what, I didn't - or else I wouldn't be here!''
 
Having been popular at school, Aaron was afraid to return, fearing that he would fall in front of his classmates. The reactions were difficult, but not in the way he had expected.
 
''They were very sympathetic, a little bit too sympathetic, you know? I obviously was into my sport, and then running - [but] I couldn't do it properly. All of my friends would be around me, and that. It got on my nerves a bit,'' he says. ''I was 13 when I had my accident, and seeing typical 13-year-olds … compete in sport. Ah, it just got on my nerves, you know? I felt like saying … but that part of my life's gone.''
 
Brian and Aaron met at The Eley on the Park Cafe, at The Avenue Neighbourhood House in Blackburn South, where they both work once a week on a volunteer basis. The cafe is staffed by people with ABI, overseen by both paid and volunteer staff, and administered by EACH Social and Community Health. Aaron works as a barista, charming the younger female customers, while Brian works in food preparation.
 
''He stands out,'' says Brian, with a smile. But then, it's probably a bit of himself he sees in the young kid. The cafe provides real life skills and ongoing social rehabilitation for its staff, which is an important part of recovering from brain injury.
 
NICK Rushworth knows the value of quality rehabilitation. The same year that Aaron was struck by a car, Nick too was hit while riding to work at the ABC. ''Classic sort of a bicycle accident - a car was turning across me, and collected me head-on. Over the bonnet - took the full force of the impact on the right side of my face, underneath the helmet. I've now got a hand-sized metal plate where the right side of my face and skull used to be,'' he says.
 
Now executive officer of Brain Injury Australia, Nick says that while stroke is the leading cause of acquired brain injury, motor vehicle accidents account for one in three traumatic brain injuries (caused by force to the head).
 
''The general public awareness level about brain injury lags about 20 or 30 years behind that of other disabilities,'' he says. ''There are over 500,000 Australians living with a brain injury, and there are 22,000 hospitalisations for traumatic brain injuries every year.''
He says the rule of brain injury is that no two injuries are the same. As each individual is unique, so is their brain, and so is their recovery from the injury.
 
''Very important is the kind of person they were before the injury - their access to rehabilitation, how close they were to a major teaching hospital, the kind of care they received upon admission. It's a sort of a lottery,'' he says.
 
Nick has gone on to not only live without significant consequence to his professional life, but to champion the cause of brain injury for others.
 
''[Mine] was a very fast recovery. I was five minutes from Royal Albert Hospital. I was two weeks in hospital, three weeks in rehabilitation. I was back at work full time [within weeks]. A recovery that's got a great deal to do with the pure accident of family: my father happens to be a brain surgeon and I have two other doctors in the family. Ninety-nine per cent of my constituents don't have access to that kind of support.''
 
Although Brian, too, received top-level care, his recovery wasn't as smooth as Nick's. Brian had not long begun his second marriage when he had his accident. After months in hospital, Brian and his wife moved to eastern Melbourne while he was a day patient at the Epworth Rehabilitation Clinic for more than six months.
 
Moving to Melbourne also meant he was closer to his sister Shirley. One day she contacted a friend who was president of a golf club.
 
''[Brian] was a good golfer, and they thought that might help him, getting out on to the fairway, if he could get a practice in,'' Shirley says.
 
''I wanted to see how capable he was at doing physical things, and how he would be able to co-ordinate. He got on the practice fairway and started hitting balls normally.'' Shirley has tears in her eyes and laughs. ''And I thought, oh - that's wonderful!''
 
But other basic things, like recognising what a toothbrush was and how to use it, had to be relearnt and the toll on those closest to him was heavy. Six years after the accident, Brian and his wife divorced.
Recently, Brian began seeing a new doctor, who took him off medications prescribed to ease the fits that had plagued him after his accident. Shirley says that, since this adjustment, Brian has improved greatly and is almost back to normal. She feels positive about his future.
 
''You can't afford to be too optimistic,'' she says. ''But gradually, you could see him getting better. And after that, I became optimistic, thinking to myself, right, well, he's going to get a lot better … And then realising the brain does rejuvenate.''
 
Aaron's recovery, beyond the physical battle, took a psychological toll. While Brian was in the midst of a successful career when he was injured, Aaron has had to grapple with all the ''could have beens''. At times it has left him feeling very dejected.
 
''I had just turned 13 when I had my accident. I could have been anything I wanted,'' Aaron says. ''I was classified: 80 per cent of my injuries are permanent. For 12 months, I wasn't walking. And I dreamed of the day, I dreamed of the day when I would. That I would come in here [to the shopping centre], just by walking.''
But at times, the physical pain was almost too much to bear. ''Physio was the worst. My physio would say to me, 'Walk', and I couldn't … It used to be a killer.''
 
Eventually, he gave basketball a go again. Aaron hesitates when he thinks of how it went. He answers in low tones. ''Nah.''
 
Despite the ups and downs, Aaron has persevered. ''The meaning of rehabilitation is to start over. And I had to start all over again, from scratch. I had to relearn to walk, go to the toilet … work out prices, and that.''
 
He is now looking to the future. ''[I have] time to breathe, and have another go at life.''
 
Brain Injury Awareness Week starts tomorrow, brainlink.org.au, bia.net.au.
 
Photo: Craig Sillitoe
Altered States
 
by Rebecca Butterworth
August 14, 2011