Texas man, shot in the head, explains recovery process for traumatic brain injury

From The NY Times:

COLLEGE STATION, Tex. — Mark Steinhubl (pictured) does not remember being shot. The bullet tore into his skull just above the right eye and cut through the right side of his brain. The slug obliterated some memories.

He woke in a room full of white lights and bleeping machines, his head a mass of bandages. His parents were there. Doctors and nurses came and went through a swinging door, asking him to hold up fingers or follow a penlight with his eye.

Time collapsed. He remembers only snatches, snapshots. Friends’ faces. His parents saying he had been shot. Scrawling messages about his pain on a white board. Tossing a pencil at a visitor.

“I couldn’t speak, and I couldn’t move my right side at all,” Mr. Steinhubl said. “That was really confusing to me. I would touch the parts of my face with bandages. I was confused and frustrated. Why was I in such a white place?”

Few people understand what Representative Gabrielle Giffords of Arizona faces as she begins her rehabilitation at the Memorial Hermann hospital complex in Houston, but Mr. Steinhubl, a 20-year-old college student, is one of them.

Two years ago, he suffered a similar ordeal as Ms. Giffords – a bullet damaging half the brain, the deadly buildup of spinal fluid, the removal of a piece of his skull by surgeons to relieve pressure. He also went through the same program at the medical center’s rehab hospital — TIRR Memorial Hermann — that Ms. Giffords is expected to do.

“She needs to realize that it won’t be instantaneous,” Mr. Steinhubl said in an interview. “She needs to set these small goals for herself.”

Early on the morning of Jan. 4, 2009, on the last day of Christmas break, Mr. Steinhubl was shot in the head at a friend’s house. He declines to talk about the shooting, but court records show that the person who shot him was a fellow senior at his Houston high school.

Mr. Steinhubl was taken by ambulance to Ben Taub General Hospital in Houston, where trauma surgeons cut away part of his skull and gave him drugs to induce a coma, waking him only for short stretches once a day for neurological tests. He underwent four major operations. He lost his right eye and all hearing in his right ear.

Four weeks later, paralyzed on his left side, he was wheeled into the rehabilitation institute flat on his back on a gurney, wearing a helmet to protect the side of his head where the skull had been removed. He could not even sit up for more than a couple of seconds without being overwhelmed with dizziness.

It was the beginning of months of frustrating rehabilitation, relearning things he had learned as small child: how to walk, bathe, brush his teeth, tie his shoes. “It was a long process, and I was really impatient,” he said.

But Mr. Steinhubl managed to graduate from Jesuit Strake College Preparatory on time that May and entered Texas A&M University just nine months after the shooting. That rapid progress is a testament not only to the skills of the therapists at the institute, which has a national reputation for helping survivors of brain injuries, but also to his own drive. “I was really determined to get back to my life,” he said.

Ms. Giffords, who remains in intensive care at Memorial Hermann-Texas Medical Center, is expected to be transferred to the institute as soon as her health improves. On Sunday, her doctors said she was likely to remain in intensive care until at least the end of the week because of a slight buildup of spinal fluid in her brain after she was flown to Houston from Tucson on Friday.

The congresswoman has a catheter draining fluid from her skull, and it must be removed or replaced with a more permanent shunt before she can be transferred. “We just have to wait and see if the fluid buildup issue resolves itself,” said Dr. John Holcomb, a trauma surgeon and retired Army colonel.

Before his shooting, Mr. Steinhubl had been a top student at his prep school and a hooker on the school’s varsity rugby team. He was 180 pounds of muscle, an energetic and bright young man who had scored high on his SAT and was applying to elite colleges.

“He was a normal 18-year-old who didn’t have a whole lot of use for his parents,” said his mother, Marie.

After his injury, Mr. Steinhubl said, it became a challenge simply to sit up in bed. He and his therapist would set small goals — for instance, to sit up for five seconds at a time — then try to accomplish them. By the end of a week, he was able to sit in a wheelchair. The footrests were taken off, forcing him to propel himself down the hallway. He slowly regained use of his legs.

“In my mind I could do all these things, but when I was sending these messages to my body, I couldn’t,” Mr. Steinhubl said. “I felt like I could run down to the basketball court and start playing, and I couldn’t.”

Another therapist worked on his paralyzed left arm. At first, he was asked to set it on a wheeled board and roll it back and forth, using his shoulder muscles. Over days, his ability to control the muscles came back. When he had use of the arm again, the therapists put a mitten on his right hand to force him to use his left for everything.

By the second week, he was being asked to stand for a few seconds at a time, then to lengthen that time incrementally. Then therapists taught him to walk again, just as one does with a baby. He held the therapist’s arms at the elbows and shuffled forward as the therapist moved backward. Later, he would push a grocery cart full of basketballs up and down the halls.

Days at the institute can be grueling for patients, Mr. Steinhubl said. Every morning patients are asked to write out their goals for that morning — to stand a few more minutes, to tie their shoes, to dress themselves. Many of the fine-motor exercises seem simple, but they can be extremely difficult for someone with a brain injury. He spent hours picking up marbles with his left hand or putting toothpicks in a jar.

He had to fight feelings of depression and hopelessness. Early on in his stay, he recalled an irrational moment when he refused to get into the wheelchair that had been brought to his bedside. “I knew if I did I would never walk,” he said. Eventually his therapist persuaded him that the wheelchair was a necessary step on the road to standing up.

“We know a lot of kids his age who didn’t jump out of bed and go to their therapy,” said his father, Andy Steinhubl, a management consultant. “There was a lot of depression evident. I didn’t see that with Mark.”

Mark Steinhubl said he just wanted to escape the hospital. “I knew I was going to get out — I was going to go back and live my life,” he said.

Not only did his body seem to ignore his will at times, but his mind was dulled as well. He labored over simple math problems that his speech therapist gave him and had trouble recalling the details of stories he had just read. Even forming simple sentences seemed to take more mental effort. “It was really slow, and I had to really dig for the answers,” he said.

In his third week at the institute, Mr. Steinhubl started walking, and his recovery picked up speed. By the end of a month, he was able to balance on one leg and jog down the hall. He was sent home on Feb. 28, three months before his caregivers had predicted he would leave. He still faced months of therapy at an outpatient clinic.

In March, he had surgery to cement back in place the pieces of skull doctors had removed after the shooting. He started going back to school, but could handle only three hours a day and had to rest for a period between classes.

These days, he is a sophomore at A&M, living on his own in an apartment. He has adjusted to being deaf in one ear and to the loss of his eye. But he still has not regained full use of his left hand, and his days of playing guitar are over. “I can play Guitar Hero,” he says, smiling at the plastic guitar that goes with the video game.

Mr. Steinhubl said he has yet to decide what to do with his life. He is studying chemical engineering, but also taking courses that would pave the way to medical school. His brain is still healing, he says, and he cannot yet take a full load of courses. He needs extra time on tests and has trouble taking notes in lectures.

But he is alive, he points out.

“I know there is a plan for me being here, because God decided to keep me around,” he said. “There must be a reason.”