In addition to my publishing career, I also work as a physician specializing in brain injury. I’ve been working in the field for 12 years, and I’ve seen just about every kind of head injury there is, from concussion to military brain injury to a kid who had a car roll over his head (not recommended).
Unfortunately, when I read books about brain-injured characters, I feel like they often get it wrong. So as a brain injury doctor, I’d like to offer some tips for writing about head injury.
8 Tips for Writing About Head Injuries in Fiction
- I just want to say this from the outset, so there’s no confusion. A second head bonk is never curative. Never. There are no reported cases where somebody has a memory loss from being hit in the head, and then they get hit in the head again and it gets better. I can’t emphasize this enough. Don’t do it in fiction, and don’t do it in real life.
- Emerging from an extended coma and being just hunky-dory is essentially impossible. Three months after brain injury, if your character has not made any kind of significant recovery, their chances of a good recovery are terrible. If they were to emerge from the coma six months or a year later, they would be severely impaired, probably for the rest of their life.
- You can see just about anything with a brain injury depending on where the bleed is (or if there’s a bleed at all). You can give your character memory loss, speech difficulties, paralysis on one side of your body, agitation, vision problems, breathing problems, swallowing difficulties, or extremely minimal deficits. Like snowflakes, no two brain injuries are exactly alike.
- The initial test to diagnose a head injury is a CAT scan of the brain without contrast (which most people in medicine refer to as a CT). Later on, other imaging can be helpful like an MRI, but that’s the test your character needs right away when they are wheeled into the emergency room.
- Your character can walk around with bleeding in their brain. I have seen people come in and were bleeding for a couple of weeks and didn’t even know it. It happens a lot with elderly people who have more space in their skull. With young people, the symptoms are usually seen immediately.
- A concussion is a mild traumatic brain injury that may or may not involve a loss of consciousness (must be less than 30 minutes and usually even shorter). Usually any imaging studies would be negative and a hospital stay is not required. The most common symptom people have with concussions is headaches, which usually go away within a few months (usually less). Your character may also have irritability, difficulty concentrating, difficulty sleeping, and blurred vision. If they have any confusion, it should go away within 24 hours.
- There’s no medicine that can be given to cure a brain injury. If your character has bleeding in the skull that is putting pressure on their brain, there are medicines that can reduce the pressure, or else the surgeons can perform any one of a number of procedures to relieve the pressure. The kinds of brain injuries that may require surgery are subdural hematomas and epidural hematomas.
- It’s very hard to intentionally fake deficits from a brain injury. There are actually a few very simple tests we give to patients if we think they’re faking it, so tell your character not to try it!
