The slow road to recovery after brain surgery

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Kirsten Hanson doesn't remember trying to jump from the third-floor balcony into the swimming pool at her best friend's family vacation home in Mexico. She doesn't recall catching her foot on the bar above the concrete barrier. And mercifully, she has no recollection of toppling to the pavement below, just shy of her target and smashing her skull, cracking her nose, jaw and left wrist.

Only much later was she able to piece together what happened from what others told her: her friend's horror; the panic to find an English-Spanish speaker who could summon help to the remote, gated resort community outside of Playa del Carmen; the long ambulance ride to the nearest hospital, only to be redirected to a larger hospital another hour away in Cancun with the means to conduct emergency brain surgery.

More than four years and multiple surgeries later, Ms. Hanson, now 24, recognizes she is fortunate. She can think and speak clearly. She moves without impediment. And with the exception of a pale scar that peeks out from her hairline and another on her wrist, she bears no visible evidence of the accident that nearly killed her. She now has a new understanding of her own resilience.

Yet life after a traumatic brain injury has been, at times, infuriating.

As many who have come back from a brain injury will attest, the period of rehabilitation is unlike that of any other illness. The brain stores our memories and determines our personality. When it is injured, we can struggle to communicate, forget names and faces, or, in severe cases, lose the very values and traits that have defined us. It can be disorienting for loved ones and surprising for the sufferers.

During the two years it took to recover, Ms. Hanson had problems with memory, reasoning and controlling her temper around those in charge of her care. She didn't always understand the severity of her injury: As her brain healed, she didn't feel lucky to have survived. She felt frustrated about being treated as an invalid, guilty for making her friends and family worry, and, for the most part, she felt physically fine; her brain, which was swollen and missing tissue that surgeons needed to extract, didn't register its own impairment.

That didn't stop others from constantly reminding her she was in worse shape than she felt.

"The hardest part was people telling me how to feel the whole time," says Ms. Hanson from her studio apartment in Toronto's Liberty Village neighbourhood. "As much as I'd like to say the healing process was really hard, it really wasn't because … the whole time, I wasn't in pain."

Back in 2011, as an unconscious Ms. Hanson was rushed into brain surgery and given a 4-per-cent chance of survival, her mother, Deborah Shennette, received an urgent call at her home, halfway around the world in Paris: Her daughter had been in an accident and was seriously injured. Ms. Shennette sprang into action. She packed her bags, jumped into the shower and took a taxi to the airport, where she caught the first Air France flight to Mexico. Over the next 17 hours, cut off from Internet and cellphone access, Ms. Shennette was left to her thoughts as she made the journey across the Atlantic, to Mexico City and then to Cancun.

"You pray a lot," Ms. Shennette says of having nothing but time to contemplate her worst fears. "You pray for good news. And prepare yourself if it isn't."

For the next four days, Ms. Hanson remained in a coma, though doctors noticed her condition improved daily. But even when she regained consciousness, it was far from clear she would be all right.

"People don't wake up from a coma and then start having a conversation with you, like you see on TV," Ms. Shennette says. "She still was very out of it a lot of the time."

After another four days in hospital, Ms. Hanson was deemed stable enough to be transported by air ambulance to the Foothills Medical Centre in her native Calgary. Ms. Hanson remembers only fragments from this time. She recalls feeling her mom gently shake her awake, and thinking, why am I naked? She remembers sitting up in the air ambulance to ask for a sip of Diet Coke, only to have the medical attendants panic at the risk of her hitting her head on the plane's low ceiling. "Whoa," she remembers telling them. "What are you guys freaking out about? It's fine. I just want a sip of Coke." And she remembers seeing only darkness after arriving at the Calgary hospital and hearing a fellow patient's screams.

At Foothills Medical Centre, where she stayed for two weeks, Ms. Hanson felt and acted aloof about her accident. The severity of her injuries did not sink in. She rebelled against the medical staff, ripping off her neck brace and deliberately moving around during a computerized tomography (CT) scan to sabotage the process. She greeted visiting friends as though nothing had happened. ("I was like, 'Hey guys, what's up? Like, what are ya doing? It's good to see ya,'" she recalls.) And although she had access to a mirror, she failed to realize that her hair had been shaved and the top of her skull was stitched up like a softball. Nor did she notice in the reflection that her nose and jaw were broken.

"All I was looking at was how skinny I was," she says, explaining she lost nearly 7 kilograms while in hospital. "And I was like, 'Yeah, I look good,' you know? It was so stupid."

Ms. Hanson's irrational behaviour continued after she was discharged to her mother's care. The two temporarily moved into a condo her family owned in Calgary, where Ms. Hanson grew bored and angry under constant supervision.

To allow room for her brain to swell, surgeons had removed a palm-sized piece of bone from above Ms. Hanson's left eye, which left her in a precarious state, as any impact to the unprotected area would have been fatal. Ms. Hanson, who was naturally sporty and outgoing, felt cooped up, unable to do many of the activities she loved. She couldn't go running, skiing or drinking with friends.

"It really, really got on my nerves. I never fight with my mom, but I was fighting with her so much," she says. "I was so brain injured that I was so rude to her."

Even though her doctors and family members had briefed her about her condition, she was still unable to process it. Months after her accident, she was stunned to overhear her mother mention she'd had brain surgery over the phone.

"I was like, 'Mom! What? What? You should've told me that!'" she says. "Certain things like that, like really big details, I'd get super-confused."

Yet Ms. Hanson continually surpassed others' expectations about her recovery. As Ms. Shennette explains, one of the doctors Ms. Hanson encountered in Calgary was surprised to see she was not only able to walk and talk, but had dressed herself up fashionably for the medical visit. And only two months after her accident, Ms. Hanson, who had been studying international relations at the University of St. Andrews in Scotland, was taking courses online.

"I've always been a really smart person, so I really did it because I was bored," she says, adding that strangely, she began gravitating to subjects such as chemistry and math, since reading and writing essays – tasks that had previously come easily to her – suddenly felt difficult.

Over the next two years, however, Ms. Hanson became more like her old self. The swelling in her brain came down and a plastic surgeon reconstructed her forehead and skull. She was better able to control her temper and restored her close relationship with her mother. She also regained her interest in essay-writing, recently earning an English degree from the University of Calgary. She is now planning to attend law school.

"It was the weirdest thing. When you have a brain injury, you can actually feel conscious stages of your brain healing that you could never explain to anyone," she says. "You'll wake up at some point and just be like, 'Oh, I can feel that I'm a little bit better.'"

Ms. Hanson still has trouble with her short-term memory. She meticulously writes down events in her calendar so she won't forget them. And she now requires days instead of hours to study for exams. She has also permanently lost her sense of smell and much of her sense of taste, since part of the tissue removed from her brain was responsible for processing smell. Yet that hasn't stopped her from growing herbs on her apartment balcony, nor from experimenting with the collection of cookbooks she keeps on her kitchen counter.

In the winter of 2013, Ms. Hanson joined her family on vacation in Mont Blanc on the French-Italian border, and she strapped on skis for the first time since her injury. She raced down the slopes as though she hadn't been hurt at all, surpassing her companions. It was exhilarating. She felt fearless.

"I had been through what I had been through and it made me realize that first of all, you're not really living unless you're doing everything to have the most fun you can," Ms. Hanson says. "And second of all … there's no use in being scared; we're not as fragile as we think we are."

She attributes her recovery to her doctors, particularly the doctor in Mexico who performed her brain surgery. "He saved my life, you know?"

Ms. Hanson has been meaning to thank him via e-mail, but finds it too difficult to express her gratitude. She will one day, though, she promises, adding: "I hope that some day if I go back to Mexico, I could meet up with him."