Brain injury: recovery and a lot of rediscovery

Each time Cathy Crimmins' husband reads about himself in her new book, it seems like an amazing story. The second time he read "Where is the Mango Princess?" Crimmins says he called from out of town to say some of it was excruciatingly embarrassing and, at the same time, he laughed. "Did that really happen?" he asked.

As Crimmins tours on behalf of her new book, visiting Sinai Hospital tomorrow, her husband is reading it a third time. The boating accident that left him with a severe brain injury and what happened after he awoke from a deep coma is a story she tells him over and over, but he can't retain it.


The biggest difference in a person after a traumatic brain injury is a lack of self awareness, Crimmins says. Simply put, the new brain can't remember the old brain. Watching her husband Alan Forman, a 44-year-old Philadelphia lawyer, re-learn such daily chores as tying his shoes or putting dirty plates in the dishwasher made her realize what an amazing organ the brain is.

He has the same face, the same body, the same funny laugh. But the old Al is gone.


Two million people suffer brain injuries every year, and many never recover. Others, such as Forman, recover in amazing ways but become a different person.

Crimmins, a best-selling author ("Newt Gingrich's Bedtime Stories for Orphans"), magazine writer, assistant professor of creative writing at the University of Pennsylvania and consultant to science museums (she helped write the Maryland Science Center's exhibit on plasma in space), had remained at the family's vacation cottage the day her husband was injured. It was the summer of 1996, and they were visiting a lake resort near Ontario, Canada.

In a scene that could have been taken from a James Bond movie, Forman was hit on the head by a speedboat that flew over their smaller skiff, which also carried his daughter and friends. The force of the blow was the same as if he had been thrown through a car windshield at 70 mph. Doctors in the Canadian trauma center where he was flown predicted he would awaken from his coma but never walk again. His brain swelled and banged his skull, but as Crimmins explains, the physical injuries were only part of it; Forman's brain chemistry was altered.

The damage was to the front part of his brain, the area that controls emotions, personality and judgment. The back region, the brain stem that runs the body's physical parts, was untouched. When he awakened five days later, Forman believed he was 12 and back in Brooklyn. He knew his name and his wife's name. And he asked for the Mango Princess. His daughter? His wife? No, the Mango Princess, he insisted. He had just been talking to her.

In the difficult weeks following her husband's accident, Crimmins was insulted when friends suggested she keep a journal that might lead to a book. But once he came home, she began to write spontaneously about the early stages of a person recovering from a traumatic brain injury. The dialogue she wrote from her near-photographic memory reveals the mysteries of her husband's mind.

There was the day early in his rehabilitation when he demanded to know the time of the meeting. If someone else is in charge, he told Crimmins, he had to know who it was so he could hold a meeting and tell them what to do. When is the meeting? he demanded.

"Al, there is no meeting. It was a coup. I'm in charge."

"That's what I was afraid of," he responded.


There was the day she discovered two things about her husband - first, that he could read and second, that he wanted to masturbate constantly. This - along with a steady stream of curse words - took all her energy to manage.

Cursing is, oddly, something those with brain injuries do - even those from families who would never say such words - and to their family's extreme embarrassment.

With the chemistry to his frontal lobes damaged, Forman no longer had the same impulse control. In the first few years after his injury, he would laugh, cry and grow angry easily. In the hospital, he cursed at visitors, threw fruit and discussed "the defective Al Forman." His doctors were pleased; had he been withdrawn, the outlook for rehabilitation would have been bleak.

She was dumbfounded. Her husband was incontinent, paralyzed, angry. She had a giant toddler on her hands.

It wasn't until Crimmins got her husband into the Magee Rehabilitation Hospital in Philadelphia that she began to see progress - he learned how to remember things he'd done, such as going to the bathroom.

At first he couldn't play the card game Concentration for more than a few minutes. Scrambling eggs was overwhelming. From pictures of his brain, she discovered how new information would take him twice as long to process, a condition called cognitive fatigue.


"Your wife married you for better or worse," medical aides told Forman one day, trying to motivate him. "This is the worse."

She recalls the day her husband, an avid gardener, turned to her and asked, "What is this?"

It was a geranium, the most common of flowers.

As she witnessed her husband read and write again, walk, speak and learn anew whole clusters of knowledge that had been dear to him, Crimmins' despair was balanced by her sense of humor.

Finally the day came when she read something startling in the log Forman was urged by doctors to keep: "I am getting ready to be a real person again."

Returning to work required help - an aide helped him organize, write, even do billing. But one thing he and others learned is that the more he used his brain, the more he would recover after the trauma.


"He is a very smart man and always was. He understands rationally the science of what happened to his brain," she says. "I don't think I would have been able to write this book if he wasn't such an interesting man."

Although her husband remembers the details of his marriage, the physical things, the places they've been, the people they knew, he has forgotten the emotional side of the old marriage. "It's been much altered," Crimmins says.

She misses her old husband desperately, she says.

"My husband died that day. I have a different husband, and it is not the same person," she says.

As many as 75 percent of marriages end in divorce after a partner has suffered a brain injury.

I am not sure what the outcome is, no one ever is," Crimmins says. "I know that if I were hit on the head, my husband would stay with me.


He was, is a wonderful person. On the other hand, I would never put anyone down [who chose to leave]."

Forman has worked hard to regain his knowledge of flowers and birds - and law. He now works part-time in an attorneys' office handling estates and trusts, work he has always done.

Her hope is that he will continue to be independent, and they will come to "some resolution about our new life, something that might not happen for 8 or 10 years down the road."

As for the Mango Princess? The couple's daughter, 11-year-old Kelly, thinks the Mango Princess was up in heaven and told her dad to come back to his family. Crimmins says she isn't so sure it wasn't "some woman he met at a business conference! I do know, he always liked the Caribbean and tropical fruits."

Seriously, she adds, she wondered where his mind went when he was recovering, and she would like to think "he was in a nice place and the Mango Princess was helping him have fun."

'Where is the Mango Princess?'


Who: Cathy Crimmins

What: Reading from her new book about her husband's recovery from brain injury

Where: : Zamoiski Auditorium at Sinai Hospital

When: 7 p.m. tomorrow

Admission: Free

Call: 410-601-6185