Sarah: This injury’s made me reflect on what the load on my brain was like before the accident.
It’s a few weeks before my bike crash. I’m on the train going into the city to find my daughter some shoes. I’m on my phone. Checking my emails. Searching for which shop to head to. My kids are fighting for my attention. We get off at Town Hall in the centre of Sydney. It’s Friday afternoon so it’s mayhem. We take forever to find the right shop.
You don’t need to have had a brain injury like me for this to be relevant. The trauma of my accident can teach us all something about our lives.
David Strayer: With smartphones, we carry in our pocket a little digital computer that connects us to pretty much everybody on the planet…and you can connect 24/7. So you’re now constantly multitasking and trying to do all kinds juggling all kinds of things. And that tends to deplete the reserve the mental reserve probably some of the glycogen and glucose supplies in the prefrontal cortex that make the brain work. So even though it seems to be something we think we’re good at we in fact are not.
Sarah: David Strayer is a professor of Cognitive Neuroscience in the Department of Psychology at the University of Utah.
David Strayer: I bet most of the people who are listening to this think that they’re good at multitasking, that’s just that’s the statistics. But The evidence is actually really clearly the opposite. We are not good at multitasking our brains tend to just do one thing at a time even though we have billions of neurons in terms of our behaviour. We’re really just doing one thing and then one thing and switching back and forth and that switching from one activity to another is is very difficult to do. It’s mentally demanding. There are a handful of people who tend to be much better at it than most and we kind of refer to those as super taskers. And we found out that now about 2 percent of the population. Are these extraordinary people who can multitask like we all think we can. When we tried to study that systematically by looking at what happens in the brain and looking at neuroimaging and EEG studies you can clearly show the brain becomes kind of overloaded when we try and multitask and that we just don’t do it as well.
Sarah: My head’s full of work. I’m a journalist at SBS TV.. I’m also managing our household, wrangling our kids – they’re two and five. We don’t have any other family in Australia. My partner’s frantic running his arts organisation. I still keep a busy social life. I love late nights out in hectic loud bars drinking with friends. BUT AFTER THE ACCIDENT I CAN’T DO ANY OF THIS. I CAN’T MULTITASK.
David Strayer: You are putting heavy demands on the prefrontal cortex the frontal part of the brain the most recent developments in terms of the primates brain that are involved in things like planning and decision making and problem solving and working memory and executive decisions kind of the kind of the thinking part of the brain in many respects but it’s also the part of the brain that’s coordinating multitasking. And when we see people who do and constantly are kind of shifting back and forth between this task the next over the course of a day you see that those those areas of the brain become very metabolically active and over time fatigued. And so if you think about that brain drain. At the end of a couple of hours of that you’re just kind of like you’re kind of completely depleted. And so what we’re seeing is the metabolic energy that’s used by that frontal thinking part of the brain is depleted. And one of the best solutions that we’ve found is to set that aside and go out and walk for a little bit you don’t then use those prefrontal regions of the brain to kind of try and multitask and you restore those areas and that’s why we see these bursts of creativity after you’ve set a problem aside for a while you’re letting the brain rest and come back to a more kind of reset.
Sarah: Does it matter where you walk?
David Strayer: Probably. So what we’re seeing is that if you’re would say walking in a busy urban area with lots of traffic and things you have to interact with lots of manmade things that have a lot of horns honking and so forth that’s probably not going to be so restorative. It may still have physical benefits in terms of helping the you know the exercise part but the best place to do it is in a park or you can go on a hike in the bush or something like that where you can kind of get away from it all. That tends to be more restorative
And so over the last decade we’ve seen a really big change in how people live. They’re much more tethered to their phones. What my question has been and there’s a number of researchers who are asking what impact does that Change in technology have in terms of how we think, our social emotional part of the brain, our cognitive mental thinking part of the brain, and kind of the stress levels
Sarah: Before the accident, I like a bit of gardening and camping and hiking. But it’s not a big part of my life.. I don’t own a hiking tent or backpack. I learned to meditate about six years years ago but I haven’t done it in ages. I was pretty content with my jam-packed life. And I kept trying to cram more in.
When I was knocked off my bike a car was driving on the wrong side of the road. The doctors said it was lucky I was wearing a helmet. My head could be way worse. But at this point the focus is on my shoulder injury.
Ten days after the accident I somehow catch a crowded bus in rush hour, and walk towards RPA hospital. I find the fracture clinic and it’s clear why the discharge doctor suggested arriving before it opened. It’s chaos. There’s no order to who’s being called. The TV blares in the waiting room…I can’t bear it. I try the corridor but there’re two women chatting…it’s too much for my head. I retreat to an outdoor bench and just watch the rain and cars. This is maddening. I haven’t learned yet to just sit and be. But I’ll be forced to get better at this very soon when these days turn to weeks and then months.
It’s hours later when I see the shoulder surgeon. First I see his registrar. I record our consult on my phone…cos I’ve been struggling to remember stuff.. I can’t write cos my shoulder’s in a sling. My head’s super foggy. Maybe from the endone I’m on for my shoulder pain. Or is it the head injury? I can’t concentrate on what people say to me. I’m really struggling to manage the treatment for my shoulder.
Registrar doctor: So what I’ll do now is I’ll just have a look.Do you have any other medical problems?
Sarah: Um I’ve just got the head injury at the moment.
Registrar doctor:And how is that? Do have you have any nausea vomiting still persisting from that?
Sarah: No no. I can’t read or anything I find like I found it really hard just sitting in the waiting room.
Registrar doctor: And are you seeing anyone for that?
Registrar doctor: Did the trauma team sort you out with anyone to see?
Registrar doctor: I’ll try and tie you in with somebody then.
Sarah: But we move back to my shoulder cos that’s the focus.
Registrar doctor: It might be even more severe than the x-ray looks.
Sarah: More severe did you say?
Registrar doctor: mmm, I’ll get Dr Smithers in.
Sarah: The registrar goes off and returns with the surgeon, Dr Chris Smithers.
Dr Chris Smithers: So the main issue for you I think I think we’re going to do some more x rays. It’s going to confirm to me that it’s a grade 3 injury and then it will be except well discussing the pros and cons of surgery. We do occasionally operate on grade threes but that’s more commonly in patients who do a lot of overhead activity.
Sarah: The surgeon’s right. The follow-up X-Ray shows a grade 3 dislocation. My collar bone has completely separated from my shoulder blade.
Dr Chris Smithers: It’s not it’s not really clear cut it certainly it’s not saying it’s not jumping out to me and saying this definitely needs surgery. It’s not saying that okay.
Sarah: He patiently explains that it’s borderline whether we need to operate. Part of it’s cosmetic. If I can cope with a permanent lump, would he bother? The surgeon pauses. He says he’s the same age as me and wouldn’t operate if it was his shoulder. I appreciate his frankness. This is information I can follow.
Dr Chris Smithers: But equally it’s managing this not operatively it’s going to be somewhat prominent.
Sarah: It’s the Book Week Parade at Billie’s school. She chooses Charlotte’s Web. I glimpse her parading around in her spider’s costume that Miles made out of old tights stuffed with newspaper. But I’m overwhelmed by the noises and commotion of the school playground. It hits me like a brick. It’s the same When I do the school pick-up or drop-off…I feel scared. Basketballs, handballs, kids running and screeching. Well-meaning parents trying to talk to me. People caring, asking how I am, if they can help?
Sarah Macdonald: there was just a completely reduced capacity to concentrate and engage and as much as you tried to hold conversations you obviously reached a limit very very quickly of how much you could listen
Sarah: Flicking through my diary, opening it to THE DATE OF THE ACCIDENT, it makes my chest tighten. I go rigid, I start shaking. There it is: The 8am exercise class I never made it to. “Miles take kids to climbing gym”, “12.30-4.30 Billie to Sophie’s party”, “5pm Dalia and Miream for early dinner”. The next day: Family morning walk or bike ride, Bunnings for garden stuff, 2-4 Billie to Zahra’s gymnastics party.
Then my diary’s blank. I’m forced to do nothing. Until five days later in my awkward left-hand scrawl I wrote “10am doctor”.
A week later my diary’s filled with friends rostering themselves on to help me around the house and with the kids. Miles often works late. I’m blessed to have an army of supporters who feed us, wash our dishes, do our laundry, entertain us and keep us sane.
One person on this roster was my friend Sarah Macdonald. We met a few years ago when we were both new mothers.
Sarah Macdonald: You could see it in your face and in your expression and in your body that you were wanting to be able to engage as you would expect yourself to but you were very clearly unwell and needed just you needed small amounts of stimulation before you were you know just you. You just looked very drained like someone who’d been you know concentrating heavily on something for a very long time
Sarah: When I tell Sarah Mac that I’m making this podcast she suggests I record a conversation with her. To get her perspective on what I was like.
Sarah Macdonald: it was such a layered experience so I think for you that it wasn’t just that you were physically depleted and but there was so much else going on in terms of doctors not being sure as to how to respond to the injury and your symptoms and then you know the emotional aspects of not working and what that meant. I think what that meant for you was very significant
Sarah: Sarah Mac looked after me and my youngest daughter Emerald. She’d pick us up from the light rail station near her house so we could come and hang out. Drink cups of tea and eat her yummy food.
Sarah Macdonald: I don’t quite know how you handled it so gracefully to be honest because I don’t think I would have I would have felt so locked in by that experience and I know that you did feel that at some points that but you also took opportunities to kind of make yourself well and and try different things.
Sarah: That’s good to hear. Sometimes I feel like maybe. People saw me as a victim that I was that I was kind of just because it went on for so long. I would get a bit better and then get back again and I kind of also had this fear that I think I still do a little bit that people didn’t quite believe me or understand you know that there wasn’t that there was an element of like really because it was such an invisible injury.
Sarah: I think you were very good at just kind of getting stuck in there and not getting weirded out by the fact that I was being weird.
Sarah: It’s the end of my second week off work. All I can do is sit out in the backyard and stare at the trees. I’m also drugged up on endone for my shoulder. It’s an opiate, a really strong painkiller.
But my head’s getting worse, not better. This is scary. What’s happening? No one can tell me. My GP hopes it’s still the endone making me fuzzy. But now I can’t even read the school newsletter, or picture books to my daughter. It’s two weeks after I was knocked off my bike and I’m really struggling to be around my boisterous kids.
I record a voice memo after seeing my GP so I can remember what she said. I stand in the street shouting into my phone.
Sarah: Dr Jenny Thai Tues Sept the first. re headaches and head injury she said to just totally rest for a week. Don’t read anything, text, email give it total rest. She’s not too concerned as headaches are, I gave them 5 out of 10 in terms of strength. And she said you can get low level headaches for a few months from mild concussion however wants to reassess me in one week so I’ve got to make an appointment for next Tuesday.
Basically I’ve got a bruising on the brain and it will be sore. Yeah she wasn’t concerned that it had got worse in the last week she said that can be a build up as well.
And also written a letter for the police for me to take to the police so they can charge the driver. I think that’s all. Thanks.
Sarah: My friend Dalia invites me to take a break in her quiet apartment at Bondi Beach for the weekend.
Dalia Nassar: You were at the time having trouble being around a lot of noise and a lot of people talking
Sarah: I make a discovery. It soothes my head. The headaches are gone . I can think clearly The fog lifts.
Dalia Nassar: I felt you actually got better even though it wasn’t very long that you were here. You seemed to have fewer headaches while you were here and it was just amazing because you would sit and watch the waves for hours and that was something that most people just don’t have the time or the interest in doing. And then after that you would feel really good. And I think that was something surprising for me that it would be so quick Um we took a lot of walks along the beach and you would sit and watch the waves look at the water and just be calm near them.
Sarah: Later I chatted to Dalia in her Bondi home.
Dalia Nassar: My name is Dalia Nassar. I’m a friend of yours we’ve been friends about ten years and my professional title is Senior Lecturer in Philosophy at the University of Sydney.
Sarah: The waves are constant, they don’t make any demands on my brain. I don’t need to decipher them. I can just let them wash over my head.
Dalia Nassar: You were very fragile. I think a little scared of people of sounds of what they can do to you. You were really trying to piece things together but having a hard time you had a lot of headaches and everything seemed like an enormous task. You couldn’t read. You couldn’t watch TV. So things had to be done very slowly and in a very quiet way
Sarah: I’m super sensitive to conversations around me on the beach. My headache comes back after watching Bondi posers doing too much exercise, some of them even in bikinis. They interrupt my tranquility.
Sarah: So you’re actually a philosopher of nature if I can call you that.
Dalia Nassar: You can call me a philosopher of nature someone actually called me a philosopher of forests or the trees or something like that. I don’t think that’s as true because I’m not only interested in forests.
Sarah: Why do you think that staring out at the ocean that weekend helped my brain.
Dalia Nassar: The first thing that comes to mind is the importance of our experience of beauty and sublimity in nature. I think it’s very few people out there who would deny that we really do find something beautiful about nature and that experience of beauty is a calming experience. It can be also exalting like it really inspires a lot of excitement. But I think in some ways that experience of beauty makes us feel at home in nature that there’s something about our capacities to experience beauty that cohere with nature. There’s some kind of harmony between ourselves and nature and that is you could say what we would call an experience of beauty in nature. one of the philosophers that I’ve worked on, Emmanuel Kant, worries about people who don’t experience nature precisely because it’s such an essential experience the experience of natural beauty and natural sublimity for our sense of our self and our sense of connection to the natural world. So he thinks imagine people who aren’t able to experience nature. What would that be like for them and for him who is writing in 1790. That was an impossible thought but he’s still ventured it. And today we can definitely think actually that’s quite possible in fact most people aren’t experiencing nature most of the time. What did Emanuel Kant think might happen if humans were deprived of nature. We would no longer have a sense of connection to the natural world. the fact that our cognitive capacities so well map on to the natural world such that we experience beauty gives us a sense Oh. We’re not just here randomly
The other experience that he talks about is the experience of the sublime which for Kant is an experience of excitement and fear. I think ultimately in both cases we’d be missing out on essential characteristics of human nature. Kant says Something that I think is super interesting in relation to this he says angels can’t experience beauty. Animals can’t experience beauty. Only humans can. And why is that. Because to experience beauty we have to have certain cognitive capacities we have to have sensibility we have to have imagination and we have to have understanding. and it’s the way that these sensibility imagination and understanding work together that gives us the feeling the experience of pleasure in beautiful things. So I think we’d be missing out on being human in some ways.
Sarah: What was I like to hang out with. Like when we came back to your apartment and stuff?
Dalia Nassar: It was very relaxing actually because you were an easy guest in some ways you needed lots of times to yourself.
So I remember you feeling less headachey less fatigued just calm or more centered in yourself pretty quickly after taking those walks.
Sarah: I still don’t make any connection between the power of the ocean to help my head, the refuge I’ve found in my garden and the concept of nature as a healer.
The doctor asked me to keep a record of my headaches but I struggled to write. So I started recording voice memos on my phone.
Sarah (Head Diary): Yesterday I got a headache just with the morning stress of trying to get kids out the door etc then I was ok but then later on I got a headache after writing one text message.
Sarah: Billie turned six a few weeks after I was knocked off my bike. Later we talked about her memories of that time.
(Conversation with Billie)
Sarah: Just if you start playing with the pen it will make pick the microphone is very sensitive so any noises you make like picking the pen or kicking your legs it will pick up on the microphone.
What do you remember about the time that Mummy was recovering and that I wasn’t working?
Billie: I think you went on a lot of bushwalks. I remember you went on quite a few. You didn’t read much. Yeah I remember you like asking me to like be quiet because you kept getting headaches as well. Cause yeah.
Sarah:Can you remember how you felt while mummy was recovering?
Billie: Um Well. Sometimes I felt a bit lonely. Because, cause you always kept going on bushwalk and he also kept having rests. And um. Also Emerald was, was Emerald still having sleeps during the daytime back then?
Sarah: She was but I found it quite hard to get her to go to sleep because I was supposed to take her in a stroller for a walk around the block and I couldn’t push the stroller so I think she stopped having them.
Billie: Yeah cause yeah cause my sister Emerald was quite little. I didn’t play with her much so I felt quite lonely as well.
Sarah: Oh that makes me feel really sad to hear you say that. I’m sorry Billie.
Did it feel like a long time and were you worried that I might not get better.
Billie: Well I knew you would get better but it did feel like a long time but it was 18 months and that’s a year and more than a half.
Sarah: It’s Billie’s birthday party. The invites went out last month, before the accident. A bunch of kids and their parents are descending on our house. I can’t cancel. Birthdays are such a big deal for kids. Billie’s already had enough upheaval since my crash.
So my parents fly over from New Zealand to help. It’s an African-themed party – Billie gets her African heritage from Miles. He and my mother create an impressive cake with zebras and tigers climbing up mountains of icing.
When we made the invites I imagined a spring party in our enormous backyard. But it rains. We’re stuck in our small house, squashed into the living room. Parents and kids and siblings hunker into corners. It’s super noisy. Pin the tail on the elephant brings a few to tears. I’m almost in tears. Then the rain stops. We run into the garden. My head finally starts to clear. I feel calm being outside.
Sarah (phone voice memo recorded after Dr Thai visit):
I saw Dr Jenny Thai today..She was a bit concerned that I’m getting headaches after being asleep and also just when I’m resting when I haven’t been around any stimulation. She did also say that the endone could be causing some of those headaches. I also wanted to come off the endone anyway but she said important to do it slowly.
Sarah (phone voice message sent to Great Grandma):
Hi great grandma it’s Sarah. um I’m sending you a voice email because I’m not able to do emails and things at the moment with my headaches. I’m just having to take a break from all that but wanted to say thank you so so so much for the coloring in books and necklaces for Billie. They arrived yesterday and she’s thrilled.
I’m not even sending text messages at moment, unless they’re one word.
I think I’m getting there it’s just the head stuff that’s taken a bit of a backwards step. I think it’s nothing to worry about yet.
Sarah: It’s four weeks after the accident. I’m easing off the endone but I’m still feeling tired and foggy.. Damn. It’s starting to dawn on me. My brain isn’t right.
When I left the hospital after the accident the doctor gave me an A4 page of instructions. By 4 weeks my head should be fine it says. Just like that. If symptoms persist please seek help. I’ve reached the end of the 4 weeks and I feel like I’m getting worse. My GP wants to bring in more experts.
Eventually I score a cancellation appointment with a neurologist. I catch two trains to Bondi Junction. I feel nervous and excited. It’s a relief to finally be getting some answers. Soon I should know what’s wrong. I thought this would all be over by now. I keep telling work I’ll return in a couple of weeks.
I’m back in another waiting room. I sit for an eternity. Well, half an hour feels a lot longer when you can’t distract yourself by reading. I eye up the magazines longingly. At least there’s no TV. I’m anxious. Is he going to tell me I’ll be stuck in this fuzzy headspace? Finally Dr Ron Granot shakes my hand and welcomes me into his rooms.