Providing Compassionate Service for Brain Injury Clients
Concussions are a common result of accidents involving injury to the head, yet are frequently misunderstood and even trivialised. Even an apparently mild concussion can have life-altering consequences.
Davidson & Williams partner Steven Florendine tells us more about the subject, and about the importance of building trust and compassion with injured clients and their loved ones.
Can you tell us a little about the proportion of your clients who have suffered mild or severe brain injuries?
Over the course of my 23-year career, the vast majority (at least 70%) of our clients who have been in a motor vehicle collision sustained some degree of a mild traumatic brain injury (mTBI), commonly known as a concussion. Tragically, many of these people are unaware of that potentially life-long problem until we first sit down with them to learn of the constellation of symptoms they have experienced since the collision.
Why is it that brain injuries are so prevalent among those who have suffered collisions?
Motor vehicle collisions are the second leading cause of brain injuries, behind falls. This is not surprising considering the number of people driving and how easily collisions produce pernicious injury. According to the Centers for Disease Control and Prevention, brain injuries are typically caused by a violent blow or jolt to your head or body, which is exceptionally common during a motor vehicle collision. All anyone needs to do is watch any slow-motion video of a low-speed collision to witness how we all tragically become bobbleheads.
How can a brain injury go unnoticed in an initial diagnosis of a sufferer’s medical condition?
In my experience, several common myths continue to persist, even among some primary medical care providers. First, it is not true that you must lose consciousness to sustain a concussion. Concussions are associated with and because of altered consciousness.
The second pernicious myth that seems to cause a lack of proper diagnosis is being asked “Did you strike your head?” This question is asked often, presumably because the questioner believes striking your head is a necessary condition to suffer a concussion. Again, the literature is clear: you do not have to strike your head to sustain a concussion. The forces behind whiplash (very aptly named) are easily sufficient to produce concussions, and all too often do.
Motor vehicle collisions are the second leading cause of brain injuries, behind falls.
What everyday difficulties do victims of concussions or other mild brain injuries often encounter?
This question would need a weekend seminar to offer a full response. It is a fog of symptoms that often slowly descends on those who have sustained injuries to their brains. It can be a fine mist of only a few symptoms that creeps into almost every aspect of their lives: mild headaches, mild nausea and vomiting, and maybe some dizziness. Or occasionally it can be so thick with symptoms that the strongest lighthouse cannot help a person find safe harbour. In addition to headaches, nausea, vomiting and dizziness, all of which can be relatively short-lived in mild concussions, individuals can also experience many more serious and sinister problems, ranging from memory impairments to damage to the pituitary gland.
Those who have encountered a thicker fog of symptoms can expect to experience additional difficulties with short or long-term memory issues. The effects of this form of impairment cannot be overstated. Many clients are forced to resort to unimaginable reliance on their cell phones or post-it notes just to be able to get through an average day without missing their appointments, to pay their bills, or to meet their loved ones.
An inability to concentrate or focus is also often found in the haze. This can occur during everyday conversations, when that next word in an already formed sentence is just occasionally lost. Or it can be so severe that conversation is almost avoided entirely.
It is a fog of symptoms that often slowly descends on those who have sustained injuries to their brains.
Fatigue can be an enormously complicating issue when attempting to navigate through the fog. Many people are fatigued despite having what they believe to have been a good night’s rest. They report always being tired despite sleeping more than they are accustomed to. Tiredness can escalate in frequency and severity and is accompanied by some degree of insomnia. Many people suffering from post-concussion syndrome (the lingering effects of this horrible injury) experience some degree of this condition too. They either cannot get to sleep easily or, once asleep, cannot stay asleep. The failure to get sufficient restorative sleep simply exacerbates all the symptoms they were suffering from the days and weeks before.
In extreme cases, the force of a collision can even damage or “flatten” a person’s pituitary gland. This tiny gland, when damaged, cannot produce hormones like it once did. A lifetime of growth hormone supplements can be insufficient to help. Without effective treatment, a person can easily sleep at least 18 hours just to get through the remaining six hours in a day.
Photo- or phonophobias also often accompany mild traumatic brain injuries. Light – especially ubiquitous fluorescent lights – routinely produce migraine headaches that can last for days. Loud noise can also produce headaches which leave these brain-injured people heading straight for quiet and dark rooms, which sadly seem representative of what their lives have become.
Mood issues are also commonly experienced as people navigate through the haze. Their loved ones often comment that the injured person is simply not the same person as they were before the collision and resultant brain injury. They are more irritable, moody and angry. An individual who was once a calm, patient person can suddenly have their fuses shortened to mere millimetres.
These short descriptions of many, but not all of the constellation of symptoms, hopefully illustrate how life-altering the fog of concussion really is. When a thick fog really sets in, it should be easy to see how it can impact every aspect of a person’s life. From a student’s inability to complete their educational goals to impairment so significant that it affects whether they can manage or keep their jobs and sadly, but all too frequently, keep any of the relationships they once had. Many failed romantic relationships are scattered through the post-concussion landscape once the fog (that does not lift) lumbers on.
When a thick fog really sets in, it should be easy to see how it can impact every aspect of a person’s life.
How should clients be aided while recovering from these?
Education, patience, time and certain specific treatments seem to be the best guide those with concussions navigate back to “normalcy”. Once properly diagnosed, a patient with a concussion at least knows why they are struggling. They can then, hopefully, be given sound recommendations for specialists and coping skills to help with their specific symptom-set. But more is required. Much more.
Their loved ones should be educated on what to expect from this “new” person in their lives. This step is crucial and almost always overlooked. One of the main problems with those who have sustained a mild traumatic brain injury is that they “look completely normal”. They are not in a cast; they are not utilizing crutches; they do not have any of the blood and gore easily associated with injuries. Yet as we have seen, they clearly are injured – but their injury only manifests itself through the symptoms.
How can a personable conversation with the client and their family help in this process?
This is an exceptionally important step in recovery, not only for the injured person, but for their loved ones: they are all walking around in the fog. Sadly, only the one with the concussion initially experiences it. Shining the light on what to expect can allow loved ones to also become beacons of light for someone with a concussion. Simply Illuminating what to expect and stressing the need for patience is sometimes sufficient. Letting loved ones know there are reasons why their partner, parent, child, or friend is still laying on the sofa hours later without having “accomplished” anything is helpful. It can defuse the situation from one of accusations and blame to one of understanding.
In what ways do these issues become more pronounced when the brain injury is severe?
All the symptoms we have discussed so far are ones commonly experienced by people who have sustained a “mild traumatic brain injury” or “concussion”. As serious as many of these symptoms are, most symptoms in a “mild” concussion resolve fairly quickly, with 2 years seemingly the typical end point for recovery. However, some people with a mild concussion will suffer from a lifetime of walking through and with the fog. These are still considered “mild” concussions. Their standard diagnostic tests, including regular MRI and CT scans, will be interpreted as “normal”. Obviously, that does not mean they have not sustained a concussion. The fogs effects will continue to waft through many aspects of these people’s lives as they barely lumber on.
When a brain injury is deemed severe, the effects and symptoms are much more pronounced and often are obvious and include death or coma.
Shining the light on what to expect can allow loved ones to also become beacons of light for someone with a concussion.
What other sorts of injuries do you help clients in overcoming?
While a large percentage of our clients have sustained a concussion, it is by no means the only injuries that we commonly help clients with. We see and help with every injury imaginably sustained in vehicle collisions. Vehicle collisions are almost always violent events and cause serious and lasting damage. We commonly see multiple fractures to all limbs, the spine, face, head and torso. Whiplash is also very prevalent.
As with brain injuries, all of these injuries have varying degrees of severity. Many seemingly “simple” injuries, often of the whiplash variety, linger and linger and develop into what is known as chronic pain. A separate article could easily be written on the insidious impact of pain that lasts for longer than six months. This condition also leads to varying degrees of reliance on different pain medication, including opioids, which can help or lead to devastating addictions.
How do you enshrine compassion as part of the services you offer?
Compassion is an essential part of how I have been practising law for more than 23 years. It is often a race for the Kleenex box between me, my staff, and the injured clients and their family. It is not so much something we insist upon in our office; it is more the magnetism between like-minded people. I am drawn to people who are compassionate, who have a strong desire to want to help people who are suffering. Those who are not like this naturally simply do not seem to be drawn to or be able to handle the issues that always accompany injury cases. We are helping people through what is often one of the worst experiences they have ever had or will have. Being able to feel for these people and understand they need help and answers, sometimes at all hours of the day, is what sets us apart.
About Stephen Florendine
What has motivated your interest in assisting clients with brain injuries?
Initially, I just fell into this area of law right out of law school in Texas in 1999. But immediately, I knew this was what I was meant to do. I am fascinated by the medical aspects of injuries, the science of injury and collisions, and the personal interactions with clients.
Unfortunately, injury law reared its ugly head several times in a personal way for me. Many members of my family have suffered various injuries, including several that will last a lifetime. These have helped me experience what it is like to be the “loved one” who walks through the fog with the injured person. I have experienced loved ones who have and continue to experience many, if not all, of the symptoms described above. This has helped me immeasurably in understanding intimately what my client’s loved ones go though and to help to have some idea of the pain my clients are going though.
Do you have a creed or philosophy that you follow when it comes to delivering compassionate care for your clients?
It starts with the idea that this is not just business for us: it is personal. We are “open” 24/7/365. Our client’s problems and symptoms do not only exist Monday to Friday, 9-5. So, we strive to be available to them in some fashion, whether by email or telephone call, at almost any hour and any day. We have often responded to client questions and needs late at night on a Friday or at all hours on weekends.
Steven Florendine, Partner
501 4 St S, Lethbridge, AB T1J 4X2, Canada
Tel: +1 403-328-1720
Steven Florendine joined Davidson & Williams in 2007 and made partner in 2011. With more than 23 years of practice under his belt, he is greatly experienced in the field of personal injury law, with a deep understanding of clients’ circumstances in addition to their injuries. He volunteers on several local and provincial boards and was recognised as a Lawyer of Distinction in 2021.
Davidson & Williams LLP was founded in 1885 in Lethbridge, Canada, and today bears the distinction of being Western Canada’s longest-running law firm. Its team of experts covers many areas of law including personal injury, immigration, family, energy, wealth planning and tax.