Traumatic Brain Injury 159balked at the saddle and bucked to remove it from his back. Johnny performed the same ritual for
several days, and early one Sunday morning he slipped into the saddle. At first, the horse bucked
a little to remove him, but gradually he began to tolerate the new weight of the saddle and rider.
Over the next few weeks, horse and rider became a team. The day of the accident, when the reins
fell to the ground, the horse obediently stayed by the fallen rider until help arrived.
One crisp autumn eve ning, while returning to the corral, Johnny deci ded to give the stallion
its rein. The horse began a slow gallop and sped to an open, unrestrained dead run. Then, unex-
pectedly, a diamondback rattlesnake hidden in the sagebrush struck at the horse’s front feet. The
Appaloosa abruptly stopped, reared onto his hind legs, and threw Johnny to the ground. During
the fall, his forward- moving head struck the horse’s rearing head with enormous force, knocking
him unconscious. The impact ruptured blood vessels in the frontal lobes of Johnny’s brain and
fractured his nose and jaw. He laid in a clump of sagebrush for several hours until he was discov-
ered, placed in a pickup truck, and taken to a nearby dirt road, where an ambulance rushed him
to a hospital.
Every one knew Johnny and Juanita’s marriage was in trou ble. Perhaps it was the strain of their
jobs, ever- pres ent money prob lems, lack of communication, or a combination of stressors. Before
the accident they had separated twice and were in weekly counseling in a desperate attempt to
save their marriage. Six months after the accident, Juanita filed for divorce and custody of their
daughters. The accident and Johnny’s condition had ended all hope of saving their marriage.
Juanita had been offered a job by her uncle in Texas, and it was time for her and the children to
move on.
The diagnosis on Johnny’s chart was “frontal lobe syndrome secondary to closed head injury.”
Patients with frontal lobe syndrome have prob lems with metacognition and mental executive
functioning, as well as perseveration, shallow or labile emotions, and a tendency toward concrete
thinking. Johnny had all of these symptoms and a significant response delay, which usually occurs
with major frontal lobe brain damage. His response delay was mournfully apparent when Juanita
and his daughters bid him farewell on the day they began their journey to Texas.
Nurses, aides, orderlies, doctors, therapists, and some of the other patients knew about the
impending farewell visit from Juanita and the children. The halls were unusually quiet and somber
as visiting hours approached. Johnny lay in his bed, staring at a tele vi sion mounted in the corner
of the room, apparently watching a talk show. As the show broke for a commercial, Juanita and her
daughters entered the room.
Juanita was dressed casually for the car trip and gave her ex- husband a parting kiss. But it was
Johnny’s daughters, ages 3, 5, and 7, who brought tears to the eyes of the rehabilitation nurse who
was adjusting the bed sheets. They hugged and kissed him and promised never to forget him, but
Johnny showed no emotion and said nothing. He continued to stare at the tele vi sion set, apparently
oblivious. Fi nally, the farewells were complete and the visitors left. During the entire emotional
farewell, Johnny barely acknowledged their existence and seemed to be more interested in the
muted tele vi sion talk show. As they entered the elevator, the quiet in Johnny’s room was broken by
the barely intelligible words, “ Don’t go.”