After the trauma: ‘Don’t save me and leave me’

After 19-year-old Ryan Farrell fell off a high railing, head first on to concrete, during a night out in Dublin city centre, his family were told there was little that could be done for him.

His father, Gerard, who had been called to St James’s Hospital in the early hours of February 17th, 2015, had to break the news to his wife, Sandra, who was herself in hospital at the time, for treatment of chronic Crohn’s disease. She discharged herself immediately.

Advised by medical staff to get their eldest son back from New York as soon as possible to be at their youngest son’s bedside, the Farrells knew that Ryan’s prognosis was considered very bleak indeed.

Having been transferred to Beaumont Hospital, Ryan was in an induced coma, with five bleeds on his brain – although no bone in his body was broken in the six-metre fall. However, infected lungs became the most immediate threat because he had developed pneumonia after inhaling vomit in the accident.

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The family were given a room just off the ICU, where they could stay around the clock during the agonising 10 days Ryan spent in a coma. The couple, who have four adult children, found themselves part of a tight-knit group of patients’ relatives, all waiting for news of loved ones.

“It was mostly bad news. It was horrific,” they recall.

At least for them there was the joy of Ryan coming out of the coma, but they were warned he would be a high-dependency case, needing a long stay in the National Rehabilitation Hospital.

Four years later, there is still amazement in Sandra’s voice when she says Ryan never spent one day in the rehabilitation hospital. Instead, within less than a month of the accident, he walked back through the front door of their Firhouse home, with his mental faculties seemingly intact and severe fatigue being the main after effect.

“The doctors at Beaumont said they had never seen anything like it,” she says of her son’s speedy recovery.

Now aged 23, Ryan sits across from his mother at the kitchen table, cheerfully explaining that he went to a Garda station to view CCTV footage of his fall. His last memory before the accident is dancing at a nightclub; his next memory, the pain of the breathing tube being removed as he came out of the coma.

Sandra regards his survival as a "miracle" – a word which Ryan hates. But his grandmother, Gerard's mother, insisted on them having Ryan blessed with a Padre Pio glove and Sandra now "firmly believes" that was the turning point.

Brain injuries

An estimated 400,000 people are living with a brain injury in Ireland. These cover a spectrum from mild cases, where those affected can return to work, "all the way up to the minimally conscious", says Barbara O'Connell, chief executive of Acquired Brain Injury Ireland (abiireland.ie), which works with survivors.

A brain injury can happen in a second – a woman slipping on ice when putting out her wheelie bin; a teenager knocked off his bicycle; a young woman in high heels falling down the stairs – but the resulting devastation may last a lifetime, not only for the individual but also their families.

While 39 per cent of people using ABI Ireland services have been affected by a stroke, trauma cases include road traffic accidents (15 per cent), falls (14 per cent) and assaults (5 per cent). Other less-known causes are heart attacks and attempted suicide.

After families of victims get through the initial "they have survived", they begin to see the gaps and challenges, says O'Connell. She started ABI Ireland in 2000, when her brother, Peter Bradley, was on the long recovery road after a motorbike accident at the age of 23, followed by an equally serious accident many years later. She was determined to get him out of a nursing home where, at the age of 42, he was living in the midst of confused, elderly residents.

“We have a HSE that doesn’t believe in rehab really,” she contends. The value of investing in the early stages of recovery, so these people won’t need to draw on the health services for a long time afterwards, doesn’t seem to be recognised.

She believes patients are written off, with care seen as the only option. Whereas ABI Ireland strives to keep – and take – people out of nursing homes. “I can think of two fellas who we took out using a wheelchair who do not now use a wheelchair. They are walking – and one was in a wheelchair for years.”

Rehab is about empowering people, whereas care is about doing for people, she says. “If we can give the specialist intervention, their whole life changes and the power shifts back to them.”

Services

ABI Ireland’s neuro-rehabilitation services range from case management and accommodation in its 16 community houses, to day services in 15 centres and family support throughout the country. It has a long waiting list and the annual budget of €12.6 million goes almost entirely on staff pay, with the remainder on running costs.

Improvements in medical technology means more critically injured people survive. But, as O’Connell points out, “the focus is on the trauma services, not on what happens after. Part of what we are campaigning for is ‘don’t save me and leave me’.”

Although Ryan is one of the very lucky ones, he did start to have mental health problems. While he was able to go back to his part-time job in the control room of the car park at Dundrum Town Centre within three months of the accident, he struggled with resuming his studies and dropped out of college.

“I felt he wasn’t doing well, that he wasn’t coping with everyday functioning and I wanted to see if there was some sort of counselling,” says Sandra of her decision to contact ABI Ireland for help just over a year after the fall.

“I had really bad anxiety,” says Ryan. “The accident happened in February 2015 and I had my first panic attack in December 2015.” He describes himself as being “emotionally moody”.

“Snappy,” adds his mother. “I used to get the brunt of it.” She thinks he tried to act normal too quickly.

Psychological difficulties

Ryan credits the support he got from ABI Ireland for overcoming his psychological difficulties and achieving his main goal of getting back into third level – this time studying social care practice at the Tallaght campus of Technological University Dublin. The day we talk, he had received his first semester exam results with which he's very happy.

After being discharged from hospital, there was no guide in how to live, says Ryan. That is what he got from his key worker in ABI and Ryan has since run a support group for others.

Ryan’s future is bright and the only lasting effects from that fateful night of partying are fatigue and bouts of anxiety. “He is coming back to his old self,” says Sandra, adding, though, that the whole experience has put years and a few grey hairs on her.

National Brain Awareness Week (loveyourbrain.ie), beginning on March 11th, aims to promote greater awareness and understanding of the brain and brain conditions, as well as the need for investment in services, research and prevention.For more information on brain injury rehabilitation see abiireland.ie or call 01-2804164.

Read: ‘You think you are going to get back to normal’