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| A picture of Justine Lau and her mother inside a photo frame Justine made when she was in the rehabilitation centre |
Just then a cleaner passed by and in a panic I called out to her. She came over to my bedside and told me that I was at MacLehose. “What’s MacLehose?” I asked. I was astounded when she told me that it was a medical rehabilitation centre and that a month ago I had been in a road accident. The real shock came when she added that I had suffered brain damage and couldn’t walk.
That morning was the first time that I became fully aware of what had happened to me on the evening of January 13. I had been conscious since then, and doctors and family had told me, again and again, that I had been in an accident. But I was suffering from post-traumatic amnesia and to this day I still cannot remember the accident. What I know now is what I have pieced together from medical and newspaper reports, police statements, conversations and interviews after I was admitted to the MacLehose Medical Rehabilitation Centre.
At 8.01pm on that Saturday in January, as I crossed Leighton Road in Causeway Bay, one of Hong Kong’s busiest districts, I was knocked down by double-decker bus 8X. The bus driver, Li Kowk-wah, said that he jammed on the brakes and wheeled left to avoid me, but heard a collision. He stopped and looked out but couldn’t see anyone, so he got out to look.
This is what he found, he told the police afterwards: “The injured person was lying beside the right front wheel. One foot – I don’t remember whether it was the left or right – was in front of the wheel, slightly trapped. I saw that she was unconscious and bleeding (but I couldn’t see where the blood was coming from). I immediately called the police.”
By some miracle, I did not have any broken bones. I was, however, in even bigger trouble. The blood was coming from my head.
. . .
I was alive, but my life had just come to a complete standstill. I was 29 years old, and had worked for the FT in Hong Kong for more than five years. I had started as an editorial assistant, and was now a reporter. I had a boyfriend, Pak-to, an aircraft maintenance technician at Hong Kong International Airport. I was going through something of an itchy-feet phase and had even thought about moving to Sweden, where I had once studied. In a split second, any plans for the future vanished.
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| Justine (right) and Pak-to, her boyfriend |
The worst sign, Dr Pu told me recently, was that my right pupil had dilated from a normal diameter of 3mm-5mm, to about 7mm. It meant that I had an acute subdural haematoma, a dangerous blood clot between the skull and the brain. “We had to do something immediately, otherwise you could have died,” she said.
Dr Pu started my first, three-hour, surgery at about 11pm. The operation gave my injured brain room to expand and saved my life. The top right half of my skull was removed and put in a bone bank for reattachment later, leaving my head grossly misshapen.
Outside the operating theatre my parents, two siblings and Pak-to waited anxiously. I had phoned Pak-to seconds before the collision – he told me later that I said hello, then screamed. At last, a police officer had picked up my phone and told Pak-to what had happened.
The police had called my parents at their home in the New Territories, where I grew up. My father, a carpenter, and mother, a seamstress, had gone straight to Queen Mary. They glimpsed me as I was being taken to the emergency room. “You looked very scary,” my mother said. “One of your eyes was wide open and your face was very pale. Your hair was all over the place. There was some blood, too.”
. . .
The doctors were surprised how quickly I recovered after the surgery. I regained consciousness the next day, started talking on Monday, recognised all visitors and left the intensive care unit within a week. But I was in pain and had to be restrained in case I pulled out the tubes inserted in my body. And while I did not have any broken bones or facial injuries, I looked awful. Despite the bandages, it was obvious that one-quarter of my skull was missing.
My family and friends were relieved that I seemed to be recovering, but they were still worried. No wonder – I talked and acted like a child. I teased my sister about a Hong Kong movie actor she liked, forgetting that that had been 10 years earlier. I thought my brother worked at a Japanese department store, even though he had changed jobs more than a month before my accident. Sometimes I struggled to put long sentences together or find words. When friends visited, they were careful not to ask me how my day was, because I couldn’t remember.
Worse was to come. Two weeks after the crash, I suffered a seizure. A CT scan showed that my brain was bleeding again. The blood was coming from a pseudoaneurysm, a ballooning of the outer layer of an artery’s wall. The collision had forced an artery in my brain against the falx, a hard membrane separating the brain’s left and right spheres. Within hours I was on the operating table again.
Hung Kwan-ngai, head of Queen Mary’s department of neurosurgery, told me that in 20 years he had never seen a patient suffer a pseudoaneurysm after a crash. The three metal clips in my head that were used to stem the bleeding are permanent.
After the operation I became delirious, talking in Cantonese, English and Swedish. But my condition stabilised quickly and on February 8 I was transferred to MacLehose. I was physically stronger but still needed help. I had difficulty, for example, in moving from the wheelchair to the toilet. I needed people to help me in the shower. I couldn’t tie my shoelaces. Each half of the brain controls the motor and sensory functions of the body’s opposite half; the left half of my body was markedly weaker because the trauma had affected the right side of my head.
And I looked hideous. I avoided looking at myself in the mirror: the shape of my skull resembled that of a cantaloupe with a quarter-section cut away. When I wasn’t in bed I had to wear a flesh-coloured protective helmet. A fellow patient told me: “My daughter will be scared when she sees you.”
. . .
Chinese New Year fell 10 days after I was admitted to MacLehose and I was allowed home for four days. It had been a month since that ordinary Saturday afternoon when I had left my flat, expecting to return as usual the same evening. Now nothing was the same. My resourceful sister put a steel dish that we used to steam fish next to my bed, so that I could bang it when I needed to attract attention. My father installed handrails.
After Chinese New Year, I returned to MacLehose, where I was assigned a physiotherapist and an occupational therapist. I had to learn how to stand and walk again in order to rid myself of the hated wheelchair. I loathed it so much that even after using it every day for three months, I still could not wheel it properly. I simply refused to learn – I hated the thought that it might be with me for the rest of my life.
Occupational therapy focused on writing – not the type of writing that I had done for work but basic penmanship. My handwriting was now slow and unsteady, so I copied out newspaper articles. I also had to practise my signature. Eventually I started to write a diary, then to practise writing news stories.
In the evening, when friends or family visited, I insisted on going for walks. I didn’t care that I had to use a cane and that both legs ended up shaking. Josephine Ang, my occupational therapist, said that I was so impatient with my progress that I was “too hardworking”.
I had a rare taste of success during this period when Josephine took me to a shopping mall and I relearnt how to ride an escalator. But despite all this physical progress, my mental state was slipping. By March, I was going home at weekends, but every Sunday night I cried at the prospect of returning to MacLehose. I had occasional insomnia and often complained about the noise made by other patients in my ward, which I shared with nine people, most of them elderly. I was moody and unhappy and my weight had dropped from 50kg to 45kg.
I didn’t like the hospital’s food, so my mother brought me home-cooked dinners every day, even though it meant a three-hour round trip on public transport. She gave up her work to look after me. And because she was the person I spent most time with during those first few difficult months, she was also the one I threw tantrums at.
. . .
On March 30, I was discharged at last. I would live at home in the New Territories and commute to MacLehose on Hong Kong island two days a week for physical therapy. By then I could make do without a wheelchair and walk, albeit unsteadily, with a cane. I thought the move home would make me happier. Instead I became more miserable and my sleeplessness got worse. On days when I did not go to MacLehose, I had a timetable to follow. But without a therapist to urge me on, most of the time I just daydreamed.
I was plagued by a McDonald’s jingle playing in my head and it was during this period, as the song tortured me more and more, that depression set in. I was prescribed sleeping pills. Many people, including my mother – who had moved into my flat – noticed that I avoided seeing friends, did not want to go out, had no appetite and was tired all the time. My confidence had sunk because of the big dent in my head. I would cry while I was doing physio or reading the papers. I didn’t think I would ever be able to hold down a full-time job again.
My mother told me later that she feared I would commit suicide. “You kept saying you were useless and wanted to die. You were so unhappy. Every morning I went to the market very early and came back just after 8 o’clock before [your sister and brother] left for work. I didn’t want you to be home alone.”
I was also angry. I hated the bus company and its driver. I refused to believe that the accident could have been my fault, even though Pak-to told me I was talking to him on my phone at the time of the collision. Newspaper reports said I was not walking on a crossing. The driver’s testimony also suggested I was jaywalking. “The victim suddenly rushed in front of my vehicle,” he told the police.
With no memory of the accident, I could not challenge the driver’s version of events. The police found no witnesses, even though there were 15 passengers on the bus and the area is a busy one. Nevertheless, I hired a lawyer to investigate whether I could sue Citybus.
. . .
On April 25 2007, I tried to take my life. I had considered killing myself many times. I imagined jumping from my flat, but I was worried the fall might not finish me off. While my mother was out I took most of my Dilantin, an anti-seizure drug. When she got home she found me vomiting and I was rushed to Prince of Wales Hospital, near my home, before being transferred to Queen Mary back on Hong Kong Island.
No one realised it was a suicide attempt, although my mother had some suspicions. I got away with it because I was very weak and people believed that something was wrong with my prescription. Pak-to even considered suing my doctors.
A month later, I was readmitted to Queen Mary for a cranioplasty to put my skull back together. I was desperate to look normal again and the doctors were optimistic that the change in pressure in my cranium after the operation would help me to get stronger. The surgery was successful, in that it restored my skull’s natural shape. I wore a hat to cover my shaven head but no longer needed to wear the helmet. But my condition did not improve, and I found myself back in a wheelchair.
The left side of my body was even weaker than before. I had problems lifting my left foot and putting it in a shoe. Pronouncing certain words was difficult because I struggled to move the left side of my mouth, and its corner tilted up slightly. At times my left hand also failed me; at one point I couldn’t even fasten my bra.
I struggled with pronunciation, so Pak-to and I read newspapers aloud together. Pak-to, who works many late and overnight shifts, visited each day no matter how tired he was. I showed off improvements and complained about setbacks and we strolled around endlessly for my walking practices, chanting “heel, toe, heel, toe” in Cantonese as we marched (“ge tsang, ge tsim, ge tsang, ge tsim”). Of the 183 days I was either in hospital or staying overnight at MacLehose in 2007, Pak-to visited me every day but two or three.
My doctors suspected that over-shunting, or excessive fluid drainage from the brain, explained my persistent weakness. In February, a shunt had been inserted in my brain to treat a hydrocephalus – a dangerous accumulation of cerebrospinal fluid in the brain – that formed after my accident. The tube drained the excess fluid into my abdomen.
Now the tube was draining too much fluid from my brain, so on June 8, the doctors removed the tube completely. It was my fifth brain operation in five months, and also my last. I was lucky.
None of my brain’s main functions was affected long-term because most of my injuries, severe though they were, did not damage any areas that control major functions such as speech and senses. Nor did I develop post-traumatic stress disorder. My psychologist said that it was because I was unconscious after the accident and had no memories of it. The suicidal thoughts, insomnia and fatigue I suffered dissipated very rapidly.
Following the cranioplasty in May, I was readmitted to MacLehose, where I stayed until the end of August. But this time I was improving by the day. My physiotherapist, Sandy Kan, gave me acupuncture, which helped my crooked mouth and weak left leg.
Physical therapy was still boring and repetitive. In one exercise, I used my weaker left hand to place pegs one by one on a board, then remove them. I also drew circles and squares over and over. I even had to relearn how to type. To relieve the tedium, I did pottery, made silver rings and a wooden photo frame, all to train my left hand. I also did more physically demanding exercises such as jogging, badminton and swimming. One of my biggest fears had been that I’d be unable to swim, something I’d done regularly since my teens. The turning point was when I got into the water for hydrotherapy, where Sandy noticed how much happier I became.
. . .
By late summer I had learnt to celebrate every achievement, no matter how trivial. Previously routine things such as swimming laps or going out and meeting friends at night all now thrilled me. One day I took the Star Ferry from Central to Tsim Sha Tsui with my FT colleague Tom Mitchell. We also went to the Mandarin Oriental hotel for high tea and The Peak for dinner – even though I was wearing my absurd helmet. We went to Mongkok football stadium to watch a league match, and, to mark my 30th birthday, we went to Macao to watch an exhibition tennis match between Roger Federer and Pete Sampras.
I found that stories of sick or disabled people triumphing against the odds inspired me. I read books by Bob Woodruff, the US broadcast journalist who recovered from a head injury he suffered in Iraq, and by Lance Armstrong, the champion cyclist who survived cancer. I remember reading about a pianist with just two or three fingers on each hand. If she could play the piano, I – with all my fingers – could at least learn to type again.
At MacLehose, I also began attending a bible study group. I witnessed many of my fellow patients convert, but God and I just did not click. I enjoyed the study sessions, though. The people were nice, the Good Book was fun to read, and it killed time.
Some time around July or August, I even began to like MacLehose and our little community there. I had become good friends with my therapists and other patients – we called each other “comrades in arms” (“jin yauh” in Cantonese) – and went on field trips together. Sometimes it was just to walk around town, sometimes to practise taking public transport, sometimes to eat dim sum.
At the centre, I met Sir Lee Quo-wei, the former chairman of one of Hong Kong’s largest banks, Hang Seng, who had suffered a stroke a few years earlier; and Tanya Liu, a Taiwanese TV journalist who was brain-damaged in the May 2002 Potters Bar rail crash in the UK in which seven people died. I also met “Teacher Cheng”, a stroke patient and father of Sammi Cheng, one of Hong Kong’s most popular singers. Cheng taught me much about calligraphy and even more about life.
After checking out of MacLehose for the second, and last, time in September 2007, the prospect of returning to work was in sight. My doctors said my desire to work again was one of the biggest factors behind my recovery. I returned to the office on November 13 2007 – exactly 10 months after the accident.
Many people are amazed that I now lead life pretty much the same way as before my accident. I am too. The only difference is that I’ve become interested in the human brain – I read psychology at university and I’m even considering studying it again.
And I have also reached a kind of peace with my traumatic year. I decided not to sue the bus company. What happened, happened. I still refuse to take Citybus, but I don’t hate the driver any more and I don’t want to keep looking back. I just want to let it go.
To read FT science editor Clive Cookson discussing brain injuries, see his blog at www.ft.com/scienceblog.
