Gayle was hurled into the windshield when her husband’s car broadsided a pickup truck that had rolled through a stop sign. Her forehead splintered the glass. She regained consciousness in the emergency room but recalled almost nothing about her first day in the hospital. A scan of her brain revealed a few scattered bruises and mild swelling within the frontal lobes.
A week after the accident she returned home and celebrated her thirty-fifth birthday with her husband, Roger, and their two young children. When I examined her later that month, she could not recall the gift they had given her. With the help of an outpatient rehabilitation program, she worked to improve her attention span and overcome her lapses in remembering small daily events.
Within ten weeks of the accident, Gayle had grown distinctly apathetic. At first we suspected a mild withdrawal instigated by the frustration and embarrassment that comes from forgetting who had called on the phone or what she had read in the newspaper. But when she started taking long naps during the day and closing her eyes when her husband or therapists tried to engage her in conversation, we realized that she had developed a serious depression. A housekeeper had to take responsibility for the children. I considered a drug to lift her depression but decided to wait a few weeks before adding a chemical that might interfere with her still unfolding recovery.
