Ed Vulliamy 

Waking the dead

For victims of serious head-injury, a coma can be the point of no return, a nightmare only brought to an end by the flick of a switch. But now extraordinary breakthroughs are being made in even the most difficult of cases. Ed Vulliamy meets the pioneering medics performing miracles with comatose minds, and hears the testimony of people they've brought back from the brink
  
  


Rupert Avon orders a club sandwich and attentively rolls a cigarette. With one eye missing, he has to concentrate with the other, which looks slightly sideways. His conversation is agreeable, entertainingly scathing when it comes to politics and disarmingly straightforward about the disaster that befell him in September 2003. 'I'm actually registered as blind,' he explains almost jovially, 'and I do have a tendency to walk into lampposts.'

It is, however, little short of a miracle that Rupert is here at all, greeting the arrival of a wholesome pint of ale and a hefty sandwich in the Hare and Hounds at Worthing, West Sussex. Rupert was in a coma for seven weeks, after his head was crushed beneath the C-Type Jaguar he was driving in an amateur race at Goodwood, before it veered sideways and keeled over. He recommends some 'cracking pictures' which show his skull taking the full impact of the car hitting the ground, and the dent it made in the vehicle.

'Apparently, before I woke up,' he says, 'I would appear to hallucinate; there would be this witching hour about 9pm when I would start laughing my head off. Then, over the following weeks, I slowly began to surface. When I came round, there was a sense of panic. You have some idea that you're in hospital, but not why - you can't remember anything, you've just wiped it all. You've wiped yourself off the slate. It's pretty disturbing, really, and a good while before you recognise yourself, let alone anyone else.'

At the time of the crash, Rupert, now 42, was engaged to be married. But, he explains, 'soon after I came round, I had some idea of my mum and dad, but no memory of my fiancee.' As with so many cases of coma survival, he describes how they split up. 'She just couldn't take it, couldn't handle the changes in me; couldn't accept the way I was. And in a way I don't blame her. After all, I wasn't much fun to be around. In fact, I was probably bloody awful! She fell in love with person A and I became person B - someone else, someone very different.'

Most survivors of coma are people to whom disaster comes out of the blue - it could happen to you or me tonight. Regarded as death's portal, a hinge between existence and the other side, coma is an enigma in the popular imagination; a mysterious territory that some liken to a 'near-death experience' or another life, a world illuminated by the writer Oliver Sacks in his book Awakenings

Those in the medical profession say we use the term 'coma' too broadly: the fact is there are huge variations in the levels of unconsciousness suffered by each patient following a brain injury - whether through accident or illness. The brain-injured are more specifically assessed using a method called the Glasgow Coma Scale, first published in 1974 by two professors of neurosurgery at the University of Glasgow. This is a 15-point scoring system that rates the unconscious patient's ability to open their eyes, move and speak. If a patient scores eight or less they are said to be comatose.

In the days, weeks and months following a patient's original brain injury, their progress and improvement is continually monitored and each patient's length of time in coma will vary. However, if six months after a non-traumatic event (ie cardiac arrest) or 12 months after a traumatic accident (for example, a traffic accident) a patient still shows no awareness of themselves or their environment, they are then described as being in a persistent vegetative state (PVS). This, says Dr Adrian Owen, at the Cognition and Brain Sciences Unit in Cambridge, is the stage at which people tend to get stuck, and from which 80 per cent of patients do not return. And it is here that nutrition and hydration can be withdrawn.

Whatever the level of unconsciousness that is experienced by a brain-injured victim, the trauma can wreak dramatic changes and crises in a survivor's personality as they recover. Rupert Avon's passion was speed, but even now he remembers nothing about entering for the Goodwood race, or the six weeks before the accident. He describes the effect of the brain injury he sustained as 'a detachment from life, and especially from my former life. I remember things, but have no sense that it was me. The damage deadens things: there are problems with motivation, speech and motion. The washing-up piles up for days. You don't get excited about things; you feel like bollocks, everything goes grey and you get exhausted. There are times when even if Renee Zellweger was dancing naked around the sofa, all I'd want to do is sleep.'

'But slowly,' he adds, 'you start to find yourself. It begins by accepting that your life has been kicked in the teeth, that you have to roll with punches. You get depressed, but slowly little things happen that give you more satisfaction than anything major. You get that washing-up done. You start to have opinions. You become grateful for your friends. At least when they ask, "How are you feeling?" you can say, "I feel shit, actually," and they'll leave it at that.' There are upsides, too - although his fiancee left him, Rupert has a new girlfriend. 'She's a nurse,' he laughs, 'she's seen it all before.'

Significantly, both the changes to a victim's life and the way with which they are being dealt are the focus of one of the most challenging movements in science today. Recently, a range of specialisms has converged around a determination to both save and rebuild lives that might otherwise be discarded in one of two ways - either patients' lives are allowed to end because they are deemed as beyond hope, or they are left to cope unaided in a world that does not understand the complex damage that brain injury can do to a human being; a world that to a survivor can appear cacophonic, non-negotiable and hostile.

The story of successful recovery begins in the immediate aftermath of brain injury, through clinical and surgical intervention. Dr Andy Eynon, director of the Wessex Neurological Centre at Southampton Hospital, one of the few centres specialising in the treatment of coma sufferers on the NHS, explains how the Wessex is 'pushing the boundaries further than I ever thought could be achieved. I'm seeing patients who 10 years ago would have been automatically switched off, and elsewhere in many cases still are.'

There is remarkable new insight into what the brain can do while still unconscious: for instance, the ability by an unconscious patient to imagine walking around their house or playing tennis, to recognise familiar faces, indicate sexual attraction and even comprehend a joke. 'We are at the cutting edge,' says Dr Owen, 'and are now able to detect and image cognition by a person who cannot speak or act in any way.'

But that is only the beginning. 'A life worth saving is a life worth living,' says Peter McCabe, chief executive of Headway, a pressure group that co-ordinates and advocates treatment for those who survive coma and brain injury. 'What's the point of saving a life if all it is encouraged to do is to endure a life sentence watching Richard & Judy?'

Once a patient emerges from a coma or related state, new methods of psychology can help to restore identity and rebuild that person's life, which might otherwise be cast into a wilderness of little or no public understanding of the effects of brain injury. Changed, badly damaged people can be given back their lives and their own selves.

But not, alas, all of them. This treatment is available to very few of the 135,000 victims of brain injury admitted to British hospitals each year. Many of those who survive a brain injury become what Dr Martin Coleman, senior researcher at the Cognition and Brain Sciences Unit in Cambridge, calls 'the forgotten patients, whose lives have been changed forever, but who have potential and should not be forgotten'. Recovery is happening on a small scale, against the odds of NHS bureaucracy and budgeting, and against what Dr Eynon calls 'widespread nihilism' at the initial acute phase - 'the notion that nothing can be done'. Dr Eynon's colleague, surgeon Mr Antonio Belli, says: 'I used to work in hospitals where half the patients who went into neurological intensive care died. They simply withdrew care. But here, only four of 120 have died; which shows that to give up becomes a self-fulfilling prophecy.'

Most of the people treated for brain injury every year in Britain have been involved in road accidents or other direct 'traumatic insults' to the brain - and a significant proportion of those involve motorcycles. But disease, too, can assault the brain: forms of encephalitis or of haemorrhage, like that caused by the ruptured aneurysm which sent Shana Sewell into a coma in 2003, the same year as Rupert Avon.

Shana was a high-school history teacher and passionate leftwing activist when she had a 'sub-arachnoid haemorrhage', from which she emerged four weeks later. When she regained consciousness, she says, 'I recognised my two children [Chloe, then aged eight, and Corbyn, six months], but they weren't my children. Everybody looked the same, but they were not part of my story. There was no connection at all.'

Shana recalls a parallel life she led while in coma, 'where my children were the same, but different ages'. She describes how in that 'other life', there had been 'a riot in our village, and my husband was shot by the police in the arm. My home looked the same, apart from the bathroom, but it was now downstairs. And that's where I was convinced it still was when I finally came around. So much so, in fact, that when I was leaving hospital they asked if I needed a chairlift, and I said: "No, the bathroom's downstairs." When I got home, it wasn't the place it was supposed to be, and no one was who they were supposed to be either. Even now I still look at my husband's arm, searching for that gunshot wound.'

For two years, Shana 'just waited to die, to go back into my coma, to my other life. I didn't talk to anyone and I didn't want to. I beat myself up over everything. The worst part was the feeling of disconnection from the kids. I didn't love them, but I knew I should and I felt guilty about not being a good mother.'

Moreover, 'no one understands,' she says. 'They'll say how lucky you are to be alive, they'll see you walk and talk, but they won't see the inhibitions and distress. Or the fatigue: they'll think you're lazy. Or they'll say, "Oh, I forget things, too" without realising that what we do is not forgetting - it's a complete blank. If my car keys are not where I usually keep them, I have no idea how to even look for them.'

But Shana was lucky enough to enrol as a client at the remarkable Oliver Zangwill Centre at Ely Hospital. Named after a famous neuropsychologist, the centre, which is unique within the UK, was established by Professor Barbara Wilson, one of the world's leading neuropsychologists, on principles she employed in Arizona. Her staff is dedicated to the rebuilding of identity and cognitive skills required to lead an everyday life and, for Shana, work began on the basics, like how to use a tick list. 'If I once forgot to put a drink in Chloe's packed lunch,' she says, 'I'd feel so bad I'd then avoid making it every morning. So I began to tick everything off, and now I can manage - as long as there are no arguments. If Corbyn dresses himself, I can manage. If he won't, I can't.' Shana was given specific maternal encouragement, and guided to report back: 'Read a story to Corbyn - "Good Mother". Talked to Chloe today - "Good Mother".'

Shana is now a boisterous, amusing and engaging woman, very ready for a detailed and articulate rant about Iraq. 'When I came out of my coma, I had no opinions. I've got them back, but I do have trouble forming an opinion on anything that happened after my illness. I mean, the only thing I can tell you about David Cameron is that he was on Jonathan Ross.'

But brain injury doesn't only impact on the survivor - it's just as hard on loved ones, who may or may not cope. And here is a poignant twist to Shana's recovery. 'Every time Chloe gets a headache,' she explains, 'she thinks she's going to die. Every time I get one, she thinks it's all going to happen again. She lives in a world where everyone is about to drop dead.'

Shana Sewell could not have made her recovery without immediate treatment at the intensive care stage. It was partly luck that kept Rupert Avon alive after the crash at Goodwood: the fact that he happened to be in the catchment area of the Wessex Neuro Centre, one among very few places in the country pushing the frontiers of this work. 'I can tell you exactly,' says Dr Eynon, 'whereabouts in Britain to have a motorcycle accident, and where not to.' Or, as Belli says: 'There are places I've worked where surgeons and doctors walk away from cases that we'd never walk away from. I've seen people given up on who would never be given up on here, and who go on to live relatively normal lives. I have a head-injury patient now who if he were somewhere else would probably be left to die. I want to see him walking in six months' time.'

The Neuroscience Intensive Care ward at the Wessex is striking initially for the fact that nurses talk softly to people who cannot apparently hear a word; there are helium balloons and 'Get well soon' cards by the beds. 'It's fundamental,' says Dr Eynon, 'that we talk to them, put up their pictures and balloons as though they were awake. We don't know what's there, but start from the premise that memory is being registered all along.'

But the immediate concern is minimise damage to the brain, move patients on to where they can continue their recovery, and clear beds for more. 'I wouldn't do this job if my rate of failing to save a life was not below 10 per cent. Nationally it is about 20 per cent,' says Dr Eynon. 'I wouldn't want to be losing one in five.'

At the unit there is a significant shift from those with 'severe disability' upon discharge to 'moderate disability' after six months. The number of patients discharged in 'good' condition rises from five to 40 after six months. Patients are then divided into severe, moderate and minor injuries, with the number of severe patients discharged in 'good condition' rising from zero to 13 after six months, while those with severe disabilities fall from 42 to 10.

Some of these results are due to a surgical procedure called decompressed craniectomy, which involves opening the skull to allow the brain to swell. Eynon and Belli believe it should be more readily performed. Other options include an induced coma using barbiturates to slow down the metabolic rate, and 'hypothermia' to cool a patient.

So why are these measures not taken as a matter of course? 'The reasons are political,' says Dr Eynon, 'and professional. The political aspect is that there are 206 critical care beds for brain injury in the country. Last February, we did a snapshot showing that 84 patients were waiting for beds, and you have to ask: what happened to them?' He goes on to say that even his unit's ambulance had to be bought with public donations and, compared with cancer and heart disease, brain injury is 'a long way down the list of priorities for both the NHS and the public. How would you feel if your loved one had a brain injury and the doctor said: "Nothing can be done" before they've had the chance to come to a place like this, or Cambridge?'

But how can one tell whether and how someone's brain is working in a coma or vegetative state? Professor Wilson says: 'Some people are obviously more aware than has been realised. But not everyone is in agreement over this, and it makes me very frightened at some of these life-and-death decisions and court cases in which a family and the health authorities petition for the withdrawal of hydration and nutrition. I'm not talking about people who are brain dead. If they are brain dead, you switch them off. I'm talking about people who have been vegetative for months, some of whom are more aware than would appear and may be allowed to die if we don't find them. We need to assess these patients properly and help those with some cognitive abilities communicate with the outside world.'

At Cambridge they have undertaken to demonstrate that some patients in a vegetative state can 'do things with their brain, although they cannot speak or act', says Dr Owen, who specialises in imaging cognitive activity using an MRI scanner, whereby the 'motor cortex' in the appropriate part of the brain illuminates to indicate a response.

One breakthrough came with a woman in a vegetative state after a road accident in July 2005. A first test asked the unconscious patient to imagine playing a game of tennis - the same having been done with a conscious 'control' patient, and the reaction imaged. The woman in the vegetative state responded in almost exactly the same way as the control patient. The next test pertained not only to the woman's cognitive capacity but also to her sense of identity: she was asked to visualise walking around her house - 'a much more personal thing', says Dr Owen. Again, the activity in her brain was the same as that in the conscious control. 'It showed her brain was acting in response to a command and stopping when we said so. From that,' says Dr Owen, 'we can start to draw some interesting conclusions about consciousnesses.'

For these tests, images were ready a week later. But the latest scanning technology enables the Cambridge team to read a patient's cognitive activity as it happens. One patient in a vegetative state had tattoos showing him to be a Liverpool fan, and he was asked to imagine taking penalties. 'He did,' says Dr Owen, 'and it was a real eureka moment, a method of real-time communication with someone unconscious ... We have to be careful, ethically,' he adds, pointing to other, gratifying discoveries: that patients in a vegetative state need not lose either their sense of humour or a physical attraction to others. Unconscious patients can respond differently to a picture of someone comely than to... well, never mind. Dr Owen then shows an image of the brain of someone unconscious being told a joke, and responding. Patients in a vegetative state can also recognise the faces of people they know, as occurred with Kate Bainbridge. 'It was an incredible voyage of discovery,' recalls Dr Owen. But Kate's long, hard road had only just begun.

Kate had been a 'very bright, kind, shy and quiet' young woman. She had a first-class degree in history from Southampton University, worked as a nursery teacher and had bought a house with her boyfriend Steve, whom she intended to marry. She was 26 when a strand of encephalitis attacked her brain in 1997, sending her into a coma for 11 months.

Two years after coming round, after apparently no effective psychotherapy, she crossed paths with Professor Wilson, who found her in a state of 'depression [which] could be seen to involve suicidal ideation, a sense of worthlessness'. But a series of tests showed that Bainbridge's brain was 'functioning at a much higher level than people had assumed', and within 18 months of careful therapeutic attention she had made 'an almost complete cognitive recovery', according to Wilson's report.

Before meeting Kate, we communicate through her preferred method, email. She is articulate, passionate, and she discusses her admiration of Jane Austen. In person, she is charming and very severely disabled, moving what she can - and deploying facial expressions - with supreme effort. At first, she is too determined to use her letter board, which involves pointing to each letter in every word she wants to say - trying instead to speak with sounds her mother has come to comprehend perfectly, and that Professor Wilson can almost understand but which, to a stranger, waste the articulacy of what she has to say.

So, with the letter board, we have a painstaking but unforgettable conversation about coming round and the frustration of not being able to demonstrate that she was conscious, about the unhappiness of hospital - and her determined recovery. 'I hate seeing people just sat in front of the TV,' she 'says' in defiance of that life sentence in front of Richard & Judy. She explains that Van Dyck is her favourite painter and how a visit to the National Portrait Gallery was 'like meeting old friends'. Music 'is more important now; it helps my mood'. We discuss Rachmaninoff and a trip to a Proms concert in which a schoolfriend was playing. She talks about the pop music she listens to - but which, she says frankly, 'can be depressing because it is about things that will never happen to me'.

Of her boyfriend, she reflects, letter by letter: 'He chucked me, but that is not a bad thing, because he belonged to the old life... Your life changes completely,' she says. 'I have friends who still help me, but I've fallen out with others because I have lost so much and they cannot see what I am suffering.' Her message, which she delivers wringing her hands in defiance, not despair, is: 'Don't give up. Fight. I am not religious, but I have faith. I have girl power.' But then, heartbreakingly: 'I feel a failure.'

However, according to Professor Wilson, 'she is exceptional, a true heroine. One of the very small number of people to be in a state of reduced consciousness for a long time and make that level of cognitive recovery with that level of physical disability. It's just so easy for people like that to slip through the net.'

The reason Professor Wilson is internationally renowned is her pioneering - campaigning, indeed - determination to identify the 'cognitive deficits', and behavioural and then emotional problems encountered by survivors of coma and related states, and to devise ways of overcoming them. Ways of 're-establishing identity,' she says, 'which is now becoming a hot topic in the world of brain-injury rehabilitation'.

How and why people are transformed by an experience of coma and its related states is only partially explicable, physiologically and psychologically - 'It's all very anecdotal,' says Dr Martin Coleman. And although there are specific clinical conditions in hospital, common symptoms and psychological models to apply, every case is different, and conversations with survivors are utterly unpredictable - as one realises at the Oliver Zangwill Centre. To spend time there is to see human lives recreated and rebuilt, and reclaiming themselves, in an entwinement of professional dedication by the staff and sheer willpower among clients who have survived an injury which can impair or destroy a person's will. Yet none of it, and none of them, is straightforward. This place is almost as strange as it is humbling and wonderful.

Some of the recovery here may seem serendipitous, but none of it happens by accident; it occurs by careful design, through what resident clinical psychologist Dr Fergus Gracey calls 'real-life focused rehabilitation' - re-establishing the survivors' identity and ability to function in their families and in relationships which can seem changed and remote, and in what has become a bewildering, alienating and unfamiliar world. Psychologically, the process moves from the identification and treatment of 'cognitive deficits' to activities that rebuild 'what has broken down ... in social life, emotional life, family issues and self-awareness'.

Survivors of coma and its related states, says Dr Gracey, have an 'impaired sense of autobiography'; a potentially catastrophic notion of who they were and are now and how the two connect - or do not. 'Some people say they can't remember who they were, and feel an acute sense of mental loss. Others think: "Before, my life was sweetness and light, and now my life is destroyed." In marriages and personal relationships, it might be just too much to accept that something has gone, for either the patient or the spouse.' What the recovery work deals with is 'this powerful mix of the mental moment of who you are now, trying to organise things, without struggling to be who you once were'.

Brain-injury survivors can encounter difficulties 'making a cup of tea or catching the bus'. Social and personal intercourse is intimidating and sometimes impossible. Survivors are 'impulsive and disinhibited', sexually and otherwise. 'That which keeps a person on the right side of the ropes just isn't there,' says Dr Gracey. There are problems with abstract thinking, decision-making or understanding the consequences of actions. 'People can become aware only later of the consequences of decisions and failures - and we need to teach them how to be aware of those consequences.'

The recovery methods must work with 'careful calibration between expectation and reality', continues Dr Gracey, because survivors can suffer a terrible sense of failure if they cannot achieve a simple task, the result of which can be 'avoidance, denial, apathy and problems with initiation'. A client may 'miss an appointment, then stay in bed for three days'. What the Oliver Zangwill Centre offers is 'a safe milieu in which to ask: "What threats or losses to the self is that person experiencing?" And to work with them, with what is there, and help them think through problems in a systematic way, to get on track.'

The results are so extraordinary sometimes it is hard to believe what is being said. Derek Wilcox, whose brain was impaired and who went into a coma when fatty embolisms stopped blood from reaching it after he fractured his leg in a car crash, calls his coma 'a blessing'. He credits the changes in him for his decision to 'end the wrong marriage'. He has not been able to return to work as a teacher but has rebuilt his life, does volunteer work for the Sue Ryder charity (which offers palliative and neurological care), has regained his joy at singing and conducting polyphonic music from Georgia and met a new love in Georgia through the internet 'who only knows me like this ... It is since my injury,' he insists, 'that I have come to realise the beauty of life, because I have been so close to the edge.'

Not all clients are so openly celebratory. Taxi driver Graham Parr was driving along a road he had used for more than 25 years when a car driven by a drunken 16-year-old hit him head on, killing her and her two friends. Graham was in a coma for eight weeks. '"Loveable rogues" they called them in the paper,' he says, a benign man for a moment full of contempt. He now drives again, even down that same road - Angel Drive, outside Ely - but his 18-year-old daughter sits in the back clutching her mother's hand. 'She just doesn't ever think we're going to make it to our destination,' he says.

Graham Parr, who says that 'they virtually wrote me off,' didn't recognise his own wife, children, mother or father-in-law when he came round. 'I came back slowly,' he says, 'remembered who I was and that I just wanted to go home. Eventually, I'd hobble around on my stick to get the paper, but when my wife asked me to get milk as well, I'd come back with just the paper. Once, I made up my mind to buy a T-shirt for my son and some flowers for my wife, but I got the taxi home without them, and I've no idea where they ended up.' He also experienced problems with language, bad language. 'I was swearing at my brother once, and my sister ticked me off - it was murder.' The Oliver Zangwill Centre became part of Graham's new life, as well as his guide to recovery - he now helps to organise the 'clients' forum' where they discuss their treatments with staff.

Most people are coy about the intimacies and challenges of domestic tribulation, but not the survivors of brain injury, and especially not the formidable Sarah Tebboth, who has worked and cursed alongside her husband Stephen since his motorcycle crash. It is as a couple that they have prospered at Oliver Zangwill, 'after I'd been looked through like I didn't exist by a lot of doctors who simply can't grasp how the relatives come into it,' Sarah says.

'We've been together for 30 years,' she adds, 'and though we'd had a happy relationship, we never realised how much we loved each other. It sounds a bit Pollyanna-ish, but there is an opportunity. You're not messing about any more because you pass through the shadow of the valley of death; you realise how short the time is, because he so nearly died. The fact that it is so fragile makes life more precious.'

What Stephen, an engineer working with Cambridge University, decided was this: 'Recovery begins with the realisation that you cannot get back to being the person you were. It is when you say to yourself: "I'm a different person now and let's see how it works" that things start to happen.' The realisation that he had changed beyond a point of no return was his own, but 'quickly became part of my work here [at the Zangwill Centre]. I remember an assessment, when Andrew Bateman, the clinical manager, said to me: "Get real. You are not going back to work in a couple of days." That advice grew into an acceptance of what had happened to me. It ended the denial phase, and I realised I could start to heal.'

Sarah proceeds to be almost as merciless as she is loyal in recollections of her own ordeal, alongside that of her husband. She talks about how 'I was insane for the first weeks - completely mad, you lose a layer of skin, just pleading: "Please don't die, just please don't die."' She recalls the intensity of the intensive care relatives' room at Addenbrooke's Hospital in Cambridge, 'friendships with people you never see again', and how 'I used to talk to him for hours and hours even though he was unconscious, and tell him jokes'. She also remembers 'the first time we laughed together again - in an intensive care ward - at some doctor, I think'.

Sarah talks about how the sexual disinhibition common among coma survivors 'started to show itself even on the rehab ward, and is very difficult for wives to handle ... But in fact,' she says, 'Steve has not been sexually functional since his accident. Not good - Pollyanna your way out of that one! It's a problem and may remain a problem, but we're working on it.'

The conversation becomes more and more uninhibited: 'I mean, you are more rigid now, darling,' she tells her husband, 'though being an engineer you were always borderline.' 'I suppose so,' agrees Stephen. 'I've certainly lost all sense of social nuance.' 'He's far more dependent than I or he would want,' she continues. 'It seems a little tough, but it was important to him and to me that he was an independent, active individual, not an appendage. It's exhausting always being the advocate, and there's the whole, "Does he take sugar?" factor, people putting on that soppy voice because of his physical disability, which at least is a badge of some kind, and that sympathetic face, without seeing the real damage.' To which she adds: 'We try to deal with that by not giving a fuck what people think.'

'But at the root of it all has been that first, basic question,' says Sarah. 'What have I got? Who is my husband? Can I live with this? And the answer in my case - though by no means all - was yes. It's not really because I love him, it's more because I like him, we can still make each other laugh, and I like living with him. And I'm extremely proud of his toughness.' 'Yes, I always tended slightly towards the wimp before,' offers Stephen. 'Well, that's rubbish, actually,' scolds his wife. 'But it's true that now you've been tested.'

· Additional research by Cath Rapley and Laura Potter If you would like to make a donation to the Wessex Neurological Centre, send a cheque (write Head Injury Research on the back) to: Mailpoint 101, Wessex Neurological Centre, Southampton General Hospital, Southampton. To contact Headway or make a donation, go to www.headway.org.uk or call 0808 800 2244

 

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