Monday, August 2, 2010

Medical Mondays: Meet Phineas Gage


Hello! This week's question is from Jessica, a.k.a. the Alliterative Allomorph. She asks:

Is it possible to be shot in the head, survive, lose all long term memory, but still function like normal, and retain all short term memory from rehabilitation onward?

Well, in researching this answer, I found Phineas again. I'd learned all about Phineas Gage in medical school, but his case is so extraordinary (and relevant to today's topic) that I thought it was high time you all met him.

Before reading, I must warn you THERE ARE SOME REALLY GROSS THINGS COMING so if your stomach is weak, look away my friends.

Here he is. Isn't he handsome?



Phineas was an American railroad worker. In 1848, the 25 year-old was doing his usual job of tamping down explosives into a hole with his iron rod when he neglected to add the buffering sand between the explosives and his rod. As a result, the explosion shot the iron straight through his skull as in the diagram above.

The 13 pound iron bar landed 80 feet away. Amazingly, he was able to sit up and talk. He was conscious all through the examination by the physicians later. He did, however, vomit once, and in doing so, a half a cup of brains leaked out of his skull and fell on the floor.

Sorry. I had to add in that gross-out. I didn't learn that one in med school.

Anyway, after spending over a a month in coma as his brain swelled and became infected, he eventually recovered and was able to work. He died 12 years later from complications of a seizure disorder (epilepsy) due to his head trauma.

So. How does this relate to today's question?

Well, in penetrating head injury such as bullets and knives, the mortality is incredibly high, well over 90%. But, as in Mr. Gage's example, people can indeed survive.

Gunshot wounds to the head are particularly traumatic. The higher the velocity of the missile, the worse the damage is. Not only do they destroy brain tissue as they tunnel their way through the skull, but they also cause shock-waves and often destroy tissue in areas well beyond the simple path of the bullet.

As for memory problems? In my earlier post on amnesia, we learned about anterograde and retrograde amnesia.

For this character, they'd need loss of long term memory but retention of short term memory. This is definitely possible. This person would have retrograde amnesia, meaning loss of memory before the accident. The can remember things after the accident, but even then, may have problems converting short term memories (lunch with a friend today) into long term memories (a week or year later, no memory of that lunch).

The great thing about memory loss is that different combinations of memory loss can occur with severe injuries. In the world of fiction writing and head trauma (which seems to be a common occurence!), you have plenty of room to make it work out for your character the way you want it to.

Hope this helps, and hope I didn't gross you out too much!

71 comments:

The Alliterative Allomorph said...

Wow! Thanks Lydia! I logged on especially for this. Awesome, so when someone asks if my character's trauma is realistic or not, I can lead them to you! You're a gem! xx

Aubrie said...

My goodness! This was so interesting I had to keep reading even though it was gross. :)

Candyland said...

BLEH! I lost my recently digested toast.

Laura Eno said...

Your medical Mondays are awesome! Thank you for putting so much work into this so that we can hurt our characters realistically. :)

aspiring_x said...

ooh! i love half cup of brains! best part of my morning!

Alesa Warcan said...

Huh, interesting. He lived for 12 years after the accident?
I see that it's not known to exactly to what extent his personality changed...
What a fascinating case! Thanks for sharing!
-
About gunshot wounds... They are tremendously variable depending on the kinds of ammunition used.
Most are created as a balance between damage and precision with a focus on impact or on penetration.
Here are some links to ballistic gel shots demonstrating what different kinds of bullets do to soft tissue.

Ballistic gel test handguns.

Frangible munitions.

A rifle shot.

patti said...

LOVED it and will reserve a few Reclaiming Lily questions for you, just to make sure my M.D. friend is up on her journal articles!!

This is a great blog!!!
Patti

Lindsay (a.k.a Isabella) said...

Wowsers. He leaked half a cup of brains!
Awesome post, Lydia. Now I need to find a way to get some head trauma into an MS. Where's my crowbar...?

Lua said...

Wow! This was a splendid read after my breakfast! :)
But wow! Awesome post and really creepy, interesting information! Thanks Lydia.

Lydia Kang said...

Hey AA, glad you liked it! Have a great vacation!

Alesa, thanks for those awesome links! I knew that ammunition today does different things based on how they are designed. That is awesome!

Bee said...

This is so good, Lydia. I bet all this research comes superhandy during writing!

Alex J. Cavanaugh said...

That's incredible he survived, especially in that day and age. And I watch too many horror movies - can't gross me out!

Solvang Sherrie said...

You are a wealth of information! Oddly enough, your answer actually helps me understand some things about my brother's head trauma and memories. Thank you for that!

Laura Pauling said...

So cool. I love real stories like that. :)

Carol Kilgore said...

Fascinating. Poor Phineas Gage. It's good writers have some wiggle room in manipulating memory.

Kerri C at CK Farm said...

Gross?? Nah, very interesting! I wondered about that after reading The Girl who Played with Fire. Thanks for the details :)

Matthew Rush said...

Strangely enough I actually first heard about that guy in a cracked.com article. I thought it was all made up until I looked it up. Crazy!

Holly Ruggiero, Southpaw said...

Wow, it's amazing he survived at all.

~Nicole Ducleroir~ said...

I would never guess someone could survive Gage's accident -- especially in the mid-1800s! What a perfectly gruesome and informative post. Thanks!!

Jemi Fraser said...

Fascinating - kinda disturbing - but fascinating.

Taryn Tyler said...

Ugh! Poor guy. That was a bad day at work.

Faith said...

Wha... he lost brain matter and lived for 12 years afterward?!? Okay, that's AMAZING. And bizarre. And I'm SO glad I logged on here this morning because I'm going to be thinking about this all day... possibly Googling Phineas for more info... has anyone written a book about his life & the incident? (beyond clips in med texts)

Terri Tiffany said...

Facinating is right!! Enjoyed this a lot!

Jolene said...

Great story.
It's amazing what we can survive.

Liza said...

I've read about Phineas often and am always amazed by the story. I think I read that his personality changed quite a bit as a result of the accident and that he became quite volatile.

Munk said...

It sounds like poor Phineas had a bit of a memory problem to begin with...

Slamdunk said...

Great question and response.

Phineas Gage's story is something else.

Elle Strauss said...

This is interesting! Not really useful to what I'm writing now, but definitely interest. Thanks!

Melissa said...

I learned all about phineas gage in psychology class in both the fall and the spring semesters. His case is so fascinating. Yet again you do a fascinating medical topic. Love it.

The leaking brain bits is both disgusting and morbidly fascinating...

Saumya said...

Oooohhh. I saw a brain "leak" the first time I volunteered in a trauma center. That case is so interesting!! And he was a handsome guy!

Bathwater said...

A good story is always made in the details. I can just imagine the man loosing his brains when he throws up... nice detail!

Mayowa said...

Explosives? Brain leakage? This is definitely Medical Mondays lol.

Great post, the memory loss approach is always handy for stories.

Karen Lange said...

Interesting stuff. Not planning any head injuries for my WIP, but you never know. I know where to go if I need the info!
Happy Monday,
Karen

B.J. Anderson said...

Wow, that is CRAZY!! Thanks for the info on this Monday afternoon.

Tahereh said...

WOW. FASCINATING.

Amanda Sablan said...

This was fascinating. Memory is a strange thing.

Abby said...

This is so so so fascinating. Thanks for posting this! I actually didn't know that this was possible.

Brains leaking out? ew. Ok, I'm going to have dinner now...

Mohamed Mughal said...

Your post underscores the notion that fiction rests on a superstructure of fact and that fiction writers have an obligation and burden of doing the research.

Fascinating post!

The Words Crafter said...

Wow, that was a very interesting post. I've read of people surviving strange injuries to the head, but never leaking out brains....wow.

Tricia J. O'Brien said...

Gah! That is so disturbing and fascinating. One thing about your blog, it's full of surprises!

notesfromnadir said...

Now that's an amazing story!

Not too grossed out, but then I know not to come over here on Monday & eat cupcakes or anything like that! :)

Jen said...

I should have known this was a question from Jessica, because it was so flippin awesome!!!!!!! How crazy though!

Lynda Young said...

I find myself oddly fascinated...
great post!
W.I.P. It: A Writer's Journey

Amie B said...

thanks for stopping by my blog today and entering my contest! and thanks for linking to me in your sidebar! it sure does count!

i love your post. i think it will come in really handy for a MS i'm currently working on!

Shannon O'Donnell said...

Great post, Lydia. My (former) step-father was shot in the head in a hotel in Georgia during a robbery. I was six years old. I am currently 42 and he is still alive today. He is not the same person he was before the accident, but he has lived a relatively normal life all this time.

Betherann said...

This is GREAT! (Is that weird?) Anyhoo, thanks for commenting on my blog so I could find this fabulous post (and blog!).

Jackee said...

That is absolutely fascinating! I even had to read it to my husband (also a doctor). :o)

Also, I need to thank you, Lydia. You've inspired me to reach out and help writers with my experience too and give them a chance to ask questions about animals and plants, things I studied for years. So thank you!

Have a great week!

Danyelle said...

Ha! I remember him. Never knew about him vomiting up his brains though. *Bleh* The thing that fascinated me about him was how his personality changed after the accident. It's amazing how a little gray matter can mean the difference between nice and quiet and loud and abrasive. :o)

Theresa Milstein said...

Oh, this was so gross to read. I cringed as I read it. I was never meant to be a doctor, as you can tell.

My mother had a brain trauma from falling. She had to relearn most functions again, but it only took a few months. She has some lasting problems (like taste) but got most of her memory back. Though she doesn't remember anything until about two months after the accident.

B.E. Sanderson said...

I heard about this case in college, too. And no, I never heard about his brains leaking out either. Eww.

Thanks for the information, Lydia - even if it was a little gross.

Christina Lee said...

wowee---amazed and naseous at the same time!

Paul C said...

I marvel and shutter every time I read about this amazing incident.

Heather Kephart said...

He looks like the kind of guy you don't mess with, missing brains or non! Wonder if his neighbors started visiting and asking for half a cup of brain?

Rachna Chhabria said...

Hi Lydia..the moment I started reading this post I made up my mind to discontinue...but ended up reading it. It did gross me. But you never know, it may come in useful when one of my characters is shot in the head.

Alexandra Crocodile said...

We read about Phineas in psychology class as well - apparently he changed some of his personality traits after the accident - naturally:) I didn't know the part about the brains falling out though:) Yuck.

Talli Roland said...

Oh, UGH! And I'm just about to have dinner, too! You did warn me but I had to keep reading.

Jonene Ficklin said...

Wow, that was fascinating! I remember hearing about him and seeing the spike. Thanks for doing this service. I can't wait to read more.

Great blog and very interesting!

Jonene

Robert Guthrie said...

I am so jazzed to have found your blog, Dr. Writer!

DEZMOND said...

this was almost a forensic post, but very interesting ;))

Belle said...

I work on a lot of psychology texts, and they always mention Phineas Gage, but I never thought to think about what that kind of head trauma means for a character in terms of memory loss!

RoseBelle said...

My friend was shot in the head when he was a teenager. The bullet lodged inside his brain and the doctor said to keep it there since removing it may kill him. I was surprised that he was perfectly fine after the incident. You would never have guessed that he has a bullet in his head/brain.

This is a very interesting post. I learned a lot today.

Sharon K. Mayhew said...

Whew, I'm glad I didn't just eat! Ick...head wounds.

BTW...I'm terrified of Dodge Ball. :)

bard said...

In spite of it's frailties, the human body is an amazing organism.

JEM said...

Oh that was such a cool story. Not grossed out at all. Just realized this also makes me sound a wee bit creepy.

Jai Joshi said...

*shudder*

I don't think I'm going to get the image out of my head of this guy vomiting while his brains leak out of his skull. I'm going to be thinking about it all day.

*shudder*

Jai

Amanda Borenstadt said...

Super-de-duper post! Loved the description of brains leaking out! I'd love more of that. LOL

Heather said...

Another fascinating post! You get the best questions! The brain is a complicated and interesting thing isn't it? I love stories that tackles things like this.

LeishaMaw said...

That was amazing. Thanks for the cool story. :)

Krispy said...

Totally covered Phineas Gage in school too - for Psych class though. Always a crazy story to hear, and yeah, I've never heard that gross-out part before either. We never went that far in depth and were more focused on discussing the memory loss part anyway. Yuck. But also kind of more amazing!

Thanks again for fascinating post! :D

A.L. Sonnichsen said...

Whoa. That is amazing. Yet another example of truth being stranger than fiction!!

Amy

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