Remind Me Why I'm Here: Sifting through Sudden Loss of Memory and Judgment. Diana Lund. New York: iUniverse, Inc., 2006. 214 pages, $18.95, softcover: ISBN 0595383513.

"Who are YOU?" said the Caterpillar.

This was not an encouraging opening for a conversation. Alice replied, rather shyly, "I-I hardly know, sir, just at present-at least I know who I WAS when I got up this morning, but I think I must have been changed several times since then." - (from Alice in Wonderland by Lewis Carroll)1

In reading Diana Lund's well-written and carefully detailed personal account of her journey following a motor vehicle accident that resulted in mild traumatic brain injury (mild TBI), one is reminded of the tale of "Alice in Wonderland" by Lewis Carroll. After her car accident, Ms Lund confronts a self that she does not clearly recognize, much as is captured above in Alice's conversation with the Caterpillar. Also, much like Alice, Ms Lund's experience after her injury involves a series of changed views of self, accompanied with strong uncertainty regarding these self-perceptions.

Prior to her injury, Ms Lund's identity was as a successful, independent woman who had been successful academically in undergraduate and graduate training in mathematics and who relied on her sharp intellect, memory, and problem-solving abilities in her work as a project manager for a software company. Her postinjury reality meant that this sharp mental acuity on which she had relied, and had in large part formed the foundation of her self-identity, was no longer dependable. Skills and tasks that had been second nature became effortful and, at times, were experienced as impossible. This upheaval of sense of self has often been described in scientific writings regarding TBI,2,3 yet having the information presented through the eyes of an individual undergoing the experience makes a more powerful impression for those providing services to persons with TBI as well as for survivors and their family members and friends.

Ms Lund presents her story through a series of chapters that describe key periods of time presented in roughly chronological order within her course of recovery. Yet, time periods often overlap and backtrack. This writing technique further underscores the sensation of an "Alice in Wonderland" experience as the reader follows Ms Lund's story, wherein a sense of the space-time continuum is disrupted. For example, chapters 1 through 8 primarily chronicle her experiences from months 1 to 3 postinjury and comprise the majority of the book, with relative emphasis on key events during this timeframe. However, in chapter 7, Ms Lund scopes outward to give a "7-year" postinjury view and then returns to describing the first 3 months of her postinjury course in the following chapter. Even within chapters that intend to describe early time periods, the author frequently scopes outward to give a "present-day" view.

The author focuses primarily on the first year after her injury, though she does provide an update and overview of her experiences in an epilogue that describes her impressions up to 9 years postinjury. During the initial section of the book, entitled "An Odd Discovery," Ms Lund covers the initial date of injury with an account that thoroughly captures the confusion and distorted sense of time and reality that is frequently encountered following a traumatic event. The additional chapters in this section cover her gradual discovery that all is not as it was before her injury and describe her attempts to return to the workplace and her experiences of failure that contributed to a sense of despair and fear. Thus, this section focuses on the gradual discovery of a changed sense of self. The next section of the book focuses on months 4 through 6 and details Ms Lund's attempts to deal with this changed self by developing compensatory strategies, working with a therapist, seeking information, and networking. The third section addresses the anger and frustration that was experienced because of miscommunications with healthcare professionals, growing strains on interpersonal relationships, conflicts between the need to form a current sense of self and either hanging on to or letting go of a preinjury sense of self, and dissatisfaction with the lack of guidance and direction in seeking help after mild TBI. The fourth section covers a sense of grieving for what has been lost and a growing sense of acceptance of the changes that have occurred. Finally, the book closes with an epilogue that provides an overview of the entire experience, seen with the perspective of time, wherein the author acknowledges the pain experienced but sends a message of hope and acceptance.

Although other authors have presented personal accounts of the journey after TBI, this book makes several unique contributions. As is pointed out in the foreword to this book by Dr Yehuda Ben-Yishay, one contribution of this memoir is that it provides a description of the experiences of an individual with mild TBI for whom cognitive interventions were to a large degree absent, delayed, or accomplished on her own. Such accounts, where rehabilitation professionals are largely absent from the picture, illustrate the struggles that surround reestablishing a satisfying sense of self without the assistance of an organized professional support system. In keeping with the "Alice's Adventures in Wonderland" analogy, such individuals are without the guidance of an individual, like the White Rabbit, to find their way through this confusing course. Rather, the psychological transformations that such individuals undergo occur through personal endeavor and through the help of trusted individuals within the individuals' own support systems.

In addition, more so than has been presented in other first person accounts of recovery after TBI, Ms Lund demonstrates a tenacious attempt to find answers to her questions about her injury through reading research from fields such as neuroscience, neurology, and psychology, and attempting to integrate this information with her own experience. Such integration is oftentimes effective, and certainly points out the extraordinary lengths that were undertaken to find meaning in her experiences. However, while this search for knowledge and attempts to make sense of symptoms and negative test findings is admirable, caution should be placed on some of the conclusions she draws. For example, attributions of symptoms to certain scientific theories or diagnostic labels may or may not be accurate. In the appendices, a section on "faculties returned" after injury lists a chronological ordering of events postinjury. Throughout this timeline, the author describes "possible brain injury" from events that are unlikely to have caused brain injury (eg, "whacked head on underside of car roof when getting out of car"). The concern is that such descriptions could be unduly alarming to the lay reader who may encounter this text.

While the insider's view of the experience of the struggle to understand the new sense of identity and personal accounts of symptoms experienced is valuable and will likely resonate with persons affected by brain injury and with those among their support networks, perhaps most striking and relevant for healthcare professionals is the experience of frustration and despair that Ms Lund describes that can be directly linked to the delayed receipt, and, in some aspects, absence of accurate information about mild TBI. Certainly, it is very likely that some of the pain and stress that Ms Lund faced early in her course after mild TBI may have been alleviated with timely, accurate information.

There is a body of literature that supports the notion that early education through the provision of reasonable expectancies regarding likely common symptoms and compensatory techniques for such symptoms, typical course of recovery, and suggestions for gradual return to preinjury activities can have a favorable impact on outcomes following mild TBI.4-6 As the title of this review suggests, Ms Lund's book should also serve as a "call to arms" for those of us within rehabilitation to ensure that such educational offerings are made available broadly through emergency departments and primary healthcare settings. In addition, Ms Lund's descriptions of interactions with healthcare professionals throughout her early recovery suggest that training to make certain that communication with patients is clear, including taking the time necessary to ensure that terminology is not misunderstood and that test results are interpreted in a way that is relevant to the client, is vital. Ms Lund's account should serve not only to provide a personal account of a journey of transformation as the result of a mild TBI that will be of value to survivors, family members, students, and healthcare professionals, but also as a reminder to rehabilitation professionals and those involved in the care of persons with TBI that this role as educators and advocates for provision of services to this underserved population is one of the reasons why we are here.

Margaret A. Struchen, PhD

Department of PhysicalMedicine and Rehabilitation, Baylor College ofMedicine, Houston, Tex, andMemorial Hermann/TIRR, Houston, Tex

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