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Book Review

A Couple's Struggle in the Aftermath of Traumatic Brain Injury

WHERE IS THE MANGO PRINCESS? by Cathy Crimmins Alfred A. Knopf $24, 262 pages


"Where Is the Mango Princess?" is a chronicle of the life, "death" and rebirth of Alan Forman, who was hit by a speedboat on vacation and suffered severe brain damage. A successful lawyer with a literary background, Alan emerged from the hospital scarred and changed forever. His neurotic edginess was gone. He was no longer interested in esoteric foreign films. His expectations, as well as his conversation, were simpler. And, like many survivors of traumatic brain injury, he was an enigma to his wife, Cathy Crimmins, who found herself suddenly living with a stranger. "The 'old' Alan died on July 1, 1996," she writes, "and a new one arose, created by the rivers and lakes of bruises that coursed over his brain . . . ."

It is a stirring, lyrical comment about her husband's transformation, through calamity, into a different person. But as is true of many memoirs of illness, the transformation extends to her as well. The dominant focus of "Where Is the Mango Princess?" is not a patient's overcoming obstacles, although this is an important part of the story, but how illness forces spouses, often quite painfully, to undergo a similar rebirth in spirit as they care for their stricken loved ones.

About 2 million people are traumatically brain-injured every year, Crimmins writes, usually from car crashes in which seat belts weren't worn. On vacation in Canada, a speedboat plowed into a skiff carrying Alan, striking him in the head with as much force as if he was thrown through "a windshield at 70 miles per hour." Crimmins describes it all, from her first sight of Alan ("splayed across the stern . . . strangely motionless except for an occasional rapid jerk of a leg or arm") to the agony of having this tragedy paraded past vacationers and busybodies on the way to the hospital.

In the days after the accident, Alan lay comatose as doctors struggled to stop the bleeding and swelling of his brain. CT scans showed that Alan's problem was "global," bruises and hematomas covered his frontal lobe, which controls speech and movement. The doctors didn't know what would happen.

Miraculously, Alan awoke a few days later. But Crimmins confesses that having him in a coma was easier to handle. For he was no longer the same person; he looked at Crimmins and the world with a mystified expression. Even though she had been "a hands-off wife," soon she was feeding him, bathing him, coping with his memory loss.

Alan also lost his inhibitions as he recovered: He frequently cursed, and, to her horror, masturbated in front of nurses, visitors, even their 9-year-old daughter Kelly. Crimmins soon realized that her brilliant husband was gone: "I once had a husband who was doing a dissertation on Samuel Beckett, who had a thing for obscure Japanese cinema. . . . I can't imagine being married to a man who won't be able to discuss books or go to the theater with me." Instead, he was like a character invented by Beckett, muttering enigmatic statements and questions, such as the one that gives the book its title.

It is a little known-fact, Crimmins reports, that only about 5% of couples stay together after traumatic brain injury. It is no wonder, because in addition to personality changes and mood swings, the battles with HMOs and the ignorance of people who don't understand (brain injury is "the hidden disability") conspire to ruin any hope of peace at home.

When he finally returned home, Alan seemed "perpetually stoned," Crimmins writes, easily fatigued and disoriented by even slight rearrangements of the furniture. "I miss his dark side," she says. "Now I wince as he chortles over mediocre cartoons. He has the personality of a sightly loony backslapping salesman."

Sex and love, too, were problems in the weeks after his return. Their bodies connected, Crimmins writes heart-rendingly, but their hearts remained apart: "I try to look into his eyes, but there's nothing there." But later, as he recovered, Alan reached out to Crimmins with shy, sincere demonstrations of affection. He surprised her with a sappy sentimental birthday card: "It's funny how one's expectations can change: I cherish the amount of initiation it took for him to remember me and set aside a moment . . . to buy the card," she writes, noting that the old Al would never have given this card, unless he meant it to be ironic.

Watching Alan's struggle to rejoin the work force, Crimmins found a man determined to regain his dignity. His milder personality also showed her why their friends "find Alan's new softness more appealing. He has no defenses. He is an open book. . . ."

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