What A Race Car Crash Does To Your BrainStef Schrader6/09/16 11:10amFiled to: Bad BrainsRacing24 Hours of LeMonscrashOrlovedconcussionFree Coco276160EditPromoteShare to KinjaToggle Conversation toolsGo to permalink Graphic credit: Angelica Alzona/Gawker Few things are more dangerous in racing than your car dying on track in the middle of a turn. You’re probably going to get hit unless the car starts right back up. It’s just a matter of when and how hard. I took a hard hit in February and then spent three hellish months recovering from a concussion. Advertisement Dizzy spells. Memory loss. Insomnia. Depression. Difficulty finishing sentences, let alone doing my job as a writer. These are just some of the problems that completely interrupted my life as I recovered.Concussions are more often associated with contact sports, but the botched handling of traumatic brain injuries in the NFL and more brought concussions into the spotlight everywhere, including in auto racing. Advertisement After everything I have learned and struggled with since then, I have to wonder: are concussed drivers getting back in the car too soon? Photo credit: Eric Rood Death of a StatesmanMy crash happened at the 24 Hours of LeMons season opener: the ’Shine Country Classic at Barber Motorsports Park in Alabama. If you’re not familiar with LeMons, it’s where teams of mostly amateur drivers in $500 beater cars decked out with humorous themes run for hours upon end. I’ve been driving in LeMons for five years now. Even though my job entails writing about cars and racing, it’s something I do for fun outside of that, and Barber was supposed to go the same way as countless other extracurricular races I’ve done. Sponsored In Alabama I was in a true LeMons car: NSF Racing’s 1949 Nash Statesman Airflyte, which looked as if it had been pulled out of the Florida swamp. Photo credit: LeMons Über-Gallery I was in worse shape than the car that weekend. I had covered two snow events in a row for Jalopnik, and somewhere I picked up a nasty cold that eventually turned into full-blown pneumonia. Photo credit: Ron Vickers I wasn’t going to let that keep me from racing, though. We weren’t running a team radio, so I didn’t have to talk in the car. The Nash’s cavernous cabin had a steady flow of fresh air whenever the car was moving. Driving was pleasant, and felt great. Advertisement The car did what LeMons cars do: It broke. During my second stint on track, the Statesman’s engine developed an electrical problem, losing power at high RPM. I was no longer just slow; I was a hazard. As I was trying to limp the Nash back in for repairs, it started to run smoother on the back stretch. I was convinced it could make it up one last hill and get back into the pits safely under its own power.Surprise: it died on top of that hill. Advertisement The engine turned over slower and slower as it climbed, dying before I had a chance to pull the Nash off the pavement. Neither screaming for help from a too-far flag station down the hill nor pressing the starter button made any difference.In-car view from a car that passes the Nash before the crash. Advertisement First I felt a huge thump, which was far more violent than I realized at the time. What I initially mistook for something jamming into place on the Nash was Grassroots Motorsports’ Mazda Miata slamming into the Nash’s rear. The Nash popped into the air, breaking the frame in the front of the car upon landing.That was soon followed by a second thump from a Porsche 944 hitting the Miata and driving it further underneath the rear of the Nash. At that point, the Miata became the world’s largest spatula and flipped the big black egg wheels-up. Both cars were likely still traveling at highway speeds when they hit the Nash. Scene of the crash. The Nash’s fuel cell came loose in the collision. Photo credit: Eric Rood The unreachable kill switch. Photo credit: Stef Schrader Inside the Nash, transmission fluid from its broken differential oozed down the dashboard. I screamed for anyone to come help as I fixated on a big red kill switch that was mounted on the roll cage—just out of my reach. It’s best to kill any electrical spark in the car if you’re in a big accident to prevent a fire, and I panicked because I couldn’t reach our kill switch. My shaken head couldn’t remember that there was another, smaller kill switch next to the starter button I’d been trying to use to restart the car. Advertisement Eventually, my voice became too weak to keep yelling. I realized that I wasn’t on fire and resigned myself to hanging upside-down until emergency crews could come. Emergency crews on the scene. Photo credit: Eric Rood The ambulance ride of shame back into the paddock started with a basic once-over to see if there were any injuries I couldn’t notice. The only pain I felt was an ache in the outside of my left hand and some dull pain at the base of my skull. A ride over to a local emergency room was offered, but I didn’t feel as if I needed it. Rear of the Nash after being towed back to the paddock. The right lower trailing arm was crushed, and the transverse leaf spring and differential cover were broken. 5/8" bolts on the transmission crossmember were also sheared off on impact. Photo credit: Ron Vickers Looking at the wreckage, it was a testament to modern safety gear and our teams’ respective cage builders that everyone walked away with only a few bruises. The Miata went about four feet under the Nash, pushing its drivetrain four inches back. Grassroots Motorsports described the wreckage as “some of the worst we’ve seen at any event.” Photo credits: Eric Rood Damage to the Porsche 944. Photo credit: Eric Rood The force of the impact was enough to annihilate all three cars, and my head was in the middle of all that force. Advertisement Advertisement The impact was so hard that the foam liner inside my helmet actually gave way, crushing the foam in several places. Nothing was loose inside the car that struck my head—that was all from the force of two cars running into the back of the Nash.At the moment, all the adrenaline from the crash made me feel as if I could have kept racing another car—which would have been monumentally stupid. The medics told me to rest instead, and to seek medical attention if I started to feel forgetful or dizzy. All Downhill From HereThe day after the race was when I really started to feel broken. Advertisement My shoulders were unbearably sore where the harnesses held me in during the crash. My headache extended from the back of my skull all the way up to my front right cheekbone. I was woozy and absentminded.It’s normal for the onset of symptoms from a concussion to be delayed like this, but that doesn’t make them suck any less.The drive to return my rental car that night was terrifying. I almost didn’t feel as if I was driving from inside the car. I couldn’t maintain my speed on the interstate. Every time I needed to glance at the heater or the speedometer, it took too much mental focus away from driving. Advertisement Advertisement When I got to the security line for my flight home Monday, I couldn’t handle the pain and the confusion anymore. I broke down in tears.At the doctor’s office, I failed a few balance and concentration tests that were very close to those of a field sobriety test. (I really shouldn’t have driven there.) I also failed several other embarrassing tests where I couldn’t remember how to do math or finish my own sentences.My doctor ran through the Sport Concussion Assessment Tool (SCAT) test, a guide to the right questions to ask and tests to do on someone who may have a concussion. It’s often used to establish a baseline of observations for comparison in follow-up visits. I got asked everything from what month it was to whether I felt like my head was in a fog. Advertisement The diagnosis was confirmed: I had a concussion—specifically, a concussion without loss of consciousness. It didn’t matter that I hadn’t been hit in the head, either. The acceleration-deceleration process is what causes a brain to shift within the skull and become concussed.People do not always think of them in this context, but a concussion is a mild traumatic brain injury. There’s actual damage to the brain that has to heal.When I asked my doctor if he knew how bad of a concussion I had, he explained that descriptors for the concussions themselves such as “mild,” “moderate” and “severe” are no longer in use by the medical community, even though they still show up all the time in media coverage. Advertisement Advertisement It’s currently impossible to accurately say how severe a concussion is at diagnosis. Eighty to 90 percent of concussions resolve themselves in a 7 to 10 day period, according to the Consensus Statement on Concussion in Sport from the 4th International Conference on Concussion in Sport. It’s very difficult to tell right away who will have symptoms beyond that. My doctor explained via email:We would have cases where someone would get knocked out, and would be labeled severe with no return to play for a minimum of 4-6 weeks. However, their symptoms would clear within a week and [they] would then have to sit until the 4 week mark. Others would be labeled mild with [return to play] within a week and would have symptoms 6 weeks out. So yes, basically, unable to determine at onset.Little did I know, I wouldn’t be back within six weeks, either.Home Very AloneMy doctor ordered me to shut down for three days. In order to allow my brain to heal, I had to drop everything. Advertisement Injuries to other parts of the body, my doctor explained, are often immobilized to allow them to heal. A brain can’t really be immobilized, so the usual treatment for a concussion is to keep mentally taxing tasks to a minimum.This meant no driving, no writing, no reading, and only light fare if I wanted entertainment. Action movies were out, but light comedies, music and podcasts were okay. Small screens, like the phone I kept using to tell people that they were wrong on the internet, were also to be avoided.Problem is, I write for Jalopnik. My job entails driving cars, reporting on motorsports, and lots of reading and writing. Everything I do, both for work and for fun, was expressly forbidden, so this diagnosis and treatment resulted in a lot of mind-numbingly dull involuntary sick leave. Advertisement Advertisement When the three days were up, I thought I was ready to return to work. But when I tried to think of sentences to write, the chunks came together out of order, necessitating many revisions to get my work to make sense. Other times, I would forget what I was saying mid-sentence, or focus on something so long that I would trail off into a blank stare. Sometimes I knew exactly what word I needed to use, but couldn’t remember it. I was easily frustrated and overwhelmed. I erroneously assumed that my doctor’s advice to slowly get back to work meant that I could jump right back into almost a full workload. All I do is sit in front of a computer, so how hard could it be?I was now having trouble getting to sleep, too, so my doctor prescribed a mild dose of Ambien. It didn’t do much, so I was stuck in this vicious cycle of being unable to sleep and unable to be productive because I was so tired during the day.Drivers Won’t Admit Anything Is WrongFortunately, Jalopnik was accommodating of my injury and my reduced workload, but my desire to push through and get back to normal as soon as I could was strong. The experience made me think about other racing drivers who have suffered concussions, and the one big problem that faces them: there’s next to no short-term incentive for a racing driver to report a concussion. Advertisement The long-term consequences of multiple traumatic brain injuries are terrifying, but we’re talking about people who are often A-OK driving with fractured ribs, pneumonia and other maladies. Why would a head injury be any different?As such, concussions in racing are widely underreported. Dr. Gary Hartstein, who served F1 for many years, explained that mild traumatic brain injuries have “long been under-diagnosed, under-treated, and... minimized” while later acknowledging the root of the issue: “Yes, you racers sure do want to get back into your cars.”Two of the most famous recent examples of a driver racing while concussed involved NASCAR’s Dale Earnhardt Jr. In 2002, Earnhardt admitted that he drove for several races with a concussion. Advertisement In 2012, Earnhardt again tried to brush off a concussion sustained during a tire test, according to USA Today. But his experience five weeks later in a much softer crash at Talladega Superspeedway—one where he later said he “knew something was just not quite right”—finally convinced him to sit out the next two Sprint Cup races to let his brain heal. Taking a break from racing doesn’t always guarantee that you’ll have a spot in your car when you come back. It’s much easier for someone like Dale Earnhardt Jr. to take time off, as no one’s going to replace him in the top levels of NASCAR. A driver further down the field, not so much.Add in the desire to win a championship or perform well and it’s easy not to seek help for a brain injury, as four-time NASCAR champion Jeff Gordon admitted in 2012 to USA Today: Advertisement If I have a shot in the championship and my head is hurting, I’m not going to say anything. It’s not the way it should be, but it’s something most of us would do. That’s what gets a lot of us in trouble.This mindset is dangerous. When The New York Times caught up with several NASCAR drivers who experienced multiple concussions throughout their career, they reported that some “still grapple with the effects, including memory loss, mood swings, irritability, difficulty walking and depression.” Advertisement Fortunately, major racing series have developed tougher protocols for identifying concussed drivers and pulling shaken heads out of the car in response to all of the headlines.For example, both NASCAR and the International Motor Sports Association utilize on-site medical staff to check drivers immediately after any incident where a head injury is suspected, per their respective series representatives. Drivers under both sanctioning bodies must be cleared to resume racing activities by a doctor who specializes in brain injuries. Advertisement One hole in NASCAR’s concussions protocol, reports The New York Times, is that it only kicks in if a driver goes to the infield care center. If a driver drives away from a crash, as Dale Jr. did in 2012, it’s up to them to seek care. Formula One, by contrast, uses sensors in the car itself to alert officials of excessive G-force. If a car and driver experience over a certain amount of force, that driver must meet with medical personnel. Formula One’s medical car. Photo credit: Getty Images Likewise, building trust between drivers and the doctors who serve them would help with the epidemic of underreporting. Dr. Stephen Olvey, a former IndyCar doctor and former director of the Neurocritical Care Unit at Jackson Memorial Hospital in Miami, confirmed that part of the issue is within the medical community itself:The problem is the medical profession has lagged behind this. I went to a neurology conference two years ago, and there were a couple of neurologists that were rather well-known who were kind of scoffing at the idea of chronic traumatic encephalopathy and having too many concussions.[...] There’s still people that think you have to be knocked out. There’s still people that think you had to have hit your head. None of that’s true. You can have a very significant concussion and not hit your head at all.Having a consistent, accepted view that concussions are serious, potentially debilitating injuries would go a long way in making sure drivers take doctors’ opinions on the matter seriously. Advertisement In stark contrast to the National Football League’s hired quacks, the major American professional motorsports series now err on the side of caution whenever a driver might be concussed. They also seem to embrace cutting edge technologies and the work of research hospitals.NASCAR, IMSA and IndyCar all now mandate a baseline concussion test (such as the Immediate Post-Concussion Assessment Test, or ImPACT) before the beginning of the season. The 30-minute computerized ImPACT test “measures several neurocognitive functions including memory, reaction time, attention span and other cognitive abilities,” explained USA Today. Drivers take the test before the season starts to set a baseline to compare with a result from the same test after a significant collision. Advertisement After NASCAR made baseline concussion testing mandatory in 2014, Earnhardt Jr. explained to USA Today that it should make a big difference in identifying an injury that’s easy and all too tempting to hide:It makes perfect sense to make it mandatory. I think it was nice of them to look into ways they could protect us from ourselves really. The test is really simple, and it’s pretty straightforward.When you get into an accident, you can take this test again and find out exactly what is happening to your brain if things don’t feel right. This test can pinpoint where in the brain you’re struggling, what kind of injury you have, what kind of things you can do to rehab and to recover. It helped me a lot.Another issue is that concussions have too few injury-specific symptoms, which sometimes leads to a misdiagnosis. The SCAT test, for example, assumes that any symptom a patient has is the result of a concussion. Many researchers are now using imaging to discover the specific changes that happen to a concussed brain. Advertisement Some of that research is uncovering some tough conclusions. For example, new MRI research suggests that the damage from a concussion—even for those whose symptoms go away relatively quickly—lasts longer than previously thought. Damage to the roof of the Nash. Photo credit: Stef Schrader Continuing RecoveryA couple weeks after my crash, I was still weirdly emotional, bursting into tears over relatively minor things or sometimes for no reason at all. I started to worry if I’d done permanent damage or if I’d ever return to normal. Anxiety and depression are common side-effects of a concussion, and they hit me hard. I felt forgotten and useless.I wasn’t allowed to race for a while, so I couldn’t do many of the events where I’d see other people. It took over two months before it was medically okay for me to just ride along with someone else driving on track. There was some concern that the motion would cause me to puke in some unlucky individual’s right seat. Advertisement I still couldn’t sleep, either, so I was told to try doubling my dose of Ambien. That just gave me vivid, terrifying nightmares, so I quickly returned to my smaller, somewhat ineffective dose as needed. Balance also continued to be an issue, which hindered any activity where I was on my feet for a while. One of the cars from Circuit of the Americas’ Pirelli World Challenge weekend. Photo credit: Stef Schrader When I tried to cover a Pirelli World Challenge race in March, I felt like the guy from Vice who went to the Westminster Dog Show on acid. I kept losing my train of thought, forgetting which words I needed to use, and staring blankly into space. At one point, the media room where I was started to spin and I just had to sit and do nothing until it stopped. Advertisement Later that month, I started easing back into more of my regular activities. I could drive longer distances, and try racing on simulators. Exercise was also something I’d held off on for fear of losing my balance and getting another concussion before this one was healed. With my dizzy spells becoming less frequent, I was okay to start working out again—and hopefully get some muscle back.It took a full three months before I was medically cleared to go back to racing. While pro athletes who only have to focus on a sport tend to recover quicker than that, surely I’m not the only one whose recovery lasted longer than expected.Everything Still SucksCleveland Browns cornerback Joe Haden nailed the worst part of getting a concussion on the Brownscast a while ago: the uncertainty. You’re waiting to return to your life, but a concussion is an injury that doesn’t have a solid timeline for recovery. You see other people fill in for you and it’s easy to get stuck in the idea that you’re not needed. When you’re finally back, how do you know you’ll be as good as you were before? Advertisement Concussions damage the myelin sheath which protects nerves in the brain, reports the Vancouver Sun. Myelin is also the substance that is damaged in multiple sclerosis patients’ brains. Specially tuned magnetic resource imaging of hockey players’ brains showed that the myelin appears to separate from the nerve in a concussion. Researchers found that the myelin gradually repairs itself over a two month period following a concussion. Thus, concussions may need more time to heal than symptoms suggest.I was told that it could be a month before I was better, then there was another month because the symptoms weren’t resolved. It took another month before I could track a car again, and now I think I’m mostly okay—until I can’t remember something. Damage to the side of the Nash. Photo credit: Stef Schrader The pervasive attitude of “it’s just a concussion” certainly affected my recovery. We think of them as mild traumatic brain injuries and the default response to a mild injury is to harden up and deal with it. Given the high consequences of accumulating several of them in a row and the fact that a brain injury of any sort completely interrupts your life, “mild” is definitely a misnomer here. Advertisement Advertisement Until we discover better ways to diagnose, treat and prevent concussions, recovery will suck for longer than patients want it to. That’s why it’s so important to give concussion sufferers the appropriate time and resources they need to heal. [H/T to LeMons Racer Lounge and the 24 Hours of LeMons forums for various accounts of what was going on behind the Nash.]Stef Schraderstef.firstname.lastname@example.org@stefthepefEditor, Black Flag. 1984 "Porschelump" 944 race car, 2010 Mitsubishi Lancer GTS.