A guest at the New Zealand International Science Festival, to be held in Dunedin from July 5-13, James Piercy will offer insights into traumatic brain injury. He should know - he has suffered one, writes Shane Gilchrist.
James Piercy didn't know much about his brain - any brain, for that matter - until his was damaged.
Piercy's life changed on January 30, 2011 when, during what was supposed to be another ordinary Sunday outing, a nail punctured the tyre of his family's car, which slewed off the road near Norwich, England, and into a tree.
His wife Kate (36) was killed on impact. His three children, now aged 16, 13 and 8, suffered minor injuries. Piercy, the front-seat passenger, suffered a severe brain injury and spent six days in a coma, followed by more than six weeks in hospitals.
''My head injury was classed as very severe and my recovery described as 'phenomenal','' says Piercy (46), who will share both his story and insights into brain function at the New Zealand International Science Festival, to be held in Dunedin from July 5 to 13.
In his talk, titled ''What's Going on in his Head?'', Piercy will use scans, video clips and even a model of his skull (made by a friend with a 3-D printer) to describe his injury and his recovery.
''I tell my story, from the roadside to where I am now,'' Piercy explains via phone from his home in Norwich earlier this week.
''I talk about the things that were really hard at first, the improvements, the frustrations.
''I also touch on the broader-picture things, what other people might suffer, such as psychiatric problems.
''I don't go into great detail about electrochemistry in the brain and so forth. I talk more about what we know about the pathways and connections in different areas of the brain and how, in terms of injury, there are areas that are more important than others.
''For instance, we know there are functions in areas of the brain that can be taken on by other areas. So what's important are these connections, these pathways between areas in the brain.''
With regards to Piercy's own grey matter, scans have revealed a small circular area of damage on the right side of his brain and more diffuse damage on the left. Because the left side of the brain controls the right side of the body, most of his problems are on his right side.
''I suffered some right-side weakness, which has improved dramatically over time. I don't have any paralysis but there is a loss of sensation.
''Those injuries are typical with the type of accident I had - a hard impact and a bit of shaking around.
''The main issue is fatigue. If I try to do too much, say multi-tasking, concentrating hard for long periods or getting stressed, then I get tired really quickly.
''As well as the brain injury, I suffered some skull fractures and that messed with the muscles that control movement in my eye and I have permanent double vision'', for which he wears a pirate-style patch.
''Based on how long my amnesia lasted after the accident, I am judged as 'very severe','' Piercy says, referring to the Glasgow Coma Scale, a widely accepted measure that defines a ''very severe'' brain injury as one whereby a patient has lost consciousness for more than six hours.
''My consultant has told me my recovery has been phenomenal, that I've done much better than expected.''
Piercy says early intervention was crucial. Treated at the scene by an air ambulance service that included a doctor, he was sedated and his body temperature cooled.
''These measures reduce brain activity and that would have been a big help. I was also lucky because I was young and relatively fit.''
Piercy speculates that his background might have helped, too. Having run a science centre in Norwich in which he explained science to schoolchildren, he then moved on to a job as a science communicator, teaching eminent scientists how to better present and relay their research.
''There has been some recent research around what is known as 'cognitive reserve', linking the number of years spent in education with recovery.
''That is, if you are used to learning stuff and making new brain connections, the better your recovery chances are.
''Being high-functioning probably does help, but that doesn't mean everyone who went to university necessarily has a greater chance of recovering from a brain injury.''
The phrase ''lifelong learning'' might be overused, jargon perhaps, but it is an important concept, Piercy says.
''It used to be said that brain cells never recover. We now know that they do. Brains continue to rewire themselves throughout life.
''It is true that the connections aren't as quick when you are older. It is a fact that is harder to learn the violin when you are 60 than when you are seven.
''But the brain does have this plasticity.
''So we should make an effort to learn new things.''
Piercy has no recollection of being told his wife had died.
He says his inability to absorb such news was helpful early in his recovery but, ultimately, has hindered the process of grieving.
''In the longer term, it has been much harder. But, probably, in the early stages, it was helpful.
''I didn't get really depressed at the time because I had forgotten.
''I might have been told this awful news, but an hour later it was forgotten, until I was told again.
''While I was in hospital dealing with my own problems, I wasn't burdened with this awful news.
''I'm told that I did know the kids when they came. However, I don't remember them coming to visit.
''However, my retrograde memory - all that had happened before the accident - seems to have been unaffected.
''For instance, when somebody from a scientific committee on which I was involved came to visit, I was very interested in the minutes of the last meeting.''
Six months after his accident, Piercy stood in front of an audience and delivered a ''pilot version'' of his current public address. Two years after the crash, he began presenting ''What's Going on in his Head?'' at a range of venues, from science festivals to hospital lecture theatres.
The importance of that ability to communicate ideas to others cannot be overlooked.
''Because it had been my job to get up and talk to people, I found it really powerful to be able to do that again. Afterwards, I thought, `Wow, I can do stuff - I will have some sort of future'.''
Piercy now works part-time as a science communicator for British-based agency Science Made Simple. It is a role that takes him around the world, as well as into schools and scientific institutions closer to home.
''Having the chance to work is a very powerful thing. I could look after the kids by myself; I'm well enough to do that, and it's great to be home with them and give them cuddles, read them books and everything that goes with that, but I need to get out and do stuff.
''Early on, my mum came and lived with us and helped out. I have a new partner now who helps with the kids and that gives me the chance to do things like take this trip to New Zealand.''
Still, there are frustrations.
His speech is affected when he gets tired (''that really bugs me, because I speak for a living''); he can only sit in front of a computer for a couple of hours now when he used to be able to do six or seven (''that annoys me''). In short, Piercy can still function, but not at the level he did before.
''Learning to live with that has been one of the biggest challenges. On the scale of things, it's pretty minor. Some people have to learn to walk.
''There are things I have had to put in place to help me cope, such as planning, lists etc. I'm not good at coping with sudden changes.''
Some people who have suffered a traumatic brain injury (TBI) experience changes in personality but retain a certain insight into what has happened; others may behave differently and be completely unaware they are doing so; some may exhibit aggressive and/or irritable behaviour; depression and obsession, too, are among a TBI's many effects.
''Luckily, my personality doesn't seem to have changed because of my injury,'' Piercy says.
''Well, no one has said to me I'm very different to how I used to be.
''But if I am different, it has more to do with coming to terms with such a bereavement. And coming so close to your own mortality changes your perspective on life.''
Which brings us back to the primary reason Piercy speaks about brain injury: he had to make sense of his own situation.
''Some people don't want to know, but I needed to get my medical notes and read them.
''I've been trying to investigate it. And in trying to come to terms with what happened to me, I've learned more generally about brain function and what can happen to other people as well.
''I try to keep the content of my talk scientific; it's about the stuff we know. But because I'm talking about my brain, there is a really powerful personal connection with people.
''The discussions and questions after my talks tend to be about the personal and emotional side of things.
''There is a message that comes through from the fact I'm standing up there. People come up and say I've given them strength to carry on and deal with their own problems.''
The talk
James Piercy presents ''What's Going on in his Head?'', Hutton Theatre, Otago Museum, Great King St, July 7, 7.30pm-9pm.
He will also take part in Cafe Sci: ''Take a Good Look at ... The Brain'', a panel discussion, Hutton Theatre, Otago Museum, July 7, midday-1pm.
The New Zealand International Science Festival ''Leave Boring Behind'', runs from July 5-13. www.scifest.org.nz.areas
