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Ted Freeman and the Battle for the Injured Brain

Ted Freeman and the Battle for the Injured Brain: A case history of professional prejudice

Peter McCullagh
Copyright Date: 2013
Published by: ANU Press
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  • Book Info
    Ted Freeman and the Battle for the Injured Brain
    Book Description:

    This book recounts some experiences of young Australians with catastrophic brain injuries, their families and the medical system which they encountered. Whilst most of the events described occurred two to three decades ago they raise questions relevant to contemporary medical practice. The patients whose stories are told were deemed to be ‘unsuitable for rehabilitation’ and their early placement in nursing homes was recommended. In 2013, it is time to acknowledge that the adage of ‘one size fits all’ has no place in rehabilitation in response to severe brain injury. Domiciliary rehabilitation, when practicable, may be optimal with the alternative of slow stream rehabilitation designed to facilitate re-entry into the community. Patients’ families were impelled to undertake heroic carers’ commitments as a reaction to nihilistic medical prognoses. It is time for the Australian health care system to acknowledge those commitments, and the budgetary burden which they lift from the system by providing family members with support to retrieve career opportunities, most notably in education and employment, which have been foregone in caring. Medical attendants repeatedly issued negative prognoses which were often confounded by the patient’s long term progress. Hopefully, those undertaking the acute care of young people with severe brain injury will strive to acquire an open mind and recognise that a prognosis based on a snapshot observation of the patient, without any longer term contact provides a flawed basis for a prognosis. The story of these patients and of Dr Ted Freeman has wider implications.

    eISBN: 978-1-922144-32-4
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Acknowledgments
    (pp. vii-viii)
    Peter McCullagh
  4. Acronyms
    (pp. ix-x)
  5. Preface
    (pp. xi-xiv)
  6. Introduction
    (pp. 1-12)

    The work of Ted Freeman and the local medical profession’s response to it raise several critical issues that have ongoing relevance for Australian health consumers and health policymakers alike. The first is the capacity of the health system to respond appropriately to catastrophic disablement. Until the 1980s, at least, the conditions in which many people with severe disabilities were kept shocked most outside observers. Today, awareness is higher and more resources have been allocated, but long-term care institutions remain the subject of myriad complaints.

    Another worrying issue that his story raises is the closure of some medical minds and the...

  7. 1. The origins of a commitment
    (pp. 13-32)

    In order to place Ted Freeman’s career path in context, I asked him to describe his background leading up to his first involvement with people with brain injuries. This chapter is his response. He prefaced that description with a quotation:

    What we are today comes from our thoughts of yesterday.

    And our present thoughts build our life of tomorrow.

    — The Buddha

    He told the following story.

    In 1949 at the age of sixteen I worked pushing a barrow at the Sydney City Markets. I had been a schoolboy at Canterbury Boy’s High School in Sydney—a selective high school...

  8. 2. Misdiagnosis: Patients’ stories
    (pp. 33-58)

    Statistics of brain injuries cannot adequately convey their longer-term impact on affected people and certainly fail to reveal the manner in which decisions and commitments made, on their behalf by others, can influence their longer-term outcomes. This chapter examines the stories of 10 of Ted Freeman’s patients, based on his clinical notes and written by him so as to facilitate their accessibility to lay readers. These stories are reproduced without modification and have been selected from two dozen included by Freeman in a chronological account of his work. That selection has been undertaken in order to illustrate a number of...

  9. 3. Families: No easy way forward
    (pp. 59-78)

    Any reading of the preceding chapter is likely to leave a strong impression that the families of the patients whose stories are summarised were very much part of those stories. The frequently cited adage that a severe brain injury inevitably affects more than one life springs out of the pages. Family responses can range from utter despair and literally walking away from the affected member consigned to a nursing home or similar institution to a total commitment to attempts to rehabilitate him or her, usually at home.

    It does not require too much reflection to realise that there are major...

  10. 4. Emergence from coma after brain injury: Freeman’s contribution
    (pp. 79-100)

    This chapter discusses the initial events during emergence from coma and the ongoing strategies that Freeman adopted to facilitate this. In each case, it is intended to recount the story of his contribution to the advancement of recovery at these two stages of the process, whenever possible, using his own words.

    As a background, the beliefs and practices inherent in managing comatose patients in the early 1980s are touched on. The inferences drawn by Freeman, acting on the basis of observation, to shorten the duration of coma, are examined in the light of studies employing brain scanning to study consciousness,...

  11. 5. What future after emergence?
    (pp. 101-124)

    This chapter’s primary aim is to describe the development and implementation of Freeman’s ideas for assisting patients and their families through the period after discharge from an acute-care hospital. What it was possible to achieve in practice evolved through several stages, largely as a result of the changing circumstances within which he practised. The intersection between Freeman’s life and his fight on behalf of his patients, referred to above, is most evident in this chapter.

    Freeman’s absolute horror at the plight of those who had been effectively abandoned within the healthcare system, with no possibility of ongoing rehabilitation, was clearly...

  12. 6. Trials and tribulations
    (pp. 125-146)

    Reference has been made in the preceding chapter to the period during which Ted Freeman had an association with the Westmead Hospital as chief investigator in a research project into severe brain injury. This association was a consequence of the award of a substantial financial grant from the NSW Government Insurance Office (GIO) intended to test his ideas for procedures to facilitate awakening patients from coma after brain injury and their subsequent rehabilitation. Freeman’s association with the hospital and its receipt of the GIO grant were both terminated abruptly during the course of preparing for a clinical trial.

    This chapter...

  13. 7. Concerted opposition in Australia
    (pp. 147-174)

    The events described in the two preceding chapters—namely, the evolution of Freeman’s ideas and practice on domiciliary rehabilitation and the machinations evoked by the availability of a large grant of research funding—occurred against a background of considerable hostility towards those ideas and practices. The extent to which this general hostility fuelled the antagonism expressed in individual situations and happenings is not readily discernible after a quarter-century. Similarly, questions about the relative contributions of various influences to the development and entrenchment of the opposition are not easily resolved. This chapter recounts a sample of the hostile responses from some...

  14. 8. International support forthcoming
    (pp. 175-190)

    If one is to attempt to form an unbiased assessment of the value of Freeman’s work, it is clearly necessary to search beyond the hostile opinions some examples of which were given in the preceding chapter. One possible approach would be to examine the extent to which his proposals for management of people with severe brain injuries have been reflected in clinical practice during the three decades since he began to apply them. Another, more direct, course of action could be to refer to evaluations of the man and his work by others with acknowledged expertise in this field. Both...

  15. 9. Some conclusions
    (pp. 191-198)

    The history of Ted Freeman’s commitment to improving the subsequent lives of young people who had sustained brain injuries, and their families, includes many events that neither he nor they are likely to have foreseen. Those events raised issues with particular relevance to acquired brain injury but also suggested broader questions related to more general aspects of systemic healthcare delivery and to medical practice, and the relevance to it of ethics and research. Whilst all of these topics have been considered in preceding chapters, it may be helpful to assemble some of them here in order to consider briefly their...