Concussion changes life for CentraCare physician

CentraCare Clinic – River Campus Hospitalists

In her role as a hospitalist at St. Cloud Hospital, Sarah Carter, MD, was accustomed to working long shifts, overnights being her favorite, seeing multiple patients each shift and helping her adult and pediatric patients at a time when they needed her most. She also has fulfilled multiple leadership roles, including being past chief of staff, assisting colleagues and helping build the vision and blaze trails for improving health and health care. But all that time spent in the hospital could never prepare her for the next chapter.

“I never thought that it would happen to me,” said Sarah Carter, MD. “As a physician, I knew about concussions associated with sports. I didn’t realize a simple fall, hitting my head, and knocking myself out could do the same thing.”

Dr. Carter was working an overnight shift at St. Cloud Hospital when she slipped, fell, and hit her head on a steel door frame.

“I do not remember falling and was only unconscious, at most, a minute or two. When I regained consciousness, I thought I’d be fine; I wanted to get up and see my patient in the ICU,” Dr. Carter said. When staff helped Dr. Carter up and into a wheelchair, she was instantly dizzy and nauseous.

In the Emergency Room (ER), Dr. Carter received a CT scan which came back normal. “I thought everything was fine; I wanted to get up and drive home. Looking back, what surprised me the most was how initially I didn’t recognize my own deficiencies. I was in the ER for about five hours and in retrospect, I don’t remember most of my time there.”

Dr. Carter called her husband and returned home, suffering from headaches and major sensitivity to light, noise, and movement. Her employer required a physician’s note to return to work. “I was healthy before this happened,” she said. “I didn’t have a primary care provider.” She called in a favor and one of the providers that works with concussions was able to help her. She was seen at CentraCare’s Rehabilitation Center at CentraCare Health Plaza where she was told that she would be out of work at least six months; that was three and a half years ago. Initially, those months were filled with therapy appointments; speech therapy and occupational therapy for the first year and a half, and even longer in physical therapy.

“I didn’t realize how many speech problems I was having. I couldn’t find the words; I’d say the wrong words. I would argue that what I was saying was correct,” she said.

The goal was to return to her job as a hospitalist physician. About four months after her fall, she started easing back into some of her job duties such as going to meetings. “I went to the first meeting and I was so far behind. I was listening intently but not able to keep up. It was very real then of how cognitively deficient I was — I went home and cried.”

Due to the visual issues, she was referred to a neuro-optometrist, prescribed prism lenses and underwent vision therapy, and she saw an audiologist for the noise sensitivity with subsequent audiology therapy. "I would not be where I am at today without the help of Kelly Collins, MD, my rehab physician, and the many awesome therapists. CentraCare has an unbelievable rehab center!"

Together with her employer, Dr. Carter gradually transitioned back to work with modified duties. She is currently back at the hospital working nearly half-time, still limited by her headaches as well as light, noise and screen sensitivity. A variety of adjustments such as limited hours, physical adjustments to lights and surroundings, and shadowing other providers helped ensure a smooth transition.

One of the biggest challenges Dr. Carter experienced as a patient with a concussion was isolation. “You feel so distant from everyone. You can’t go out to eat because of the lights, the noise, and the constant movement around you. You can’t go shopping. You can’t read or use screens. One thing to help someone who’s suffered a concussion is to remember to include them, even if you don’t think they’ll come. Send them a quick text or stop by for a short visit to let them know you’re thinking about them; listen and let them tell you how they are doing; let them know what is going on in the world outside of them.”

Dr. Carter’s advice to others who may have suffered a concussion:

• Be patient with yourself. Everything takes way more effort than it did before.
• If things don't seem right, keep advocating for yourself and request to see a provider that specializes in traumatic brain injuries.
• The emotional outbursts and inability to control emotions is unbelievable.
• Therapy is essential to recover.
• Make sure you have a support person that attends your appointments with you.
• Neuro fatigue is indescribable. It is different than being tired; your brain literally shuts down.
• Know your limits and take yourself out of a situation when you’ve reached them.
• A concussion like I had completely changed my life. It can be so frustrating; you just want to be “normal” again. Try to find and accept your new normal. Seek help if you need it.
• Even though “time” becomes a “four-letter” word, it is true; the symptoms do slowly improve, just not always as quickly as you would like.
• Work with your employer; advocate for your needs. It is important to be open and honest. Open communication will provide you with support as well as the most effective return to work.

While concussions are especially common among those who participate in sports, keep in mind a variety of other factors can cause injury to the brain, such as falls, car crashes, or blast injuries from the military. The signs of concussion can be subtle and difficult to identify. Watch for changes in behavior, personality, or memory, sensitivity to light or noise, feelings of confusion or just not feeling right.

Concussions can vary from one individual to another and the recovery is not always the same. The severity and recovery process of Dr. Carter’s concussion is not typical of most concussions; thankfully, most concussions resolve in under 1-2 months and don’t need extensive treatment. Please follow up with your primary care provider if you have questions.

Learn more at BrainSafeMN: Know the Symptoms

More Advice from Dr. Carter

One of the positive things that happened as a result of Dr. Carter’s experience is her colleagues have been made more aware of what can happen after a concussion.

See Dr. Carter’s answers to questions you may have:

Q: How has your personal experience affected your role as a physician?

Dr. Carter: “I’m much more aware of patients who have experienced ‘insignificant’ head trauma. They can still have a concussion even though nothing shows up on a scan. It’s possible health care professionals can miss a concussion if they don’t ask the right questions.”

Q: What should you say/not say to someone who’s suffered a concussion?

Dr. Carter: “People are well meaning and concerned, but don’t say, ‘You look fine,’… ‘You look so good.’ What they don’t realize is my head hurts like crazy. It’s the most frustrating comment. Instead, ‘it is so good to see you’ or ‘I am glad you are here today’ are much better comments.”

Q: What advice can help other providers help patients with a concussion? 
Dr. Carter: “As physicians, we want proof. We want to see labs, images, etc. and that’s not there for a concussion. It’s very difficult to explain what’s really going on. The CTs and MRIs may look fine — everything looks fine. But the symptoms are real.”

• Symptoms can be inconsistent and initially worsen in the first few weeks.
• Anytime a person has a significant blow to the head it should be taken seriously, and they should be monitored for the development of symptoms. People, as well as their providers, are very dismissive of the symptoms.
• Just because you "look good from the outside," doesn't mean you aren't having significant symptoms.

Q: What have you learned about concussion care?

Dr. Carter: “I believe concussions that occur outside of sports are often overlooked and down-played. I don't believe that health care providers are aware of the complications that can occur. I have had a very prolonged recovery with multiple complications. Post-concussion syndrome is a real thing!”

“I had no idea of the multiple therapies that are needed to overcome the deficiencies that a concussion can cause such as speech therapy, occupational therapy, physical therapy as well as seeing a neuro-optometrist, vision therapy and audiology therapy.”