Over My Head: A Doctor's Own Story of Head Injury from the Inside Looking Out.

Claudia L. Osborn Andrews McMeel Publishing Kansas City, Missouri 1998, 239 pp. $21.95 Hardcover ISBN 0-8362-5419-8

Claudia Osborn was enjoying a summer bicycle ride one evening in her quiet tree-lined neighborhood, when a heedless young man lost control of his car, swerved around a street comer into her lane, and sent her flying over his car. She was not wearing a helmet. This book details the aftermath of the traumatic closed-head injury she sustained in that life-altering moment.

Dr. Osborn had been practicing medicine for two years as an osteopathic doctor of internal medicine in Michigan. She was the director of the medicine residency training program at her hospital. Now, after admission into emergency and an overnight stay as a patient in the hospital where she had practiced, she was at home, making little progress toward recovery. Before the injury, she had been a vigorous, empathic, accomplished person both in her personal and professional life. At home, she perseverated regarding her need to return to work, had no short-term memory, lacked stamina, and found it almost impossible to plan and manage activities of daily living. How could she do the analytic thinking and complex tasks required of a physician?

Nine months after her injury, spurred by her desire to regain the ability to practice medicine, she, in concurrence with her neurologist and with the support of family members, enrolled as a trainee in the Brain Injury Day Treatment Program at the New York University Medical Center in Manhattan.

Challenges posed for the trainees by the staff of talented professionals, including six psychologists, were daunting, unremitting, or so it seemed to the trainees. All of these "coaches" worked with all of the trainees, but each trainee was assigned to one coach for problem-solving and personal guidance. Six months into the program, Dr. Osborn was devastated by her coach's observation that, given the severity of her closed-head injury, she would not be able to return to her career as a practicing physician.

All of the coaches worked steadily with her. As weeks and months went by, she began, slowly, to sense the validity of their words and to appreciate the necessity of their assessment. Driven by her passion for medicine, she undertook a second session in rehabilitation, followed by vocational trials. In all, she lived apart from her family and friends for fifteen months.

Over My Head gives us her story in energetic, colorful, fascinating style. Not only does she tell her own story, she also narrates the experiences, during and after the program, of two women and six men who were her classmates. Dr. Osborn was able to construct her accounts from her copious day-to-day note-taking, journal writing, and letters home. This book is a guide and a revelation for all persons, lay and professional alike, who want to learn the meaning of traumatic brain injury. The book is instructive but also very personal, livened with the author's penetrating, wry, wistful humor.

The body of medical knowledge Dr. Osborn learned and practiced pre-injury has remained essentially intact, although she cannot readily apply it to a developing medical situation. However, using the strategies refined at the NYU rehabilitation program, and given her skills as an educator, she has been able to return, in a part-time capacity, to her teaching position as associate clinical professor at Michigan State University College of Osteopathic Medicine.

Before her injury, Claudia Osborn was a person of great resolve, and she continues to be that person. She enjoyed the love and care of family members and friends, and she continues to receive and return that love and care. She writes, "This would be a great story if I had been able to return to the practice of medicine ... Longing for what one had has a way of popping up at unexpected times ... But over time, the intensity eases ... This new life is truly mine. I own it and I am earnestly trying to learn ... what God intends me to do with it. I was a happy woman before my injury. I am a happy one today."

Louis J. Cantoni, Ph.D. Former Professor and Director of Rehabilitation Counseling Wayne State University, Detroit, Michigan