When you break a bone, you usually know it right away. You can pinpoint the reason and time when it happens. Pain hits you in the moment and lingers, sometimes for weeks, as you heal.
When you injure your brain, it's a different story.
Professional snowboarder Kevin Pearce found that out after a string of concussions over the years culminated in 2009, with a final blow to the head during a practice run while training for the Vancouver Olympics. He was 22.
"When your brain is injured, it doesn't always tell you that it's injured," Pearce, now 28, told Mic. "The most surprising thing to me is how little I could understand what was happening and what this injury was and what it meant. For months and months, I had no clue what was happening and how this was going to affect my life."
Traumatic brain injuries (TBIs) can derail anyone, no matter the age or stage of life. For people in their 20s and 30s, the experience can dramatically shift the trajectory of their lives at a time when careers and aspirations are just beginning to take shape. And for Pearce and other TBI survivors who spoke with Mic, finding a path to recovery has been an ongoing process of reevaluating their hopes and dreams, even wholly redefining themselves.
Invisible injuries: Although less than 10% of concussions result in a lack of consciousness, all concussions — from mild ones to full-on throttling of the brain inside the skull during major accidents — are considered traumatic brain injuries. Every year, 1.4 million Americans are seen in emergency rooms for TBIs, according to the Centers for Disease Control and Prevention.
"Many of the problems that people have after traumatic brain injuries include difficulty walking, balance, eyesight, as well as problems with cognition and being able to think properly," Steven Flanagan, Chair of NYU Langone Medical Center's Rusk Rehabilitation, told Mic. "People have difficulty paying attention, concentrating, organizing themselves, solving problems. Memory is often impaired."
Brain-injury survivors can have a harder time determining just how serious their injuries are at first. The fact that injuries are not always physically apparent to others can make that understanding even more elusive and frustrating.
Ann Boriskie didn't know she had a brain injury until a year after she was in a car accident. She had surgery on her neck and elbow but didn't realize she had also sustained a severe brain injury.
"Not one doctor even thought to ask me about a brain injury, but I knew because very quickly I started having concussion symptoms," she told Mic. "They just sent me home and said, 'Oh, you'll be fine.' I went the first year thinking I was crazy."
"They call it the hidden disability because you can't see it," Boriskie added. "If you saw me, it doesn't look like there's a thing wrong, but I'm in constant pain."
"They call it the hidden disability, because you can't see it. If you saw me, it doesn't look like there's a thing wrong, but I'm in constant pain."
Life before and after: Even as the physical pain fades, adjusting to the new limitations and realities of a post-TBI life can be tough.
After his final snowboarding accident, Pearce stayed in the hospital for months trying to regain many of the functions he'd lost. He says he doesn't remember the accident itself or the first three months of recovery.
"I remember doing these exercises to swallow," he said. "From there, it was on a treadmill. Then it was trying to write and figure out how to draw. And then from that place, it was continuing on shooting baskets and swimming, slowly progressing to where I was before."
Despite his doctor's and family's recommendations, Pearce believed he would be able to return to professional snowboarding for the first couple of years after his recovery.
"It became clear and abrupt to me of what this injury was and how it was going to change my life when I got back on a snowboard for the first time," Pearce said. "It was two years post-injury. It wasn't until then that I could understand how bad, how real, this injury was."
Nicole Eastman was 29 when a traumatic brain injury dramatically upended her life. While completing a residency as a doctor in rehabilitation medicine, she was hit by a truck going 65 miles an hour on her way to work — just two weeks after her wedding.
"I really do believe that the person that I was, that person died," Eastman, now 34, told Mic. "I truly became someone different through my accident."
Eastman suffered a mild concussion and was knocked unconscious. Afterward, she continued to experience chronic pain, memory issues and sensitivity to light and sound. Even now, standing for longer than 15 minutes is still painful for her. The adjustment to a life after her injury — "going from being a doctor in my residency training to becoming pretty much a full-time patient" — has been another significant part of her recovery.
"My life completely changed," she said. "I lost something that I worked very hard for. Nobody feels good about having something taken away from them when they didn't have any sort of control over the situation."
Finding a way forward: According to NYU's Flanagan, one of the most important parts of recovery from traumatic brain injuries is time itself.
"Rehabilitation or recovery from a brain injury is a process," Flanagan said. "Unlike if somebody has an infection, take an antibiotic and you're better in the course of a week or two, recovery from brain injury is really one that takes some time."
For Eastman, recovery and acceptance also came with time and hard work. Her family moved to Grand Cayman from Michigan, where it was easier to manage pain in the warm weather, and she started creating online training courses that teach holistic healing practices. She also manages a Facebook page support group for people with brain injuries.
"I had to come to the understanding that there was a purpose for my life, that there was a reason that I had been given a second chance at life," Eastman said. "Finding people on social media like Facebook who had a better understanding of what I was going through, it made me feel less alone."
Boriskie started the nonprofit Brain Injury Peer Visitor Association in 2006. The organization coordinates volunteer visitations to patients in hospitals around Georgia in order to help them during the recovery process.
"We visit with patients. We support them. We hand them a huge pack of information that has all sorts of CDC facts, other survivor stories, newspaper articles and a book list so they can find different books on brain injuries," Boriskie said.
She believes that the only way she was able to recover was choosing to push forward, through the memory loss and impaired cognition. She volunteered at her children's school and helped them with their homework as a part of her recovery.
"I was told two years after the wreck I went from being a Master's degree-level person back to high school," she said. "That's a horrible thing to have to learn."
Six years after his accident, Pearce can snowboard again, though not professionally. He has a foundation and travels around the country talking to people about how to love themselves and their brains.
"It's been caring for my brain in ways that I never used to care for my brain, stopping doing all of those things that are so bad for your brain," he said. "I'm still continuing to work on it, to remember everything that I want to remember."
For all of these survivors, time and strength has helped them overcome the symptoms left behind from their brain injuries. Boriskie believes that overcoming an injury is often a personal choice.
"It's either you lay down and say, 'Woe is me, I'm gonna die,' or you keep living and you try to get as close to your normal life back," she said. "I was gonna get as close back to who I was, and I worked towards that."
To learn more about the journey of recovery from traumatic brain injuries, watch the Netflix Original Documentary My Beautiful Broken Brain, now streaming, only on Netflix. See the trailer below: