S1 Episode 1: An Eraser in My Brain, Part 1

Pulitzer prize-winning New York Times journalist Alissa Rubin talks with Dr. Stieg about the helicopter crash that seriously injured her, and the long road to healing her body and her brain.

Dr. Stieg: I’m happy to have my patient, the New York Times Baghdad Bureau Chief and Pulitzer Prize winning journalist Alissa Rubin. As our special guest in 2014 Alyssa was seriously injured and nearly killed in a helicopter crash in the Middle East. Her skull was fractured in addition to many serious injuries so often with traumatic brain injury, we hear about the events, but have no idea about what the patient goes through. Today, Alyssa will share her story — a long and miraculous recovery. Welcome Alyssa. So just to set the pace and tone, can you go back to that time in 2014 and tell us why you were boarding this helicopter in Kurdistan and then what happened?

Alissa Rubin: I was going on the helicopter because as you may remember, there were between 20,000 and 50,000 Yazidis who had fled from an area that the Islamic State had invaded in Northern Iraq. They had gone first to Mosul, which is the place everyone’s heard of. And then they branched out into other areas. We knew that the Kurdistan and Iraqi, sort of, military were taking with them food, water, sort of very, very basic supplies to leave for the refugees who were running out of water. It was—

Dr. Stieg: So these people were living there to escape from— they weren’t living there by choice?

Alissa Rubin: Well, Oh no, they were certainly not living there by just, they had fled there and they had fled with really nothing, pretty much. Some of them were barefoot. It was an extraordinarily harsh environment and particularly in summer in Iraq is scorching really hot. It’s dry. It’s a lethal environment, particularly for vulnerable people.

Dr. Stieg: So you were going there then to just see—

Alissa Rubin: To see what it was so that we could tell people, as a journalist, you want to see it yourself. And so I was very excited and fought very hard to get a place on the helicopter going up and really very unworried. I’ve been on a lot of helicopters and mostly US military, but others as well. I don’t ever worry about it.

Dr. Stieg: Looking back now, having read what you described, is that a helicopter you’d actually want to get on? It sounded to me like it was overloaded, overtaxed…

Alissa Rubin: Well it wasn’t overloaded going up. And after all, that was where you made the decision was based on, you know, what was the number of people on it and what was in it and what was in it was, you know, lots and lots of water, bananas, bread. I remember very clearly worrying that I was crushing the bread and then the bread wouldn’t be very good to eat because there were no seats on this helicopter. This is a metal tube in the sky held up by a propeller. I had talked to the helicopter pilot before I got on and I knew he was a very experienced person. So that gave me quite a bit of confidence. And there was a member of the Iraqi Parliament coming up. The only Yazidi member. And I thought, well, if they’re going to put a member of Parliament on it, you know, what’s there to worry about. And so we got up there, and there were very, very ill people, elderly children, people could barely walk. And the pilot I think really had a heart of gold, and he wanted to help as many as possible. And the people just rushed onto it. As soon as all the food and water was unloaded — and way too many people got on.

Dr. Stieg: And that was the problem — it was overloaded and it crashed.

Alissa Rubin: Right. It crashed. It went up about seven meters, eight meters maybe. We don’t know exactly. And then it fell.

Dr. Stieg: So what’s your recollection of that? Do you have any recollection of that immediate event?

Alissa Rubin: The immediate moment of contact, I don’t remember. I remember that it began to tip. The pilot righted it a little. And then it began to tip again. And I was waiting for the crash and I never experienced, in my memory, the crash. I’ve regained a lot of my memory of the event, but not that.

Dr. Stieg: So what’s the first thing you remember?

Alissa Rubin: I remember coming to and thinking I’m alive and I also thought I have to get out of here, but I didn’t really know how to do that. And finally I thought, I think if I just hoist myself up using my arms, I can do it, and then my arms couldn’t do anything because both my wrists were crushed and I looked down and I didn’t know why they weren’t working.

Dr. Stieg: And fortunately, there were some people there to at least help you in a first aid fashion. The photos I saw, it looked like you must’ve had a large cut on your forehead.

Alissa Rubin: I had a lot of cuts. I had, I think when you saw me they’d put about 15 stitches in my face, but there was no one on the mountain with a first aid background. Very luckily there were some, some guerillas who were there who were fighting with the Yazidis. One of the men took off his scarf and he tied my wrists, so they were sort of immobilized and I could never thank him enough for doing that because the pain was excruciating.

Dr. Stieg: So fast forward then — I presume a, an emergency helicopter came, picked you up and they took you directly from there to where?

Alissa Rubin: Back to the Iraqi Army base from which I had left where I was put into, I think it was sort of like a minivan on the floor. I mean all of this was very primitive and we bumped over. Uh, it was horrible.

Dr. Stieg: And this, you remember this?

Alissa Rubin: I remember it was awful. Yeah, I mean I remember I came in and out.

Dr. Stieg: Excruciating pain?

Alissa Rubin: Excruciating pain everywhere. Wanting to sleep and being afraid to sleep because I was afraid that something bad would happen in my brain and maybe I wouldn’t wake up. And then they took me to a trauma hospital and they were worried about bleeding in my brain and they did an MRI and they decided I could travel somewhere and then they put me in a taxi, I guess. And the taxi was driven to the border and then I was transferred into another taxi for the other side of the border, right? I mean it was awful. I came to kind of came in and out of consciousness. I don’t remember all of it.

Dr. Stieg: Sophisticated enough that they had a, had an MRI scan, which is great, but then taxi transport…

Alissa Rubin: Then they very kindly, the Turkish government, they were medevacking the Yazidi member of Parliament to Istanbul and they medevacked me as well.

Dr. Stieg: And your health care experience in Istanbul was positive?

Alissa Rubin: Yes, it was very, very positive. I was in the American hospital, people spoke English. But I have to say I had only one thought I was able to hold onto at a time and that thought was that I, I wanted, I wanted to have written an article out of this experience. I went there for a reason and I felt horrible and guilty that and terrible that somehow this had happened and I, I had to do something before I completely fell apart cause I, I couldn’t really think in any coherent way to be honest.

Dr. Stieg: I guess I want to dissect this a little bit. You were having terrible symptoms, but you still have this bond, emotion, emotional sense that you wanted to accomplish what you wanted to accomplish. What were the, what were the symptoms you were experiencing through this? You said you were fading in fading out, afraid of going to sleep, afraid you weren’t going to wake up

Alissa Rubin: That and an enormous pain because they hadn’t treated anything and they were afraid of giving me morphine because of the sedative effects and the potential damage I think that could cause. I had a punctured lung and I, I couldn’t have walked if I wanted to. I mean my, everything kind of collapsed.

Dr. Stieg: What would you say about your thought processes? Did you feel like you were oriented and you could…?

Alissa Rubin: No, no I didn’t. I, I just felt like I was holding on and I didn’t have a good sense of time. I remember that. I remember I’d opened my eyes and one of my colleagues came with me and he was there and then I’d open my eyes again a little later and he wouldn’t be there. And I wouldn’t know if it had been a little time, a long time. It was a blank.

Dr. Stieg: And then we fast-forward a little bit and we get this phone call that there is a an American journalist over in Istanbul and they ask if we would be willing to accept you and transfer because, in doctor-speak you had a moderate traumatic brain injury. That’s obviously more serious than a mild traumatic brain injury, which is more commonly known as a concussion. But the worst problem was all the other injuries that you had, the wrist fracture, the punctured lung, you did have multiple facial fractures and all these lacerations.

Alissa Rubin: And then my nose was quite broken and the septum was sort of askew.

Dr. Stieg: Yeah, and then the thing that was really not addressed at all, certainly in the acute phase was the lingering effect that this had on your brain in terms of how you’re functioning. And that’s why I’m totally surprised that was — was it in the Istanbul hospital bed that you still wrote an article?

Alissa Rubin: I didn’t write it. I dictated it to my colleague Rod Nordland. That was the only way I could do it because I couldn’t use my hands at all. I mean, they were completely bound up, they were broken, they were in shooting pain. And so I knew I wanted to do this because I didn’t know how long I’d be able to do it for. So, and I also really felt strongly that the pilot was not incompetent. He was a person of great heart and he had died doing this and I felt like, why should I have lived when he was, he actually saved a lot of people. Those people, almost all, lived. A couple of other people didn’t, there were, I’ve gone back now and tried to trace everybody. So I think a total of probably three or four died, but the others survived.

Dr. Stieg: Obviously you knew that you had injuries and you ate and you know when we all get sick, we realize we’re not at our, on our A game. But when did you realize that it wasn’t only that you weren’t on your A game, but there is actually some changes that occurred as a result of this crash?

Alissa Rubin: It was after I got home. I was lying on the bed I grew up on basically and I took down a book of, I still remember it was Chekhov’s short stories and I thought I’ll, I’ll just read these. I can’t really remember them now. Anyway, I, you know, I read them in high school, I was reading and my mother had put down the book. My mother came in and she said, “Oh, what are you reading?” And I didn’t know what I had been reading. I had no memory of what I had been reading. It was like there was an eraser in my brain coming behind each word and wiping it away. And I was terrified because that’s all I do. I read, I think about what I’ve read. I come up with questions and I go out and talk to people and then I write it and if I can’t read and retain anything, what use am I? And there was one other thing that happened. I went to get my first hand therapy for to recover and I got to the counter where they check you in and the woman said, who are you here to see? And I said, “I don’t know.” And then she said, “Well, why are you here?” And I thought, “I don’t know, why am I here?” And I was, I burst into tears.

Dr. Stieg: You’ve won enumerable awards for journalism. You’re an incredibly accomplished individual. So I can just imagine what was going on in your mind or what wasn’t going on—

Alissa Rubin: I just felt like I was a child, you know, and didn’t really know where to go to sign up for a class or something. And so I remember I came in to you and I was very, I felt very strongly that I had to go back to work. And you said, “Well, I can write you a note, but you will fail if you go back this soon. You’re not ready.” And I was really upset and I think I began to cry there too. And that was actually very useful. We both recognized that there was something more going on for me. I mean, there was not just the actual injury, but the emotional reaction to the injury and, and how that pulls you down because you’re not yourself anymore.

Dr. Stieg: What people need to understand is that as a result of your injury, you didn’t have a specific blood clot or some focal injury to your brain, but what had happened was the connection fibers between the various regions of your brain had been disrupted. And like any other organ, it takes time for those things to improve and at the time of that office meeting, I had two goals. Number one was to get you to realize that you weren’t there yet because I knew from your hospital bed you had told your editor or your boss that I’m going back to Baghdad, which I was totally in favor of, but not just then. So I was hoping to give you the realization of your problem, but then also the permission to cut yourself some slack because that’s not something you do for yourself normally. Can you characterize that, you know, after we had that conversation, some of the emotional repercussions of the feelings that you were having?

Alissa Rubin: I guess I was glad that you were blunt, but angry that you were blunt because I really felt like I didn’t have a lot of time. I thought, if I’m away too long, somebody else will take my place. It doesn’t matter. We are all fungible and I, you really know that as a journalist — that’s why the system works. I felt terribly precarious emotionally and also in terms of what my future would be. I have to say you were helped a lot in the advice you gave because I happened to have a very close friend who also came to see me at the same time, who’s also a doctor, who also said, you, you’re depressed and you need to do something about this.

Dr. Stieg: It was clear to me in many people around you that you were suffering from depression and probably from post traumatic stress disorder. I really look forward to talking with you about this in more detail.