You can’t pick your parents, and you can’t pick the side of your brain that you damage.

I always thought that injuries to the left side of the brain would be the worst, because that’s where the language centers generally are. And talking is basically all I do. But after seeing uncountable numbers of strokes and brain injuries, I’ve changed my mind. Right brain injuries are worse.

The right side of the brain controls attention, memory, reasoning, and problem-solving. Very often, people who have an injury to the right side of their brain have very bad insight into their deficits (anosognosia). Let me tell you, it’s really hard to recover from brain damage if you don’t even recognize that you have a problem. Also, many people with right brain injuries become absolutely obsessed with their bowels. Even more so than my elderly parents.

But one of the most striking deficits that you can see with a right brain injury is left hemineglect. That happens when you basically stop paying attention to the left side of your world: like it doesn’t even exist! (It can happen on the right, but it’s less common and less marked due to redundant processing of the right side.)

A while ago, I had a rehabilitation patient named Lucy with horrible left neglect. When I first met her, she was lying in bed; her head cocked over to stare to the right. When I stood on her left side to talk to her, she wouldn’t turn her head no matter what. I finally gave up and stood on her right side.

“Lucy,” I said to her. “Can you lift your left arm for me?”

Lucy glanced down at her arm. “Oh, that’s not my arm.”

“It’s not?”

She shook her head. “No, that’s the arm of the patient in the bed next to mine.”

Granted, our hospital can be crowded, but we generally do try to keep two patients out of the same bed.

We worked with Lucy to improve her left neglect. She improved, but it was still pretty bad. Lucy would walk into walls on the left and only eat the right half of her lunch tray. But the most intense moment in Lucy’s recovery came a few weeks into her rehab stay. A physical therapist named Jim went into her room to treat her, and she started screaming her head off. We’d never heard her shriek like that, and several people came running.

“What’s wrong, Lucy?” a nurse asked her.

Lucy pointed to Jim. “That man is a rapist!”

Now even though Lucy had a brain injury, that is a very serious accusation that we had to take seriously. After all, people with impairments are often a target of abuse. We got Lucy calmed down, and we asked her what Jim had done to make her think he was going to rape her.

“It says right on his badge that he’s a rapist!” she cried.

Jim’s badge said “physical therapist.” Because Lucy had a left neglect, she didn’t read the left side of that phrase. So all she could see on his badge was “rapist.”

Jim was acquitted of all charges.

Freida McFadden is a physical medicine and rehabilitation physician who blogs at A Cartoon Guide to Becoming a Doctor.  She is the author of Brain Damage.

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