"You watch a football game, and it seems the collisions are much worse than what you have here," Spitz notes. "But you have to understand the physics of this kind of injury. Your brain is relatively soft. It's about the consistency of liver, and it's sitting in this bony skull. The tops and sides of the skull are fairly smooth, but the underside -- the area just above your eyeballs -- is rough and coarse. When your head strikes something, the brain can bounce inside the skull, and it gets bruised. The underside is especially vulnerable."
Compared with some closed-head injuries, McClelland's is a mild one. To a casual observer, her speech, coordination and general comportment seem quite normal. But testing reveals a wide range of cognitive problems, evidence of serious damage to the underside of the frontal and temporal lobes -- areas of the brain that control memory, number skills, judgment, concentration, the ability to multi-task and a host of other functions essential to everyday life.
The epilepsy presents a further complication. Most cases of epilepsy, a condition that disrupts the normal electrical activity in the brain and causes seizures, have no known cause. Spitz estimates that fewer than 10 percent of the cases result from a specific trauma, such as a car accident, and in those, the seizures may not start until months after the trauma; the epilepsy is a by-product of a faulty healing process rather than the blow itself. (Studies of head-injured war veterans, Spitz notes, indicate that there may also be a genetic component that helps determine which cases develop into epilepsy.) As the body seeks to repair areas of damaged brain cells, new interconnections are formed that can alter the usual balance between excitatory and inhibitory impulses in the brain. In a sense, the brain becomes overheated; a seizure is the result.
"Think of the wildfires in the mountains," Spitz suggests. "This begins in one region, where you have a few cells with too many excitatory inputs, too many sparks. It's healed in an aberrant way, which allows this abnormal activity to take place. A fire breaks out. Then it spreads."
In time, McClelland's seizures are brought under control with medication. Other effects of the injury seem to have no remedy. Her family doesn't need the doctors' battery of tests to know that McClelland's cognitive skills have deteriorated. They can see her life spiraling into chaos.
Three months after the accident, McClelland gets into an argument with her supervisor at the auto-glass shop about her erratic performance and ends up quitting her job. She has trouble finding another one. Her mother drops by her apartment and is shocked by what she sees. Of all her children, she'd always felt closest to Sunserea; she admired her optimism, her high energy, the keen sense of organization that allowed her to work three jobs, dote on her kids and still keep her home immaculate. Now all that seems to have disappeared overnight.
"The place was a wreck," Janet Morgan recalls. "Dirty clothes piled around. A tower of dirty dishes. And she was buying things impulsively. She bought a puppy because she felt lonely. She didn't even have money for food at the time. She couldn't understand why I was so angry about it."
Morgan persuades her daughter to move in with her and her husband. For several months, Morgan struggles to find ways to ease Sunserea's burden, but even the simplest tasks often prove frustrating. She washes the same clothes over and over, cleans the same room over and over. She takes two hours to fix a relish tray, forgets to cook enough food to feed everyone in the house. Minding more than one pan on the stove at a time is a strain.
"It got to the point where, if the smoke detector went off, Josh would say, 'Dinner's ready,'" McClelland recalls.
Far more troubling, Morgan says, is the shift in her daughter's personality. The old Sunserea used to play games with her children, spend hours with them working on their homework. The person who moves in with her is irritable, impatient, unable to cope with background noise or family get-togethers. She can't concentrate on a movie or a book, can't help her son with elementary math problems. She yells at her kids, weeps, retreats to her room with agonizing headaches. Who is this woman?