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COMA: Interview with Liz Garbus for HBO Special

Traumatic Brain Injury (TBI) is a major international public health issue. It is estimated that as many as 5 million US citizens may have had TBI and the incidence is higher in Europe and South Africa. Young males (15-24), infants and children under age 5, the elderly over age 75 are all more likely to suffer TBI than the general population. Transporation accidents are the leading cause of injury, followed by falls and violence.

Award winning filmmaker Liz Garbus has done it again with a quiet, restrained film Coma about TBI, which will air on HBO July 3, 2007. I interviewed Liz earlier today and, paraphrasing our conversation (I did not record it):

JC: What sparked your interest in this subject?

LG: Sheila Nevins, President of HBO Documentary Films approached me about the idea when the nation was so polarized over the Terry Schiavo case - persistent vegetative state was not understood by the public. And for me as a parent, as we did the film, it became about the Mothers. Mothers don't ever abandon their children - it cuts across all classes, even people who can't afford to give up their jobs to take care of their kids - they do. Mothers are tireless advocates for their children, no matter what.

JC: I was struck by how understated and low key the film was - could you talk about that please?

LG: It was a long process - we shot 200 hours of film at JFK Johnson Rehab Center
following these four families who allowed us into their lives - it was a very unique and privileged situation that we had. We were observing the emergence of consciousness - a slow, painstaking phenomenon. So the approach is restrained to honor their struggle - to treat it with dignity. These families are living in a twilight zone between life and death - and we witnessed some amazing moments - like Sean [young man in vegetative state] crying...

JC: The neuropsychologist, Dr. Giacino, was the key player of the Rehab Team. I found that to be true in my own TBI work - but most people aren't aware of the role of the neuropsychologist.

LG: Yes, I wasn't familiar with the field beforehand, but I found him to be the Guide to the Brain, the Mystery Explorer, our Guide to Outer Space of Consciousness. He was the one who did a battery of tests and helped the families understand what has happened, what is happening. Although you can't give a prognosis, he provides a road map of what can be expected.

JC: You did an amazing job of showing the willpower of the individual...

LG: It was a great honor last night - we had a screening of the film for HBO and Tom [one of the four amazing patients in the film] and his fiancee came. They are living a happy, loving life now, and that's as much as any of us can ask for, isn't it? Tom's stubborness, anger, drive - with brain injury you are locked inside yourself - but the anger and frustration pushes you to recovery.

JC: I always say that anger is a very underrated emotion - the frustrations brain injured people endure are intense.

LG: Tom was pissed - cognitively he knew he was in Rehab - he knew he had to do some things to improve but he was like, why do you want me to throw these rings on this stick? Some of the therapies struck him as ridiculous. And he had this condition we talk about in the film - anosognosia - so he lacked insight into himself - it was part of the brain damage.

JC: So what are some things you would like people who watch the film to come away with?

LG: There's a larger social argument - funding to keep intensive rehab. Private insurance companies stop paying for aggressive therapies if there is no improvement after 6 weeks - but studies show that people improve for up to a year post injury. So that means people with top potential are languishing in nursing homes due to lack of funding.

JC: So I take it you're going to go see Sicko [Michael Moore's film premieres June 29, 2007]?

LG: Yes, we went to a screening - and I hope this draws attention to an important subject and sparks a lot of debate.

JC: And the other points about your film you want people to come away with?

LG: It's about the power of family, the power of love. Life is fragile. I'm a parent and I went home every day and just hugged my kids and remembered every moment with them is special...For the families involved I hope a community develops from this - a community of support for TBI patients and families.

JC: Thanks for your time and thanks for bringing attention to this important subject.

Thank you Google Images for use of Photo.

For more about TBI see:

CDC Concussion Management Tool
from Medicine for the Outdoors written by our Chief Medical Officer, Paul Auerbach, MD

and this 18 minute video clip, on HBO's website.

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