Business major Madison Brandes had to relearn the alphabet and how to read after a driver ran a red light and T-boned the vehicle in which she was a passenger.
When Madison Brandes woke up on June 22, 2014, her life was good.
It was a Sunday. Just two days earlier Madison finished Red Raider Orientation at Texas Tech University, and she was excited for the coming school year. Even better – she and her parents shared a plane from Lubbock to Austin with then-Chancellor Kent Hance, and she got to meet him and take a picture with him.
That night, one of her best friends, who'd been on vacation in Florida, came by to tell Madison about the trip.
That is the last thing Madison remembers about June 22, 2014.
Other people have told her the rest of the story of that day. Madison invited two other high school friends over to hang out. Her parents went to bed, leaving the four women in the living room. Someone suggested they go to P. Terry's for milkshakes. It was only a few minutes away. They piled in a car and headed out.
Just two or three minutes later they were waiting at a stoplight to turn left when a driver speeding through the intersection hits a car, then jumps the median and hits their car before overturning on the other side of the road. All four are badly injured. The doors won't open. Madison, in the passenger's seat, hits the left side of her head. Her skull cracks. Her brain swells. She could die.
Her parents don't even know she has left the house. Madison's mother, who works at University Medical Center Brackenridge, gets a text about incoming trauma patients. It is a routine text to alert staff about an influx of patients to the ER.
Then her phone rings.
The first 24 hours
James and Lori Brandes and their son, Bradley, drove past the accident scene on the way to Brackenridge. They avoided the emergency vehicles and avoided looking too closely at the damage.
At the hospital they listened to the neurosurgeon. Madison had a serious brain injury, he told them. She needed surgery immediately to stop the bleeding and swelling in her brain. In fact, she needed multiple surgeries – three in the first eight hours, to control the swelling and bleeding. In the third surgery, the doctor took out a portion of her skull. None of the surgeries repaired the damage. They just kept Madison alive for now.
Her family waited, still reeling.
“As parents you're just shocked as to what you're hearing, because that person you left 30 minutes ago was sitting on the couch laughing and talking with friends,” Lori said. “We just didn't know. We had no idea what the future would hold. We didn't know what the next hour was going to hold.”
The Brandeses spent 10 days at Brackenridge: Madison in a hospital bed, hooked up to machines and IVs, unconscious, stitches covering her shaved head, Lori, James and Bradley on foldout couches and makeshift beds. Madison has two memories from her almost two weeks there – the nurses trying to get her out of bed to help her walk, and getting into an ambulance to be transferred to Texas Neuro Rehab in Austin.
“My parents would tell me stories,” she said about her time at Brackenridge. “I'd be asking for water, but would actually ask for lettuce. I would mix everything up. I couldn't hold a conversation.”
One of the long-term effects of Madison's traumatic brain injury (TBI) is aphasia. She has trouble finding the right word for what she wants to say. She knows what it is; she can describe it. But the actual word eludes her. This remains an issue today, but it's lessened. In the weeks immediately after the accident, though, she struggled with every word. Nothing made sense.
The first month
She spent two weeks as an inpatient at Texas Neuro Rehab (TNR) doing physical, occupational and speech therapy. The physical therapy wasn't too bad; Madison said one exercise involved walking on a treadmill while a therapist handed her an item from the left. She would take it and transfer it to the right side.
Occupational therapy was harder. One task was to make cookies, which required her to read and comprehend the recipe and follow the instructions.
“That was hard, but the speech therapy was definitely the hardest for me,” Madison said. “I had to relearn the alphabet. I had to relearn how to read.”
Speech and language pathologist Christina Portell worked with Madison from those early days. She could barely read single letters. Three-letter words were too much.
“It was almost like an extreme case of dyslexia,” Christina said. “She was one of my very severe aphasic patients.”
What surprised everyone was Madison remembered how to text. The texts didn't make much sense, and she couldn't read the texts sent to her. But the muscle memory allowed her fingers to find the right buttons on the phone. One of the first things she wrote out was the name of her best friend, who was in the car with her that night.
They kept going every day. After two weeks as an inpatient, Madison went home. Her parents, who hadn't slept at their home since the night of Madison's accident either, put together a bed in their room. They wanted to make sure Madison was taken care of, that they could meet her needs, that she wasn't afraid. She was still missing a portion of her skull and had to wear a helmet to protect her brain. The risk was far from gone.
Every day one of her parents would drive her back to TNR for speech therapy. Madison remembers these appointments.
“They would take me out on walks, and they have chairs outside of TNR that have longhorns on them,” she said. “They would ask what it was. I couldn't think of a chair. Or I couldn't think of the word for tree. They would do this every day to see if I could remember. They would take me to this big tree and ask, ‘What is this? What are we standing by?' And I couldn't think of the word ‘tree.' I knew what it was, but I just couldn't match it with the word.”
It was frustrating, she acknowledged, but said she never let it show. A common hallmark of people with TBIs is aggression; they're frustrated with what they can't do anymore and lash out. She remembered hearing cursing and screaming. She was told she kicked a nurse or two in the hospital, but Madison never yelled at Christina.
Madison's attitude stood out to Christina more than anything else.
“She always had an amazing attitude and motivation,” Christina said. “She's never been down, per se, no matter how difficult and challenging it is for her.
“It was just a slow, slow journey.”
Madison and Christina met for a year, until Madison returned to Texas Tech in August. After she got familiar with the alphabet again, Madison would bring a book to her appointments. She would read out loud and Christina would time her. She got stuck on bigger words and would need help; now she still gets stuck but is able to sound them out herself. Her reading speed is equivalent to that of a third-grader.
Lori said as Madison got better at reading out loud they discovered she would sometimes use the wrong word without realizing it. They had to work through that as well.
For the first few months she remained almost completely dependent on her parents. It was like bringing a baby home from the hospital, Lori said. The family bonded in a way they hadn't before.
As she healed, Madison's life returned to some semblance of normal. She moved back into her room, which she soon was sharing with the puppy her parents promised to get her after surgery to replace the missing piece of her skull. The dog is named Gracie Rose – Gracie for the grace of God, Rose for Dr. James Rose, the neurosurgeon who pieced Madison back together.
Madison is even driving again, an admittedly terrifying thought for Lori. And when Madison said she wanted to start school at Texas Tech, an even more terrifying thought, Lori and James agreed.
“We knew this was the next thing,” Lori said. “This is what she's worked so hard for. This is her path.”
That serendipitous meeting on the tarmac at Austin-Bergstrom Airport came up. The Brandeses contacted Hance, who helped arrange last-minute scheduling and on-campus housing. In August she came to campus as a Red Raider, thanks in large part to administrators who did what they could to make sure Madison was taken care of.
“We're just so very thankful for the Texas Tech family,” Lori said.
From the outside, Madison is experiencing college the way it should be experienced. She pledged Kappa Kappa Gamma, she's made new friends while still hanging out with friends from high school and she's thinking about changing her major. She loves being here.
But school has been hard. Madison struggled to keep up her first semester. She had access to the Student Disability Services (SDS) and qualified for extra time on tests and getting help during class. But she found keeping up with her 12 hours of coursework to be almost impossible. She can't simply read the textbook to learn the material, and she has difficulty grasping concepts through a 50-minute lecture.
“It takes Madison probably quadruple the amount of effort it would a student who doesn't have any difficulties,” Christina said.
Tamara Mancini, the senior assistant director at Student Disability Services, said Madison, like many students who use SDS, want to succeed on their own, so her first semester she didn't use all of the available resources.
This semester Madison is getting several hours a week of tutoring through the TECHniques Center. She also gets her textbooks scanned onto a computer so she can listen to them instead of read. She leveled 100 percent with her professors. Instead of taking the earlier approach of mentioning that she's part of SDS, she approached each one, explained about the car accident and the brain injury and said she would need extra help.
“I talked to them about the accommodations I need, and they said, ‘We can help with anything you need,'” she said. “I feel like if I let them know everything I need it'll go a lot smoother.”
“I am definitely seeing a difference in her overall spirit and her willingness to use the services at her fingers,” Tamara said.
It's not just struggling through her business classes, though. Madison's skull has not fully healed, leaving her brain less protected than it should be. If she goes to a party, a football game or does an intramural sport and hits her head or is knocked down, it could do significant additional brain damage.
“In a way it was almost more challenging because she looks so normal and yet she would have to go into the classroom, meet with the teacher and say, ‘This is what happened to me, this is what I need help with,'” Christina said. “That in itself is a challenge for anyone. If you're on crutches everyone understands what kind of help you need. She just looks so normal. There are some of those kinds of challenges that no one thinks about.”
The rest of her life
Madison is focusing mostly on today, next week, spring break, the rest of the semester. She's debating changing her major from business, which has lots of math, to something she can handle a little better. She's thought about physical therapy – since she's had so much experience with the healing powers of therapy – but even then, she worries the classes will be more than she can do.
Her mom thinks about the future more. The driver who hit the girls' car is in jail; he is scheduled to go to trial later March 14. Lori has tried to keep the story in people's minds; all four girls, after all, will be dealing with the aftermath of another person's drunken choice for years. Christina Portell agreed.
“This was a result of somebody being completely irresponsible impacting a life for years,” she said. “Madison will always have challenges. She will always have to use compensatory strategies.”
Encouraging people to think about how their choices affect others is the main reason the Brandes family is willing to talk about the most difficult trial they have faced. Another is because, even with all the trauma Madison has experienced and will experience because of the accident, she is alive.
“I really feel like these girls, they have something special in store for them and they just don't know what it is,” Lori said. “I told them, ‘You're here for a reason, and part of that is to make people understand how their actions can affect others.'”