Reel to Real
Cathy Breneman, RN, CLCP
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Movies are great! There’s the movie in which someone is in the hospital hanging on for dear life and, amazingly, he pulls through with little or no complications. Or how about the soap operas in which a “star” can be in a coma for years and miraculously wake up and not lose a beat. There are times in our lives when we wish life were more like the movies. Sometimes reality can be very painful. The experiences that we share while supporting a loved-one after trauma, following a patient as a case manager, or delivering treatment as a direct care staff member or a therapist certainly put life into perspective. Recovery after injury takes on a very different “screenplay” for every individual.

No doubt, when it comes to brain injury, movies project the sunny side. That isn’t all bad because it feels good to feel good and we like movies because they involve fantasy and escape from reality. However, some may contributeto certain myths regarding the seriousness of brain injury. So let’s have some fun, watch a few flicks, and see where it takes us.

50 First Dates
Starring: Adam Sandler, Drew Barrymore, Rob Schnieder, Sean Astin, Dan Aykroyd

If you like to laugh out loud, 50 First Dates is the flick for you. This is a story about a young woman named Lucy Whitmore. She and her family live in Hawaii on the island of Oahu. As was a yearly tradition, she and her father take a road-trip to pick a pineapple in honor of his birthday. The two are traveling down a dirt road when Lucy’s father takes his eyes off of the road for a split second and a cow crosses in front of their vehicle. In an effort to miss the cow, he slams on the brakes. This sends the car swerving out of control and into a tree. Lucy spends three months in the hospital in a coma. A CT scan confirms she has permanent damage to her right temporal lobe and will suffer from a syndrome called Goldfield Syndrome for the rest of her life. Goldfield Syndrome is fictitious, but in the movie it is a mental condition that limits short-term memory to a 24-hour period. You guessed it. When she falls asleep at bedtime, she has no recollection of the previous day. In fact, her memory loss takes her back to the day of the accident each subsequent day, minus the memory of the accident.

In reality, all families make dramatic accommodations for the changes that the person injured experiences, but this movie has a unique twist. Lucy’s father and brother repeat the events of the day of the accident, October 13th, over and over and over so Lucy doesn’t have to repeatedly experience the pain of knowing that her life had been changed forever by a brain injury. The extent to which they all go to maintain the illusion begins with fake newspapers and runs the gamut. (I won’t give away all of the details because I don’t want to spoil some of the humorous scenes.)

Henry Roth, a veterinarian at Hawaii’s Sea Life Park, sees Lucy in a cafe one day and falls in love. Henry, known as a player on the island who admits he will never settle down, is steered clear of Lucy by her overprotective friends. Once Henry understands the situation, he is intrigued and keeps coming back, even after being shot down on a daily basis by Lucy who doesn’t remember him from one day to the next. Part of the humor of the movie is the lengths that he goes to to woo her and get her to remember him, which he learns is impossible. When the family realizes that he is committed, they embrace Henry’s involvement with Lucy. Henry, who must have been a therapist in another life, sets out to give Lucy a routine by structuring her environment so that she and her family can move on with their lives. The process he chooses is bittersweet but effective.

Lucy’s family goes overboard to “keep her in the dark” about her own personal tragedy. You know what I mean. “She looks normal so let’s just act like nothing has happened.” Wrong approach! Until Lucy sees a police officer ticketing her vehicle for expired plates (the tags were never updated so that the deception could be carried on), she has no idea that she is actually a year older. Life is passing before her without her knowledge and no one is offering her the tools that she needs to make any sort of cognitive recovery. That is, until Henry comes along. I’ll leave the ending for you to discover.

Overall, I give this movie a “qualified thumbs-up” in its portrayal of brain injury. Even given the fictitious elements and the idealistic story line, it delivers the message that brain injury is tragic and has lasting effects on the person injured and the family. Not many movies come this close.

The Majestic
Starring: Jim Carrey, Lauren Holden

The Majestic is a feel-good, traditional, “American” movie. In one respect, it is a movie about patriotism and pride and in another, it is about human relationships and standing up for what is right.

This movie takes place in Hollywood in the 1950’s, when the American government was overly zealous about strict beliefs in patriotism. Peter Appleton, a “yes-man” screenplay writer, is unjustly accused of being a Communist. He is “blacklisted” and loses his chance to produce his first screenplay, so he goes on a drinking binge. On his way down the California coast, while intoxicated, he swerves to miss an animal on a rain-soaked, one-lane bridge and plunges into the river below. He is found sometime later, washed up on a beach in the small coastal town of Lawson. There, Appleton, suffering from amnesia, is mistaken for Luke, the long-lost son of Harry Trimble. Harry is the owner a small defunct theater called "The Majestic." Harry Trimble is just one of many parents in the town whose sons were killed during World War II. In fact, so many were killed that the town is nationally recognized for its sacrifice and given a bronze war statue by the President of the United States.

Peter Appleton, with no memory of who he is, finds himself in a small town where his striking resemblance to Luke Trimble, whose body was never recovered, triggers excitement throughout the town. There is a point in which Peter really thinks that he is Luke Trimble. Peter befriends most all of the townspeople, reopens “The Majestic,” and falls in love with the girl that Luke once loved. She doubts all along that he (Peter) is Luke but makes many unsuccessful attempts along the way to “jog” his memory.

Slowly, Peter begins to recall who he really is and the circumstances that led him to the town of Lawson. He gets the chance to share the truth with very few people before the FBI shows up to take him away. Of course when the townspeople realize that he is a “fake,” it is devastating.

When Peter returns to Hollywood to defend himself and stand up for what is right, all of Lawson have their televisions tuned to the hearing. Peter makes good and even makes reference to the town of Lawson regarding their losses suffered in the war. Not only does he regain the respect of the townspeople but he also brings tourism and revenue to their quiet existence.

The frustration that Peter experiences due to his memory loss is very common following brain injury (although his eventual complete recovery is not very realistic). The townspeople provide him with love and support and make every attempt to structure his environment into one that should help him regain a sense of who he is. This movie gives you the realistic sense of what it might be like to have amnesia following an injury. It also communicates the potentially devastating consequences of driving while intoxicated.

Regarding Henry
Starring: Harrison Ford, Annette Bening

This movie opens with attorney, Henry Turner, a cruel, greedy, self-absorbed workaholic, defending a case in the courtroom. In the case, he represents a doctor who is clearly liable for the death of a human being because of negligence. Henry is a defense attorney known for his ability to basically lie, cheat, and steal his way to victory. He wins the case with a “who cares about the right outcome” attitude.

After a celebratory dinner, Henry and his wife Sarah return home. Henry leaves shortly after arriving home to walk to the local convenience store to buy a pack of smokes. He interrupts a robbery at the store and is shot in the right frontal lobe, leaving him in a coma with severe brain damage. When he awakes from coma, Henry must start from the beginning. True to real life, he must learn how to talk, walk, and generally live his life again.

Henry’s rehabilitation course includes a stay at a program that specializes in brain injury rehabilitation. While the movie progresses rather quickly, the series of events are as might be expected in a rehabilitation environment. However, some of the therapy scenes leave a lot to be desired. For example, there is a scene where the physical therapist (PT) cannot get Henry to speak (that’s right, the PT, not the Speech Therapist). So he takes Henry down for breakfast and orders breakfast the way that he (PT) would order it–spices and all–not the way that Henry would order it. When he sets the plate of food in front of Henry he says, “When you start telling me what you want, you can order. Until then, I will do the talking for you!” When Henry takes a bite of his eggs, he chokes due to the spiciness, and then he speaks. I realize that the therapist got Henry to speak, but there are better ways to achieve the outcome. Where I work, you would be collecting your final paycheck if you treated a participant that way! Even after this, you find yourself loving the therapist. Indeed, the PT becomes a pillar of support for Henry.

As happens so often with a frontal lobe injury, Henry has significant personality changes. In this case he turns into a nice, thoughtful, caring, human being. However, he could just as easily, as one scene shows, strike out when confronted with a situation that he could not handle. The movie does a nice job of illustrating some of the personality changes associated with brain injury, as well as how an individual relearns information. In one scene, Henry wanders out of his home where his housekeeper is supervising him. Henry walks the streets and finds himself inside an X-rated movie. Henry is clearly shocked by what he sees on the screen and is sure that he has never participated in such an act. Further into the movie, he is reintroduced to the concept of “making love” where he makes reference to the movie and how he hopes he doesn’t have to do what he saw in the film.

One of the elements of the film that I appreciated was how Henry’s daughter is a part of her father’s rehabilitation team. Initially, she is not allowed to see him because her mother is worried that she will be frightened. When she is finally allowed to visit on the day of discharge from the rehabilitation setting, she is terrified of her own father. Ironically, in the end, it is the daughter that helps Henry feel comfort in returning home, as she shows him how to tie his shoelaces and teaches him how to read again.

This movie is rated PG-13 and is fit for young teenagers. It shows the process of recovery after brain injury from beginning to end. It portrays the sequence from the very scary time when a person is not awake at the hospital, through the stage of a loved one not recognizing people that are very important to him, and finally coming home when there still may be a lot of work to do.

Finding Nemo
Starring: Ellen DeGeneres, Albert Brooks, Alexander Gould, Willem Dafoe, Geoffrey Rush, Brad Garrett, and Barry Humphries

What incredible color, indeed! The scenery under the sea, in this animated film, appears as magical as a dream. The story of Finding Nemo is based on the adventures of a clown fish named Nemo, born with an undersized fin. Nemo’s father, Marlin, is overly protective of him because Nemo is all he has. Nemo’s mother and all of the other little fishy eggs were lost to a barracuda. When Nemo goes off to his first day of school, his father warns him to stick close to his teacher and never to venture into the drop-off point beyond the reef because this is where danger lurks! Of course, being a little fishy and knowing that “nothing can happen to me because I am invincible,” he swims off and is captured by a scuba diver looking for an exotic fish for his niece’s birthday.

Nemo’s father, Marlin, is devastated! He sets off on a journey to Sydney, Australia to find his son. Along the way he encounters a bright, blue fish named Dory who has short-term memory problems. She reintroduces herself, forgets where she is going, and at one point, thinks that Marlin is stalking her. When Marlin asks her, “What is wrong with you?” she says, “I was born this way, I think.”

The two get into all kinds of trouble. At one point, they encounter three sharks who are members of the “Fish are our Friends Not our Food” club (a take-off on the AA concept). What a giggle that was! Dory, with her flighty, innocent personality keeps you laughing in even the most dangerous situations.

Along the way, Marlin inadvertently gives Dory a memory strategy (in the form of your basic repetition) that helps them to eventually make their way to Sydney, Australia. They find a snorkel mask from the diver that captured Nemo. The mask has an address on it for a location in Sydney. Marlin has Dory repeat this address over and over until you almost want to scream, “STOP!” Guess what? She remembers the address and she herself is amazed.

There are all kinds of wonderful, clever creatures along the way. This movie is very well done from the scenery to the voices that were chosen to speak for the characters. From the perspective of reality and memory loss, this comical film has a sense of realism. For example, Dory and Marlin go their separate ways because they believe that Nemo has met his maker. Dory encounters the very real, very alive little Nemo, but of course, she has no clue who he is due to her memory deficit. But, by using her memory strategies that she has learned along the journey, she is able to piece together Nemo’s name and the fact that he is looking for his father. She then comes to the delightful conclusion that Marlin and Nemo are the reason that she is swimming in the ocean near Sydney and sets out with Nemo to reunite him with his father.

This cute animated movie has some valuable lessons for both young and old. When you employ strategies, rely on each other, and work hard to achieve your goals, the rewards may be big in the end. YOU MAY EVEN FIND YOUR NEMO!

While You Were Sleeping
Starring: Sandra Bullock, Peter Gallagher, Peter Boyle, Glynis Johns, Bill Pullman

While You Were Sleeping is a movie about a lonely, Chicago subway ticket- taker named Lucy. She is head-over-heels in love with a man (Peter) that frequents the station on his daily commute. She talks about him and dreams about how her life would be with him in it. He doesn’t even know that she exists! Then one Christmas Day he speaks to her and she is so shocked she cannot even respond! In the next instant he is mugged and thrown onto the tracks. You guessed it: Lucy pulls him from the tracks and saves him from the train that is barreling down on the station.

Peter is taken to the hospital and Lucy tries to figure out a way to get in to see him (family only). A nurse in the Emergency Room overhears her say, “I was going to marry you,” and makes the assumption that Lucy is Peter’s fiancé. The nurse then tells the family that his fiancé is by his side, which as you can imagine sends his family into a frenzy. The rest of the film is about Lucy winning over the family while Peter lies in a “movie coma.” You know, the one where the victim lays there peacefully, never a hair out of place. He never has to eat or be cared for. They finally show him with an intravenous line attached. Too late! Not exactly the real deal.

The problem comes in when Lucy begins to fall in love with Peter’s brother. She is “engaged” to a man who doesn’t even know her, but has become so attached to the entire family that she cannot bring herself to tell them the truth. Along the way, Peter’s godfather figures out the real deal but keeps the secret because he knows that Lucy is one of the best things that has happened to this family in a long time. In fact, when Peter finally wakes from his “movie coma” (I might add with absolutely no cognitive impairment, etc.), his god-father convinces him that he has amnesia and that Lucy is, indeed, his fiancé. I won’t go into any further detail because I would spoil the movie for you.

If you are looking for an education on “fairytale coma” this is your flick. Better to watch it because it is a cute, lighthearted, romantic comedy than to expect the realistic sequence of events following a serious brain injury.

Memento
Starring: Guy Pearce, Carrie-Anne Moss, Joe Pantoliano, Stephen Tobolowsky, Harriet Sansom Harris, Cullum Keith Rennie, Jorja Fox

To summarize the film in one word–Wow! Great movie, but you have to pay close attention to detail. This film starts at the end and works its way backward.

Leonard is a former insurance investigator and crime victim who is trying to find the man who raped and murdered his wife. Throughout the film he has two focuses: one, his revenge toward the man who violated his wife and two, the last insurance file that he denied because he thought the man was “faking” his claim of decreased memory following an accident. The complication in the plot is that Leonard has no short-term memory. During the attack that ended his wife's life, Leonard suffered brain damage when someone hit him from behind. Now, although his long-term memory is fine, he can't remember any recent events. He can meet the same person a hundred times and can’t remember his/her name or who they are. To compensate for his condition, Leonard relies upon a series of Polaroid snapshots that he takes. He documents short notes about the people that he takes pictures of so that he can refer to the photo the next time they meet. In addition, he tattoos pictures of significant events on various areas of his body. Not exactly the ideal memory compensation strategies, but they work for him (or so he thinks).

Along the way, backward, Leonard is assisted by Teddy, a police officer who would like to see Leonard get his revenge. He is also assisted by Natalie, a friend whose motivation may not be as it seems. This story is told in pieces, each scene starting where the other has ended. Dispersed throughout the film are bits and pieces about the last insurance file Leonard handled. At first you are confused as to why he keeps referring to the file, but it becomes clear (or does it?) toward the end of the film. I am afraid I will have to leave you hanging here because if I told you any more I would simply give the ending away.

In Conclusion
The movies presented here offer a little of everything. In terms of their portrayal of brain injury, some of these movies help to decrease the myths about the life-changing events of brain injury and its effect on all concerned. Others are purely fantasy that may have families and professionals who view them shaking their heads, wishing the effects of brain injury in the movies were how it would happen in real life.

All of these movies are available on DVD or VHS. So rent your pick, sit back, and watch in the comfort of your favorite chair. It’s movie time!

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