'They are shadows'
Dec 17, 2003 Chicago Tribune
By Julia Keller, Tribune staff reporter
Kane's brain would work the way it was designed to work, with the perfect synchronicity of idea and action, of intention and gesture. If he wanted to scratch his left ear, he did; if he wanted to ponder the existence of a higher power governing human affairs, he did that too. Everything meshed.
And then, at about 1:10 a.m. on June 23, Kane lost control of his Honda Gold Wing motorcycle along Interstate Highway 290 near Itasca. His head smashed into a concrete barricade.
At that moment, Kane's brain -- the approximately 3-pound pinkish-gray mass suspended inside his skull, that he, like most people, largely took for granted as long as it did its job -- was ripped from its moorings like a sailboat in a hurricane.
Whatever Kane was contemplating in the seconds before the accident -- his wife, Jill, his son, Jimmy, his ambitions or his memories or simply how pleasant the night air felt on his face -- it was the final time his brain would function the way it had functioned throughout the 48 years of his life.
In less time than it takes to say "Jim Kane," he was no longer Jim Kane.
"With brain injury," said Dr. Ghada Ahmed, "you are reborn. You are not the same person you were."
Ahmed would meet Kane 49 days later, when he was taken from an acute-care hospital to the Brain Injury Medicine Unit on the 10th floor of the Rehabilitation Institute of Chicago, which, after its recent renovation, is now the newest and among the most innovative units in the nation.
In the United States, a traumatic brain injury occurs at least every 21 seconds, making it the No. 1 cause of death and disability for people under 44.
So prevalent is brain injury, and so little does the public seem to be aware of it, that earlier this year the Centers for Disease Control dubbed traumatic brain injury a "silent epidemic."
An estimated 1.5 million Americans annually suffer a traumatic brain injury. The exact number is a murky unknown because of significant underreporting and misdiagnosis. Even mild traumatic brain injury, including sports-related concussions, can result in physical and emotional problems. Some 5.3 million Americans are living with disabilities from brain injury.
Yet it is through brain injury that researchers have gleaned much of their knowledge about the brain, from a new understanding of consciousness to a realization that undiagnosed brain injury among children may be complicit in violent behavior later in life.
Scientists have discovered more about the brain in the past 10 years than in the previous 10 centuries -- yet by all accounts, are still at the threshold of understanding the brain's deepest secrets.
"The brain is the last bastion of science," said Dr. Ricardo G. Senno, medical director of RIC's brain injury unit. "Brain injury medicine is where cardiology was 50 years ago."
Had his accident occurred in 1993 instead of 2003, Kane most likely would have died. In the past several years, however, better emergency care at accident scenes and improved neurosurgical techniques in trauma centers mean that more people than ever before survive severe brain injury.
Yet they face excruciating ordeals. Dr. Jeff Frank, director of the Neurosurgical Intensive Care Unit at the University of Chicago Hospital, said, "In critical care, the decisions are life and death decisions. In neuro intensive care, it's a more complicated dynamic. It's not, `Will the patient live or die?' but, `What does the patient want to live with?'
"Brain injury is unique," he added, "because it affects personhood."
Most people think of themselves as unalterably unique. They may change their opinions about their political affiliation or their favorite novel, but their fundamental essence is inviolate. Yet with brain injury, that sturdy self seems to drop away like an elevator in free fall, which is what makes brain injury uncannily devastating, even among other life-changing calamities such as spinal cord injury.
Christopher Reeve made that point when he titled his 1998 autobiography "Still Me." Even without the use of his limbs, the paraplegic actor and advocate for the disabled was still himself. He didn't suffer a brain injury, so his personality was intact.
The families of people with brain injury, however, know another reality. For them, "it's like there is a new family member," said Dinh To, one of two social workers on RIC's brain injury unit. "That's the hard part. It's like they are bringing home a new baby. Or an adopted child."
During stays that average 26 days, patients on the 10th floor begin the second half of their lives: That was then; this is now. The 10th floor is the place where they first become aware of the difference -- the difference between a brain that did their bidding to a brain that has turned into an "enemy," as Kane would later describe it.
"Families always ask, `Will he be the same?' The answer is no," said Tom Wolf, To's colleague on the unit. "With severe brain injury, they are the shadows of the former person."
At the moment of impact, Jim Kane's brain went through a biological Armageddon. The attack by the concrete barricade -- and to the brain, it was an attack, a vicious, world-ending assault on its frontiers -- initiated a series of responses by the brain that would bring cataclysmic consequences. The battle was joined.
The brain, which floats in a pearly sea inside the skull, is both superbly well-defended and pathetically vulnerable, Senno said. "It's protected not only by the skull and the cerebral spinal fluid, which acts as a kind of shock absorber, but also by our eyes and ears, which alert us to danger, and by our hands, which we can hold out and protect ourselves with, and by muscle layers. The brain is protected -- but it's not protected from going 80 miles an hour and hitting the windshield or falling 20 feet."
When the brain is struck, its first response is edema: swelling. Just as other areas of the body swell if injured, brain tissue also swells. But unlike an ankle or arm, brain tissue has nowhere to go. It is blocked by the skull, which usually protects the brain but in the event of injury becomes its worst enemy.
Unable to go out, the swelling tissue begins to go in, pressing relentlessly on the capillaries threading their way through the brain, causing their collapse. That, in turn, cuts off the oxygen supply to the brain. The brain is an oxygen hog: It typically comprises less than 5 percent of an average woman or man's weight, but sucks up more than 25 percent of the body's oxygen. Without it, cells quickly begin to perish.
The wallop sustained by Kane's brain savaged its basic metabolism, the exquisitely balanced chemical and electrical system by which his 100 billion or so neurons went about their business of regularly making some 1,000 trillion connections to other neurons. As cells die -- some instantly, some over the next 24 hours or so -- from a traumatic blow, their death throes trigger the release of chemicals that destroy other neurons.
That is why, even though blows to different areas of the brain can result in different impairments -- a concept known as localization -- a brain injury anywhere affects the brain everywhere.
In the minutes following impact, the brain continues to swell, heading desperately for the only exit it can find: the foramen magnum, the hole at the base of the skull through which the spinal cord rises. Nestled next to the foramen magnum is the midbrain, home to the respiratory center -- which means that, as brain tissue squeezes its way down through the foramen magnum, it cuts off breathing.
As Kane lay by the highway, his brain was in chaos. The pressure was building, the cells screaming for oxygen, toxic chemicals flooding his neurons. He was unconscious, which occurs, researchers now believe, when the electrochemical signals passing between cells are disrupted by the lightning-storm of injury unleashed across the brain.
He was dying.
"For a brain-injured person," Senno said, "time is standing still." To Jim Kane, the world had ceased to exist; it flew away from him, ever fainter, ever further, and with it went the fundamental essence of a man unique in history -- just as every person is unique -- known as Jim Kane.
Once he was ferried by helicopter to Loyola Hospital's emergency room in Maywood, however, the world rushed back in. It descended with the bustle and din of modern trauma medicine: the formidable array of knowledge and technology that enables physicians to treat brain injury more effectively than ever before. This is the so-called "golden hour," the crucial interval just after injury during which severely brain-injured patients, once written off, now can be saved.
Incoming patients with brain injury are quickly evaluated according to the Glascow Coma Scale. It measures the depth of unconsciousness by assigning 1 to 4 points to responses such as eye opening and reactions to pain and to commands. Tallies of 3-8 indicate severe brain injury; 9-12, moderate; and 13-15, mild. The lowest possible score is 3.
Kane was judged at 3. The rankings are important because studies generally agree that the longer and deeper the coma, the less promising the recovery.
Within minutes, Kane's brain underwent a CT (computerized tomography) scan, a specialized X-ray that can reveal the location of bleeding and other damage.
Kane's injury was closed, meaning that the protective covering around the brain called the dura mater (Latin for "hard mother") had not been pierced, despite his fractured skull. Open injuries typically result from bullets or other penetrating wounds.
His brain was swelling so rapidly, with such dire consequences for brain tissue and its delicate filigree of neurons, that physicians made a drastic decision. They put Kane in a barbiturate coma, effectively anesthetizing his brain so that it would require less oxygen, a contingency employed in less than 5 percent of brain-injury cases. With the blood supply to Kane's brain already so catastrophically curtailed by the swelling, his brain would suffer less, physicians reasoned, if its requirements for blood also were reduced.
Brains are injured in two general ways. In one scenario, linear forces -- such as Kane's head striking the concrete barricade -- cause a coup-contrecoup injury, in which the brain hurtles forward against the skull, then hits the skull again in the opposite direction when the brain bounces backward. Often, the second injury -- the "contrecoup" -- is more damaging than the initial impact.
In another, the brain undergoes a violent wrenching, in effect a whiplash, resulting in what is called diffuse axonal injury. The white matter coating the axons -- spidery conduits whisking information from neuron to neuron -- is sheared.
Because it happens deep within cells, diffuse axonal injury doesn't show up on scans. Yet it can be even more devastating than coup-countrecoup, since it affects memory and other crucial cognitive functions. Many people who endure traumatic brain injury demonstrate signs of both: Their heads have struck solid objects as well as been violently whirled about.
Most likely, trauma patients with brain injuries have sustained other injuries too -- torn skin, fractured limbs, ruptured organs. Which should be taken care of first?
As a young intern, Senno recalled, he approached a patient with a bewildering host of serious complications. Senno has never forgotten the words of a senior physician who made an instant case for priorities:
"Save the brain."
Modern neuroscience was born with a brain injury.
In 1848, a railroad worker named Phineas Gage was planting explosives to clear land in Vermont for new track for the Rutland & Burlington line. Tamping the powder with an iron rod, he accidentally set off the dynamite. The rod blasted into his left cheek, shooting through his brain and rocketing out the top of his skull.
Gage survived and later seemed to be physically normal, but his personality was permanently altered. The hard-working, considerate man had turned into a lazy, ill-tempered lout. It was, his friends said, as if he had become a different person.
Through Gage's ordeal, researchers confirmed for the first time that injury to specific areas of the brain -- in Gage's case, the prefrontal cortices -- could produce specific deficits, and that the brain affects the entire constellation of human behavior: not just reasoning skills, but also the ability to empathize, weigh the consequences of actions, plan for the future.
These days, exploring the brain is big business. In late September, Microsoft co-founder Paul Allen pledged $100 million to establish the Allen Institute for Brain Research in Seattle. It will capitalize on a growing fascination with neuroscience, an accelerating awe that has transcended the scientific world and moved into the general public. Oliver Sacks, Steven Pinker and Antonio Damasio are among the brain researchers who have written best-selling books.
Now the challenge is to transfer the new knowledge about the brain from the laboratory into the lives of brain-injured people.
That exchange has been under way for at least a decade in emergency rooms. Thanks to a new understanding of brain biochemistry and new, more detailed imaging techniques such as MRIs (magnetic resonance imaging) and CT scans, along with procedures to monitor pressure in the wounded brain, physicians have made tremendous strides in treating severe brain injuries in those first critical hours.
Brain injury continues to be one of the primary routes through which breakthroughs in neuroscience occur, said Dr. John D. Corrigan, director of the Ohio Valley Center for Brain Injury Prevention and Rehabilitation at Ohio State University. "There is always a resurgence of study after a war. The Vietnam War was a milestone in the study of brain injury," as battlefield surgeons figured out under fire how best to deal with head wounds.
Some 20 percent of injuries to American soldiers in recent conflicts in Iraq and Afghanistan have included injury to the brain, according to the Defense and Veterans Brain Injury Center, created by the U.S. Congress after the Gulf War in acknowledgment that brain injury is not like other injuries. With more soldiers surviving their brain injuries, just as more people in the general population now survive, the need for specialized brain injury rehabilitation was clear.
Despite those record rates of survival, severe brain injury still can be lethal, killing at least 50,000 people annually. Recent victims have included Dr. Robert Atkins of low-carb diet fame, who slipped on the ice, and Washington Post publisher Katharine Graham , who tripped on a stone patio. The most ordinary of events -- a trip, a slip, a slide, a stumble, a fall -- can, if the brain is injured, bring about the most devastating of fates, including but not limited to death.
Dr. Hunt Batjer, chairman of the department of neurological surgery at Northwestern, who has performed emergency brain surgeries for more than 25 years, said that possibility of lost selfhood torments families. "They always say, `Will he be a fireman again? Will he be a lawyer again?' I have to tell them that it is completely impossible to know."
Founded in 1954, the RIC building at 345 E. Superior St. rises in the midst of other rectangles, other gray-flanked structures that take their earnest places in the giant tic-tac-toe board of downtown Chicago.
Along with treating patients for calamities such as spinal cord injury and amputation, the 20-story, 155-bed facility is a major research center, from the lab on the 14th floor where scientists study the complex mechanics of walking, to the 17th floor, where prosthetics and orthotics are created.
When the elevator opens on the 10th floor, you step off, pass through a set of glass double doors and enter a bright, open space with a cool white floor. Therapists stride quickly through the halls to fetch patients for their sessions. Phones trill at the circular reception desk. Patients arrive and depart, sometimes showing up initially on gurneys with eyes closed and bodies motionless and then, if they are fortunate, leaving by walking out under their own power -- making way for another patient, and then another and another.
"Unfortunately, we've had tremendous growth in brain injury," Senno said. "I'd rather be put out of business. I always tell people, `I'm good at what I do, but you don't want my services.'"
In August, the brain injury medicine unit moved from the fourth floor to the 10th, the culmination of a two-year, $5 million renovation to create one of the most innovative such units in the nation. Everything on the 10th floor is geared toward therapy and research, toward stimulating the brain to get back to business as quickly and efficiently as possible -- and then figuring out what worked and why.
"The philosophy in rehabilitation used to be, `Let's wait and see what happens,' " said Senno. "Now, we're capturing people early. We're aggressive."
Upon admission, patients are evaluated according to the Rancho Los Amigos Cognitive Scale, a 10-step road map through traumatic brain injury. Each patient goes through all 10 steps -- from "No Response" at level 1 to "Purposeful and Appropriate" at level 10, with stops along the way at levels such as 4, "Confused-Agitated," and 5, "Confused-Nonagitated" -- but always at her or his unique pace, remaining at steps for wildly varying lengths of time.
"Show me 5,000 brain injuries," Senno said, "and I'll tell you 5,000 stories." Every patient is different, yet from those singular experiences Senno and his colleagues try to extrapolate general principles about the brain, principles that may be subsequently applied in the rehabilitation of the next wave of injured brains -- the brain of a Jim Kane and other patients whose stays at RIC intersected with his.
The brain of Sarah Conrad, 24, a new bride and high school English teacher who loved Ernest Hemingway and the Chicago Cubs -- and whose car was hit broadside by another motorist on Mother's Day just minutes after she left her Plainfield home.
The brain of Nick Contri, 52, a funny, sarcastic man who could do anything with his hands, from creating metal sculpture to building kitchen cabinets -- and who slipped off a ladder and fell 25 feet onto a concrete parking lot in Munster, Ind.
The brain of John Sanders, 28, a dark-eyed charmer who had just made an offer on a house in Wildwood, Ill., after asking his girlfriend to marry him -- and who was thrown from his motorcycle in downtown Chicago.
The brain of Patrick Welch, 18, a recent high school graduate who delivered pizzas for spending money and dreamed of being a detective -- and who was struck by lightning while stepping out of a summer-school class at Illinois Valley Community College in Oglesby, Ill.
On the 10th floor, people such as Kane, Conrad, Contri, Sanders and Welch, all of whom were assessed at level 4 when they arrived except Conrad, who was at 5, had awakened hours or days or weeks after their accidents. They were restless and baffled, blinking in the fierce sunlight of a permanently altered world.
A world in which everything they did -- the most casual gesture -- suddenly constituted an excruciating ordeal.
A world in which physical activities taken for granted throughout their adult lives -- eating, talking, reading, breathing, going to the bathroom by themselves, writing their own name -- suddenly represented astonishingly difficult tasks.
Yet brain injury is not just a crisis of the body. Bodies heal, and they heal in uniform ways. "A broken leg is a broken leg," Ahmed said. "But the brain -- it is different for everyone. A brain injury is a lifetime diagnosis."
In the first days after he was settled into Room 1046, Jim Kane babbled. He ranted. He muttered about what he called "the Greek Mafia" coming to kill him.
He was a man who, if you asked him where he lived, would rattle off, "1304 N. 32nd Street," the apartment in Melrose Park where he had hadn't lived since 1978.
A man who ate a bar of soap that somebody left overnight on his bedside table because he didn't know what it was.
A man who went from an attentive and loving husband to a stranger screaming profanities at wife Jill and his therapists but who, when informed of what he'd just said, would cringe with shame and disbelief: "No, no, no -- I would never say those things. It wasn't me."
And it wasn't Jim Kane -- not the same Jim Kane, anyway, he had been on June 22. That Jim Kane disappeared into the black folds of a summer night.
In years past, a Jim Kane might have been written off, his brain injuries too severe, his prognosis too bleak. But not at RIC.
Not at a facility overseen by Senno, who knew something about long shots, about the power of persistent effort.
The 42-year-old physician was 9 years old when his family left Argentina to settle in New York. Because Senno and his sister spoke little English, they felt isolated and lonely, he recalled. Perhaps it was that ordeal -- being an outsider in an incomprehensible, seemingly closed world -- that pushed Senno into physical medicine and rehabilitation, a specialty often dismissed as the treatment of patients "other people don't want," he said frankly.
Senno can recount even less flattering nicknames for physical and rehabilitative medicine: the wastebasket specialty. The last car on the train. He and his sister, however, became physical medicine doctors, sometimes called physiatrists. She practices in the Boston area.
Senno's amiable, easygoing manner could fool you into forgetting the gravity of his daily duties. With his wire-rim glasses, thatch of thick black hair and slender build, Senno looks like a perpetual graduate student: intense, nimble, energetic, always ready to jump into any conversation about just about anything, from Harry Potter (news - web sites) to the best way to pattern the bricks in the back-yard patio he was creating. He favored herringbone, because it was the most difficult.
The 10th floor reflects Senno's personality, his blend of calm-minded realism and visionary fervor. He knows the devastation wrought by brain injury -- he can, like any doctor who specializes in the field, rattle off the grim statistics, the every-21-seconds stuff -- but he also believes science is making gains in what previously has been dismissed as a hopeless condition, an irrefutable doom.
Senno believes passionately in the concept of brain injury medicine -- in the notion that brain injury should be a specialty such as cardiology or nephrology. Only in the past few years, Senno said, have physicians begun to understand how central the brain is to everything else the body does during its healing. Every drug, every surgery, every therapy ought to be evaluated in light of what it does to the brain.
He dreams of the day when brain injury rehabilitation will echo brain injury emergency treatment, where survival rates have dramatically improved in the past decade. In an increasing number of emergency rooms, new specialists known as neuro-intensivists handle a severely brain-injured person's care. The brain injury takes precedence over whatever else is going on in the body.
"It used to be, if you brought someone in [to intensive care] and they didn't get better right away, that was it," said Edward J. Sylvester, author of "Back From the Brink: How Crises Spur Doctors to New Discoveries About the Brain" (Dana Press), a study of the neuro-intensivist movement that will be published in January. Yet with what physicians now know about brain injury, "we've bought the brain time."
The U. of C.'s Frank, one of only a handful of neuro-intensivists in the nation in the fledgling field, said brain-injury patients formerly were "parceled out among specialties. It's bad for patients because no one is in charge. It's bad for families because they don't have a single person to talk to. We [neuro-intensivists] control the whole body."
Senno hoped for a similar consolidation at the other end of the brain-injury spectrum: the rehabilitation end.
"This is where you live," Senno would say, grabbing the plastic brain model off the metal shelf in his office and jabbing a finger at the frontal lobes. "This is what makes you who you are."
By observing how the wounded brain struggles to resume its diverse and intricate functioning, scientists have gained promising insights into the brain's bedrock enigmas.
Dr. Donald G. Stein, neurology professor at Emory University School of Medicine and co-author of "Brain Repair" (1997), said, "It used to be that if you didn't see recovery [from brain injury] in the first six weeks, the attitude was, `Why bother?' You were nuts if you said the brain could repair itself. But we're learning that even years after an injury or stroke, you can promote plasticity," the brain's ability to change itself in response to its surroundings and experiences.
Despite promising research in brain injury medicine, however, the field still is ignored by many physicians and medical school administrators. Dr. Michael Pietrzak, executive director of the International Brain Injury Association, declared, "TBI [traumatic brain injury] hasn't been high on the priority list for physicians because everybody thought, `Well, there's nothing you can do.' "
Few medical school curricula include specific courses on brain injury. "I didn't have a single class on brain injury," said Senno, a 1994 graduate of the University of Illinois School of Medicine. "Not a class, not an hour. Zero."
Because the traditional thinking about brain-injured people was: Give up. A damaged brain is a damaged brain. Period.
Even if some recovery did occur, most physicians were convinced that it was bunched toward the front end of rehabilitation, then tailed off.
"There was a myth," Senno said, "that recovery from brain injury stopped after six months. Our research shows that it continues up to five years. If you can get someone to do this" -- he wiggled his right index finger -- "then after that, maybe they can pick up a pen."
And after that, maybe they can pick up the pieces of their lives.
Jill Kane was dozing on the couch in the living room of their Rolling Meadows home when she got the call early that Monday morning. She was in the car in minutes, rushing toward the hospital.
Jill, 45, is pretty and shy, with light blond hair that curves around her pale face and a soft, soothing voice. A voice that always seems to promise things would be better. A lullaby kind of voice.
Jim was big and sociable, a guy who might remind you of TV actor Jim Belushi. Fond of spaghetti dinners and kids and fixing things. He could fix anything, Jim could, from engines to toasters.
In family pictures, Jim's the one making the funny faces, with an arm slung around his wife's shoulder and a big, half-moon grin that crinkled the skin around his eyes. He had had a tough childhood, with constant money troubles in the family, and he had dropped out of high school to get a job and help with the bills. That was Jim: He always helped out.
They had been married 26 years. They dealt with life together, Jim and Jill, with the bad times and the frustrations, as well as the amazing, joyous things, such as the birth of their son 19 years ago. They bought a tidy little house. Jill worked for a company that made fasteners; Jim got a job repairing jewelry. For their 25th wedding anniversary, Jill surprised him with a shiny blue Honda Gold Wing motorcycle, almost 800 pounds of muscular chromium beauty. His dream.
Late on the next-to-last Sunday night in June, Jim decided the evening was just too gorgeous to miss. He loved motorcycles and had been riding since he was 16. He had owned five during their marriage. He and Jill often rode together, with him in control and her sitting behind him, hands cinched around his waist, cheek against his back. Jim was such a good driver, she said, that she could fall asleep on long rides. He was smooth and careful. He knew what he was doing.
Sometimes he wore a helmet. Sometimes he didn't.
This time, he didn't.
When Jill sent him off that night, did she have a premonition? A flicker of dark foreboding that she couldn't quite put her finger on?
No, Jill said. "It was just, `See you later, bye.' He wasn't his spunky self, and I hoped the ride would perk him up. It was such a beautiful night." Jim, she recalled, pulled on his black leather coat and gloves, just as he always did before a ride. "You wish," she says now, "that you'd known it was the last time." The last time, that is, that life would be normal.
The crash happened as Kane was returning from River Grove to Rolling Meadows, riding north along what is known as the 53 extension of I-290, near the line dividing DuPage and Cook Counties.
At the hospital, Jill was told that her husband probably wouldn't survive. His injuries were grievously severe: skull fracture, broken neck, bleeding in his brain. They handed her his wallet, which was covered in blood, and showed her to the waiting room.
When she finally was able to see him five hours later, she was stunned. His face was grotesquely swollen, his body sprouting lines to so many chiming monitors that he looked like part of a machine himself. Nobody knew. Nobody knew anything.
The days were not parceled into separate sunrises and sunsets but instead tended to blur into a single gray stretch of anguished waiting. Finally she was told that Jim was going to make it. He would remain in the drug-induced coma for 28 days, but he was going to make it.
His life was saved. She thanked God. His life was saved.
The real ordeal, however, was just beginning.
Every accident divides the world for the patient and their loved ones: Before and after. Sarah Conrad taught at Oswego High School and dreamed of her life with Pete -- and then her car was struck, and everything changed forever.
Nick Contri fixed heating and air conditioning units and loved going out to eat with his wife, Susan -- and then he fell off a ladder, and everything changed forever.
John Sanders had big plans for his girlfriend Cathy and his two small children -- and then he crashed his motorcycle, and everything changed forever.
Patrick Welch was a lanky, good-looking kid just a month past his high school graduation who was rebuilding a Chevy pickup in his parents' driveway -- and then he was struck by lightning, and everything changed forever.
Who, their families wondered, would emerge from the bundle of bandages and jungle of intravenous lines in which their husbands or sons or daughters or sweethearts were enmeshed?
Jill Kane knew who Jim Kane had been -- big, hearty, lovable Jim Kane. Funny, sweet Jim Kane. The guy who could fix anything. But who was her husband now? Who was this sullen stranger? You are your brain, she had been told over and over, and his brain has changed.
Who would he be?
Copyright © 2003 Chicago Tribune
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