Pulitzer prize-winning New York Times journalist Alissa Rubin talks with Dr. Stieg about the helicopter crash that seriously injured her, and the long road to healing her body and her brain.
Dr. Stieg: I'm happy to have my patient, the New York Times Baghdad Bureau Chief and Pulitzer Prize winning journalist Alissa Rubin. As our special guest in 2014 Alyssa was seriously injured and nearly killed in a helicopter crash in the Middle East. Her skull was fractured in addition to many serious injuries so often with traumatic brain injury, we hear about the events, but have no idea about what the patient goes through. Today, Alyssa will share her story — a long and miraculous recovery. Welcome Alyssa. So just to set the pace and tone, can you go back to that time in 2014 and tell us why you were boarding this helicopter in Kurdistan and then what happened?
Alissa Rubin: I was going on the helicopter because as you may remember, there were between 20,000 and 50,000 Yazidis who had fled from an area that the Islamic State had invaded in Northern Iraq. They had gone first to Mosul, which is the place everyone's heard of. And then they branched out into other areas. We knew that the Kurdistan and Iraqi, sort of, military were taking with them food, water, sort of very, very basic supplies to leave for the refugees who were running out of water. It was—
Dr. Stieg: So these people were living there to escape from— they weren't living there by choice?
Alissa Rubin: Well, Oh no, they were certainly not living there by just, they had fled there and they had fled with really nothing, pretty much. Some of them were barefoot. It was an extraordinarily harsh environment and particularly in summer in Iraq is scorching really hot. It's dry. It's a lethal environment, particularly for vulnerable people.
Dr. Stieg: So you were going there then to just see—
Alissa Rubin: To see what it was so that we could tell people, as a journalist, you want to see it yourself. And so I was very excited and fought very hard to get a place on the helicopter going up and really very unworried. I've been on a lot of helicopters and mostly US military, but others as well. I don't ever worry about it.
Dr. Stieg: Looking back now, having read what you described, is that a helicopter you'd actually want to get on? It sounded to me like it was overloaded, overtaxed...
Alissa Rubin: Well it wasn't overloaded going up. And after all, that was where you made the decision was based on, you know, what was the number of people on it and what was in it and what was in it was, you know, lots and lots of water, bananas, bread. I remember very clearly worrying that I was crushing the bread and then the bread wouldn't be very good to eat because there were no seats on this helicopter. This is a metal tube in the sky held up by a propeller. I had talked to the helicopter pilot before I got on and I knew he was a very experienced person. So that gave me quite a bit of confidence. And there was a member of the Iraqi Parliament coming up. The only Yazidi member. And I thought, well, if they're going to put a member of Parliament on it, you know, what's there to worry about. And so we got up there, and there were very, very ill people, elderly children, people could barely walk. And the pilot I think really had a heart of gold, and he wanted to help as many as possible. And the people just rushed onto it. As soon as all the food and water was unloaded — and way too many people got on.
Dr. Stieg: And that was the problem — it was overloaded and it crashed.
Alissa Rubin: Right. It crashed. It went up about seven meters, eight meters maybe. We don't know exactly. And then it fell.
Dr. Stieg: So what's your recollection of that? Do you have any recollection of that immediate event?
Alissa Rubin: The immediate moment of contact, I don't remember. I remember that it began to tip. The pilot righted it a little. And then it began to tip again. And I was waiting for the crash and I never experienced, in my memory, the crash. I've regained a lot of my memory of the event, but not that.
Dr. Stieg: So what's the first thing you remember?
Alissa Rubin: I remember coming to and thinking I'm alive and I also thought I have to get out of here, but I didn't really know how to do that. And finally I thought, I think if I just hoist myself up using my arms, I can do it, and then my arms couldn't do anything because both my wrists were crushed and I looked down and I didn't know why they weren't working.
Dr. Stieg: And fortunately, there were some people there to at least help you in a first aid fashion. The photos I saw, it looked like you must've had a large cut on your forehead.
Alissa Rubin: I had a lot of cuts. I had, I think when you saw me they'd put about 15 stitches in my face, but there was no one on the mountain with a first aid background. Very luckily there were some, some guerillas who were there who were fighting with the Yazidis. One of the men took off his scarf and he tied my wrists, so they were sort of immobilized and I could never thank him enough for doing that because the pain was excruciating.
Dr. Stieg: So fast forward then — I presume a, an emergency helicopter came, picked you up and they took you directly from there to where?
Alissa Rubin: Back to the Iraqi Army base from which I had left where I was put into, I think it was sort of like a minivan on the floor. I mean all of this was very primitive and we bumped over. Uh, it was horrible.
Dr. Stieg: And this, you remember this?
Alissa Rubin: I remember it was awful. Yeah, I mean I remember I came in and out.
Dr. Stieg: Excruciating pain?
Alissa Rubin: Excruciating pain everywhere. Wanting to sleep and being afraid to sleep because I was afraid that something bad would happen in my brain and maybe I wouldn't wake up. And then they took me to a trauma hospital and they were worried about bleeding in my brain and they did an MRI and they decided I could travel somewhere and then they put me in a taxi, I guess. And the taxi was driven to the border and then I was transferred into another taxi for the other side of the border, right? I mean it was awful. I came to kind of came in and out of consciousness. I don't remember all of it.
Dr. Stieg: Sophisticated enough that they had a, had an MRI scan, which is great, but then taxi transport...
Alissa Rubin: Then they very kindly, the Turkish government, they were medevacking the Yazidi member of Parliament to Istanbul and they medevacked me as well.
Dr. Stieg: And your health care experience in Istanbul was positive?
Alissa Rubin: Yes, it was very, very positive. I was in the American hospital, people spoke English. But I have to say I had only one thought I was able to hold onto at a time and that thought was that I, I wanted, I wanted to have written an article out of this experience. I went there for a reason and I felt horrible and guilty that and terrible that somehow this had happened and I, I had to do something before I completely fell apart cause I, I couldn't really think in any coherent way to be honest.
Dr. Stieg: I guess I want to dissect this a little bit. You were having terrible symptoms, but you still have this bond, emotion, emotional sense that you wanted to accomplish what you wanted to accomplish. What were the, what were the symptoms you were experiencing through this? You said you were fading in fading out, afraid of going to sleep, afraid you weren't going to wake up
Alissa Rubin: That and an enormous pain because they hadn't treated anything and they were afraid of giving me morphine because of the sedative effects and the potential damage I think that could cause. I had a punctured lung and I, I couldn't have walked if I wanted to. I mean my, everything kind of collapsed.
Dr. Stieg: What would you say about your thought processes? Did you feel like you were oriented and you could...?
Alissa Rubin: No, no I didn't. I, I just felt like I was holding on and I didn't have a good sense of time. I remember that. I remember I'd opened my eyes and one of my colleagues came with me and he was there and then I'd open my eyes again a little later and he wouldn't be there. And I wouldn't know if it had been a little time, a long time. It was a blank.
Dr. Stieg: And then we fast-forward a little bit and we get this phone call that there is a an American journalist over in Istanbul and they ask if we would be willing to accept you and transfer because, in doctor-speak you had a moderate traumatic brain injury. That's obviously more serious than a mild traumatic brain injury, which is more commonly known as a concussion. But the worst problem was all the other injuries that you had, the wrist fracture, the punctured lung, you did have multiple facial fractures and all these lacerations.
Alissa Rubin: And then my nose was quite broken and the septum was sort of askew.
Dr. Stieg: Yeah, and then the thing that was really not addressed at all, certainly in the acute phase was the lingering effect that this had on your brain in terms of how you're functioning. And that's why I'm totally surprised that was — was it in the Istanbul hospital bed that you still wrote an article?
Alissa Rubin: I didn't write it. I dictated it to my colleague Rod Nordland. That was the only way I could do it because I couldn't use my hands at all. I mean, they were completely bound up, they were broken, they were in shooting pain. And so I knew I wanted to do this because I didn't know how long I'd be able to do it for. So, and I also really felt strongly that the pilot was not incompetent. He was a person of great heart and he had died doing this and I felt like, why should I have lived when he was, he actually saved a lot of people. Those people, almost all, lived. A couple of other people didn't, there were, I've gone back now and tried to trace everybody. So I think a total of probably three or four died, but the others survived.
Dr. Stieg: Obviously you knew that you had injuries and you ate and you know when we all get sick, we realize we're not at our, on our A game. But when did you realize that it wasn't only that you weren't on your A game, but there is actually some changes that occurred as a result of this crash?
Alissa Rubin: It was after I got home. I was lying on the bed I grew up on basically and I took down a book of, I still remember it was Chekhov's short stories and I thought I'll, I'll just read these. I can't really remember them now. Anyway, I, you know, I read them in high school, I was reading and my mother had put down the book. My mother came in and she said, "Oh, what are you reading?" And I didn't know what I had been reading. I had no memory of what I had been reading. It was like there was an eraser in my brain coming behind each word and wiping it away. And I was terrified because that's all I do. I read, I think about what I've read. I come up with questions and I go out and talk to people and then I write it and if I can't read and retain anything, what use am I? And there was one other thing that happened. I went to get my first hand therapy for to recover and I got to the counter where they check you in and the woman said, who are you here to see? And I said, "I don't know." And then she said, "Well, why are you here?" And I thought, "I don't know, why am I here?" And I was, I burst into tears.
Dr. Stieg: You've won enumerable awards for journalism. You're an incredibly accomplished individual. So I can just imagine what was going on in your mind or what wasn't going on—
Alissa Rubin: I just felt like I was a child, you know, and didn't really know where to go to sign up for a class or something. And so I remember I came in to you and I was very, I felt very strongly that I had to go back to work. And you said, "Well, I can write you a note, but you will fail if you go back this soon. You're not ready." And I was really upset and I think I began to cry there too. And that was actually very useful. We both recognized that there was something more going on for me. I mean, there was not just the actual injury, but the emotional reaction to the injury and, and how that pulls you down because you're not yourself anymore.
Dr. Stieg: What people need to understand is that as a result of your injury, you didn't have a specific blood clot or some focal injury to your brain, but what had happened was the connection fibers between the various regions of your brain had been disrupted. And like any other organ, it takes time for those things to improve and at the time of that office meeting, I had two goals. Number one was to get you to realize that you weren't there yet because I knew from your hospital bed you had told your editor or your boss that I'm going back to Baghdad, which I was totally in favor of, but not just then. So I was hoping to give you the realization of your problem, but then also the permission to cut yourself some slack because that's not something you do for yourself normally. Can you characterize that, you know, after we had that conversation, some of the emotional repercussions of the feelings that you were having?
Alissa Rubin: I guess I was glad that you were blunt, but angry that you were blunt because I really felt like I didn't have a lot of time. I thought, if I'm away too long, somebody else will take my place. It doesn't matter. We are all fungible and I, you really know that as a journalist — that's why the system works. I felt terribly precarious emotionally and also in terms of what my future would be. I have to say you were helped a lot in the advice you gave because I happened to have a very close friend who also came to see me at the same time, who's also a doctor, who also said, you, you're depressed and you need to do something about this.
Dr. Stieg: It was clear to me in many people around you that you were suffering from depression and probably from post traumatic stress disorder. I really look forward to talking with you about this in more detail.
New York Times journalist Alissa Rubin talks with Dr. Stieg about the cognitive and emotional effects of her injuries, and the treatments that helped get her back to work and to her life.
Dr. Stieg: Hello, I'm here again with Alissa Rubin and we were talking before about her trauma and the subsequent events that resulted in depression and post-traumatic stress disorder and I wanted to pick up from that area again. Did you recognize that you were depressed or did somebody have to tell you that?
Alissa Rubin: I recognized it but didn't want to admit it to myself even, and I think many people are depressed and have different ways of dealing with it and some people retreat and some people work and I am someone who works for me. Work is a wonderful antidote to anytime that I feel down at all, you know, I start to do a project, I'm writing, I, I'm exercising, I'm maybe taking long walks and it dissipates. And none of those things, none of the remedies that I had recourse to in my daily life that have worked quite well for most of my life worked for me because I couldn't physically do them. I could maybe walk, but I couldn't do my work in the way that I used to.
Dr. Stieg: Was there a stigma for you about the concept of depression or was it just the fact that you're just an a type A personality and gosh, I'm going to lick this?
Alissa Rubin: No, it was that it felt more profound than that I have to say because it had a physical origin and I had been very, very excited. I can't tell you how excited when I got the visa to go to Baghdad and was able to help in this incredible story from a journalist standpoint, but also a moment when you can bear witness to atrocities. That's, that's the whole reason you do this kind of coverage. And that had been taken away from me. I felt very unfairly and then my body had betrayed me and my body had never betrayed me that way before where, you know, I was alive but I couldn't do what I had set out to do. Usually mind over matter takes you a long ways and so I, I did understand what was happening. My, my father was a psychiatrist and I didn't feel like depression was a terrible thing to admit to. I felt like most people should admit to it more and deal with it and then be able to have productive and happier lives. But I didn't want to admit it because this time I felt like, I knew how to have a happier life and it involved running and working and thinking and I couldn't do those things.
Dr. Stieg: Did going to see the psychologist and beginning the cognitive remediation — did that help you gain insight into this and how to deal with it?
Alissa Rubin: Yes, it did. And it was something I really didn't want to do at that point. I'd seen a lot of doctors. I'd had so many tests and MRIs and CT scans, and I remember when you wrote down her name, I just thought, Ugh, not another one. And I went to her and I remember the very first session she said, well, what exactly are you experiencing? And I said, well, I'm trying to work a few hours a day, which I had been told I could do. And after about two hours or so, I'm exhausted and I can't keep going. And she looked at me quite sternly and said, "Well, you shouldn't be trying to work for two hours. You can't do that. You should work for about 40 minutes and then take a five minute break in which you do not do anything. You don't look at websites on your computer, you don't sleep, you don't do anything." And that was a revolutionary idea to me and I was extremely doubtful about it because I thought, how can you not do anything? I mean you could clean, or you could, there must be something I could do. And that the whole point was not to do anything.
Dr. Stieg: That's something many Americans should learn is how to be bored and do nothing for a period of time in their life. Now did this, your initial reaction was obviously revolt, but obviously you came to terms with it.
Alissa Rubin: I did because I made a decision and I remember quite clearly making it and I thought, all right, I don't know this time, what's going to work. So I will do everything even if I don't like it. And you had recommended this, you had recommended seeing a psychopharmacologist and seeing if you know some kind of antidepressant would help. Even a low dose, whatever would work. I do think it had some effect.
Dr. Stieg: I just, I feel compelled right now to, to make this pitch that people need to really understand the complexity of the brain and it isn't solved by just one physician and that's why, I as a neurosurgeon, started getting you involved with these neuropsychologists, the neuropsychopharmacologists and the physical therapists because they were working with your hands and helping you with your exercise and all of these emotional, physiologic and psychologic issues obviously come together in your brain and it was important to get you to work on each one of those individually. But having it done in a coordinated fashion to facilitate and expedite your care. You're an example of how that worked.
Dr. Stieg: Where was your family in all of this?
Alissa Rubin: Well, I think my family was not particularly engaged. They supported whatever I wanted to do in a general way. My husband works in Europe and he was in Europe working. My mother was around, she's in her eighties and so there's a limit to what she could do, but that was actually probably fine because she's a very, she was extremely consistent. She was no different than she has been my entire life, which is, you know, she'll occasionally bring you a cup of tea and she'll be happy to talk with you, but she's not going to be terribly involved.
Dr. Stieg: What doesn't kill you makes you stronger, huh? *laughs*
Alissa Rubin: I knew that it mattered to me to go and maybe more than anyone else in my family. She's always respected that and always been very realistic about it and I am very grateful to her for that because lots of parents might not have understood that. My sister was working, so I didn't have a real family support network, but I did have a couple of friends who were enormously supportive, and... I was tired every day. I was doing physical therapy five days a week because I had different parts of me that didn't work and I had a terrible hematoma, which was totally benign, but it made it hard. It hurt and it made it hard to walk because it was where it was. But I was going to say the other thing that the cognitive therapist taught me was something that I really use every day. I've used it already today. It was that you tend, I think for whatever reason, when you've had this kind of brain injury to start to do several things at once, you're very unfocused and I would be really interested to hear why that is because I still don't understand it. So I would, I would start an email and then I would think something like, Oh, I need to write Dr. Stieg or I need to write Ann, or my cousin Prudence's birthday is coming. And I would open another email and then another and I would soon have three, maybe three emails open, and something I was reading on the screen and get none of them finished and be exhausted.
Dr. Stieg: You'd never had attention deficit disorder.
Alissa Rubin: Not to my knowledge and I was puzzled and she said, well, when you feel the impulse to open a second email, have a notebook next to your desk and write down whatever the item is that you need to do. So you're reassured that you have it anchored there. You will not forget it and then complete one task at a time. And I now do that and I now prioritize my emails in a somewhat obsessional fashion, but, but that continues to work and it's, I think that's a little bit leftover attention deficit disorder that I will have to discipline myself to work with for a long time or maybe everyone has that. I don't know.
Dr. Stieg: You're more complex because of the injury you sustained. It's a little bit of attention deficit, but it's also just a memory disorder and that has to do with the particular area of your brain that was injured.
Dr. Stieg: Was it during the cognitive remediation you were going through, you realized that you were also suffering from post-traumatic stress disorder?
Alissa Rubin: I would not have thought of it as that because I didn't have a lot of what I've seen in post-traumatic stress because because of having been a Bureau Chief in war zones. I've seen symptoms, not necessarily in soldiers but even in our own journalists who are out with troops a lot. You see the effect of the stress and I, I wouldn't have defined it that way. I think that what I had had was memory loss of the most upsetting moments of the accident.
Dr. Stieg: Which would be a stress and what, I actually learned something in preparing for this and that you went through something called EMDR, eye movement desensitization and reprocessing that you must have read about this, thought about it, and elected to do it. Or—
Alissa Rubin: Actually the friend of mine who encouraged me to listen to you on the question of, perhaps needing cognitive reconstruction and some kind of low-level antidepressant also recommended that I see someone for this. She said, you know, it's very interesting. I know some people who do it in New York who do it very well. She's a psychiatrist. She gave me a name and I called the person and I really liked the idea of it because it wasn't a commitment to long-term therapy. It wasn't what I thought of as something where, you know, I was going to go back to France or Baghdad or Afghanistan and you know, I'd be interrupting some process — my father had done, you know, everything from short term to psychoanalysis. I didn't really want to do that. I didn't want to go through that kind of thing. I wanted a quick fix.
Alissa Rubin: And so it appealed to me that it was something that you could do in a — you can't say how many sessions, cause everybody's different but three to six let's say. And that it had been used quite effectively and you know, sort of the post-September 11th periods and it was remarkable. You retell what happened and something and I could not, I don't know that the literature explains it, but something happens on the second or third retelling and things surface that didn't surface the first time. And I had a memory that surface that was very, very helpful.
Dr. Stieg: You come to terms eventually with what happened?
Alissa Rubin: Yeah. And you don't feel, I don't know, you don't feel upset afterwards.
Dr. Stieg: And what's important for people to know is that the, it's been espoused that this is about 80% successful in patients. So it seems to me one of the major hurdles for people like you or anybody with PTSD is just accepting the fact that they have this inner turmoil and seeking help. And there are very good ways of getting help.
Dr. Stieg: It's remarkable to, to watch how the brain works because by retelling it, you see, you see how you've pushed something down.
Alissa Rubin: What the thing that I remembered was that after I had become conscious in that in the helicopter, I suddenly — everything went black and I couldn't see. And I thought, "Oh my God, I'm blind and if I'm blind, what will happen?" I can't do anything anymore. I, I would rather be deaf than blind. What a horrible thought, you know? And that was, it was so terrifying and I felt my whole life was sort of stopping before me. Yeah. I wasn't dead, but so what, I couldn't see anymore. Well, what had happened actually is I had a lot of blood and it had congealed over the eye and coagulated and, and somebody pulled it open after about an hour and a half and I must've started from the light and they said, "Oh, she can see."
Dr. Stieg: I think it's important also, to say that, that you've gone through the psychology, you've gone through the, the EMDR and you've gone through using some medications and physical therapy. All of these are exceedingly important and they all kind of come together in you as a person. You still have some symptoms and I was wondering whether you could describe — what are the workarounds that you're using now to do what you're doing and you're working at the computer. You'll write yourself little notes.
Alissa Rubin: I do. I use a lot of those cognitive disciplines. You know, keeping notes when you're working. Keeping notes, really whenever you feel you might forget something and therefore you're going to start something else. I also have tried when I'm not like when I do take a break, you know, if I'm feeling like I'm losing my focus when I'm writing, I'll try to stop myself. Now what's really hard is to not do something, you know, look at some article I've been wanting to read or spend that time buying some item I need to buy online or whatever. But I, I'm aware of the value of leaving blank space.
Dr. Stieg: Did you have to come to terms with these workarounds? Was there an emotional aspect to it or is it just you realize that it's good for you so you'd do it?
Alissa Rubin: No, I think what helped me is that I, I actually feel, and I remember discussing this with you, that I think more sharply now than I used to, and it may be that I think a little slower and that has actually made me more precise because I'm not scattering myself so much. So I feel like when I write a sentence, I know more clearly what I want to say. And it may be because I'm not trying to do three things because I now acknowledge I can't do three things at once. So it might be a skill that could be useful to people who haven't had any, haven't fallen out of a helicopter, um, uh, or had some other... But I mean it's, I don't know whether the brain can really multitask and maybe it, it actually wants to focus. You can answer that.
Dr. Stieg: it functions best if it focuses. And I think multitasking is, is an overused term. I think we can multitask doing simple things, but if it comes down to writing a Pulitzer Prize winning article, you can't do that. Thinking about two or three other things, you've gotta be focused, you mentioned a little bit about your headaches. Those are persistent, controlled with medication, controlled with mindfulness, or how are you doing that?
Alissa Rubin: I have never found mindfulness really that helpful. I can barely do my five minute breaks when I need to. I'm, I'm not a very good person at the Zen level or which I, I wish I were. Lots of people seem to get a lot out of it, but that's not, that's not who I am. I really control it with, with medication taken. When I feel it happening, sometimes I'll think it's kind of on the edge and I'll lie down for half an hour in the dark and it'll subside and then I won't need to take the medication. But it is something that is more frequent. I can't say that it follows a pattern. I think like a lot of migraine sufferers, I know there are certain triggers for it. I avoid those triggers completely. Um, I know that wine for instance, is a trigger very sadly, and I just hardly drink at all anymore.
Dr. Stieg: I always appreciate it when you send me the bottle. *laughs*
Alissa Rubin: Well, so I think that's the most important element is—
Dr. Stieg Are you going to do anything differently when you go back to Baghdad? No helicopters?
Alissa Rubin: No helicopters. No, I haven't. I have to say I've been in lots of planes since the accident. I haven't been in any helicopters, but I am very careful not to promise my family that I'll never go into a helicopter because I can envision situations where one might need one. But I do think that disciplining myself to follow all those cognitive rules is probably something I'll need to do for the rest of my life and they're not really burdensome. I think you can see them as actually helping your brain. I don't know if I want to say, be healthy, but do what's best.
Dr. Stieg: It's been an absolute delight spending this time with Alissa Rubin. It's a really, every traumatic brain injury is obviously a specific story, so we can't, but your story is one of reconstruction and hope, and it also highlights the, for me and I hope for anybody with traumatic brain injury, the intensity with which one has to go at reconstruction, the levels that you went to in terms of the cognitive remediation and the EMDR and the psychotherapy and the medications and the physical therapy. All that comes together and for you who I would characterize as a type A, highly driven, motivated individual came to terms with the fact that you, you've got to accept your body's limits and you've done beautifully with that. Thank you for spending time with us.
Alissa Rubin: Thank you for taking the time.