It only took a few seconds for Rich Wiebke's life to veer off course into uncharted territory.

One moment, he was a ski instructor at a Utah ski resort, thrilled about having a job that allowed him to do what he loved best - be outside, gracefully swooping down a mountain slope and helping others overcome ski fright.The next moment, Wiebke, 33, was a person with a head injury - one of the most common and yet most devastating injuries people can suffer. In fact, it is a leading killer and cause of disability in the United States.

Wiebke remembers what happened: It was March 15, almost two years ago. He was coming down the mountain, traveling along a flat cat track near the base of the resort when he caught an edge. It's something that happens every day, to skiers everywhere.

It's not something skiers expect will change their lives forever.

Wiebke careened out of control, slamming head-first into a tree. He was momentarily knocked unconscious. It was ironic that something he loved so much became the source for so much hurt.

"That was one of the hardest things to deal with at the beginning," Wiebke said.

When Wiebke came to, he couldn't answer questions posed to him by members of the ski patrol. "What did you have for breakfast?" they asked. Wiebke could picture it: it was yellow and long. But he couldn't get think of the right word for it - banana.

Wiebke had fractured his skull from his hairline to the bridge of his nose. He looked like "Walt Frazier after a fight."When he hit the tree, Wiebke's brain had been slammed around. It would take months for doctors to sort out the resulting damage. And it would take months for Wiebke and his wife, Gail, to realize what they were up against.

A common injury

Each year, 2 million Americans suffer traumatic brain injuries, primarily through car accidents and falls. Other people, like Rich Wiebke, are injured while participating in sports and recreational activities.

For some people, the injury will cause a severe headache, dizziness, nausea, confusion and fatigue that can last days, a few weeks or even several months. For some, eventually the symptoms disappear.

For others, the injury results in more lasting, debilitating effects that can take years to correct or come to terms with. Like Wiebke, such individuals may look fine on the outside but suffer a host of invisible cognitive problems, which may make everyday life a struggle.

"One of the first things you learn (when dealing with a head injury) is you don't ask what's next, or where do we go from here," said Gail, 33.

The second thing you learn is to get as much information as you can about the problem and its treatment, Gail said.

No quick fix

After two days in the hospital, Wiebke was sent home with instructions "not to do any yard work or do any heavy lifting and that he'd be OK in a month or two," said Gail, a graduate student studying nutrition at the University of Utah.

Rich hoped he'd be back teaching skiing by the end of April. "At first I thought it was like the flu. One day I'd suddenly wake up and feel better," he said.

Gail, trying to fit her final exams in between caring for her husband and their 2-year-old daughter, couldn't understand why her husband wasn't coming around.

"Rich didn't get better. He couldn't eat at first. He couldn't chew. He just slept a lot and he didn't talk much," she said. "His balance wasn't good. He was confused. He couldn't think. You couldn't ask him something and have him answer you."

Gail finally concluded that maybe the doctors were wrong. Maybe her husband wasn't going to get better on his own.

"In this country we expect to be able to go to a doctor and have them fix you," she said. But no one was fixing Rich.

Therapy aids in recovery

In May, 21/2 months after the accident, Gail searched out therapy programs for her husband; the first program the Wiebkes tried seemed to be "guessing what to do," she said. After more searching, Gail moved her husband to the Quin-ney Rehabilitation Institute at Holy Cross Hospital, which offers a team-approach oriented program specifically geared for head injury patients.

"That's when Rich started getting better," Gail said.

Over the past year, Rich has worked at getting better like most people work at a job. He spends four hours a day at the institute. He works on exercises that help his memory, attention, balance and dizziness, inability to focus on a task, decreased stamina, light and noise sensitivities and language problems. He also participates in physical therapy.

At first, the exercises were simple: He'd track a single object as it moved across a blank background, for example. Now, he works at reasoning puzzles, memory categorization tasks and organizational strategies.

"You have to work in real small steps with him," said Lisa Schweitzer, a speech pathologist at Holy Cross. "If you push too much, it overwhelms him and sets him back."

Ordinary is overwhelming

Wiebke does quite well in controlled environments. But take him on a walk outside - with the wind blowing, tree branches moving, kids playing, the sounds of vehicle traffic - and there is a good chance he'll fall apart.

"Information comes in faster than can make sense of it," Schweitzer said. "Rich still has a long way to go. His sense of humor is returning, his ability to carry on a conversation . . . to tolerate lights and noise has improved."

Rich still can't handle anything more than a walk; he can't run, ski or even ride in a car without feeling sick. He naps two hours each day.

"His prognosis for being a ski instructor is extremely poor," Gail said. "At first I wanted to know when he'd be better. Now I don't."

Gail dwells on the little successes, the minute improvements visible day by day, rather than worrying about what Rich may or may not be able to do some day in the future.

"I don't make too many hopes and dreams about Rich," Gail said. "I just enjoy how he is now."

Dealing with a head injury often requires major life changes for other family members. Once, Rich would have been the main provider for the Wiebke family. Now, Gail knows that role is hers. When decisions need to be made for the Wiebke family, she makes them.

"There are so many difficult things to deal with every day," she said. "It's not bad, it's a change. But it's a change we're willing to make because we really like each other."


(additional information)

Head injuries

Every 15 seconds someone receives a head injury in the United States - that's two million people each year. Of those injured, 500,000 will require hospitalization.

Every five minutes, one of those injured will die - up to 100,000 people each year - and another will become permanently disabled. Most deaths occur at the time of injury or within two hours of hospitalization.

Of those who survive a head injury, approximately 70,000, to 90,000 will endure lifelong debilitation or loss of function. Two thousand people will exist in a persistent vegetative state.

A survivor of a severe brain injury typically faces five to 10 years of intensive services. Estimated lifetime costs can exceed $4 million.

Traumatic brain injury is the leading killer and cause of disability in children and young adults. Young mean between the ages of 15 and 24 have the highest rate of injury.

Motor vehicle crashes cause one-half of all traumatic brain injuries. Falls account for 21 percent, assaults and violence for 12 percent, and sports and recreation activities for 10 percent.

Child abuse accounts for 64 percent of infant head injuries.

Each year, 50,000 children in the United States will sustain a bicycle-realated head injury; of these, over 400 die.

SOURCE: Interagency Head Injury Task Force, Feb. 1989