"For some young men, it was not the fact that they thought they were invincible, but simply the immediate guaranteed benefit they got from what they referred to as the adrenaline buzz, which far outweighed the possible cost of injury to themselves or to others."
From a North Eastern Health Board report, Men Talking
"Once you think about it, well after you do it, you say, 'Jesus, I shouldn't have done that' but at the time you just hop in and floor it."
A young farmer, quoted in the report
"Life is now and I see nothing there for me. This is what I have."
A brain-injured man on his vision of the future
It's coming up to 5 p.m. on a Friday and staff on the brain injury wards at Beaumont Hospital are clearing the decks. It's about now that the phone calls start coming, looking for beds, and they won't stop until about 5 a.m. on Monday. Yes, it is that predictable, says Dr Rory O'Connor.
Some 40 per cent of brain injuries happen in those few days. There is a three- or four-to-one shot that the patient being rushed in on the trolley will be a young man aged between 16 and 25, injured in a road accident. He will probably have been the driver and the chances are that no other car was involved. So his injuries are probably all his own work, a result of the usual combination of speed, inexperience, drink and/or drugs.
Wonderful advances in acute care and neurosurgery mean that he will probably live, though not necessarily to tell the tale. "No one ever makes a full recovery from brain injury," says Dr O'Connor, a specialist registrar in rehabilitation medicine. There is always some legacy, whether it's to do with the memory, attention span, reading, headaches, fatigue . . . This is so well recognised that there is a name for it: post-concussion syndrome."
And those are the lucky ones.
"The paradox of traumatic brain injury is that survival, or even seemingly full physical recovery (and 90 per cent of head injured people make remarkably good progress in this regard), can merely add to the nature of the catastrophe," writes Dr David Webb, who has carried out research for Headway UK.
"The triumph of the body is poor compensation for the sequestration of the mind, where memory loss, impairment of attention, slowness in processing information, and reduced speed of thought are all common . . ."
The tragedy for the young man who survives a brain injury this weekend through the skill and diligence of everyone from ambulance drivers to neurosurgeons is that he and his family are only then beginning a "long, painful and frightening journey", in the words of nurses at the National Rehabilitation Hospital (NRH), D·n Laoghaire.
For all that, the subject of TBI is almost taboo. Such is its frequency, it has been described as "the silent epidemic of modern times" by Prof Jack Phillips. A recent survey asked young people whether they would prefer death or paralysis (death was the answer) but brain damage never entered the picture. Yet they are 10 times more likely to suffer brain damage than a spinal injury, according to British figures. In the media obsession with fatality figures, these are the forgotten survivors.
Part of the problem is that the classic image of the road traffic victim - the young man in a wheelchair with spinal injury - is powerful and easy to convey. How do you photograph the devastation that may lurk within and around a 21-year-old with brain damage? He may seem physically normal.
But the truth inside each small cubicle, the savage reality of the mother struggling to get a shirt onto her fully-grown son, that funny, generous lad once full of life and mischief transformed to an unrecognisable, dull, fractious child, is bleak beyond words.
"We didn't think he'd survive the first few weeks after the accident," said a woman whose 23-year-old son was seriously injured two years ago. "Between the doctors and ourselves, we dragged him back from the brink of death but when I look at him now, I think, God forgive me, there are worse things than dying."
Nearly 50 and in indifferent health, she has reverted to being the full-time carer of a grown son who has once again become a child. There is no respite care worth the name for him, only a choice between "an old people's home and a mental hospital". The emotional and physical demands have wrecked her marriage.
The devastating personality changes that can accompany brain injury in all ages is like "an unrelenting bereavement" for the family, says Sister Mary Seymour of the NRH. Marie Therese O'Sullivan, a former rehabilitation nurse who has researched the area, found that this grief is never fully resolved and that the mothers continued to search for the "old child" in the "new child".
On top of all this, the lack of social understanding and the scandalous dearth of services once they walk out of the NRH, have isolated her as surely as if she were a social pariah.
But the NRH isn't populated entirely by young men. More than two-thirds of the children under 16 are there because of traffic accidents. They are further disadvantaged because of their "immature brain", says Claire Conway, a senior nurse on the paediatric rehabilitation team in the NRH, "it's almost as if they're frozen in time".
How can that be captured in a photograph? In the meantime, despite the dedication and advocacy of people such as the nurses and medical staff in the NRH and organisations like Headway Ireland (the national association for acquired brain injury), brain injury remains taboo.
There is no national computer database, for example, to gauge the true extent of this calamitous condition which will become more prevalent as survival rates increase.
As long as hard information is not available, priority will always go elsewhere.
Dr Rory O'Connor worked at the NRH before coming to Beaumont a year ago. Many of his patients are only a few years younger than him. What are his feelings about the scenes that confront him day after day? "Anyone driving out of the NRH wears a seat belt and drives a bit slower than when they came in," he replies.
The helpline number for Headway Ireland is 1890-200-278.