In December 2014, after a day of gambling in Atlantic City with colleagues, Steve Mishkin, a mathematician from Brooklyn, New York, somehow fell on a train platform, hit his head, and suffered a catastrophic brain injury. The injury could easily have been fatal. But Mishkin recovered—remarkably so, for reasons that are as uncertain as the events that led to his injury. In “The Brain That Wasn’t Supposed to Heal,” published in The Atlantic on April 7, 2016, science writer Apoorva Mandavilli details the many “ingredients” that likely contributed to Mishkin’s recovery from his traumatic brain injury, or TBI. These included speedy treatment by one of New Jersey’s top neurosurgeons; admission into one of the nation’s best rehab facilities; long-term disability and health insurance that relieved financial stress during his long recovery; Mishkin’s own good health, education, and financial resources; and his wife’s training in psychology, which helped her plan for his recovery. “Steve’s path back to normalcy has not been easy,” Mandavilli writes, detailing his struggles and setbacks. “But many other people with similar injuries have tried all of these things, with much less effective results.”
Reporting the story, Mandavilli says, required piecing together a detailed medical narrative, investigating a stubborn mystery, diving into an unfamiliar neurosurgical research literature, and finding ways to maintain journalistic distance while reporting on deeply personal events in the lives of friends. Here, she tells TON editor-in-chief Siri Carpenter the story behind her story. (This interview has been edited for length and clarity.)
How did you learn about Steve Mishkin’s brain injury and recovery?
Amber Mishkin is a friend of mine. We don’t see each other very often, but our kids are about the same age, so I’ve known her for a few years and I knew that Steve had fallen. They were actually supposed to come to our house for a Christmas party a few days after he fell. She told me about it almost as soon as it happened, but I didn’t know any of the details.
Did you suggest to Amber that you might write about what happened, or did she approach you about it?
Initially Amber actually asked me if I knew any science writers who would be interested in writing about Steve’s story. I really had no idea how severe his injuries were. I’d seen photos of him on Facebook, fully recovered. I knew he was going back to work. Not knowing any of the details, I thought it sounded just like she wanted someone to write about how miraculously he recovered. I didn’t think it was necessarily the kind of story that I would write myself, because I don’t do that kind of thing. I said, “OK, why don’t I just come meet you and then I’ll see who among my network of science writers might be interested and I’ll connect you.” I took a day off, took my recorder over there, and we talked for several hours. And by the end of that, I knew I wanted to write it.
What changed your mind?
I didn’t really have a sense of how badly off he was, and how it was actually sort of crazy that he recovered. And then when she told me that the surgeon had said she removed some big chunk of [Steve’s] frontal and temporal lobes, that was another big flag. And then, I’m not going to lie: I was really intrigued by the whole weird mystery of how it all happened.
What were your first steps in tackling the story?
Even though I trust Amber and she’s a pretty scientific person, I just wanted to make sure that what she had understood to be his situation was actually real. So my next step was to contact the surgeon. I set up an interview with the surgeon, who was lovely, and she came to Manhattan and we talked for hours. She just gave me so much information, and then she shared her surgical notes with me. She sent me the documents from the ER. She sent me a lot of supporting information and it confirmed everything that Amber had said, and I discovered even some deeper things about the surgery. It’s just really clear that this was an unusual case.
How did your ideas about the story change as you reported it?
Honestly, when I started, I didn’t know what the story was. I didn’t know how I was going to tell it. I didn’t know who I needed to talk to. I thought that it was going to be a story about traumatic brain injury in general—Steve was going to be an anecdotal lede, and then the story was really going to be about the science of traumatic brain injury. And then I also thought, maybe what I’ll do is I’ll talk to five or six people with different kinds of injury and then I’ll build a story together, in an anecdotal way, [showing] all the different elements [that can contribute to recovery from TBI] and how they’re predictive or not predictive. That didn’t really end up being what I ended up with, either.
The central point of your story is that Steve’s recovery from his traumatic brain injury was made possible by many different “ingredients,” including luck. How did you come around to that idea?
That developed over time. As you can imagine, it’s better if you can find the one thing that helps. I spent a lot of time trying to find out if there was that one thing, and I kept hitting up against dead ends for quite a while. I kept finding out that nobody knows what the heck happens in TBI—nobody knows why somebody recovers and why someone [else] doesn’t. I had a couple of great quotes from another of the doctors that I didn’t end up including, who said things like, “Sometimes a person on an airplane has a water bottle fall on their head, and they’re never the same again; and then there’s a person like Steve who had been completely bashed up and he’s fine.” There’s just no way of telling, and that became clearer as I kept reporting the story.
The story relates the many different aspects of Steve’s treatment and circumstances that probably contributed to his recovery. You write:
Once [Steve] was injured, a series of events fell into place in just the right way: Paramedics brought him in from the train station where he fell to the hospital within minutes of his injury. The neurosurgeon on call that night happened to be one of the best in the state, and made bold decisions borne of her decades of experience. After Steve emerged from his coma, he gained admission into one of the best rehab facilities in the country, one that specializes in cognitive recovery. At the time of his injury, Steve was a 44-year-old mathematician in the best of health, and his body and brain responded beautifully to every treatment. For the crucial first six months after the injury, his job afforded him long-term disability and health insurance that kept his family free of financial stress. Amber had trained as a psychologist and redesigned their lives around Steve’s recovery.
How did you assemble all these puzzle pieces?
In the story, it’s all packaged in this one nice little paragraph. But really, each of those things is like a little strand that I had to follow. It wasn’t obvious to me at the beginning how many of those things were crucial. I knew nothing about TBI starting out, so every single thing was a possible rabbit hole. I could have spent dozens of hours on each one. For each of those things, I had to do a lot of research and talking to experts and trying to figure out what we know about each particular aspect. It really helped that my first very intense interview was with the surgeon, because I think she really is the reason that [Steve] is so much better. If you had to pick one [factor that led to his recovery], it was her decisions. I had all of her information, and I was able to take that and then vet that with other people and say, “OK, what about this piece, and what about this piece, and what about this piece?” Over time, certain things floated up to the top.
You provide a moment-by-moment reconstruction of the brain operation Steve underwent the night of his injury. Did you get those details from the surgical notes, or by asking the neurosurgeon, Lauren Schwartz, to walk through every single moment?
Both. I had hours and hours of interviews with her, but I also had her notes, which were very detailed, but very jargony. [In interviews,] sometimes she would mention a word and I didn’t even know exactly how it was spelled. But I didn’t want to waste her time. So I would look it up and try to understand what she might have done, and then I would go back to her and say, “You mentioned in the interview that you did X.… Is this what you meant?” I would send her descriptions of what I thought she might have been trying to describe.
At first, I was really taken with the idea that I would find out what happened to Steve. It was just so intriguing and hard to give up.
The circumstances of what exactly happened to Steve remain a mystery. The colleagues who were with him at the time have offered incomplete or conflicting stories about the events leading up to the fall, and surveillance video taken on the PATH train platform where he fell is inconclusive. Did you try to solve that mystery?
At first, I was really taken with the idea that I would find out what happened to Steve. It was just so intriguing and hard to give up. I thought that because everybody [I talked to] was so intrigued by the mystery, that that should be a really big part of the story. I saw the video. I got the police report. I spent time talking to the casino, talking to PATH, talking to all kinds of people. I met one of the guys [who was there with Steve], I talked to another one on the phone, and the other two refused to talk to me. And I didn’t really know where else to go with that. That was very disappointing and discouraging, because I had this idea that I could get them to tell me some things, and something would suddenly click, and it would be clear what happened. I spent way too much time trying to figure that part of the story out—a lot of wasted effort. I discovered that I really do not know any of the tricks that investigative reporters have. I have real respect for investigative journalists now. I really had no idea how hard it is to get information out of people who don’t necessarily want to talk, and to find public records.
It was really hard to keep pulling myself back from that and say, I know that everybody wants to know that, but (a) I’m not an investigative journalist and I didn’t really feel equipped to handle it, and (b) that’s not my goal. I really wanted to tell the science of the story. It was a tough decision, but I also don’t think I had a choice in the end, because I was just coming up against a brick wall.
In describing the night of Steve’s injury, you write:
Around midnight, they left the casino for the parking lot, but Steve went back in to use the bathroom and then returned to the car.
That’s the last thing he remembers.
Trying to piece together what happened next is an exercise in futility and frustration. Two of the four colleagues declined interviews, and have been uncommunicative with Steve and Amber. The other two offer variations of the same story. Both agree that the men drove through New Jersey in their rented car, listening to ‘80s music. Depending on who’s recalling it, Steve was either falling asleep and not tracking the passage of time, or awake and talking. [Later], Steve was either asleep and had to be woken up, or was fully awake but tired. On the way down into the station, the men might have been running to catch the train. Or not. Steve might have fallen on the escalator. Or not. While on the platform, Steve might have tripped over backwards on a bag. Or not. He might have said, “Oh guys, I’m going to pass out.” Or not.
How did you end up deciding to handle the uncertainty of what happened in that way?
I really struggled with writing that part. I was trying, at first, do it in the traditional way: I was trying to think of “What do I know really happened?” and putting that in. And I kept finding out: I don’t really know if that happened. And then in one of the many frustrating attempts at writing that sentence, I wrote, “Or not.” I kind of liked the way that sounded, and then I sort of kept building on that: What if I acknowledged maybe that happened, maybe it didn’t—I don’t know. That actually really captured my own discomfort with the vagueness of it all, and I thought, “OK, I’m just going to give the reader that whole thing and they can make of it what they want.” I wanted to convey the sense that something sketchy happened, but I also didn’t want to completely damn those men, because I don’t know if they were really involved.
Having it be a source who’s a friend was very hard…. The usual walls that you have to maintain were all so much more complicated this time.
What were the biggest challenges you encountered in reporting and writing this story?
Having it be a source who’s a friend was very hard. I know that Amber really, really wanted to find out what happened, and it was very complicated to be talking to these people—these guys that she wanted answers from—and not being able to tell her what they were saying. The usual walls that you have to maintain were all so much more complicated this time.
[Also,] there were reasons that [Amber and Steve] wanted to tell the story. I wanted to honor those reasons, but of course I couldn’t really let their wishes guide what the story would include. I think Amber had a feeling that they’d been wronged, and she wanted justice in a way. But I think also they wanted a positive message out there. Amber told me that when she was struggling with trying to find some hope and some optimism, she would Google traumatic brain injuries and all she would read would be articles about people who weren’t really ever the same, were really still struggling with many, many things. She said she didn’t even know that the kind of recovery that Steve had was possible. She and Steve wanted to make sure that people knew that it wasn’t overnight and it wasn’t easy—they were very sensitive about not overhyping it—but they still wanted the story out there that it was possible.
The other thing that I had to be very careful about was [that] Steve was understandably concerned that his employer not get the idea that he’s somehow compromised. It was really tough to figure out how to be honest about all of the things that have happened to him—and some of the things in there are very personal, like the sexual disinhibition and the aphasia and the panic attacks he’s had. I had to struggle with how much of that to include, to be honest and yet not make too much of them and take away from where he is now, because that’s really what matters for his employment.
Did you show Steve and Amber the story before it appeared in the magazine, or did they see it when it appeared online with everybody else?
They saw it online with everybody else. They didn’t know who I talked to, what the story became. I think that maybe in trying to maintain the lines, I was maybe stricter than some reporters might be. But I just found it to be such a slippery slope that I wanted it to be very, very sharply defined.
How did they feel about the story after it appeared?
They loved it. They are fairly private people, and, like me, there were a lot of other friends who didn’t know the details of what happened. I think in a way this was their big coming out with their story, and they got overwhelming support and love and understanding from so many friends and distant family. I think people finally got what they had been through.
Siri Carpenter is co-founder and editor-in-chief of The Open Notebook. Follow her on Twitter @SiriCarpenter.