by Ajmal Sobhan 21 February 2022
Dr. Khan had just finished his paper presentation at the American Academy of Neurology; the subject: “TBI (Traumatic Brain Injury) and AUD (Alcohol Use Disorder): How one augments the other.” That Traumatic Brain Injury and Alcohol Use Disorder have been linked together for their synergistically adverse effects on the body, has been known for many years. Recent research has further confirmed the lasting effects of trauma and alcohol on the brain. Khan’s research was the latest in correlating the two disorders.
As he stepped off the podium, his cell phone went off. He proceeded to a corner of the room and responded to the call. It was from his wife, Afreen. “Jamal (their son) is at the police station. He was arrested for DUI and marijuana. He hit a guard rail, and was found unconscious. The EMT took him to the ER. After a CT scan and observation , he was conscious , and was released. But the Police took him down to the precinct.
Khan was out of state, but it was palpable to him that his wife was on edge. “How could they release some one who was unconscious at the scene to the hands of the Police” he asked.
“I don’t know, I can’t handle this”, said Afreen.
“I will call our lawyer. How could they ever take him to the precinct if he had head trauma, even if it was mild? I will catch the first flight back. Are you alright?”
“Don’t ask,” continued his wife, “I could always see this coming. Jamal never got the right message. Khan said” Can we have this conversation when I am back home” “No,” said Afreen “ there is never a good time to talk with you” Every time I grounded him, you let him off. You undermined my authority time and again.”
“You were too harsh with him; we both could not be harsh to him,” replied Khan.
Wailing out loud, Afreen said, “Look, what’s happening to our son. He is hurt, he will have a conviction, and he will be ruined.”
Khan remained silent for a while before saying, “I will take care of him.”
Khan went back to his hotel room. He sat back and thought about his son. He had so much running through his mind. Jamal, their only child, had faced troubles before, but this time it was more serious. As he remembered the past, a wave of nostalgia swept over him – of the days when Afreen and he took Jamal back to the old country, of all the love and affection they had showered on him, and all the wonderful times they had together while camping and hiking in Colorado on the North Table Mountains and at Fern Falls in the Rocky Mountain National Park. He stopped reminiscing, called the lawyer, and said, “Allen, this is Dr. Khan. This is about my son, Jamal. He is at the Police precinct close to home, he is in for DUI and drugs.”
“Don’t worry, I will take care of that for you,” assured the lawyer. Jamal was released on a misdemeanor charge, and was directed to perform 100 hours of community service, while his driver’s license was suspended for 6 months.
This was not the first time that Jamal had gotten into trouble. His immigrant parents from Bangladesh had tried to raise him here in the US with the conservative values of their old country, but with little success. In the process of teaching their son the values they themselves held dear, the two parents had ended up confusing their kid. They rarely spoke together from the same page. Jamal, though born in the US with its relatively lax atmosphere all around, had to follow the strict disciplinary ways of his immigrant parents. Any violation led to harsh punishment. Jamal thus ended up receiving mixed messages: one of a free-spirited lifestyle in the US versus another of the conservative upbringing in the old country. While his father was understanding and sympathetic, and tried to reason with him, his mother was always a strict disciplinarian. Jamal was smart enough to manipulate parental guidelines and was able to create conflicts between his parents.
In college Jamal was an above average student, but his personality was that of a follower and not that of a leader. He was not sure where he could fit in. He was sensitive to the color of his skin. He was prone to peer pressure, trying hard to conform to the group-think of the crowd he was a part of, rather than to stand out for himself. He usually stayed away from larger groups, being an introvert, but soon fell into the company of kids who liked hard drinking, smoking grass, and having fun. He participated in several sessions of binge drinking, and hurt himself a few times without even knowing it, missed classes, and started getting failing grades. His attempts at relationship with girls was also awkward. He was instinctually troubled by the ‘ one night stands’ common at the dorms. But at the same time he had a hard time inhibiting the ‘hormone rush ‘ at his age.
The parents were unaware of their son’s downward trend in academic performance. The college did not inform them of his grades due to privacy issues. They finally heard about it from a concerned friend of Jamal’s who attended the same institution. That friend was hesitant to tattle on Jamal, but was bold enough to leave a message on their answering machine: “Things are not OK with Jamal!”
Khan and Afreen had premonitions of what was coming, but were not prepared for what followed. The pair, husband and wife, endured tense moments, but each tried to lay the blame on the other as to why things had unraveled the way they did. Though forceful and strong in his ways and with words, Khan could not intimidate his wife nor prevail over her in such matters. Losing the argument, Khan would often give up and concede the ground to her. Though his Mom was harsh at times, Jamal felt closer to her and felt he could talk with her.
The two parents went to Jamal’s college apartment, found him asleep in the middle of the day. Tons of garbage lay in the kitchen. Cleanliness, that his parents had always tried to inculcate in Jamal, was nowhere to be found around him. They found out about his failing grades; they cleaned up his apartment; and brought him home with them. They knew that something was really wrong, and decided that he needed to take a semester off to get his act together.
Jamal did not resist his parent’s decisions for him. He came home, slept a lot and gradually started being functional again. Khan was rarely home as he was busy attending to his practice, while Afreen spent all of her time nursing Jamal and getting him better again. She noticed something that alarmed her. Even after two weeks of rehabilitation , Jamal was not as sharp as he was before. His speech had a faltering quality to it. And he had developed a fine tremor that led to things falling from his hands. Alarmed, Afreen said to her husband, “ There is something wrong with Jamal. He is not acting right.”
“There is nothing wrong with him, he is just recovering from a bad episode, that’s all. Give him some time,” Khan replied. This was a knee-jerk reaction, Afreen realized, brought about because he did not like what she was saying. He had not even properly examined his own son. She was frustrated. She was dismayed by the fact that Khan never took her seriously. This had been an ongoing battle routine between the two. He tended to ignore her warning alerts till things started getting worse.
When a month had passed by with Jamal losing weight, and with no improvements in Jamal’s cognitive skills, Khan finally realized Jamal’s home-bound rehabilitation scheme was a waste of time. He quickly made appointments for Jamal to be seen by specialists: neurologists and gastroenterologists. After neurological tests and MRI, it was apparent that Jamal had suffered brain damage from a combination of alcohol use and concussion.
The neuro-radiologist invited Khan to the viewing room (imaging), went over Jamal’s MRI scan and said, “ Khan, you know this is serious for a boy of 21 to have such dramatic changes in his brain. You know Alcohol is a neurotoxin in the post-concussion phase.” It was ironic coming as it did from the neuro-radiologist, as Khan was no less an expert on these matters himself.
Khan deemed it best not to treat his own son, or to interfere with his ongoing treatment. Jamal therefore started undergoing an intensive treatment in care of the neurologist. But the family dynamics at home had not changed. Khan and Afreen frequently disagreed on how best to manage Jamal’s ailment – Khan showing more empathy, while Afreen became even more frustrated with Jamal’s increasing rebelliousness. In the process, Khan acquiesced to his wife’s management style, cutting off Jamal’s privileges even more.
Afreen imposed an eight o’ clock curfew on Jamal. Additionally, he was disallowed meetings with even some of his closest friends. Khan felt that these restrictions on his son were too harsh. He beseeched his wife to relent so that Jamal could go out with his friends. He was afraid the near-imprisonment within the four walls of the home would not be good for Jamal’s recovery. Since Jamal was unable to drive by himself, Khan suggested his friends could come pick him up, and go to the movies or to a game. Though Afreen did relent eventually, she warned her husband, “I think we are making a big mistake. I just don’t trust his friends; Jamal is going to get into trouble again, soon.”
To that Khan said, “He is 21. He can’t sit at home all the time.”
Afreen was at her wits end. She had no one to talk with. Her pent up emotions had no outlet. She was hard put to find a good listener among the community of her origin. She was not looking for advice, she wanted some one who would listen. She did have one friend , a local American lady that she had worked with in the past. After listening to her she said “ Afreen , you need to confront your husband if you don’t want to lose this boy of yours”
With the curfew lifted, Jamal started going out with his friends. Realizing it was for his own good, he seemed to be compliant, returning home on time.
Worried about her son, Afreen told Jamal, “Son, you hardly talk with us, you have become so mechanical, we need to know what is going on with your life.”
Jamal kept quiet for a while. But after his mother badgered him more, he finally said, “Mom, I can’t please Dad. I can’t compete with him, and I don’t want to be a doc.”
His mother said, “Son, you don’t have to please Dad. You don’t have to go into medicine. Do what you want to do.”
Jamal told her, “Mom, do you know that Dad started indoctrinating me to get into medicine from the time I was 12 years old? All that I have been hearing him say is, ‘Son, I am a Doc; you have to carry on my legacy; I came to this country with little and I became a well-known Doc. I want you to be better than me.’ His obsession with medicine, and his constant badgering that I need to follow his footsteps have led me to develop an aversion towards Medicine.”
“Jamal, your dad does have great aspirations for you. But you don’t really need to follow in his footsteps. Just do what you like best, but try to become the best at it,” his mother consoled.
Jamal expressed his wish to his mom that he liked community work He said he would like to work at the homeless shelter and at the Food Bank, where he had worked before as his court mandated duty. His Mother started to dutifully take him over to these places and pick him up at the end of the day.
His father was hardly pleased with this arrangement. He told both of them, “Helping others is fine. But when will you start helping yourself? You need to be gainfully employed, you need to stand on your own feet.”
On most occasions, Jamal would ignore his father’s lectures and stay quiet, but his father’s words affected him adversely. He could not understand how an immigrant like his father would be so lacking in empathy. He realized that his father was ashamed of him and of his failures. While some of Khan’s colleagues’ children were finishing Ivy League schools, Jamal was still at home. Jamal’s sense of failure was an underlying current that prevented him from focusing on his academics.
One day, Jamal’s friends called and asked if he would like to spend some time with them. His routine for the day at the Food Bank was just then over. At the outset, he wasn’t all that keen to go out with them as he suspected his friends might be wanting to drink. But he decided to go anyway, hoping to abstain from alcohol. He certainly enjoyed their company. He was also eager to get to meet his high school sweetheart whom he had broken up with several years earlier. As it turned out, Jamal was just not able to avoid temptation – he drank, he smoked, and he eventually ended up staying the night at his friend’s home. His mother came to pick him up. She shielded Jamal from his father’s wrath by lying to him. Sadly, soon after this, Jamal was back to drinking and doing drugs. This was within six months of his auto accident that had left him with a concussion.
Saddened by their son’s relapse, his parents took different attitudes to their son’s fall from grace. His mother continued to take care of Jamal as an addict and an alcoholic. But his father could not fathom the depth of their son’s depravity, his lack of will power and tenacity. He could not believe that someone could destroy his life by pursuing a path of substance abuse. His wife’s refrain notwithstanding, Khan continued to castigate Jamal for his weakness and lack of moral character. Though Afreen was acutely aware that Jamal was entering a state of depression associated with poor cognition, his father, busy with work ‘saving lives,’ was oblivious of his own son’s downward spiral. Afreen confronted him and said, “Do you realize that we are losing Jamal? He is not well. He is depressed. He is faltering and is developing a speech impediment. For once, can you forget about yourself and look at Jamal and show him some unvarnished love? Love is not about doing, it is about being. Love is about expecting nothing in return. Do you understand that? Are you going to help your son or are you going to watch his self-destruction?”
Khan was eventually persuaded that the state of his son’s illness was serious, that his own expectations for his son were selfish and that his attitude had been self-centered. Soon after, Khan and Afreen admitted their son to a Rehab Institute.
Jamal stayed at the Rehab for less than a month, and was discharged on medications. His parents were warned that Jamal might be suicidal. But under a watchful engagement, they said, Jamal would show improvement and would therefore no longer need to be an in-patient at the Rehab. Khan and Afreen became worried by the knowledge that their son harbored suicidal tendencies during his stay at the Rehab. They protested the planned discharge of Jamal from the Rehab, but their concerns were overruled.
Returning home, Jamal was on his best behavior. He complied with all instructions given by the Rehab as well as by his parents. He stayed mostly home, often surfing the internet, and occasionally going out for walks. His mother still worried about him. She felt he was behaving rather too well. She had a sense of nervousness with regard to him. Khan did not have the same worry, though. “You are getting paranoid,” he chided his wife. “He is fine now. Let him be as he is. Let him grow his own wings.”
Around 2am one night, they heard an unsettling “pop” noise. The sound emanated from Jamal’ s room. They rushed to the room. The door was locked from inside. With Jamal not responding to their screams to open the room, Khan broke open the door and found that his son had shot himself. He had aimed at his head with his father’s hand gun; the bullet had fractured his skull and had ricocheted off the wall. Jamal lay unconscious with severe bleeding from his scalp. The paramedics had hauled him away to the ER. He underwent emergency surgery. Luckily the bullet had not penetrated the brain. The concussion left Jamal even more vulnerable.
Though Jamal survived his attempted suicide, his condition remained unstable. After the physical damage was dealt with, he was admitted again to the Rehab Center. The Rehab Center had good psychological/ psych-counseling as part of its overall armamentarium. Jamal stayed there for three months, undergoing intensive therapy together with medications for improving his cognitive skills. He made remarkable progress. His cognitive skills became sharper over time. He told his Mom, “ the local gym is offering yoga and meditation classes, I would like to try it out.
“Ok”, said his mom, “if that is what you want to do.” A few days later he came back dejected, and told his mom : my joints are stiff and I cant focus when I close my eyes”
He finally had the courage to ask his father “ Dad, would it be possible for us to go back to the old country and spend a bit of time. His Dad thought about it and said “ Sure , Jamal “
Khan took a leave of absence from his work. He and his wife took Jamal back to Bangladesh, just as Jamal had desired. Their son now could reacquaint himself with the family roots, they thought. Also, relocating him for a while in a rural setting away from the hustle and bustle of city life would do him good, they figured. Jamal was eager. They visited a community center in Khan’s village where there was a vocation center, and also a health clinic. Jamal was very impressed with the work done there and asked his dad whether he could stay back as a volunteer. Afraid of their son’s tender health, Khan said “If you want to stay here, we will stay with you.”
Not too far from the community center was the University Hospital and the Medical Center. Khan applied there for a position as a Neurologist, and was gladly accepted; his expertise was welcome there. Afreen also found work in Adult Education at the Community Center. A house was hard to find, but they found a small one with lots of help.
Jamal was deeply satisfied with his work with children, teaching them English and computer skills. His cognitive skills improved. He joined a local drug rehab center which followed a twelve-step program. The three of them decided to stay for a year and continue their association with the Community Center and the hospital where Khan became part of the Faculty. They knew that it was temporary solution, that they would return to the States, and face reality, which would be a true test to their resolve and commitment.
On returning to the States , Khan and Afreen chose to undergo counseling as their marriage had shown increasing signs of disintegration during these stressful times. At the conclusion of these counseling sessions, after listening to both sides, the counselor made it clear that Khan was indeed a man with a larger-than-life ego, always trying to control situations, no matter how trivial. But the Counselor also made the observation that Afreen was too harsh on her son at a personal level It was not easy, but through long periods of discussion and contemplation, Khan agreed that he needed to change his attitude toward life – as a professional, as a husband to Afreen, and as a father to Jamal. He accepted that all his personal accomplishments in life as a reputed doctor would truly be meaningless, if he ever were to lose his family. Afreen consciously strived to control her reactive nature and tone.
Coming to Afreen, the counselor observed that she had been very harsh towards their son.
The counselor asked both the husband and the wife, “Well, do you feel that there still is any life left in this marriage?”
Khan’s response was sincere and immediate. “Yes, there is.”
Afreen, discomfited and unsure of herself, sat quietly for several minutes before saying, “I don’t know yet. But, I am not ready to quit.”
“Look, you two are the only ones who can save this marriage for yourselves. No one else can!” advised the counselor.
After their counseling session, Khan fell into regret about his decision to settle abroad. He called a friend whom he knew from school days. He expressed his emotions in an uninhibited fashion. He ended by saying, “Maybe I should never have gone abroad. Maybe I would have been a better husband and a father if I had stayed back.”
His friend said, “Don’t be ridiculous; it would have made no sense for you to have wasted your time here in those turbulent times. You made the right decision, and did your best. Don’t be guilt-ridden by the outcome. Put some space between you and situation at hand. You have always tried to be in control. But, you are not in control. Afreen is an adult and so is Jamal. Learn from your mistakes and apply yourself , but don’t grovel. Don’t be a prisoner of your mind or your profession. Apportion more time to the family. You will be fine even if things don’t work out as you envisioned it. Khan took his friend’s counsel to heart. Distancing himself from his thoughts was not easy for Khan. A man of high discipline and work ethics, his profession demanded good outcome for due diligence. That a bad outcome is possible, regardless, was beyond his ability to fathom. In the Morbidity, Mortality Meetings at the Hospital, intense scrutiny always would detect cause of complication or death. Most of the time it was borne out of human error. He was used to such Analysis,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Jamal remained partially disabled. His cognitive skills continued to improve, though his body remained fragile. His addiction problem stayed with him – to be dealt with the help of experts. It was apparent that his future would be not what his father had envisioned for him; but it would be one that Jamal loved and cherished for himself.
Khan and Afreen patched up their marriage as best as they could. They had invested a lot in their marriage. In the social norms of their community , the idea of separation and divorce is anathema. Those that did end up going their own way, faced a community that was judgmental , and more so towards the female. She usually ends up with a sense of isolation.
Afreen knew this very well. She had faced a husband who was so enamored by his skill as a doctor, as a man of medicine , he had the persona of God incarnate. He almost gave the subliminal feeling that “ how can you not believe I am right, I am a doctor . It was not cold blooded or deliberate but it came from his focus on the principles of medicine: if you do this, that happens. But he was bereft of certain human emotions that had to with blunders, fallibility , and wrong doing.
On the other hand Khan felt that his wife dealt with their son in a harsh fashion , in the tone of her voice, and the exemplary punishment that she would hand out. As it happens among many couples , neither felt that they were wrong. But they both felt in their own ways a responsibility to see Jamal get better and adjusted. They understood the added trauma on Jamal if they were to go their separate ways. Neither wanted that.
Was a strained relationship better than no relationship. Neither were sure about that. But in persevering to help Jamal , if they could both bury their ego to a certain degree , than there was a chance that it would not only be beneficial to Jamal , it could also help them repair a relationship . That epiphany was still not forthcoming to either. One can only surmise where this would all end up. Jamal’s future lay more in his own hands than his parents. Yet, the parents felt sincerely, that they could still make a difference.
The immigrants story is exhilarating at one level and deeply conflicted at another . The values of the old country and the cultural traditions of the new, often come to loggerheads. In dealing with their son, Khan and Afreen came face to face with these realities. The reality was tearing them apart . What lay in the future was as much enigmatic as it was uncertain. A lot of immigrants burn their bridges once they set sail for distant horizons. More than Khan , Afreen knew that there was no going back , were she to return alone. She would be isolated if not vilified, for not being the “good” wife. Her own parents alluded to it when they heard of the difficulties they were facing. Her mothers advice “ be attentive to your husband, and Jamal. Your husband is a busy Doctor, he has no time to spare”.
If she had her druthers, she would try her luck here in her new found country. Not among her own tight knit community( of immigrants from Bangladesh) but among the society at large who would not hold back because she had a failed marriage. At the same time, she was not there, yet. She wanted to try a bit harder for the sake of Jamal as well for themselves. Khan was finally coming to the realization that he was not in control, his aspirations for Jamal was unrealistic, and the only way he could hold on to his family was by letting go. Khan, Afreen, Jamal , all had work to do. The future was uncertain, as it often is, but there was a glimmer of hope if not a silver lining. It would be unfair to call it a dysfunctional family. There was no overt abuse, and no addiction among the parents. But there was lack of spontaneity, openness and understanding. The sense of isolation and the inability to share the torment created a vicious cycle. Both Khan and Afreen were keenly aware of their shortcomings. Whether they would be able to overcome the hurdles, for their own sake and that of Jamal remained an unanswered question.
PS Traumatic Brain Injury patients who continue to consume alcohol , progressively loose their cognitive skills , are more prone to further injuries , acute depression, and suicidal tendencies.