Source: The Melbourne Age [Anja Tanhane]

ONE afternoon you're walking home from the station, just on dark. There's traffic around and other people. But in a brief but fierce struggle for your iPod, you take a blow to the head and fall hard on the pavement.

Or perhaps you're at a party and fall off a balcony while drunk. Or have a heart attack that cuts off oxygen to your brain. Or you're a smoker and suffer an aneurysm one lunchtime as you queue for lunch.

You now have an acquired brain injury, or ABI, which is non-compensable — no WorkCover, no TAC. By some miracle you're still alive — neurosurgery was touch and go. But your injuries are severe, and life as you knew it is over.

You are no longer able to speak or walk, to breathe without a tracheotomy, to purposefully move your limbs or control your bowels. Instead of food and drink, a peg tube delivers nutrients straight to your stomach. Your limbs contract and require daily splinting, Botox injections, regular physio.

The speech pathologist and doctors review your "trachy" from time to time and, after many chest infections and trips to emergency, there comes a day when it is finally taken out. You still cannot speak; sometimes you make a howling sound when in pain.

Your world might as well be in a different universe from the rest of us. You recognise your family, your partner, your favourite music. Or, at least, it seems you do. Sometimes, when someone speaks to you in a soothing voice, your breathing slows and your face relaxes. You're hypersensitive to touch and sound, and often startled in the noisy ward. People still call you by your name, but what exactly is left of you? If you're lucky, you have little awareness of just how much you have lost.

You struggle through physio sessions. Nurses have to dress you. You throw up, lie curled up facing the wall, seem to look right past people. But, slowly, that contracted right arm of yours can be extended a little, your trunk control improves and — with help — you sit up.

One year post-injury, a small miracle: a pet therapist comes to visit with her playful border collie and you sit up unassisted, smile and pat the dog. Perhaps the smile is more a grimace, but still it warms the hearts of those who see it.

Your past is gone and your future isn't looking great. Soon you will leave your slow-stream rehabilitation unit and be sent to an aged-care home. There you'll receive the nursing care you need, and sometimes you might be wheeled into the lounge room during the old-time singalong, but it's not exactly Eminem or Radiohead. Your family is heartbroken, but what can they do? There's nowhere else for someone like you to go.

How much of you is left? Or is that the wrong question to ask? With all your impairments, you're still someone with a personality, likes and dislikes, fear, joy, grief and boredom. You'd probably like to go out into the community more, to not feel so locked up and excluded. You seem to enjoy working on a woodwork project when you get the chance, or helping to cut up a few vegetables in cooking group.

Today you're in a music group on the rehab ward, with people your own age. You have brought along your Killers CD, and the therapist is playing the song you chose, which is written down in your file as your favourite. You smile at people, tap your foot, seem to come alive a bit. Other people in the group are enjoying the song as well, and give the thumbs up sign. The patient next to you reaches across and takes your hand for a moment, and you look at him and smile. You have shared something of yourself, of the person you used to be and the person you are now.

Your friends no longer visit. Your partner hasn't been in for months. Only your family has stuck by you, putting their own lives on hold. After two years of this they're exhausted, and well-meaning health professionals keep advising them to take better care of themselves.

But how can they, when you are like this? Even now they feel shocked, in disbelief at what has happened to you, and their pain seems to grow more intense, if anything, as they are forced to contemplate your future. They are wondering about putting you in the same nursing home as your grandmother, since it is by far the best one around.

And you, who have lost so much already. You missed your chance at the extensive rehabilitation you needed early on, when it would have benefited you the most, because the waiting list for funding was too long.

Maybe the nursing home will do its best for you, but the activities it offers are designed for people 40 years older than you, the staff are not trained in rehabilitation, and your computerised communication device will probably flummox most of them.

The potential you had for further improvement, to enjoy activities that matter to you, to interact with people your own age, will not be fulfilled.

Your life will still have its moments of joy, especially if someone remembers to visit you with their dog, but without the hard and specialised work of teaching you how to do as much as possible for yourself, it is likely you will become increasingly dependent, bored and isolated.

Anja Tanhane is a Melbourne writer and therapist who worked for several years with people with acquired brain injury.