I would like to follow up on an earlier post in which I discussed representing a professional who had suffered a traumatic brain injury by providing some examples of these types of cases, and going into a deeper discussion about the difficulties which can arise at trial. RS was a board-certified internist who was injured when a portion of a high-way overpass collapsed onto his car as he drove under, crushing the roof, breaking the windshield and striping him on the head. The physician was unconscious for less than one minute, kept overnight in the emergency room and released the next day. The CT scan administered at the hospital was negative, and follow-up examination with a neurologist over a one-month time period proved uneventful. On return to work, he began to experience difficulties with attention, concentration and the ability to process large amounts of information. Telephone calls would interrupt his concentration, requiring him to go bath and re-read information. Tasks previously completed in an eight-hour day now took 10 and sometimes 12 hours. Fatigue from marathon days overwhelmed RS, and when he came home, he often would retire immediately to bed. During the first four years following the injury, his income not only did not drop but actually increased, though not necessarily in real dollars. While the defendant in RS’s case acknowledged that he sustained an injury, they argued that the injury and its effects had resolved, pointing to the increase in his income as proof While acknowledging that the plaintiff was not malingering, they instead argued that he had an undifferentiated somataform disorder which would improve with proper counseling and medication. Plaintiff’s counsel was hampered by the inability to locate lay witnesses to testify, as, obviously, the doctor’s patients were not informed of the situation. Friends and colleagues also were left in the dark, although they did acknowledge they did not see him as often post-injury. While the above is a compilation of many cases in which I have represented professionals including doctors, attorneys and nurses, the challenges that these clients experience, the difficulties in proving their cases and the comparatively “high” scores on the neuropsychological testing are present in each case. The best case history regarding a mild TBI sustained by a professional was presented by Lawrence F. Marshall, MD, in his chapter entitled “Neurosurgeon As Victim” (Marshall, 1989). There, Dr. Marshall explained: Following the morning meeting, he spent the afternoon touring the mountains of Vail, and while descending one that had only a modest incline, he lost his balance and fell, striking his head. He was rendered immediately unconscious for a period of a few seconds–certainly no more than 10-15… This condition cleared, but a very modest vertigo persisted. This did not interfere in any way with the descent from the mountain and in fact did not interfere with further skiing activities. Upon returning home, the neurosurgeon noted that he was a bit more distractable than was his norm and he had a great deal of difficulty remembering recent events, including particularly the location of objects necessary for work, such as a dictaphone, brief case and keys. List making, in order to call meetings scheduled and tasks to be performed became necessary, whereas they were not necessary before. Referencing articles from memory storage was difficult; authors were frequently transposed and dates incorrectly recalled. Information processing did not appear to be affected, but the ability to attend to a task required a higher level of energy expenditure than previously… Functions judged by others remains good, but is not optimal. The effect of brain injury on the professional also was addressed by Muriel Lezak in her book Neuropsychological Assessment (1995), in the example of a 30-year-old attorney who recently had graduated in the top 10 percent of his law school class. A ruptured right anterior communicating artery aneurysm left him with memory impairments that included difficulty in retrieving stored information when searching for it and very poor perspective memory (i.e., the ability to remember some activity originally planned or agreed upon for the future or keep track of and use needed tools such as memory aids). The attorney entered an organized rehabilitation program which emphasized training to enhance attention-al functioning and compensate for memory deficits. At this program, the attorney learned how to keep a memory diary and notebook which could support him through most of his usual activities and responsibilities. As Lezak explained (1995): What was overlooked was the overriding problem that it did not occur to him to remember what he needed to remember when he needed to remember it. While these cases are extremely difficult, as professionals, attorneys are well-suited to communicate the injuries and their effects to decision-makers including adjusters, judges and, ultimately, jurors. Attorneys often are chastised for failing to understand their clients–they commonly are told they are unable to appreciate the jobs and activities in which clients participate and how the subtle residuals from a TBI affect activities of daily living (ADDS). When representing the professional who has sustained a TBI, it is very easy for the trial attorney to empathize with his/her client. When one’s client talks about difficulty doing multi-task projects and the inability to “keep all the balls in the air,” the trial attorney can appreciate and understand what it is that the client is complaining about. It almost is a “there but for the grace of God go I” syndrome that exists, as the trial attorney is able in this one case to substitute himself/herself and understand the client’s viewpoint, thereby appreciating and speaking from the heart when describing the daily difficulties faced by the client.