Traumatic Brain Injury and Medical Trauma in The Center of Everything

“Lately, Polly thought her mind was a river, constantly scouring and pooling, constantly disappearing, filling with details that glinted and vanished.”

Jamie Harrison’s The Center of Everything follows Polly Schuster, a forty-something mother and editor living in Montana. In the wake of a mild traumatic brain injury (mTBI), Polly is balancing recovery with the daily pressures of parenting, family obligations, and community crises. The novel unfolds during a tense summer when Ariel, a family friend, disappears after a kayaking accident. As the search for Ariel intensifies, Polly contends with cognitive lapses, resurfacing childhood memories, and the pervasive doubt brought on by her injury.

Polly’s mTBI manifests less in dramatic physical deficits than in subtle but pervasive disruptions of memory, attention, and self-confidence. She describes the “fuzziness” of thought, the persistent doubt about whether she is remembering correctly, and the exhausting vigilance required to track her own cognitive lapses. For many patients navigating disruptions in memory and attention, this doubt becomes the most corrosive symptom: is this forgetfulness temporary, or is it a sign of permanent decline?

The novel underscores how medical trauma is not only an injury to the body but also a disruption of identity. Memory and perception are foundational to a sense of self, and when they are unreliable, patients often experience frustration, irritability, and defensiveness. Polly, once quick and intuitive, now finds tasks no longer second nature. Her impatience with herself spills into her relationships, creating conflicts that are difficult to explain to those around her. This reflects a common experience among patients navigating identity disruptions, who may push themselves to appear “normal” to family and colleagues, only to feel invalidated when their invisible struggles are minimized or dismissed.

Harrison places Polly’s recovery in the context of acute stress: the disappearance of Ariel. As search parties comb the river, Polly is simultaneously combing her own mind. Her mTBI has changed her relationship with her memory and she spends most of the story sifting through present doubts and resurfacing childhood memories. The external crisis heightens her internal one, forcing her to confront the fragility of both current and past recollections. What can she trust about her own mind, her own history? The text illustrates how trauma in the present can unearth unresolved trauma from the past, especially when the cognitive scaffolding that normally holds memory and perception steady has been shaken.

Importantly, Harrison highlights how deeply recovery is embedded within broader contexts. For Polly, her injury highlights the impressions her history, family, and her geographic place in the world have left on her. Polly’s injury is one thread in a dense fabric of relationships, responsibilities, and the past.

The invisibility of mTBI, and cognitive concerns more broadly, often leaves patients caught between two worlds: appearing outwardly intact while feeling inwardly disrupted. For Polly, this disruption takes the form of a constant tension between her past competence and her present uncertainty, what she describes as a “river” of thoughts that glint and vanish. For many patients, such invisible symptoms are easily misinterpreted or diminished by others, leading to invalidation. This lack of recognition feeds self-blame and defensiveness. Polly’s internal self-admonishments, such as her frustration with fatigue and her fear of losing credibility, collide with the limited understanding of those around her. The result is a double burden: grappling with the confusion of not fully trusting one’s own mind, while also grieving the inability of others to grasp that struggle.

Harrison, who experienced a minor head injury herself, has described this internal conflict as the most challenging aspect of her own recovery: the fear of forgetting something important, the uncertainty of whether one’s own mind can be trusted. That same unease runs through Polly’s story, shaping her interactions and self-perceptions. For patients with mild TBI, this tension is often invisible to others but profoundly disruptive internally. The erosion of confidence in memory and cognition creates a feedback loop of frustration, irritability, and self-doubt, all of which complicate recovery and strain relationships.

As clinicians, we risk reinforcing this isolation when we overemphasize physical recovery and minimize the emotional and social dimensions of injury. Functional improvement may be the most visible endpoint, but it is not the whole story. When we can appreciate the complex landscape of recovery as an interwoven story of past, present, and future, we can help to expand our patients’ understanding of recovery and their capacity to fully engage in it.

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