Sophie Papp and her family had a ritual for the recently departed. Whenever a relative died, she and her brother and cousins would all squeeze into a car and drive to Koksilah River, an hour north of their homes in Victoria, British Columbia. There, they would spend the day swimming in the glassy jade water, letting the current drag them along the squishy riverbed and gazing at the native arbutus trees, whose red bark peeled like crinkly snakeskin. After her grandmother passed away, Sophie—a sweet, reserved 19-year-old with gray-blue eyes and freckles—joined her younger brother, her cousin Emily, and a close friend for a drive up-island. It was September 1, 2014.

On the way, the group made a quick stop at a Tim Hortons for coffee and breakfast. That’s the last memory Sophie has of that day. About 45 minutes after the stop, Emily, who was driving, spilled her iced coffee. Her attention slipped from the highway, and she lost control of the Volkswagen Golf. The car skidded across multiple lanes in both directions before somersaulting into a ravine on the opposite side of the road.

Of the four, Sophie was most severely injured in the crash. At the crash site, EMTs gave her a score of six on the Glasgow Coma Scale, indicating profound brain trauma. She was rushed, unconscious, into Victoria General Hospital’s trauma center, where doctors and nurses worked to save her life. After a week, she emerged from the coma.

In her second week at the hospital, Sophie’s convalescence began to assume perplexing qualities. Just days after regaining rudimentary communication skills, she was engaging in extended, in-depth conversations with everyone around her. “One day she spoke a sentence, and then not long after, she was talking endlessly, about everything,” her mother Jane recalled. Sophie asked staff how old they were, whether they had children, what their most interesting cases had been. She slipped effortlessly into sincere, heartfelt exchanges with the floor’s nurses’ aides.

One morning, she had an appointment with a radiologist to discuss MRI scans she’d taken a few days earlier. With her mother at her side, Sophie interjected with one question after another. “Are any of the lesions in the cerebellum?” she asked. “Has an fMRI been done? What about the thalamus, fornix, and pons? Have they been affected?” The radiologist paused, and his furrowed brow and sharp eyes slid over to Jane, briefly, before turning back to Sophie. “How do you know these things, Sophie?” he asked. In the days before the appointment, Sophie had convinced her father to borrow several books on neurology from the library. After he dropped off the texts on neuroscience and brain anatomy, she “read away into the night,” she remembered.

All her life, Sophie had been a “fairly introverted, cautious girl,” Jane remembered. As her time at the hospital progressed, though, that young woman faded more and more from view. When a nurse went through the neurology wing and marked each room with colored tape, Sophie snuck around and mischievously peeled all the tape off. One night, after most of the patients had gone to sleep, she wheeled around the floor and changed the dates on all their whiteboards to December 24. When a technician explained that he would be doing something called a “propeller rotation” while she was in the MRI machine, she told him, “It’s not a helicopter, so fuck you.” She found one of the neurosurgeons who made rounds on her wing handsome, and she asked him out on the spot. With intense sincerity, she queried one of the physicians on her care team about where the source of consciousness lay in the brain. “She was really, really social, and that wasn’t the Sophie that we knew from before,” Jane recalled.

Sophie’s doctors believed that her traumatic brain injury (TBI) affected her executive functioning, including her inhibition control. The result was a more disinhibited person—one who acted freely, spoke effusively, and approached others with a directness verging on audacity that her old self wouldn’t have dreamed of employing. The metamorphosis wasn’t limited to the way she communicated with others, either. In her monthlong stay at VGH, Sophie grew more emotional than she’d ever been before. An even-keeled girl during most of her adolescence, she rose to a boil quickly that September, tumbled into the undertow of powerful mood swings, and broke into convulsive crying jags.

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