This is a case of a 14-year-old male who suffered a severe traumatic brain injury. His narrative is derived from follow-up over an interval from 1-week postinjury through 33-year postinjury by virtue of participation in a 24-year prospective longitudinal study follow-up study and further outreach for this chapter. This chapter summarizes his postinjury course from age 14 to 47 years of age. In contrast to the famous case of Phineas Gage who came to represent the classical poor outcome after traumatic brain injury, we have named him Phineas Re-enGage to emphasize his fluctuating but primarily sustained positive quality of life changes in multiple domains of function that occurred after 11 years of severe postinjury psychiatric, socio-emotional, and occupational dysfunction. The chapter discusses biopsychosocial aspects of the outcome of pediatric traumatic brain injury.