“I don’t expect either of them to survive,” the on-call doctor told me as I neared the hospital. Just a few minutes before, I had received a phone call: Motorcycle accident. Two injured. Both with severe head injuries. Upon entering the Emergency Room, I moved toward the first trauma bed and found a man in his thirties who only opened his eyes and moved when painful stimuli was applied. It was hard to tell if his unintelligible vocalizations were due to the trauma or inebriation. Initial workup revealed internal bleeding and a severely shattered femur. I suspected at least part of his poor mental status was due to hemorrhagic shock—something we could treat.
Next, I examined the patient on bed two, a 16-year-old boy struggling to breath. He was even less responsive than the first patient: intermittently responding to pain, intermittently extending his arms in a posture that denotes severe brain injury. He had several facial fractures, evidenced by the blood running from his nose and gurgling in the back of his throat. With suctioning and a device to keep his airway open, he was able to breath on his own. He also had a femur fracture, several lacerations, abrasions, and a puncture wound into the chest. We quickly placed a tube to re-expand his collapsed lung. Surveying his other injuries, I knew his poor mental status was due primarily to a traumatic brain injury. There was little that we could do. We have no CT scanner or advanced Neurological interventions. In a different setting, he would be in an Intensive Care Unit on life support. Here, the best we could do was prescribe some medications to decrease brain swelling, optimize his airway, and tell his parents to expect the worst and hope for the best.
After undergoing surgery overnight, we found the first patient to have significantly improved mental status in the morning. He remained pleasantly confused for the next few days, but eventually his neurological status normalized and he is recovering very well from surgery to stabilize his fracture. His companion, however, remained unchanged. We were amazed to see him still alive, but there were no signs of improvement. Every day we assessed his coma score --measured from 3 (coma) to 15 (normal exam). For the next few days, Kody (name changed for privacy) scored a 6 which denotes severe brain injury. He was teetering on the brink and we didn’t know which way he would go. The many days without improvement predicted a poor outcome, but his youth and the fact that he was still breathing on his own, gave us some reason to hope.
About the fifth day, he started opening his eyes spontaneously. It may seem like a small thing, but it was a big sign of improvement. Over the next week, we started feeding him through a tube into his stomach and he slowly started moving his arms and legs — another huge relief for us. By the third week, he gradually become more aware of his surroundings and could focus his attention on those around him. His parents noted that he would respond to commands and squeeze his mother’s hand in response to her questions. The day that he raised his hand in a wave to return my morning greeting, I knew he would be okay. The only question was the extent to which he would recover. His ability to swallow returned and he was able to eat without a feeding tube. However, his speech remained impaired. He would moan and groan but was unable to speak or make intelligible vocalizations. I could tell this frustrated him as he struggled to communicate his needs. A family member who works at our nursing college asked me about his prognosis. It is always hard to tell how much function will return with brain injuries. Often it takes months to see improvement and determine a patient’s new baseline function. I told her that his recovery so far was miraculous but I didn’t know whether he would recover his ability to speak or if he would have to relearn some skills. She assured me that from the moment of his injury his family had been fervently praying. His grandfather was one of the first pastors in the area and despite the initially grim prognosis, they had not given up hope.
At prayer meeting that Thursday, I asked our missionary community to pray for this young man and for restoration of his speech. That night, I researched communication boards and other adaptive equipment for patients with aphasia. The very next day, his mother proclaimed he was speaking. I didn’t believe her. I thought she was misinterpreting his groans as words. Try as we might, we couldn’t get him to say anything. The following morning, as I walked up to his bed, I greeted him as I had every morning, “Morning, Kody.” “Morning” he prompted replied. I was shocked, amazed, and very excited. That was definitely intelligible speech! Since then, we haven’t been able to get him to stop talking. He rambles on in full sentences, mostly asking for his favorite food: donuts.
Kody is now a month out from the accident and still has a long road of recovery ahead. However, looking at where he started a month ago—on the brink of death, struggling to breath, minimally responsive, with a very poor prognosis—I would say his recovery is nothing short of a miracle. We praise God for his hand of healing and the renewed life he brings. At Easter we celebrate that God can bring life from death and hope from despair. I pray that you may experience a taste of new life and hope this Easter.