Life before the brain injury was busy. Ray was on the move all the time. He worked in the automotive industry for a supplier and was in Mexico, Canada, or China more than he was at home in Michigan. 

In 2008 we were living in Northern Michigan but had to move to Texas for employment.  After we moved back to Michigan, we purchased a small log cabin “up north” and this became our happy place when Ray wasn’t working. We would spend time snowmobiling in the winter, making bonfires in the fall, and river tubing in the summer. I work as a travel agent, so we also tried to go on vacation as much as possible. Usually, we’d travel to somewhere in Mexico, but we had also been to Ireland the last couple of years. This past year we made it to Aruba, which was a bucket list trip for me, and there was never a dull moment.

On the Thursday of our trip, we signed up for an excursion to ride four-wheeled electric scooters. They were built for the military by an Israeli company and were virtually unflippable—or at least they were supposed to be.

We rode for almost three hours and were on our way back to end the excursion. Ray was riding behind our guide, who was some distance in front of me. They went around a curve about 300 yards from the entrance to the excursion company. When I came around the corner, I saw our guide was on the ground next to Ray, holding Ray’s head in his t-shirt. He turned and yelled to a co-worker to call an ambulance.

Many strangers stopped to help. They moved me out of the way and helped load Ray onto a stretcher and into the ambulance. Ray does not remember anything from the accident. He was not talking, just trying to take his oxygen mask off. Meanwhile, I was standing there in a wet bathing suit and cover-up before someone eventually gave me a blanket to wrap myself in. From the way Ray was breathing while unconscious on the ground, I already knew things were going to be bad. Somehow, I stayed calm and focused, waiting to find out what the next step would be.

At the hospital, I was told by the doctors that Ray had received a full body scan, and while they found no internal injuries or broken bones, he did have a severe traumatic brain injury (TBI) that could possibly be fatal. He was conscious at this time but heavily sedated. They told me they needed to completely sedate him and place a breathing tube.

The doctors pulled me aside to discuss what was happening. I asked the neurosurgeon if he could put in an ICP monitor to measure the pressure inside the brain, and he said they did not have the capability in Aruba to provide this kind of care. He mentioned that they normally send these kinds of complicated patients to Colombia. I am going to guess my facial expression said what I was thinking and another physician jumped into the conversation. This doctor had spent eight years as a Neuro-ICU doctor in Belgium and she was very clear she knew what she was talking about and how important it was to get to a more specialized facility as soon as possible. Unfortunately, Michigan was too far away, and Miami was as far as she would let him fly. 

***

The next morning, I saw my husband surrounded by machines and he looked like he had been in a boxing match. His face was swollen, his eyes were purple, and he was connected to a ventilator. He also had a C-collar on his neck for the only broken bone found—a chip at the base of his skull. While I was standing there in shock, the nurse kindly handed me a small plastic bag with Ray’s wedding ring. 

Within a few hours I was notified that the insurance company had arranged a medevac flight and that we would be on our way to Miami that afternoon. Jackson Memorial Hospital (JMH) said they had a bed available and were waiting for our arrival. When the medical flight crew, who I believe were a respiratory therapist and an ICU nurse, arrived at the hospital, things started to feel very black and white. I was asked if I understood what was happening and what the possible complications were with flying Ray to the United States. They were very direct and stated there was a chance Ray’s brain could herniate in-flight and there would be little to nothing they could do for him, but staying in Aruba was just not an option. I was taken to the airport with my carry-on sized suitcase and Ray was taken by ambulance to the plane. You know it’s a small island when the same ambulance crew that picked him up from the scene of the accident also delivered him to the airplane. 

Once our plane arrived in Miami we were taken to the JMH by ambulance. It felt like a scene from a hospital TV show as we arrived at the trauma bay, with its glass doors opening and the EMTs wheeling in the patient on a stretcher, and the flight crew following  behind them. Even further behind was a woman with some luggage and no clue where she was or even what her name was. The patient and stretcher were whisked away behind a sea of green scrubs, with at least 35 to 40 interns all angling to see what they could learn from this experience—an experience which became more and more surreal with each step.

***

On the third day of our six week stay at JMH, Ray started to show increasing signs of stress after a resident came in and did a physical examination to test for a pain response. I was asked to go to the waiting room for a short time. Forty-five minutes passed and no one had come to update me, so I started having a complete meltdown. Eventually I went to find someone to tell me what was happening. I found out Ray’s brain pressure numbers started to increase so they took him for a CT scan. Everything was fine with the CT but the fiberoptic cable for the ICP monitor had gotten bent and was not showing accurate numbers. It had to be wrapped for support, and Ray calls this time his “Teletubby” stage.

The following Monday morning I met the doctors who would be working with Ray for the next few days. The nurse practitioner who worked with the neurosurgeon covering Ray showed me his brain from the CT scans. She was straightforward and said that in most patients they would expect this to be a fatal injury. Because Ray’s Glasgow Coma Scale (GCS) score was only 3, the lowest possible score, he was diagnosed with a severe TBI.  They explained he had more than three locations of his brain affected, and they were going to try and save “what was left.” I appreciated their honesty, and I was not delusional regarding his possibility of recovery. Still, I asked if the fact that he was so heavily sedated could have anything to do with the low GCS score. Plus, he hadn’t gotten worse, so wasn’t that a good sign? The team did acknowledge that the sedation could in fact be contributing to his low GCS. I also knew my husband and his personality, and I felt that this personality and his determination would be huge factors in his recovery. The team was noncommittal whenever I asked them about this, though, as they said they were unaware of anything that suggested personality played a role in TBI recovery.

Over the next couple of weeks I learned so much about all the machines and how Ray responded to the different medications and treatments. In addition to the breathing machine, he was on a cooling system that kept his temperature normalized. A couple of the doctors were very kind and took their time explaining things to me. I learned about how TBIs “normally” progress and how the first 10-14 days are vital to monitor for swelling and bleeding. Whenever I pointed out patterns I noticed with Ray or gave them background on his health, the nurses were very supportive. The doctors, on the other hand, were a bit skeptical at first, but they came around to see I was able to help when they were not always there to see subtle changes. 

Meanwhile, the University of Miami Health System (which is affiliated with JMH) had a research study in progress called Electrophysiologic Biomarkers of Consciousness Recovery after Acute Brain Injury. They asked if I would consent for Ray to be a participant and I was more than happy to help. They connected him to an EEG monitor and came in twice a day to have him listen to music and recorded commands as a way to look for brain activity that was clinically undetected. Unfortunately, Ray was so medicated and paralyzed as part of his medical treatment (to accommodate the cooling system) that he did not show any response, or at least none that I was aware of.

***

Ray started to stabilize about two and a half weeks after his accident. His medical team slowly weaned him off the cooling system and then off each sedating medication. Time was passing quickly at this point, and they needed to get the breathing tube out of his throat. With the bone chip at the base of the skull, they called in a special team of surgeons to evaluate him. He was added to the surgery schedule so many times, but it kept getting cancelled and rescheduled. It was so frustrating not knowing when things would progress, but the surgery did eventually happen. It was a blessing in disguise.

Over the weekend, Ray started to breathe “over the ventilator” on his own. There was a lot of activity going on between the respiratory therapists and the doctors. They were testing to see if he still needed the ventilator or if he could be extubated. He had been relying on the ventilator for about three and a half weeks at this point. Eventually, the doctor said “let’s do it,” and Ray was extubated and breathing all on his own a couple hours later. This was on April 1^st, but even though it all seemed to happen all of a sudden, it was definitely not a prank. 

Click here to read Part 2 of Ray's Story of Hope.