By Alexandra Reynolds, MD (left), and Michael Reznik, MD (right)
In 2004, Caroline (name changed for privacy), a 19-year-old Bulgarian-American woman, was hit by a car while crossing the street in Manhattan, suffering a severe traumatic brain injury as a result. She had cerebral edema on presentation to the hospital, along with a large subdural hematoma, which required an emergent left hemicraniectomy and evacuation. Postoperatively she was kept intubated and sedated in Cornell’s Neuro ICU, and she proceeded to have a prolonged recovery. Despite her life-threatening injuries, she believes that her hospitalization lasted only a week or two.
On her first memories of the experience:
“When I woke up after surgery, I remember that my vision was very, very blurry. I could not see more than shadows. I remember well that I was hearing people’s voices, and that’s how I knew who was visiting me. For some time I was not able to say anything, but I did hear people, and I recognized the voices of family and friends, which made me feel very warm.”
Caroline had a sense early on of the gravity of her situation, though she wasn’t able to make out everything that was said. “I don’t really remember at that point what the doctor [said] about recovery. I do remember that neither the doctors nor my parents [wanted] me to see myself in the mirror …
Caroline says her parents were told her condition was very serious, and the doctors weren’t sure if she would survive. “Doctors can’t obviously promise anything that is not realistic, and in my case, I remember people telling me that in fact they said the worst because they had no idea what would happen. It is hard to say something optimistic [at that time], but … the way you say things, it matters. Really, the only thing I like to see in moments like [these] is a positive person with good energy.”
She does remember her medical team in a positive light and feels immense gratitude to everyone involved in her care. “I wish I knew the names of the doctors who saved my life. All the doctors and nurses I had were great.”
On the recovery process:
Recovery for Caroline was an arduous process, and one she felt she had little control over, at least at first. “I remember that I felt as if I was slow, but I knew all the people around me, and inside I felt like myself. I’m just not sure what actually came out.”
But even during her hospitalization her neurological function began improving markedly, and she was ultimately sent home on discharge, having completely bypassed the need for a stay at an acute rehabilitation facility. During the course of her recovery period, she was able to slowly retrain herself to perform her activities of daily living with the help of her family, whom she credits for her recovery. But at times, progress seemed to come to a standstill.
“I was mostly in bed. I remember getting very tired just going to the restroom, which was next door to me. I could only lie down on the side where my head had a bone, and they gave me a helmet to wear if I [went] outside. I slept most of the day, and I tried little by little to start walking, but really only a few minutes would make me very tired.” She attributes her slowness, at least in part, to a feeling of being incomplete. “I think the fact that a big bone was missing in my body, that made it worse. I do think that it had a big part in making me feel unbalanced and tired. I assume it is very strange for the body to suddenly be missing a big bone. After [the surgery to put it back] … the left side of the head, where the bone had been missing, that entire area was numb. I felt dizzy for a while, especially when I turned my head. Any sudden movement — getting up, turning during the night from one side to the other, sitting down, bending over — all these [things] would make me dizzy.
”Eventually she was able to go back to school, despite a constant feeling of tiredness. “It was hard to stay up late. I needed my sleep. I could not cheat my body with only a few hours of sleep anymore.” Most frustrating for Caroline, a violinist, was losing her coordination and dexterity. “After the accident, when I tried to play violin my hand coordination was gone. It felt as if I had never played before. I even played just five minutes and it was very difficult and tiring.” But impressively, as the years have gone on, she has been able to return to playing the violin professionally, and she credits her music and art in general for helping her push herself forward.
Even though she’s made essentially a complete recovery, she still feels some residual symptoms. “Sometimes when the weather changes or it is rainy I feel a bit more in the clouds than normal. My memory is a bit worse, and I get tired a bit more [than I used to]. But nothing that really gets in the way of my normal life. Very rarely I feel dizzy, maybe a handful [of times] per year, and it’s usually if I have not had enough sleep.” She also had to overcome a fear of being in cars and driving because of the traumatic experience she endured. “I had fears of distance and speed. I still think I tighten up unconsciously when someone is driving. I never learned how to drive from fear, and actually this summer … I finally got a learner’s permit.”
Overall, Caroline says she’s grown from having made it through the ordeal. “Going through this accident and recovery has made me stronger … more mature, and most of all, I appreciate life and all the things I am able to accomplish every day. When I have difficult moments in my life or career, I try to remind myself how lucky I am to have survived [that] day. I consider it my second birthday.”
On giving advice to others:
Caroline believes that others facing similar situations should try to stay positive and patient, and recognize the importance of family and friends in providing support. “If there is anything that I could say to a family in this situation, probably the best [advice] is to stay as calm and happy around the sick person as possible … I felt the best when I saw my parents happy and relaxed (if [relaxation] is at all possible during these times). But honestly, just don’t think about what happened, and try to stay strong in the moment. Positive energy and laughter is the best medicine.
[To the] people who are recovering from the accident, I would say a few things. My approach was not to ask too much information of what happened — to this day, I don’t really know details. I think it is not important, after it happened, to know the negative details. When I was recovering and it took such an effort and energy to even go to the restroom, I remember thinking ‘Wow, how amazing is the human body?’ We do so many things during the day: wake up, shower, go to school, spend all day at school … You never realize all this until you are not able to do it … But believe that you will gain everything back with a little bit of patience.”Michael Reznik, MD, is Assistant Professor of Neurology, Alpert Medical School, Brown University/Rhode Island Hospital. Michael is a very active member of NCS and an invited guest writer for the Stories of Hope section in
Currents.Alexandra Reynolds, MD, is a Neurocritical Care Fellow Columbia University/Weill Cornell Medical Center, NY, NY. Alexandra is an invited guest writer for