Robert Alexander Bodroghy, MD,
PGY-2 Neurology Resident, Temple University
Lauren Koffman DO, MS
Assistant Professor of Neurology, Temple University Hospital, Philadelphia, PA
The word summertime usually evokes thoughts of vacations, outdoor activities, and a more easy-going lifestyle, especially for college aged kids. June 5, 2011, put an unexpected end to the spoils of my summertime fun. I was nineteen years old and had just finished my first semester of undergraduate studies, with a major in athletic training. The last exam I took was in Anatomy and Physiology, which will become relevant later in the story, and I was ecstatic to have a break from that intense studying. The story of what happened next was explained to me at a later time, as I have no recollection to this date, and only remember seeing a movie the night before with my parents. The following details are recollected from friends, family and medical records.
My friend and I were enjoying the beautiful weather outside and decided to go for a ride on motorized scooters. A tragic mistake was made at this point – I was not wearing a helmet. We were riding through small neighborhood roads when my friend, who was ahead of me, alerted me that a car was coming around the corner. By the time I noticed the car it was too late. I attempted to swerve out of its way, and the car to swerve out of mine. Unfortunately, we chose the same direction and collided head on traveling at approximately 30 mph. I was launched head-first off the scooter into the windshield, and then struck my head on the cement. At this point I was unresponsive.
EMTs arrived and I was transported by Medivac helicopter to the University of Maryland Medical Center Shock Trauma Unit. I arrived and was rapidly assessed for trauma. The initial head CT showed multiple kinds of bleeding within the brain, as well as bruising of the brain tissue and a skull fracture. In addition to the head injury, my lungs were injured and I was placed on a ventilator. My family was cautioned that there was a very high possibility I would not make it through the night.
The brain injuries developed swelling and there was an increase in pressure within the skull. The neurosurgery team was able to relieve some of the pressure by drilling holes into the skull, allowing for blood to be drained, and reduce the amount of swelling and pressure. While this initially succeeded, the drains clogged within a few days, and again the brain pressures increased. The next step would be to remove a large piece of skull, a surgery known as a hemicraniectomy. The nursing staff noticed that the drain was able to be fixed, and once drainage resumed the surgery was not needed. Although I was spared this surgery, there was another drain that was placed to drain spinal fluid and help with swelling, which became infected and required a long course of antibiotics.
While the teams were working to reduce the brain swelling, I was kept in a medically induced coma. Propofol is a sedating medication that can be used, but there is a risk of developing a life threating reaction- propofol infusion syndrome. This syndrome can cause many serious problems such as abnormal heart rhythms and kidney failure. I started to show signs of developing this syndrome, but luckily my medical team recognized the signs and were able to switch medications before the syndrome progressed.
I then began to experience paroxysmal sympathetic hyperactivity, which was extremely difficult to manage. This included symptoms such as a rapid heartbeat, profuse sweating, and elevated blood pressures. My family was instructed to limit any noise or tactile stimulation to me, as this would help the brain rest and improve these symptoms. This was obviously a struggle for family – to sit and watch your loved one in serious condition without being able to touch or talk to them.
Despite all the above obstacles and an initial poor prognosis, I was able to breath on my own without the ventilator three weeks later. While I was able to leave the hospital, the obstacles had not come to an end. I was admitted to a rehabilitation facility and my family was again given a grim outlook. While there I participated in intense speech therapy, physical therapy and occupational therapy. The left side of my body remained weak and I had to relearn how to walk, talk, and perform basic activities of daily living.
The difficulties were not only physical, as I experienced challenges in communicating with my family and healthcare team. According to my family, whenever someone was unable to understand my requests my response was consistently “that’s messed up,” with occasional profanities thrown in. I was only able to name two animals or fruits at a time. The interesting thing is that during one of the speech therapy sessions, despite these profound language deficits, I asked one of the neurologists how my pia mater was spared yet there were subdural and subarachnoid hemorrhages; I attribute this to all my studying during that anatomy and physiology course.
As my speech and motor function improved through these therapy sessions, the discussion arose about any permanent deficits. My family was told that it was unclear whether there would be any permanent residual deficits, but that it was unlikely for me to return to undergraduate studies. About two weeks later, I was discharged home. My instructions then were to rest and sleep as much as possible to let the brain recover. I slept approximately 18 hours most days. My family encouraged me to attempt to read and solve basic math problems during the limited awake hours. This continued for a few weeks, and then it was time for my one month follow up appointment.
The examination at this follow-up appointment was very encouraging, and I was told that if I felt up to it, I could attempt to take just one easy course to see if I could handle it. I enrolled in an art history class in the fall, and somehow never missed a semester of school after the accident. I managed to do well in this class and was eventually able to return to my full-time undergraduate studies. It was at this point I decided that I would give it my best attempt to become a physician, and specifically a neurologist, as I believed that I had a unique perspective to offer to patients based on my own experience.
In addition to returning to my undergraduate studies, I became a certified EMT. This was a surreal experience as I was practicing alongside the same crew that responded to my traumatic accident a few months prior. Although I had my struggles through my undergraduate pre-med studies like any other student, I managed to graduate with a Bachelor of Arts in Biology. I was ecstatic to have this incredible opportunity to continue my quest of becoming a neurologist and enrolled to take the MCAT exam. Upon completing this exam and all the tedious applications, my dream came true and I was accepted to medical school.
Four years later I received my Doctor of Medicine degree, after having the opportunity to study in multinational healthcare systems. I then entered the match for residency and was lucky enough to match into neurology. Currently, I have completed one year in internal medicine, and am at the beginning of my neurology training at Temple University. It is such a humbling experience to be on the other side, to be caring for patients in a position I was once in. I am beyond grateful to have survived this horrific experience with no residual deficits, but also to spend my life attempting to give others an opportunity for a second chance that I was blessed enough to receive.
During this entire story countless friends, family members, and strangers from my small town came together to host fundraisers to help with the enormous medical debt that my parents were accruing. To this day, I have unwavering gratitude to those thoughtful individuals, in addition to the incredible healthcare workers that saved my life.