By Candace Gantt, Carter Gantt, Margot Wallace, and M. Sean Grady
On a bright and glorious morning in July of 2005, I was cycling with my friend on Goshen Road in Chester Country, Pennsylvania. It was only two weeks after completing a grueling 70 mile, half-Ironman race in Lake Placid, New York. That morning, I was hit by a reckless construction truck pulling a trailer. At about 20 miles per hour, I bounced off the road, hit a telephone pole and then a stockade fence. I suffered a broken clavicle, several broken facial bones and a traumatic brain injury. My riding buddy called 911 on her mobile phone, and the Willistown police and EMT crew arrived within minutes and immediately called to have me medevac’d to the Hospital of the University Pennsylvania’s (HUP) level 1 trauma center. My husband was called and arrived to see me in the HUP emergency room trauma center within the hour and was met by the chaplain and neurosurgeons. The news was bleak: I was in a coma. That night, an emergency craniotomy (removal of my skull plate) was performed to allow for the swelling of my brain that accompanied my head injury. During my recovery, the doctors were not certain that I would be able to walk or talk again. After two weeks in the critical care unit and one week in step down, I was transferred to a rehabilitation center near my home. All my family could do was hope and pray that one day I could return home. As I was gaining my cognitive and physical strength at the rehab center, my hope turned into dogged determination. I was focused like a laser beam on running again, getting back on my bike and playing with my girls (which I didn’t know at that time would take many months in addition to several years to recoup my cognitive skills).
After three months of inpatient recovery, I returned to HUP to have a cranioplasty, which returned my skull plate to its rightful place and attached it with metal plates and 40 titanium bolts. Humpty dumpty was back together. I attended outpatient rehabilitation for four months additional and eventually started running again. Nine months after my accident, I was running in a race. Five years after my accident, I completed a half Ironman again! And this year I will enjoy the glory of finishing an Ironman with my family and friends at my side. I will never be able to repay the doctors and nurses at HUP for giving me my life back! Cling to your hope, never, never give up.
A Daughter’s Thoughts: Message from Carter Gantt
In July 2005, my mother, Candace Gantt, was struck by a construction vehicle when out for a bike ride. I was about 11 years old, and that afternoon I arrived at home with my babysitter as if nothing happened. When I first realized that something was wrong was when my mom’s friend came over, and started speaking in hushed tones to our babysitter, who had sent us upstairs. Things only got stranger when my grandmother arrived, unannounced because “she loved us so much.” My fears were concerned when my dad came home, and sat us in the family room, which we never use, to tell us Mom was in the hospital. I was only given the bare minimum details and only learned the true severity of the trauma as I grew older. When the paramedics arrived, the decision was made that due to the perceived traumatic brain injury that she needed to be airlifted to the Hospital of the University of Pennsylvania, and cared for at the prestigious neurosurgery unit there. When my father arrived at the hospital, he was told that in all likelihood, my mother would never walk or even talk again. The surgeons removed a piece of her skull in efforts to relieve some of the pressure that had mounted from the swelling in her brain. My mom was in a coma for weeks.
When faced with difficult times, some turn to faith to ease their pain, praying to God that their loved one would survive and return to her normal self. However, the one reaction, which is universal and necessary in these difficult times, is hope. This is the path I chose to take. Hope helped me believe that the doctors at UPenn could fix my mom, make her walk and talk again. Hope helped me to believe that the woman who I visited in the hospital, in the wheelchair, with the helmet who was missing the piece of her skull, would once again return to being my mom. Hope was what allowed me to get up in the morning and have the ability to say "she will get better." Without hope, recovery is, well, hopeless. Hope is one of the most important, If not the most important aids that a family can have when faced with trauma. Hope helped my family, and my mother, survive the most monumental road block in our lives.
Today, my mom is better than ever; she can compete in her favorite past time, triathlons. In fact, many people can’t even tell what happened to her. Besides the many scars and occasional trouble recalling names (but honestly, who doesn’t do that? I’m sure just about every middle-aged woman can relate) but very fit, and returned to her pre-accident state. This year, she will be competing in an Ironman Triathlon, which most people would never even consider. But she, a traumatic brain injury survivor, will be trying. Hope saved her life and even ours, and remains a core trait of everyday life in our household one of the many imprints which this accident has tattooed onto our lives.
The Impact of Candace on the Caregiver: Thoughts From A Novice Nurse: Margot Wallace
A PowerPoint presentation picture flashed on the screen in front of a room of 50 new to practice nurses. The instructor talked about the various tubes, drains and equipment attached to the patient. The only story associated with the picture was a cyclist hit by a truck: nameless, faceless, no known outcome.
Fast forward four weeks to my first days as a staff nurse on the neurointensive care unit when the picture surfaced again. Only this time, the photo of the patient attached to a menagerie of equipment was accompanied by a story. My preceptor spoke about a triathlete who was on a training ride when she was struck, her ICU stay, and most intriguing to me, her recovery. Suddenly this picture had a name, a story and personal meaning.
The Candace Gantt story is filed away in many nurses brains to be retrieved when they need to be reminded of why they chose to be a neuro nurse. Nurses and physicians alike would recount her story on tough days, sparking hope and reminding us why we do what we do. I told her story to nurses that I oriented. I told her story to the parents of a child who was in a car accident with a severe traumatic brain injury. I told her story to my fellow triathlete friends. Her story was told over and over, yet I had never met her.
When I finally met Candace, I was in awe. I was in awe of her story, in awe of her recovery and in awe of her relentless dedication to the Ironman. She was impeccably dressed, spoke with clarity and carried herself with poise. The untrained eye would never label her a traumatic brain injury survivor. I had difficulty pairing the picture I saw in orientation with the woman who stood in front of me.
Training for my own Ironman has proven to be quite rigorous, grueling and some days just downright awful. When I begin to feel mentally and physically defeated, I think about Candace and her battle to be liberated from the ventilator, to walk and ultimately train for her own Ironman.
Candace has been a source of inspiration for me on a personal level. The initial photograph introduction to Candace was an inspiration for me as a new to practice to nurse, to know that someday I may have the opportunity to be a part of someone’s TBI recovery. Since meeting Candace, she has been a source of inspiration for every long swim practice, every steep elevation I climb on my bike and every mile logged.
The Physician Perspective: Neurosurgeon, M. Sean Grady
The first time I meet Candace, she was in a coma, intubated and had just been through trauma resuscitation. It’s a common scenario for me as a neurosurgeon, and having seen the CT scan of her brain, I was very concerned, not just in the short-term management but in the long-term outcome. After placing monitoring devices to measure intracranial pressure and brain oxygenation, she failed to respond to conventional medical management to raised pressure. I decided to rapidly move to decompressive craniectomy to limit the secondary damage of brain swelling. In talking with her husband prior to that operation, his main concern was whether she would live. I reassured him that was quite likely, but what I was very uncertain about was what her neurological function would be. That question did come up in the course of our conversation, and I gave the usual “we’ll have to wait and see.” What experience has taught me is we just don’t know, particularly when it comes to the cognitive recovery after TBI. Her kind of injury can easily result in lifelong nursing home care, a quality of life that many might reject.
Fortunately, that was not the case, and Candace made a spectacular recovery, as you can read. Many of us involved in her care can take some pride in our role in that outcome, but really what we did was optimize the chances for her own body and brain to recover. I wish we knew what separated recoveries like hers from many less successful cases whose examination and CT scans look so similar. I believe family and faith surely play an essential role. Medicine and neurosurgery remain as much an art as a science; balancing hope and realism is a skill that is constantly in practice. I have had the enormous privilege of being a neurosurgeon for over 25 years and bring to mind my failures much more than my successes, as is true with many surgeons. Patients like Candace give us our daily inspiration and are among the greatest rewards we receive for the opportunity of being in this profession.