It was an unseasonably cool early September morning. Jessica and I woke to a clamoring alarm clock, accompanied by the persistent meowing of five hungry kitties. In my thin pajamas, I shivered when I opened the door to collect the Washington Post from the front stoop.
Jessica showered and dressed quickly, skipped breakfast, hurriedly kissed me goodbye, and rushed out the door. She expected yet another hectic day at the office. She was eager to be at her desk before the first crisis developed.
Jessica and her colleagues maintained the administrative computing system at a small university. The academic year had begun the previous week. The new computer software, installed and thoroughly tested throughout the summer, revealed its inevitable flaws in real-life conditions. Student registration and billing, dormitory room assignments, parking and meal passes, and last-minute revisions to university procedures pushed the new software and its overseers to the max. Unexpected problems—if not handled at once—threatened to bring chaos to the campus.
I knew Jessica’s first stop would be the local diner for her morning jolt of caffeine, an iced tea with lots of lemon. To get there, she had to cross a divided highway, clogged with politicians, civil servants, diplomats, lobbyists, and military personnel scurrying into our nation’s capital.
The survivors of serious brain injuries are unable to recall the events that transform their lives. The shock to their brain temporarily prevents any memories from being stored. So, we can only guess what Jessica was thinking when she made her nearly fatal mistake. She probably was mulling over the work awaiting her: the papers piled on her desk, the constantly ringing telephone, the administrative fires in need of dousing.
As Jessica waited to cross the highway, a white minivan pulled up on her left, blocking her view of the two southbound lanes. A moment later, the minivan inched forward for a closer look at the oncoming traffic. Jessica might have interpreted this move as a sign that the road was clear. Whatever the reason, she drove into the path of a rapidly approaching behemoth, a Ford Expedition.
This single, momentary lapse of attention changed our lives forever.
The SUV driver, shocked by the sudden appearance of a vehicle in his path, had little time to react. He zigged left when zagging right would have been a better choice. He smashed into the driver's side of our much smaller Honda Accord, propelling it across the low concrete median into one of the two northbound lanes which, thanks to a timely red light, were vacant.
The powerful force of the collision between the two mismatched vehicles triggered the rapid acceleration and deceleration of Jessica's brain. Floating in a pool of cerebro-spinal fluid, it bounced from side to side within her more stationary skull, like a ping-pong ball in a lottery drawing. The portions of her brain that slammed against the rough edges of the inside of her skull were badly bruised. They began to swell and bleed.
As Jessica lay unconscious, pinned inside the crumpled car, crucial minutes were ticking away. Trauma specialists speak of the golden hour, referring to the sixty minutes that elapse after a major injury. Receiving expert medical treatment within this golden hour often means the difference between life and death. This is particularly true for victims of a brain injury. As time passes, the damage to their brain can escalate, often fatally, until preventive measures are taken.
Emergency vehicles reached the scene ten minutes after the accident, an amazing feat in the congested commuter traffic of our Washington, D.C. suburb. When the rescue squad arrived, they found a totaled sedan, a critically injured driver, and traffic backed up for miles.
Once the rescue squad freed Jessica from the wreck, they assessed her neurological condition. They employed the Glasgow Coma Scale (GCS), a universal, quick, and easy-to-calculate measure of the gravity of a brain injury. Jessica's GCS score of four indicated a severe trauma.
When the ambulance screeched to a halt at the emergency room doors, the trauma team, assembled and waiting, went to work. Their priority was to prevent, or at least minimize, any secondary damage to Jessica's brain.
Think for a moment about the contents of your skull. The brain consumes about eighty percent of the space. The rest is filled with three thin protective membranes and cerebrospinal fluid, which cleanses and cushions the brain.
Inside Jessica’s skull, traumatized brain tissue was swelling and bleeding, crowding the space usually occupied by fluid. This was creating stress within her skull, known by doctors as intracranial pressure or ICP. As the ICP in this confined area increased, healthy brain tissue was being pushed into and torn and bruised by the bony ridges of the interior surface of her skull. This was causing additional swelling, bleeding, and even more pressure. This perilous cascade of secondary damage was threatening Jessica's life.
When the rigid skull allows no more room for blood and swollen tissue, the only outlet is the brainstem, which attaches the brain to the spinal cord. If too much weight pushed down on Jessica’s brainstem—the regulator of vital processes, such as breathing, digestion, and heartbeat—she would die.
To measure Jessica’s ICP, the trauma team implanted a device—called an intracranial pressure monitor—into her skull, just below her hairline. Detecting excess pressure within the skull and acting quickly to relieve it saves many lives.
As the trauma team raced to preserve Jessica's life and minimize further havoc to her brain, I was blissfully ignorant of the events unfolding.
I had placed the day's newspaper atop the recycling pile and dove into a mound of my medical bills. I was home, as usual, on this workday, having retired eighteen months earlier due to disabling chronic pain.
The telephone rang. The caller identified himself as Tom, a social worker assigned to the intensive care unit (ICU) at a nearby hospital. His words, "car accident," "serious condition," and "get here as soon as possible" staggered me. I demanded more information.
"What are her injuries? How badly is she hurt? Is she dying?" Tom professionally deflected my frantic questions. "I'm not a doctor. I don't know the details of her condition,” he said. “You should get here right away."
I hung up the phone and raced around the house, trying to identify what I would need at the hospital. The one essential item—our address book filled with phone numbers—escaped my attention. I felt a knot of panic expanding in my chest. This painful tangle of anxiety and fear would be my companion, unraveling bit by bit over the next few months as I learned to cope with Jessica’s injury.
When I regained my composure, I called a cab and then waited, striding back and forth across the living room, my eyes all the time on the windswept, empty street outside.
The oldest and wisest of our cats seemed to know something awful had happened. She attempted to comfort me, but in my distress, I brushed her aside. I tried to remain calm, aware that I might soon be called on to make crucial decisions about Jessica's medical care. Despite my pleas to the dispatcher that I had an emergency, thirty excruciating minutes passed before the taxi arrived. I was bursting with fear and impatience and my lower back was throbbing from my nervous pacing.
The cab drove me past the scene of Jessica’s collision. I saw our car, reconfigured into a pile of scrap metal. How could anyone survive such a wreck? I thought. My first question to the social worker, who met me at the emergency room (ER) door, was "Is she alive?"
Tom led me to the ICU, a bright, surprisingly quiet area, the size of a basketball court. The nurses’ station on the left was bustling with doctors annotating charts and nurses dashing to and fro. A harried clerk was handling phone calls from anguished family members—soon to include more than a few of ours—anxious for updates on their loved one’s condition. The twelve patient rooms, each enclosed with a glass door, windows, and blinds, occupied the entire right side of the unit.
In the first cubicle, Jessica rested peacefully. Her eyes were closed. Except for the slight up-and-down movement of her chest, she was motionless. What grabbed my attention and wouldn’t let go was the intracranial pressure monitor drilled into her forehead. I would spend much of the next week nervously watching the screen displaying Jessica’s ICP.
I took her limp hand into my jittery one and scanned the jumble of medical paraphernalia keeping Jessica alive. A ventilator was pumping oxygen into her lungs through a tube in her mouth, freeing her body of the taxing act of breathing. A second tube, threaded through Jessica's nose, emptied her stomach to prevent vomiting. Later, this tube would be used to feed her. A cervical collar held her neck stiff. Her left leg was in traction. Needles and plastic tubing, wires and electrodes covered much of her body. Bags of medications and fluids dangled from metal stands. A pouch collecting urine hung on the side of her bed. She wore elastic stockings to guard against blood clots.
An assortment of machines, flashing numbers and displaying wave patterns, clicked and beeped, filling the silence between us. (For days, I was fearful that one of these contraptions—especially the ICP monitor—would blare that something was terribly wrong.)
A nurse permitted me to sit with Jessica for just ten minutes. When I reluctantly left, Tom guided me to a small, comfortably furnished room just outside the ICU. This closet-of-a-space provides the families of new patients the privacy to adjust to the precarious condition of their loved one. In other words, it’s a place where you can cry without embarrassment.
When Tom left me alone, I took advantage of the privacy. The images of the twisted wreckage of our car, Jessica lying motionless in bed, and the ICP monitor bored into her forehead fed my misery.
But I was grateful for two things. Jessica was alive and, remarkably, she had been wheeled into the emergency room with five minutes of her golden hour to spare.