A team effort helps little girl recover from severe head injures
By Josh Baxt
Alexandra Chisholm and her husband, Nick, were driving home from the store when they saw a fire engine heading toward their house. They had been picking up supplies for an upcoming birthday party for their four children. Since emergency vehicles generally went the opposite way, they were curious and wondered aloud what was drawing the crew in that direction. Their curiosity quickly turned to anxiety and then horror, as the fire engine pulled into their driveway. In full panic, Alexandra jumped out of the car and ran down the driveway, not noticing the ambulance and police car that had followed behind them. In her nanny’s arms was her 4-year-old daughter, Anastasie (Tasie), whose head was bleeding profusely. A 250-pound tiki statue had fallen on her.
Alexandra, who is a veterinarian, tried to balance her medical training with her maternal panic. She catalogued all the wounds that could produce intense bleeding without being serious. But then she saw the trickle of blood from Tasie’s ear and knew her daughter had a severe skull fracture.
The next 25 minutes were terrifying. Alexandra, riding in the back seat of a police cruiser following the ambulance, wondered why it was passing by hospitals, having no idea if Tasie was even alive. But the moment the ambulance reached the Trauma team at Rady Children’s Hospital-San Diego, things got better.
“When they wheeled her away from the ambulance, they were rushing, but there was no one doing chest compressions,” Alexandra says. “I knew she was alive, and I thought: If she’s alive coming in the door, she’s going to get blood, fluids, expert care—she’s going to get her needs met.”
Around the same time, Rady Children’s neurosurgeon Hal Meltzer, M.D., also a clinical professor of neurosurgery at UC San Diego, was being called in to join Tasie’s care team.
“We were concerned about the bleeding in the brain,” says Dr. Meltzer. “She had a very bad fracture, part of her head had been crushed and a piece of bone had torn through the tissue that covers the brain. But fortunately, no major blood vessels were injured.”
Following an initial evaluation, Tasie was moved to the pediatric intensive care unit (PICU) and hooked up to innumerable machines—a source of comfort for Alexandra, who saw the devices as necessary tools to help make her little girl well again. After several hours, Dr. Meltzer came out to explain Tasie’s condition to Alexandra and Nick.
“He was very calm. He told us there was nothing they were seeing that was bad for the long-term prognosis,” says Alexandra. “In this case, having several open fractures was a good thing; it relieved pressure on the brain. I was enormously relieved.”
The initial crisis was over, but Tasie’s fractured skull had to be rebuilt. This was a team effort from start to finish: Critical Care stabilized her and monitored her day-to-day well-being; Neurosurgery repaired the major fracture that was still pressing into her brain; Otolaryngology (ENT) corrected a fracture on the left side that went through her middle ear; Ophthalmology provided therapy to reverse cranial nerve damage that was making her eyes cross; Cardiology addressed a heart murmur that had developed, unrelated to the head injuries; and Rehabilitation Medicine helped her get back on her feet.
“We had a great team that worked well together,” says Dr. Meltzer. “It was a 360-degree approach to recovery.”
Caring for the Entire Family
While Tasie was their first priority, Nick and Alexandra had three other children trying to cope with their sister’s injuries. The day after the accident would have been a group birthday party for triplets Tasie, Ava and Luca and their older sister, Magdalena. So, at the end of the week, the family, working with the Hospital staff, held an impromptu party in a spare room. This was a welcome distraction for Tasie’s siblings, who not only witnessed the accident, but now were having a difficult time adjusting to her appearance. Opening a few gifts in the PICU really helped to relieve their anxiety.
The Child Life Services team at Rady Children’s also stepped in to help the siblings. Swollen and bandaged, Tasie was hooked up to various machines. Child Life staff showed the children pictures of their sister and explained what each piece of equipment was doing. Alexandra was amazed how the little, “extra” things made such a profound difference: Luca and Magdalena reading aloud, visits from the Hospital’s storyteller, impromptu concerts from a guitar player. Tasie would clam up around the Hospital staff, making it difficult to gauge her mental and emotional recovery, but would open up to the storytellers and musicians.
Alexandra saw there was more at work than just excellent clinical care.
“The one thing that characterizes this hospital is you walk in and it’s kid-centric from the get-go,” says Alexandra. “There’s no questioning what the motives of these people are. Every person you see in the hallway smiles at the kids.”
Tasie improved rapidly and was able to go home earlier than anyone had predicted. She is now a healthy, happy 6-year-old and doing well in school. The family is confident in her recovery, and they know if future problems arise, Rady Children’s will help them through it.
Rehabilitating head injuries
For young patients like Tasie Abboud, who have experienced severe head injuries, intensive care is only the beginning of their treatment. They need comprehensive rehabilitation.
Within two weeks of admission to Rady Children’s Hospital-San Diego, Tasie was already beginning inpatient rehabilitation, which consumed the majority of her hospital stay. This was a good thing, as research conducted at Rady Children’s shows that starting rehabilitation early makes a big difference.
“We have been evaluating PICU care, neurosurgery and rehabilitation and how they affect outcomes,” says Andrew Skalsky, M.D., chief of the Rehabilitation Medicine Division at Rady Children’s and an assistant professor of pediatrics at UC San Diego. “Kids that get intensive inpatient rehabilitation early on do better long-term.”
Inpatient rehabilitation may work so well because it’s so intensive. Physical, occupational and speech therapies take place three hours each day and are tailored to the patient’s needs.
Rady Children’s also has a Concussion Clinic, which helps kids overcome these brain injuries. “A lot of the treatment is education and activity modifications,” says Dr. Skalsky. “We are also looking at the effects of multiple concussions. Some people have many concussions with no longterm symptoms, while others are symptomatic for the rest of their lives. We’d like to understand why.”
Originally published in U-T San Diego, October 2013