Traumatic Brain Injury: Jaden's Story
When Sarabeth dropped her 13-year-old son, Jaden, off at his best friend’s house to spend the weekend this past June, she never imagined she would next see him fighting for his life in the pediatric intensive care unit (PICU) at Johns Hopkins All Children’s Hospital in St. Petersburg, Florida.
Jaden, from Bradenton, had gone for a ride on his friend’s pontoon boat on the intracoastal waters of Tampa Bay. They were sitting on the bow of the boat, dragging their feet through the water. The waterway was busy that day with boat traffic causing lots of waves. Just as they were about to dock, a strong wake, caused by a passing boat, hit their boat. It was strong enough to knock Jaden into the water where he quickly disappeared under the boat.
His friends and others nearby jumped into the water to find him. He soon surfaced and was pulled out of the water by a good Samaritan who put him on his boat. They stayed with Jaden and waited for a rescue boat to take him to shore, then to an ambulance. Once he was on land, that’s when everyone realized he had been hit by the boat’s propeller. He needed immediate medical attention to save his life.
Within minutes, he was being transported to Johns Hopkins All Children’s Hospital by LifeLine helicopter. An experienced trauma team was waiting for him.
At the Ready
Meghan Martin, M.D., an emergency medicine physician, was on duty that day. “I remember we got a call that we were getting a kid with a head injury and other body lacerations,” she says. “We immediately called a trauma alert and got our team together.
“When Jaden arrived in the trauma room, we began removing the bandages from his head. I could tell almost immediately his injuries were severe. He had suffered a deep head wound with exposed tissue. That was very concerning to the medical team. I knew we needed to call neurosurgery right away.”
About the same time Jaden was arriving at the hospital, Sarabeth got a phone call that there had been a boating accident and paramedics were taking him to the hospital. “That’s all I knew until I got there,” she says. She called her father — Jaden’s grandfather — and told him to meet her at the hospital.
“I was very concerned about the prognosis for this boy,” Martin says. “I was the first member of the medical team to talk to the family about the extent of his injuries. Since they were not at the accident scene, I also had to tell them what had happened based on the report we had. Sarabeth immediately put her head into her hands and began to cry. I remember telling her his prognosis is very concerning. It would be a miracle for him to survive without any long-term medical impairments.”
‘Never One this Bad’
Lucky for Jaden, George Jallo, M.D., an internationally known pediatric neurosurgeon with the Johns Hopkins All Children’s Institute for Brain Protection Sciences, was at the hospital for another procedure and was at Jaden’s bedside within minutes of Martin’s call.
“I’ve seen propeller injuries, but never one this bad,” Jallo says. “The propeller cracked his skull and severed his brain. He had an open laceration, and he had been exposed to the gulf waters, which contaminated the wounds."
“We needed to do an emergency craniotomy (the surgical removal of part of the bone from the skull to expose the brain.) In addition to that, we had to remove the bone fragments that were impaled in the brain, then close the covering over the brain, leaving the skull bone off until the swelling went down.”
The propeller also broke Jaden’s arm, fractured his leg, broke the tibia bone (the shinbone, the larger of the two bones in the lower leg) and almost amputated his ring finger. Daniel Bland, M.D., a pediatric orthopaedic surgeon was called in to repair the broken bones.
“I remember going to speak to the mom along with Dr. Chris Snyder, the medical director of the pediatric trauma program, after my portion of the surgery was done,” Jallo says. “I told her, ‘I think we are going to get him off the operating table, but I’m not sure we will get him out of the hospital. The injury impacted the dominant side of his brain that is responsible for speech and moving the right side of his body. If he survives, he may never walk or talk,’” Jallo says.
“The medical team was straightforward with me,” Sarabeth says. “I was not given much hope. All I could think about was how he should never have been allowed to sit on the outside of the boat while the motor and propeller were running. Practicing good boating safety could have easily alleviated this situation.”
‘They Were Amazing’
While the medical team focused on Jaden, the social work team was busy caring for Sarabeth and her father.
“When I walked into the Emergency Center, the social workers met me immediately,” she says. “They were amazing. They never left me by myself the entire time he was in the trauma room and surgery.”
Alivia Gatewood, LCSW, was one of those social workers who responded to the trauma alert with her co-workers.
“I could tell immediately she was very distressed,” Alivia says. “Our job is to help make sure she understood what was going on medically with her son. In the beginning, we didn’t have a lot of information we could give her. We try to make things as comfortable as possible for families involved in a trauma situation. They just want as much information about their child as they can get. We try to stay with them as much as possible as a support system.”
“The surgery lasted several hours. Jaden was in a coma, and I was told the first 72 hours would be touch and go,” Sarabeth says. “When Dr. Jallo came and talked to me, he said it’s a wait-and-see game and because of where the injury was located, Jaden probably would not recognize me, know how to talk and won’t have any movement on his right side. Also, because of the extent of the brain injury, Dr. Jallo was uncertain if Jaden would ever be able to breathe on his own or walk again. It was bleak. He was on a ventilator.
“I stayed at the hospital day and night,” she continues. “I never left. I tried to stay extremely positive.”
‘It’s a Miracle He’s Alive’
But Jaden’s a fighter and according to Sarabeth, he has always been an overachiever. So, no one should have been surprised when Jaden started to move around, recognize his family and make other physical and mental recovery milestones within days of his surgery. He was only in the PICU for 10 days. And the day he got out of the PICU on June 28, it was his 14th birthday. He was already walking and talking.
“He certainly exceeded my expectations,” Jallo says. “It’s a miracle he’s alive and back at home. His strength is equal on both sides of his body. I believe he will be able to return to school soon. He still has some speech hesitance, and he might be left with some permanent residual deficits, but he should be able to resume a normal life.”
In order to lead that normal life, he needed intense physical, occupational and speech therapy. Julie Blanshan Brett, a speech & language pathologist agrees. “It’s very rewarding to see how far Jaden has come with his recovery. When I first met Jaden, he was not talking and unable to eat on his own. Through intensive therapy, we worked on his oral motor strengthening and got him off his feeding tube so he could feed himself safely. He also had word finding and memory issues. We provided cognitive therapy to help him. What I remember most about Jaden was his great sense of humor. Through all the therapy and tasks he needed to complete. He and family remained very positive.”
“Just getting him out of bed and into a chair was difficult in the first few days,” says Rachael Thibeau, Jaden’s occupational therapist. “We worked with him for several weeks, while he was in the PICU on his functional abilities, called ADLs (activities of daily living). He had to learn how to get dressed, take a bath, get himself to the bathroom on his own. The goal was to teach him to be as independent as possible and back to his prior level of function before the accident. It’s amazing to see how far he has come.”
“There is no medical reason for him to have survived this accident,” says Martin, fighting back tears, as she recalled seeing Jaden for the first time since she met him in the trauma room. “I was blown away. Just to know that our trauma team made a difference and he survived and will be able contribute to society is awesome.”
“Whatever training Johns Hopkins All Children’s has for their trauma team, they executed It perfectly,” Sarabeth says. “I felt like all the doctors and nurses were an extension of myself. They were not only highly trained medical professionals, but they were mothers and fathers. The care they gave my son was so sincere. I like to call Jaden a Johns Hopkins All Children’s Masterpiece.”
Daniel Bland, M.D., is on the medical staff of Johns Hopkins All Children’s Hospital, Inc. (“JHACH”), but is an independent practitioner who is not an employee or agent of JHACH.