Anoxic Brain Injury: Paul’s Story
“Where’s Paul?” Hannah asks her husband, Travis, as he and their daughters were busily getting ready for a Thanksgiving Day outing. The family of five had recently moved from Washington State to Venice and were about to relish Florida’s warm sunshine at the beach. Realizing their 2-year-old was missing, Hannah immediately ran to the backyard and screamed, “He’s in the pool” while jumping in at the sight of their motionless son face down in the water.
As Travis tried to revive their blond-haired toddler, Hannah called 911. Her waterlogged cell phone was failing. She wasn’t sure the dispatcher heard the address before it cut out. Hearing the commotion from Kate, 6, and Liza, 3, who were witnessing their baby brother’s horrifying event, a neighbor alerted her dad. “Is it happy screaming or something wrong?” replies Vic Stevens, a retired deputy fire chief from Long Island, New York, living next door. He ran across the street, immediately left retirement, and forever epitomized the definition of Thanksgiving for Paul’s family. His training in cardiopulmonary resuscitation (CPR) and calmness in chaos proved invaluable until paramedics arrived.
“I asked another neighbor who was trying to revive Paul if I could take over. I held him upside down and patted on his back and tried to clear his throat. His response wasn’t good. We continued compressions. I had performed CPR before, but not on a child,” recalls Stevens. “I was relieved when I heard the sirens and professional paramedics arrived.”
A helicopter soon landed in the street in front of their homes and flew 64 miles to Johns Hopkins All Children’s Hospital in St. Petersburg, Florida, where a team of medical personnel were equally ardent not to let Paul worsen a disheartening statistic, especially in a state with an abundance of swimming pools, lakes and beaches. More children ages 1-4 die from drowning than any other cause of death in the United States, according to the Centers for Disease Control and Prevention.
Seeing her once-vivacious toddler in a coma, Hannah later recalled, “We had no idea what quality of life he would have.” Paul suffered anoxic brain injury from the lack of oxygen while underwater. It would be nearly Christmas before the family’s worst fears would be relieved. “We were praying we would get the boy we had back. We asked everyone we knew to pray for him.”
“How quickly CPR was performed was a vital part of Paul’s great outcome,” says Tisha Spence, M.D., a critical care physician in the pediatric intensive care unit (PICU) at Johns Hopkins All Children's. “There are many prognostic factors that we look at as intensivists to help determine the neurological outcome for a patient after a near drowning. But the most helpful predictor is often time. The ‘hurry up and wait’ period is the hardest part for parents.”
Breathing machines prevented Hannah from holding her son for eight days. She waited three weeks to see his genuine smile again. His recovery, like so many who suffer from a brain injury, takes more than time.
“Paul had to learn to walk, talk and eat again,” says Cindy Bozarth, a speech pathologist on Paul’s care team. “A key element was family involvement. With a lot of love, faith and therapy guidance, he was shaped back into the curious and active 2-year-old that his family knew before the accident. His family took every piece of information the rehab team provided and implemented recommendations into his day-to-day routine. It made a world of difference. It was miraculous.”
“From the very beginning, Paul’s family consistently followed through with all recommendations and assisted Paul with return to crawling, kneeling and standing. It is remarkable to see his recovery from the PICU to discharge,” says Billy Siesel, a physical therapist at the hospital. Paul’s rehabilitation isn’t over, but he’s back to being a curious 2-year-old, constantly in motion with an infectious smile.
“Seeing a happy little boy in a toy car being pushed down the hall by his mother reminds me why I chose this profession,” Spence says.
“They were with us when it was really hard and we were zombies staring at a bed,” says mom, Hannah, of including the PICU hallway in Paul’s rehabilitation exercises two months after the accident. “They see the worst of it, and they don’t often get to see the results. I call them our victory laps.”