Miracles We Have Seen

by Harley Rotbart

  Mary’s family and friends provided steadfast support, too. While Mary was in rehab, James created a schedule so that someone—a family member or friend—would be with her at all times. After Mary went home from rehab, knowing how much she enjoyed art, her friends arranged for her to spend time each week in Lynne’s art studio. At first Mary just enjoyed being in that environment; she was unable to make anything. But then a weaver helped her learn to push the shuttle through the warp to make simple weavings. Then she was able to scribble, then draw, then paint. In her first visits she would arrive in a wheelchair, driven by a home health aide. Then she walked in with a walker, then with a cane, and finally without any assistive device, having driven to the studio by herself.

  For three years after her stroke Mary continued to make progress. In addition to walking and driving she regained partial use of her right arm and much of her speech, though not to the point of full fluency. When words and phrases elude her, she waves it off with a chuckle and finds other ways to make her thoughts known.

  As it became clear that she would not be able to resume her career in education, Mary let go of her identity as an educator and claimed a new one—artist—which she finds even more fulfilling. What started as recreation and socialization has become her vocation. Sharing studio space with Lynne, she has become quite accomplished, mastering the complex cutting, pasting, and painting of fabric collage and developing a fine eye and original vision in her work. Mary lives on her own in Florida for several months each year to escape the threat of winter ice while James works and holds down the fort at home. And, as I write these words, she and James have traveled to the South to attend the birth of their first grandchild. Mary regards every aspect of her life as a blessing; she would change nothing.

  There are many miracles here. One is, of course, the physical one: that such an enormous blood clot could break down and be reabsorbed little by little, making room for Mary’s brain to re-expand, and that as squeezed and distorted as it was for so many weeks, her brain did not sustain more extensive permanent damage. Then there’s the miracle of awakening to a mother’s voice. Another is James’ unwavering belief and devotion. While we can’t know if his belief influenced the course of Mary’s blood clot, James’ tireless advocacy certainly contributed to her remarkable functional improvement, as did the deep and sustained support of family and friends. Finally, Mary’s courage, determination, resilience, and humor in the face of overwhelming odds were miraculous in their own right.

  Her spirit is now as bright as ever, not only shining on her friends and family but also lighting a path for others as she helps other stroke survivors as a peer counselor. For all these reasons, Mary’s is one of the most inspiring recoveries I’ve ever witnessed.

  Date of event: December 1980

  The Squeeze

  Harley A. Rotbart, MD

  I was a second-year pediatrics resident doing my intensive care unit (ICU) rotation at a large children’s hospital. Two young brothers, ages three and seven, were brought into our emergency room and then the ICU after near-drowning episodes. It was winter, and the three-year-old had fallen into a swimming pool with enough residual water that he couldn’t stand. His seven-year-old brother jumped in, pulled the younger boy to one of the pool’s steps where the three-year-old’s head was out of the water, but the seven-year-old was then himself overwhelmed by the freezing water and couldn’t get out before submerging. When paramedics arrived, both boys were unconscious.

  In the ICU, the younger boy regained consciousness within a few hours and was neurologically normal; he went home within a few days. The older brother remained in a coma for several weeks. The family stood vigil every day, and we, the residents, took over in the evenings and overnight, holding the older boy’s hand, talking and singing to him. We all prayed. Not in an organized way, or even in a traditional way, but each of us in his or her own way. It was on my “watch,” late at night when I felt the boy squeeze my hand while I was reading to him. Just one squeeze.

  This was now weeks into his stay and, because there had been no progress, discussions were beginning in the ICU about discontinuing life support, brain death, and organ donation. I told everyone on rounds the next morning about the hand squeeze. Most of my colleagues and supervisors attributed it to involuntary muscle spasms. Indeed, medically, by all our measures of brain function and assessments of neurologic recovery, there was not even the slightest possibility that this child could have made a conscious effort to squeeze my hand. But then someone else also felt it after rounds that morning, and then again that afternoon, now in response to command. The child’s parents were overwhelmed with joy and hope when they felt their son’s hand squeeze for the first time. None of us knew quite what to make of it or how much to hope for.

  It would be several more days before the boy opened his eyes; a few hours after that he smiled, still with a breathing tube in place. When he walked out of the hospital more than two months after the near-drowning and his heroic rescue of his little brother, we all cheered and cried. We had cried many times in the weeks preceding, and I still cry whenever I recall this story.

  5

  Unimaginable Disasters

  Terrible things can happen to people in an instant. In the blink of an eye, life or limb may hang in the balance of disastrous events that could not possibly have been foreseen or even imagined. Freak accidents, catastrophic injuries, bolts of lightning, horrific acts of crime.

  The stories in this chapter describe just such disastrous events, where hope for survival or meaningful recovery seemed futile.

  Date of event: December 7, 2007

  Free Fall: If You Are a Believer in Miracles, This Would Be One

  Philip S. Barie, MD, MBA, Master CCM

  People fall from the sky all the time, at least in New York City where I live and work. Construction workers; alleged criminals who fall from fire escapes trying to elude the authorities; troubled souls who jump—we have seen them all and cared for their injuries. There are so many skyscrapers, and even the “low-rise” buildings are often six to eight stories tall. As a general rule, people who fall three stories—thirty to thirty-six feet—have about a fifty-fifty chance of surviving. If they do survive it is a hard road to recovery. Weeks in the hospital and months of rehabilitation are in store, with no guarantee of being made whole. Falls from greater height, or from almost any height if they hit their heads and suffer a brain injury, carry a much worse prognosis.

  In 2003, my colleagues and I published a paper in a respected medical journal describing the unlikely survival of a man who plunged from the nine-teenth floor of a building. That case was remarkable, and worthy of publication for our colleagues in the field to read, because that man survived against all odds. Nearly 100 percent of those who fall ten stories are killed by the fall—they don’t even survive long enough to reach the hospital. Survival after a nineteen-story fall? Extraordinary, indeed, and seemingly impossible. I have taken care of two people who survived twelve-story falls, one who survived a fourteen-story fall, and the patient we reported in the medical journal who survived the nineteen-story plunge. The chances of survival from that height are tiny—much less than 1 percent. He survived because he struck a tree branch about two stories above ground, breaking his fall before the limb itself broke and crashed to the ground with him, impaled in his back.

  Little could I have known when we wrote of that man who fell nineteen stories that a few years later I would be privileged to be involved in a far more extraordinary and seemingly impossible survival story.

  * * *

  December 7 is a profoundly sorrowful anniversary in American history—the day the United States naval base at Pearl Harbor in Hawaii was struck from a surprise attack by the Japanese, drawing our country into World War II. That morning in 2007 was the sixty-sixth anniversary of the surprise attack. The day dawned clear and cool, with scattered clouds and a slight breeze from the
southwest. All in all not bad for December in New York City. Really nothing to foreshadow the horror about to unfold.

  About 9:30 am thirty-seven-year-old Alcides and his younger brother reported for work to wash the exterior windows of a modernistic high-rise residential tower on the Upper East Side of Manhattan, about fourteen blocks from the hospital where a life-and-death drama was about to unfold. Sheathed in black glass, the building stands forty-seven stories tall and looks like something out of a science-fiction movie. Everyone who lives or works in the neighborhood knows the building; its appearance is sleek and stark against the skyline, and it towers, literally, above every other building nearby.

  As Alcides and his brother climbed over the roofline and lowered themselves onto their platform, all hell broke loose—literally. The platform broke from its moorings and plunged onto concrete below, killing Alcides’ brother instantly and injuring Alcides grievously. In the aftermath, physicists estimated (the math is complex) that it took five to six seconds to fall from that height, speeding perhaps eighty miles per hour and still accelerating at impact. A fall from an “unsurvivable” height of more than 500 feet, at a high rate of speed, onto a concrete alleyway? And someone is still alive? Did the platform serve as a sort of parasail, slowing the descent? Pure speculation.

  When the fire department first-responders arrived at the scene, they saw both tragedy and wonder. Alcides’ brother’s body was severed in half after landing on a fence in the alleyway, but Alcides was sitting upright on the aluminum window-washing platform, breathing, dazed, semi-conscious. The ambulance crew arrived and performed a “scoop and run,” quickly and carefully lifting Alcides onto a gurney and speeding the fourteen city blocks (just under three-quarters of a mile) to our hospital.

  When our trauma surgery team was called to the emergency department (ED) to await the ambulance carrying Alcides, I knew only that the patient was said to have fallen from atop a forty-seven-story building. Wait . . . what? How is it possible that we are awaiting a living patient? I thought. Surely he would be declared dead on arrival, or it would be obvious there was little or nothing we could do.

  But we didn’t know many of these details in real time, and there was little time to question what we heard, or to dwell on the details at such a moment. There would be time later to search the Internet for news reports that would fill the gaps in our knowledge and satisfy our curiosity. For the time being, we readied ourselves for whatever the ambulance would bring to us in about two minutes. Any reliable information is helpful to anticipate certain patterns of injury or complications, but so often in trauma we don’t have reliable information. It could be because no one witnessed the event. When a patient is “found down,” for instance, were they assaulted? Struck by a car in a hit-and-run? Or did a collapse arise from some medical problem such as a heart attack or stroke, leading to injury only secondarily? Sometimes, if criminality is in-

  volved, the information available may be intended to deceive (“I was minding my own business, when . . . ”). So we train to integrate the information we have, and rely mostly on what our eyes, ears, and hands tell us from examining the patient. It will be several crucial minutes before the results of lab tests or X-rays become available. Trauma surgeons make rapid, momentous decisions every day, based on incomplete or even conflicting information. We must, or else a life may ebb away.

  The doors to the ambulance flung open and the crew ran, at breakneck speed, the thirty-foot straight shot into our ED. Suppressing our disbelief, we set to work assessing the patient and beginning treatment. In trauma, diagnosis and therapy often have to occur simultaneously, processes known as triage and resuscitation. Alcides’ face had barely a scratch, but that was misleading—the rest of his body was pulverized. He was comatose and having difficulty breathing, so a breathing tube was inserted in his windpipe and he was attached to a breathing machine. Intravenous catheters (tubes in his veins) were placed for administration of fluid and blood. He had severe injuries to his brain, chest, spine, abdomen, and limbs. Fractured ribs had punctured his lungs; catheters had to be placed between his ribs, into his chest cavity, so that suction could be applied to re-expand his collapsed lungs. A fractured spine threatened to paralyze him. His facial bones were broken, as was his right arm; he had at least ten fractures of his legs, including his left tibia (shin bone), which was exposed, protruding through the skin, and deformed. Excessive pressure was building from a blood clot on his swollen brain, a condition that can kill within minutes.

  Alcides’ condition was so precarious that moving him was risky, but he needed surgery, and he needed intensive care. We accomplished both by oper-ating on him in his bed in the intensive care unit (ICU), including drilling a hole in his skull to relieve the pressure from his swelling brain, washing out the debris from his open tibia fracture and stabilizing it, and opening his abdomen to relieve the pressure that accumulated from the massive amounts of fluid and blood he required. Three operations, in bed, in the ICU! We pumped heated blood and fluid into him to warm his body temperature in the face of severe bleeding because his blood clotting system was failing. He continued losing blood, requiring more and more transfusions—a vicious cycle because the more blood we gave him, the more we diluted the clotting factors in his system that could have slowed the bleeding, and the more he bled. In the early hours we transfused him with more than twenty-five liters (six gallons) of blood products, some of which came back out of him, in the form of ongoing bleeding, as fast as we could administer it.

  Alcides survived the night. Disbelief upon disbelief. This was truly uncharted territory for me and my team of dedicated surgeons, anesthesiologists, radiologists, nurses, and technicians. None of us had never seen survival in a situation like this and couldn’t imagine Alcides would be an exception. Yet there he was in our ICU, comatose, but still alive. What now? A lot more work, many more operations to come. As he began to stabilize, there was time to ask questions and seek answers. If he was to survive, would his be a functional life, an enjoyable life, a meaningful life? At that point, there was no way to know for sure, so we kept working.

  Through the month of December, he hung on. Unconscious and unre-sponsive, yet with normal vital signs, he remained attached to machines and monitors. He required more than twenty operations, orthopedic and others. How does the patient endure? With liberal administration of pain medication and sedatives—the so-called “medically induced coma.” The answer to the big question still eluded us—we didn’t know if he would ever awaken or what his brain function would be like if he did, but we had to prepare his broken body for the possibility that he might. That included trying to awaken him every day to see if his brain had started working again.

  Alcides’ wife was at his bedside constantly, lifting his hand to stroke her face and hair, speaking to him in hopes he could sense her presence. And then, on Christmas Day, he opened his eyes, reached for his wife, found a nurse’s face instead, stroked it and said, “What did I do?” Later, his wife would tease him about stroking another woman’s face. We were all astonished—an understatement—by his survival and his recovery of brain and speech function. As human interest stories go, there was none better. Ever. More amazement was to follow.

  Through it all, Alcides showed determination and courage and, with the love of his wife and family, became the only person I have ever known to survive a fall of this magnitude. Unprecedented, in the purest form of the word. How did he survive? The surgeon-scientist in me knows he landed on his legs rather than his torso or head. He received excellent pre-hospital care and emergency care. Brilliant surgeons did brilliant operations, time and time again. His nursing care was vigilant, skilled, and compassionate. Importantly, he never developed a serious infection as a complication of his care.

  But how was he still alive to make it to the hospital in the first place? That I do not know. Perhaps it was the hand of God, cupping him gently and lowering him to the pavement. What do you believe? And
how to explain the survival of only one of the two brothers?

  Alcides was hospitalized for about two months. Thereafter he underwent many months of grueling physical therapy and rehabilitation. He received psychotherapy as well to deal with his brother’s death—he and his brother had been close. In 2014, seven years after his fall, a New York newspaper did a follow-up story on Alcides’ progress. Now living in Arizona with his family, he told the paper the warm climate helps his bones feel better. He drives his children to school and works out in a gym. Not only is he able to walk normally, he does charity walks to benefit others.

  If you are a believer in miracles, this would be one.

  To read a contemporary account of the circumstances surrounding Alcides’ injury, see:

  http://www.nydailynews.com/news/e-side-scaffold-fall-horror-brothers-article-1.273404

  To read a contemporary account of a press conference held at the family’s request to discuss his recovery and prognosis, in which this essayist is quoted extensively, see:

  http://www.nytimes.com/2008/01/04/nyregion/04fall.html?pagewanted=all&_r=0

  To read the 2014 follow-up newspaper article on Alcides, see:

  http://nypost.com/2014/01/05/window-washer-survived-47-story-plunge-now-walks-for-charity/

  To read the 2003 medical report on the man who fell “only” 19 stories, see:

  Lee BS, Eachempati SR, Bacchetta MD, Levine MR, Barie PS. Survival after a documented 19-story fall: A case report. J Trauma. 2003 Nov; 55: 869–872.

  To read the 2009 medical report of Alcides’ case, see:

  Kepler CK, Nho SJ, Miller AN, Barie PS, Lyden JP. Orthopaedic injuries associated with fall from floor forty-seven. J Orthop Trauma 2009; 23: 154–158.

  Date of event: September 2008

  Decapitated

  Richard Roberts, MD