A Race Against Time
Racing his bike July 7 at the Tuolumne County Fair, 15-year-old Spencer came up on two jumps in quick succession. Going over the first jump, he lost control. At the second jump he flew over the handlebars and his helmet was ripped off. He struck his head, hard, and blacked out.
Spencer's mom, Nina, was at home getting ready for her shift as an ICU nurse at Sonora Regional Medical Center when she was alerted to the accident. Spencer had regained consciousness but was being ambulanced to the hospital. Nina made it to the ER just before a doctor lifted the bandage off Spencer's head.
"It was pulsing blood," Nina said. "We knew we were in trouble."
Since the Sonora hospital doesn't handle complex traumatic brain injuries, Spencer's caregivers needed to airlift him to another facility. Nina knew where she wanted Spencer to go – Packard Children's.
"I knew he just needed the best care," Nina said.
Soon Spencer was in a Life Flight helicopter to Palo Alto. Nina and Spencer's dad, Michael, followed by car.
When Spencer arrived at Packard Children's, an operating room was waiting. Neurosurgeon Michael Edwards, MD, could immediately see two things: the location of Spencer's injury was lucky but his life was still in danger.
"He had a severe open injury to his skull," Edwards said. The wound was just above Spencer's hairline on the right side of his head. "Because it was in the right frontal lobe, he had no paralysis, and was talking and following commands. But the obvious risk was that he would continue to hemorrhage and would die."
Even if he lived, the bleeding could cause lasting brain damage, and infection was also a significant concern, Edwards added.
The trauma team got to work. After anesthetizing Spencer, they began the delicate job of cleaning dirt, hair, blood clots and bone fragments out from the wound. The largest pieces of bone were soaked in antibiotic solution, and Edwards used a powerful surgical microscope to help remove every bit of debris from Spencer's brain. When the wound was clean, the team switched into repair mode, fixing the dura, or brain-covering membrane, and reassembling the clean bone fragments like puzzle pieces at the site of the injury. Then they sewed up the jagged scalp wound.
The surgery was already underway when Nina and Michael arrived at the hospital. But Spencer's care team had been in contact throughout their three-hour drive.
"On the road, they had our number and kept updating us," Nina said. "It was such a relief."
After surgery, Spencer spent three days in the pediatric intensive care unit. The team watched closely for signs of infection and gave intravenous doses of three strong antibiotics.
The Packard Children's staff also paid attention to the needs of the rest of the Morse family, part of the hospital's commitment to family-centered care, which recognizes that partnership between patients' families and caregivers is the key to quality health care.
"The nurses were wonderful – they let me sit in on rounds, asked if I had any questions and kept me in the loop," Nina said.
Nina and Michael were soon joined at the hospital by Spencer's older siblings. As the family began taking shifts at Spencer's bedside, a Packard case manager, Alison Harvey, helped them find a place to stay near the hospital.
"We always felt taken care of," Nina said.
Three days after his surgery, Spencer turned a corner. The swelling came down and his bandages were removed. Best of all, Spencer was conversant and not showing any signs of lasting brain damage. His family began to breathe easier.
A week after surgery, although he was still receiving intravenous antibiotics and had his neck immobilized in a C collar, Spencer was well enough to go home. But the care didn't end there. Case manager Alison stayed in contact with the Morse family, answering their questions at home and ensuring they received the right follow-up care in Sonora. Spencer also returned to Palo Alto for speech therapy and cognitive assessments to monitor his recovery.
Today, in spite of the severity of his traumatic brain injury, Spencer's life is back to normal. He recently started 10th grade and has returned to many of his favorite activities, including playing golf and working at the local skateboard and snowboard shop. But he chose not to go back to motocross racing. His bike is now up for sale on eBay.
"He came through this pretty unscathed," Edwards said, adding that Packard Children's high standard of care played an important role in Spencer's good outcome.
"We're used to handling very, very difficult pediatric cases," Edwards said. "This fits into the realm of acuity that we deal with all the time."
From Spencer's perspective, the best thing about Packard Children's was that "it didn't feel too much like a hospital," he said. "They just made you feel really comfortable. I wouldn't want to be anywhere else."
Nina agrees wholeheartedly. "It was an incredible experience knowing that he was getting the best care available. I am just so grateful."