By Pam Witt-Hillen, ThedaStar Flight Nurse
This is not a story about a New Year’s resolution to lose weight, but rather one of accepting the harsh reality of suffering from a traumatic brain injury (TBI) and the long, uncertain road to recovery.
On Oct. 4, 2014, 25-year-old Josh Serwas was involved in a motor vehicle crash in which he lost control of his car at highway speed. He was unbelted and consequently ejected from the vehicle, striking a large tree with his face and head. He suffered complex facial fractures, lung injuries, broken bones and a traumatic head injury, specifically known as diffuse axonal injury (DAI).
Instead of occurring in a specific area like a focal brain injury, DAI occurs over a more widespread, or diffuse, area. It results from the brain moving back and forth in the skull as a result of acceleration or deceleration forces. As this happens, axons, parts of the nerve cells that allow neurons to send messages between them, are disrupted. This causes brain cells to die, which in turn increases swelling in the brain, contributing to additional injury.
Surgery is not an option to fix the broken or cracked “wiring” of the brain. While DAI is one of the most common brain injuries, it is also one of the most devastating. Disruption in the nerve fibers and nerve communication affects a person’s physical and cognitive abilities. There is no typical person with TBI. Physiological effects will vary, and recovery and long-term effects of TBI will be unique for each person. Many patients with DAI remain in a persistent vegetative state. The brain holds some of the biggest unsolved mysteries in medicine.
In spite of comprehensive trauma care and surgery to repair his facial fractures and other broken bones, Josh remained in a coma in CCU for 24 days. Plans were being made to admit him to a long-term neuro care facility. Miraculously, on Oct. 28, Josh “woke up” and began following simple commands.
More than a year later, Josh still feels like he is waking up a little each day, in a sense. He notices some reconnection going on, and his memory is improving. He is a man with “parts still missing” as he says, and he’s learning to live with cognitive difficulties such as short-term memory loss and some physical limitations.
“Recovery” (which occurs over months to years) is a misnomer. Symptoms do not vanish like those of a cold. “Improvement” more accurately describes the process. And working to improve every day is exactly what Josh’s focus is. He said he is working at accepting his “new normal” and focusing more on believing in the person he is now—one with amazing courage and determination facing the challenges of this complex world ahead. He attributes his stamina to his eight and a half years in the military, from which he was honorably discharged. When frustrated, he goes to the gym and works out. When interacting with his family, their endless love and support for the duration of this journey is most apparent.
Josh will not remain captive of his brain injury. He will cut a new path. There are days of “a-ha”s and days of tears. Each small victory adds to his momentum. He has not given up on the old Josh, but embracing his “new me” seems to be a multiplying force forward.