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CHAPTER 1
The Incident
On September 17, 1992, Kelly Vaden Bouldin left home to grab a Burger King chicken sandwich with friends. She was fifteen years old and quite hungry after cheerleading for the first JV football game of the season. Not allowed to ride with 16-year-old new drivers, our beautiful and talented Kelly left home with Zach, the 18-year-old son of family friends. She did not come home.
At 10:20 p.m., Zach turned his head to speak to Chad, a loquacious sophomore in the back seat. The road was curvy on Westview Drive near Kelly's house, and the distracted young teenager drove directly into a telephone pole. The pole, unprotected by a curb, snapped in two. Kelly was in the suicide seat of the sturdy Honda Accord. Her seatbelt was fastened, but she had pulled out of the shoulder strap to shush the rowdy backseat passenger. Five days after her fifteenth birthday, three weeks after becoming a freshman at R.J. Reynolds High School in Winston-Salem, North Carolina, Kelly suffered a traumatic brain injury — a severe closed-head injury.
I had never heard of TBI, nor did I know it was the leading cause of death for children and young adults in the U.S. (Schroeter et al., 2010). This was a fact in 1992. It is true today.
In layman's terms, Kelly hit the right frontal portion of her forehead on the dashboard of a car that severed the telephone pole. She had no other injury than a harsh blow to the head. There was no blood, yet Kelly was unconscious. The two boys were minimally affected, and they expected her to wake within moments. She did not.
Kelly was unconscious when a neighbor, Dr. Romey Fisher, pulled her from the Honda that had no air bags. She was flailing about, and had a seizure in the ambulance during the ten-minute drive to the hospital. Because she was struck on the right side of her forehead, Kelly's brain had a whiplash reaction, causing injury and bleeding to the back left side of her brain. There was bleeding in the right frontal area of the impact, indeed in both frontal areas. Kelly also suffered brain stem trauma. She was hemorrhaging into every ventricle of her brain.
Thus only time would tell if my young child could awaken at all ... or if she would remain in a PVS — permanent vegetative state — or die.
Kelly's injuries were quite severe, and her father and I were told she might not last the night. I still hear the echoes of the emergency room receptionists: Does she have a living will? Is she sexually active? Why didn't she have I.D.? Has she been exposed to HIV? "NO, NO, AND NO ... she has never been on a date!" I know that any parent alive can imagine the pain and anguish that stole our daughter's childhood.
Yet, on that evening in '92, Bob and I were waiting for Kelly's return when the phone rang at about 10:22 p.m. Dr. Fisher, a close friend, advised us that our child was all right despite the fact that she and her friends had hit the telephone pole near his yard. My first statement was strangely calm, to the point: "Is she paralyzed, or blind?"
"No," Dr. Fisher answered. "The biggest problem is that she is not awake ... but she probably will be when you get to the hospital."
She was not. Dr. Fisher had wisely, instantly sent Kelly's ambulance to the major trauma center at Wake Forest Baptist Medical Center. The boys, both alert, were sent to another ER at Forsyth Hospital a few miles away. Had Romey made another decision, Kelly would probably not have survived.
My husband and I arrived at the hospital at about 10:45 p.m., parked illegally and flew inside. After we had answered a myriad of insurance-related questions, we were finally given our daughter's medical status. Kelly had been placed in a medical coma, and her brain was heavily oxygenated to minimize brain swelling. A pressure monitor was inserted into her brain so that if too much swelling ensued, part of her skull would be removed to allow room for further expansion. Doctors informed us that Kelly couldn't possibly awaken for at least three days. She registered a 5 on the Glasgow Coma Scale (8 or below indicates severe brain injury).
Oh, God! My child was now in the hands of strangers — strangers devoid of smiles. I was, however, oddly calm in the surreal environment of the emergency facility. I had stepped through the looking glass that separated the "normal" world from the world of those whose lives could never again be what they expected.
Soon Dr. Fisher arrived, having tended to the more minor needs of the car's other passengers. He looked at me and wrapped me in a blanket, because I was entering a state of extreme and delayed shock. I was shaking; my teeth were chattering.
"Who should I call to come be with you?" he asked.
Winston-Salem had been my home for over 20 years. Surely I should call some friends. But who to call in the middle of the night, knowing Kelly might not live until morning. Who should be called to hold me if my child died in the night? I simply shook my head.
For some odd reason, I felt I had no right to call anyone. Such a terrible burden to share. Even my older daughter Tyler, a sophomore at Wake Forest University, shouldn't be called until morning. She could have an accident rushing to the hospital. I felt I hadn't the kind of friends I needed. I was numb. I didn't want my minister with me to tell me of God's mercies, or my parents, whose grief would make our tragedy more real. I lay beside my stunned husband on an inflated beach raft in the ICU waiting room, and existed in misery until morning, trying to imagine the woes of other mothers who had rested on that wretched plastic raft.
And I was so wrong about not calling friends. The daylight came, and Kelly was still holding on. At least sixty friends swarmed the ICU waiting area, holding me and talking to my husband, Bobby, bringing us coffee, food, strength. Kelly's story was not in the newspaper on September 18. I had demanded of the police to withhold a press release so that Kelly's friends could learn about the news in a kinder way. But somehow they knew, and came by the scores. And they stayed. We laughed and prayed, and together we found the power to keep breathing, minute by minute.
Then another night came, and as our friends left, my strength waned, as if their leaving lessened Kelly's strength as well. I can't remember the second night.
The next day I turned to my best friend Ann Davis, and told her that I knew what would help me most. I couldn't be strong alone. Ann is a former nurse, and she mobilized the friends I didn't know I had.
Making a calendar of shifts (my treasured possession still), she kept someone with me every waking moment. Asking for this kind of help was so foreign to me, but I quickly learned that to survive the after-math of severe brain injury, my family would need a great amount of assistance. To obtain this level of support, I would have to ask for it, and others would be glad to give. I want to thank Ann, Barbara, Cynthia, LaLa, Diane, and all of the other names on that list of friends. I didn't realize that you cared so much about my child, or me.
When Dr. David Kelly told me my daughter was still alive in the dawn of September 18, I called my daughter at Wake Forest University. I told Tyler about the wreck without crying. I did not tell her on the phone how serious Kelly's injury was. I informed her that her sister was in a coma, but that she would be okay. Kelly would probably be awake soon. I asked Tyler not to rush but to come when she could. And she did. My 19-year-old daughter was a sophomore at Wake Forest, a business major, a varsity cheerleader; yet here she was, holding me when I needed her. I met her new boyfriend. I saw him holding Tyler up while she cried uncontrollably. The boyfriend was holding Tyler up, and then she was holding me. "I'm glad he is here for her," my mind said. She asked me what she could do and I spoke:
"Go back to school and live a normal life. ... Don't cancel anything. I need to know that one of us is living a normal life ... I need something good to think about!"
That is what she did. Tyler kept cheering, making good grades, and visiting when she had moments to spare. I would learn later from her roommate, Julie Polson, how much Tyler cried, how devastated she was, and how difficult a time this was for her.
The Red-Haired Resident
On September 18, my family was evidently assigned a social worker employed by Baptist Hospital. Sheappeared to be about twenty-two, and wore cute little suits in neutral colors. She came to see me and gave me a sideways hug.
"Mrs. Bouldin," she said, "Are you feeling depressed?"
Astounded, I made some rude rejoinder like, "No, I love hospitals and I'm just waiting to see if my child will live." Then I gave the polite response. "What do we need a social worker for?" I hemmed and coughed.
"Well, for whatever you might need," she replied. "You might need a wheelchair to take home with you or a hospital bed, and counseling is avail ..."
I told her to leave at once. My mind was unable to cope with the concept of wheelchairs at this point, but she kept appearing each morning, more regularly than the doctors.
"Mrs. Bouldin, are you perhaps a little blue today?" she would ask.
I left a call for Dr. Michael McWhorter, one neurosurgeon in charge of Kelly's case, requesting that the social worker be removed from my life. And I couldn't resist asking where this girl actually went to college. She never came back.
The red-haired resident doctor wasn't as obviously objectionable. In fact, he was the first human being in the ICU to communicate with me in any depth. Surgeons are wonderful, but so busy saving lives that a resident generally appears to cover the chitchat, or at least this was our experience. This fellow told me calmly what to expect concerning Kelly's prognosis. As if he were reading from a chart, he told me that she might not live. She might need a shunt in her brain if the pressure rose and needed relieving. She might live and remain a vegetable. Lastly, she might recover up to 90% of her former capacity, eventually. I could easily see that the resident felt this was the best-case scenario.
He then warned me that I must never, ever expect to regain the Kelly I once knew. At this point, I developed antipathy for this young well-intended person, who may have been correct except for telling me what never to do.
There is an absence of hope in such a place, an utter vacuum where dim rays of light should be allowed to survive. I will never know why I was constantly discouraged from having any hope.
Meanwhile my daughter continued to sleep.
As to the resident, he reappeared daily for about a week to remind me to keep my expectations low — until I asked Dr. McWhorter to send him the way of the social worker.
Both the social worker and the resident had good intentions. However, it was not their job to lower my expectations. Every janitor, nurse, volunteer in a hospital will take an interest in a coma victim, freely giving you advice about what to do, what rehab centers are best, and so forth. After listening to every positive word I could glean from anyone, I became inexpressibly confused. One of Kelly's doctors then told me to pick one person to listen to and trust. So that is what I did. I also learned that you can trust yourself. Take the tidbits of good advice others offer, and avoid opinions that you haven't the skill to assess.
Shearing - 9/19/92
I was told early on that Kelly had suffered from brain shearing. This phenomenon cannot be measured by an MRI. In essence, the tiny neurons that connect the brain with the spinal cord are too small to be seen on Xray. These neurons suffer a whiplash trauma during brain injury. They are stretched or broken or twisted. When a child like Kelly is young, there is good chance for the neurons to reconnect, or to form new pathways for brain signals when old ones are severed. This is a primary reason doctors cannot predict the amount or recovery for a victim of TBI — some things aren't measurable. I learned about phenomena like shearing from doctors, but mostly Kelly's nurses helped me understand her wounds and symptoms.
Doctors alerted me to a TBI filmstrip being shown twice weekly, but I was always too busy helping Kelly to attend. So I asked questions all the time. The nurses were more helpful than the neurosurgeons, who were kind but often unavailable. These remarkable women and men were encouraging, explaining that the healthier and stronger Kelly's body had been, the more likely she was to heal faster. ... So all the years of soccer and dance and gymnastics could pay off after all.
Also, nurses and therapists were very alert to Kelly's pre-wreck IQ. Evidently, the higher it had been, the more likely that she would "come back." Again, I realized prior efforts like the frequent homework help from Bobby and me had not been wasted. Kelly might never make another A, but a solid student could get well faster — a probable IQ loss after a severe TBI might not prevent Kelly from having a meaningful future, some kind of a useful life.
Things That Helped (The First Three Days)
"Humor is the absence of terror, and terror is the absence of humor."
– Lord Buckley
The ICU nurses requested pictures of Kelly, showing her as she appeared before the car crash, to be placed above her bed. They wanted to visualize the patient they were treating as a bona fide human being, not a swollen wreck victim. With the placement of those pictures, I knew that Alice, as well as the other ICU nurses, would labor to save Kelly's life. When they combed her long blonde hair in neat French braids and requested double shifts to stay with her, I knew my daughter was in good hands. Kelly's staff of nurses kept her looking lovely, which I appreciated more than words could express. They not only spent time arranging her hair, but also shaving her legs with lotion and trimming her nails.
A black sense of humor had developed in the ICU waiting room, as Bob and I sat with at least 50 of Kelly's friends each day. Zach (who drove the car) and Chad (the loud passenger) were nursing bruises and cracked ribs, and they sat with our family and friends, waiting for Kelly to awaken. Another family, the Grays, was present in our area; they received dozens of phone calls. The phone was generally answered by whoever sat nearest, usually one of Kelly's friends, and the questions reverberated, "Anyone here named Gray? Are you Mr. Gray? Is anybody present called Gray?"
"I'm black and I'm blue ... but I'm not gray!" Chad replied each time. I'd believed I would never laugh again, but I fell apart giggling. Later, when Kelly began to awaken, and would thrash and kick male attendants between their legs, we all became hysterical. The nurses christened her "Longlegs." Everything was so strangely funny — we allowed laughter to replace the tears everyone was afraid to release. Laughter is so good. It helps when nothing else can. I also recall laughing wildly when 14-year-old Carla discovered the doctors had to shave some of Kelly's scalp: "It will kill her," she hollered. Everyone laughed at the incongruity.
My closest friends, Barbara Price and Ann Davis, smuggled wine into a thermos and dragged me into a patio area to drink it. They actually made me laugh with their "chardonnay tea." They even ordered pizza for friends in the waiting room. These were the friends who never left me alone. Ann continued her calendar of visitors, scheduling someone to stay with me for predetermined periods of time. This one act saved my sanity. Alone, I always imagined the worst. With others, I was forced to remain an optimist. Friends who cared were essential to me.
Several friends who were nurses, therapists, and doctors helped the most. They had the medical terminology to explain what was going on with Kelly (They know you, and tell you the truth).
Comfortable and clean clothing helped. Since I wouldn't leave Kelly, I looked like a contaminated dirt lizard, and smelled like "hospital!" One friend, Ann Reagan, bought me two new warm-up suits. Wearing the new and clean clothes, I felt better, so I acted nicer to everyone.
Meeting mothers of persons with brain injuries, who had survived, helped hugely.
Going outdoors and looking at trees seemed to help my sense of permanence and stability. It felt like the trees were resting and waiting for Kelly to wake up.
Seeing the pressure monitor in Kelly's head read at "2" helped (this was a very good, low reading). Nurses let me stay with her more than visiting hours allowed. They knew she might die. Those little minutes holding her hand helped me breathe in, out, in, out. ... Each one mattered.
First Purposeful Movement - 9/19/92
The monitor was removed and Kelly tried to climb out of the bed. This was Kelly's first purposeful movement, her third day in ICU. She was withdrawn from the medical coma that over-oxygenated her blood to keep the swelling in her brain down. This was both a horrible and wonderful day. When Kelly was removed from life support successfully and out of deep coma, we were warned that she might not move or breathe again on her own. Bob and I waited to see the look on the doctor's face when he left us to withdraw supports. Our friends literally held us up for those seemingly endless moments. Then we heard laughter from beyond the door. A nurse rushed into the ICU waiting room to say, "She's trying to climb off the table. That little girl wants to go home!"
(Continues…)
Excerpted from "Lost In My Mind"
by .
Copyright © 2014 Kelly Bouldin Darmofal.
Excerpted by permission of Loving Healing Press, Inc..
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