- 5/28/2025
A famous brain surgeon struggles to save the life of a comatose child using a controversial new method of treating severe head injuries. In charge is Dr. Jan Ghajar, who gained notoriety in 1996 by successfully treating a woman who was savagely beaten in Manhattan's Central Park and expected to die. Dr. Ghajar believes the measure that helped save her life should be available to all.
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00:00Tonight on NOVA, head trauma in the ER.
00:06I think we probably keep it out of our minds that an accident could happen.
00:10You know, it's not going to happen to me.
00:12And you know what?
00:13It is going to happen to you.
00:14It's going to happen to your kids.
00:15Alice, open your eyes.
00:19This doctor practices a simple life-saving technique.
00:22Would your own doctor do the same?
00:24The fact that it is not performed more routinely is appalling.
00:29It's called a coma.
00:30Major funding for NOVA is provided by the Park Foundation, dedicated to education and
00:57quality television.
01:01And by the Corporation for Public Broadcasting and viewers like you.
01:14Police scour Central Park for evidence after a vicious attack on a woman found beaten and
01:18unconscious.
01:19It happened in broad daylight.
01:20She was found unconscious on the path at 408 in the afternoon.
01:23She was discovered bleeding from the head at Rochester New York Hospital.
01:27Dr. Jam Gajar is my guest.
01:28Now, the woman who was beaten in Central Park, she was in a coma when she arrived.
01:33She was beaten severely about the head.
01:36I mean, when she came into the emergency room and I saw her, her head was swollen the size
01:42of a pumpkin.
01:44Jam Gajar is a surgeon who treats severe head injury.
01:50In June 1996, he was called into a highly publicized case.
01:55A woman beaten in New York Central Park.
01:59Using controversial methods, Gajar tried to save his patient's life.
02:04Her face battered almost beyond recognition.
02:07The woman savagely beaten in Central Park remains unrequited.
02:10Emergency surgery overnight in New York Hospital.
02:12Crime scene area, second street on the west side of the park.
02:15It's still closed off.
02:16Next.
02:17Twice the patient came close to dying.
02:21Both times, she survived.
02:25To New Yorkers, it seemed like a miracle.
02:28But Gajar called it science.
02:32The public tends to personalize medical therapies and say a miracle is happening somewhere.
02:37And it would be nice.
02:39I think miracles are great.
02:41We can use them whenever we get them.
02:43But this is an application of good scientific methods.
02:47Gajar is one of the leaders of a campaign to ensure that coming out of a coma doesn't depend on miracles.
02:55The goal is to improve every patient's chance for survival.
03:01Trauma team, emergency room.
03:05Find out what the trauma is.
03:08Head trauma.
03:09Head trauma.
03:13Struck by a car while crossing the street, a child lies in a coma.
03:22Paramedics report that the child was rigidly extending his arms.
03:26Called posturing, a sign of severe head trauma.
03:29Why was he intubated?
03:33IV tray.
03:34Christine, check his extremities.
03:37We got on the scene.
03:38He was already in the back of the EMT's truck.
03:39They told me that he was underneath the car.
03:41They don't know if it was the car that hit him.
03:42They don't know if he was thrown underneath that car.
03:45But he was hit by a car.
03:46We don't have a witness.
03:47We don't know exactly what happened.
03:48Right.
03:49They're all back at the scene.
03:50And when you found this child, he was unconscious?
03:51He was unconscious, posturing in the back of their truck, right?
03:53With a right-sided gaze.
03:54We have a four-by-four.
03:56Head trauma is a leading cause of death and injury.
03:59Can we page neurosurgery as well?
04:01The ER alerts Dr. Gajar, who's been trying to bring this problem to the public's attention.
04:06Hi, I'm calling from trauma room one.
04:07Can we page neurosurgery, please?
04:09There's a trauma team in the trauma center,
04:12and they see the patient immediately when they come in,
04:15and they follow the ABCs, airway, breathing, and circulation.
04:19They make sure the patient's got an airway, they're breathing,
04:22and they've got blood circulation, because before you do anything,
04:25you have to be assured of that.
04:26There's a lot of blood in his mouth.
04:28So we had to suction him.
04:29Couldn't hit the van, of course.
04:31A nine-year-old child was hit by a car,
04:33and he was found unconscious under the car, posturing.
04:36When the patient came in, it was obvious that it was a severe head trauma case
04:40because he was not moving, he was unconscious,
04:43and the paramedics were reporting that he was agonally breathing,
04:47which means that it's a type of shallow breathing
04:50that is usually associated with impending death.
04:53The team hooks the child up to a respirator and quickly monitors vital signs
04:59before it can focus on the head injury.
05:01Does anyone have any pressure yet?
05:03He's palping at 120.
05:07We're going up the head CT. I'm just going to scan the whole way down.
05:11I just think that this kid really needs a head CT in a big way.
05:15Someone get some blankets, warm sheets. Let's keep the kid warm.
05:21The team rushes the child to the CAT scan to take special x-rays of the brain
05:26to determine what's happening inside the head.
05:28Ready?
05:30Watch the IV lines.
05:36Before the x-rays are taken, the patient starts having seizures.
05:42Seizures may be a sign that blood has leaked in the brain.
05:48These areas of injury will cause swelling, which could be life-threatening.
05:52All right, thanks a lot, Dr. Gajar.
05:56Take him off, repeat his blood pressures and get a thoracoscopy tube set up for the right.
06:03A beep from his pager and Dr. Jam Gajar heads across town to the hospital.
06:08Good evening, Jamaica Hospital.
06:10Yeah, hi, it's Dr. Gajar.
06:12Yes, Dr. Gajar.
06:13Can you reach Dr. Venue for me?
06:15Yes, doctor, one moment.
06:17On call, Gajar responds to emergencies 24 hours a day.
06:21Hello, Venue?
06:22Yeah, did you examine him?
06:24Yeah.
06:25Does he open his eyes?
06:26No, he's not.
06:27He's not opening his eyes?
06:28No.
06:29Okay, can you have the Ventric set up and a cut-down set?
06:32Yeah, the Ventric is already set up.
06:34Okay, is the mother there?
06:37Gajar is planning a course of treatment designed to prevent the so-called second accident of head injury.
06:43I'm on my way.
06:44Okay.
06:45We used to think that all the injury occurred at the moment of impact.
06:49But now we know that actually a lot of injury occurs afterwards in the first week in the hospital.
06:59The brain swells up, the brain doesn't get enough blood and oxygen, and then parts of the brain die.
07:05That injury in itself can be far worse than the first injury.
07:12Do you have a scan, a copy of the scans?
07:14I talked to the family.
07:15I told them you were on your way in and that you would talk to me when you arrived.
07:20This is his CAT scan.
07:23This white little area here is a blood clot.
07:26And he has two more here, one over here in the left hemisphere and one over here in the right hemisphere.
07:32So he's got sheer injuries.
07:35At the moment of impact, the patient's brain rocked back and forth inside the skull, tearing blood vessels and pulling nerve fibers.
07:43These injuries caused the brain to swell, blocking the flow of oxygen-carrying blood.
07:50The brain could strangulate without more room.
07:54And one way to make space is to drain clear fluid that normally accumulates.
08:00The best way to do that is to put a tube into the brain and to place the tube somewhat in the center of the brain where the spinal fluid is made,
08:08so that if the pressure gets too high, you can just drain some of this fluid and relieve the swelling.
08:30Can you hold his head from down there?
08:33We drill a hole through the skull.
08:37And then we puncture the lining of the brain called the dura.
08:41And then we put the catheter in.
08:45And usually about five to seven centimeters from the scalp, we hit the spinal fluid.
08:52And you'll see it come out.
08:54Gajar invented a device to assist in this procedure, and other techniques are readily available.
09:01But many hospitals consider this first step costly and unnecessary.
09:06Can I bring Mom in for a minute?
09:09Okay, Mom.
09:11Come in here, because I've got another problem.
09:14Can you bring the lightbulb over there to this side for me, please?
09:17Can you bring the lightbulb over there to this side for me, please?
09:26Hi, baby.
09:28Don't give up.
09:31I know you can hear me.
09:33I know you can hear me, okay?
09:36Come on, Papa.
09:38I know you can hear me.
09:40You know what I always tell you, that you're my baby.
09:43I love you.
09:44You were born, my son, to you.
09:47So you've got to put him through me, okay?
09:49I love you, Papa.
09:51He's okay, Papa.
09:53He's right here, okay?
09:55He's into cars, football, bikes, and his karate, of course, which is when he's coming home.
10:09He had just gotten his yellow belt also yesterday.
10:12His second yellow belt.
10:14That's what you want to tell me.
10:26He's a very loving child.
10:28That I can say for Alex.
10:30Everybody loves him because he's very loving.
10:35He's very affectionate.
10:37He's always touching you, hugging you.
10:39Lots of things run through your mind.
10:41Is he going to make it?
10:42Is he not going to make it?
10:44The neurosurgeon pretty much told us it's a 50-50 chance.
10:47He told us just like that.
10:49You stop and you say to yourself how much you appreciate your child.
10:54I love you.
10:56You're right here, okay?
10:58The most common cause of death and disability in young people in the age of 1 to 44 is head injury.
11:05I think we probably keep it out of our minds that an accident could happen.
11:10It's not going to happen to me.
11:12And you know what?
11:14It is going to happen to you.
11:16It's going to happen to your kids.
11:18Yeah, hi, it's Dr. Gujar from neurosurgery.
11:20Did you hear about the pediatric transfer?
11:23It was a 9-year-old boy who was hit by a car, brought to Jamaica Hospital Emergency Room.
11:28He was comatose and then had a seizure.
11:30Ready to go?
11:32Yeah.
11:35Shortly before midnight, Alex is transferred to New York Hospital,
11:39which has a special intensive care unit for children.
11:43You got the two, you count.
11:45One, two, three, go.
11:50At one in the morning, Alex's mother gets an update from Gujar,
11:54who practices at New York Hospital as well.
11:56I know that you met Dr. Gujar over at Jamaica.
12:00He probably gave you as much information as we have right now.
12:05Yeah, we measured the pressure.
12:07I want to tell you, we first put in a tube in his brain over at Jamaica.
12:11The pressure is high.
12:13And here we have it connected to a monitor now.
12:15We can get an actual number.
12:17It's a good number.
12:19It's not too high.
12:21And hopefully it will stay at that level.
12:23Everything else is stable as far as neurologically is concerned.
12:26But you know, the next three days are really crucial.
12:28See how much his brain swells up.
12:30But the good news is that right now his pressure is not too high.
12:33And you know, the question is, what will he be like ultimately?
12:37Right now we don't address those kind of questions.
12:40Right now it's kind of life and death.
12:42We're trying to prevent the brain from swelling further.
12:45That's why he's here in the intensive care unit.
12:51Throughout the night, the team will watch for any change in Alexander's brain pressure.
12:56Gujar believes that this intense bedside vigil is absolutely key,
13:01and yet dangerously missing from many hospitals.
13:05I did a survey with the Brain Trauma Foundation
13:08of 260 trauma centers throughout the United States
13:12that took care of severe head injury.
13:14And we asked them basic questions like,
13:16how many head injury patients do you see a month?
13:18Do you monitor the pressure in the brain?
13:20Let's see the brain.
13:22Go on.
13:24One fact we found out in the survey is that 70% of the centers
13:28were not monitoring the pressure in the brain routinely.
13:30And we knew from the literature that patients
13:33that did not have their brain pressure monitored
13:36and were not treated aggressively
13:38had a much higher death rate and poorer outcome
13:41than patients that did have their pressure monitored.
13:43So just that, we could see there was a problem.
13:52Back with neurosurgeon Dr. Jam Gujar.
13:55Have you ever been in a coma,
13:57or has anyone close to you been in one?
14:00Well, I had a head injury when I was seven years old.
14:03But my real, actually my real experience with brain injury
14:08was from my older sister, who's retarded.
14:11And I don't know, as a child, I guess you're growing up,
14:14I was always trying to figure out how to make her normal.
14:17And I was almost like forcing her every day to make her normal.
14:20I couldn't figure it out.
14:22And I think that was one of the reasons I went into studying the brain.
14:31On the second day, Alexander started dilating one of his pupils.
14:35And that's a very bad prognostic sign.
14:38There's a nerve that goes to the pupil.
14:41And if the brain gets very swollen,
14:44it can actually squish that nerve within the skull.
14:47And when it presses on that nerve, the pupil dilates.
14:51So he was in a very serious condition at that point.
15:00Sorry, Alex. We'll be done in a second, big guy.
15:03I'm just going to take a picture of your head.
15:05A second CAT scan is ordered,
15:07which confirms that brain swelling has increased overnight.
15:11These are cuts through the brain with a CAT scan.
15:14And here are the eyes here.
15:16And this is the middle of the brain that's going through it.
15:19And this is the base of the brain.
15:21And we look at this area around here.
15:23And because there's a lot of swelling, the brain sort of crunches in.
15:25And these black areas here are spinal fluid.
15:27And you don't see it very well.
15:29That means there's a lot of swelling.
15:31So it's like you slam your finger in the door.
15:33This finger swells up. The brain is now swelling.
15:38Well, there was family members in here,
15:40and then he just started to get very agitated.
15:42His ICP went up, his hands and his legs started going.
15:44Despite the draining of brain fluid,
15:46the pressure inside Alex's skull continues to rise.
15:50Called ICP for intracranial pressure,
15:54it climbs into the 30s, well above a safe level.
15:57He's draining okay, huh?
15:59The tube that's in the brain, which is draining spinal fluid,
16:02that's actually hooked up to a pressure monitor.
16:04Usually if the number's between 0 and 10,
16:07that's normal, I'm not worried about it.
16:09When it gets up to 20, start anticipating some bad things.
16:12Now, his pressure was 30, which is very high for a child.
16:16When swelling can't be controlled,
16:19the brain chokes off the supply of oxygen-carrying blood.
16:23The strategy now is to raise blood pressure.
16:27Keeping it 70 points higher than brain pressure,
16:30using medication.
16:32If the plan works, it will force blood through the brain
16:36during this critical stage.
16:38When you're in there with him, right now,
16:41try not to talk to him.
16:43You can just hold his hand or stroke him or whatever,
16:46but try not to stimulate him, okay?
16:49And then if his pressure's low tomorrow,
16:51then you can start doing more things.
16:57Seems to be kind of tense.
17:01Hi, Bob.
17:04Oh, what's going on?
17:06He responds, he knows that there's people around him.
17:09Yesterday, a lot of family members came around
17:13and that made his intracranial pressure go up.
17:17It's been very high, and it hasn't gone down,
17:20no matter how much they drain.
17:22It's very hard on any parent.
17:25I mean, he's still with us, he's still alive,
17:29so, you know, it's not, I can't say the loss of a child,
17:33but just the thought of it.
17:35And seeing, you know, a child under those conditions,
17:39you know, where you know that, you know,
17:41the pain and suffering that he's going through.
17:45You wonder how you keep your sanity, you know?
17:47But I just keep myself up to keep my wife together
17:51so that she won't lose it.
17:54And just hang in there, you know, a lot of prayers.
18:06As Alex enters day three,
18:09the pressure inside his skull is finally dropping.
18:12Numbers measuring the amount of blood flowing through the brain
18:15are good as well.
18:21But Kajar wants an outward physical sign from Alex
18:25that the crisis is indeed under control.
18:28Hi, how's he doing?
18:30When physicians examine a patient after head injuries and coma,
18:35there are very few signs that we can look for
18:38in terms of what's going on.
18:39There are very few signs that we can look for
18:42in terms of brain functioning.
18:44We usually do is we pinch them just below the collarbone.
18:48Did you pinch him ever?
18:50Let's see what he does.
18:58That's good.
19:00Alex's brain has just identified a source of pain
19:04and sent a signal to his hand to reach toward it.
19:07So does he move spontaneously at all?
19:09He moves his head from side to side.
19:11He moves his left more than his right.
19:13This is a sign that his level of consciousness is changing.
19:16His hands and his legs are growing.
19:18So he definitely seems like he can hear,
19:20but he won't follow commands right now.
19:22Our goal is to improve the outcome of patients with brain injury.
19:26And that first week, immediately after the accident,
19:30is an incredibly fruitful area for intervention
19:35and making a difference.
19:37But you have to really pay attention to these small fluctuations,
19:41blood pressure, brain pressure, doing operations.
19:44It's very, very intense.
19:49We have a male, approximately 30 years old,
19:52found hypotensive, unresponsive.
19:54Medics tried to intubate, unsuccessful.
19:56At a teaching hospital in New York,
19:58Jam Gajar critiques a trauma drill.
20:00It's really about the head.
20:02Okay, someone call neurosurgery.
20:03Residents practice the first steps of the head injury protocol
20:07Gajar is using on Alex.
20:09Okay, let's put some monitors on.
20:11Get a blood pressure cuff on.
20:13The team checks the ABCs, airway, breathing, and circulation.
20:17And so far, this looks no different than other ER scenes.
20:20I'll take the tube.
20:22I see a little vomitus around the cords.
20:25But the residents are about to make a controversial move.
20:29Is the fluid running in?
20:31They decide to give the patient plenty of fluid.
20:33How much fluid has he gotten?
20:35Up his fluids, both lines.
20:37Faced with this very same case Gajar has discovered,
20:41many hospitals would do the complete opposite.
20:44Basic care is so variable, and in many cases can be detrimental.
20:49We have to straighten this out before we can move forward.
20:53Gajar had discovered an alarming number of discrepancies in care
20:57when he gathered leading neurosurgeons
20:59to develop a protocol called the guidelines.
21:01That would be a real service if we could...
21:03We spent two years meeting all over the country,
21:06reviewing 3,000 scientific research articles on head injury,
21:11and then came together with a document
21:13which gives the best current treatment
21:16for managing patients with severe head injury.
21:18Hopefully when we're done with this document,
21:20we will have the data here as best summarized.
21:23We'll say the best things we can.
21:25Randy Chesnut, a neurosurgeon from Oregon,
21:28is part of the guidelines movement.
21:29The best trauma system is done bang, bang, bang, bang, bang,
21:33like a machine gun.
21:35The patient is injured, the intricate tube goes in,
21:37the IVs go in, the blood pressure goes up,
21:39they go to the CT scanner.
21:41You don't have time to think,
21:43and the guidelines basically give you the building blocks to do that.
21:45They make that bang, bang, bang, bang, bang thing happen
21:47that saves lives.
21:49Bright pupils still dilated.
21:51Using the guidelines, these residents reject
21:54some of the old ways of treating head trauma,
21:56which can actually do more harm than good.
21:58The standard of practice in head injury
22:00has been to keep patients' fluid restricted.
22:03With the idea like a sponge,
22:05it keeps the brain from swelling.
22:07Is the fluid running wide open?
22:09Yeah, it's wide open.
22:11But intravenous fluids are needed for adding volume,
22:13and therefore pressure to the circulatory system.
22:16And strong blood pressure
22:18forces oxygen-carrying blood to the brain.
22:21The problem was that by restricting fluids,
22:24the blood pressure would drop.
22:25Pressure's dropping.
22:27Pressure's dropping.
22:29Let's bring up the blood pressure
22:31while we're getting the volume in.
22:33Studies since then have shown
22:35that this actually causes a worse outcome in patients.
22:37So although what sounded like a good idea once
22:40and is sort of the dogma, it's wrong.
22:43And by pointing out the science of that,
22:45we hope to change practice.
22:48Now I want to ask our three neurosurgeons...
22:50At a trauma conference in Oregon,
22:52Gajar and Chestnut pushed the guidelines
22:53and gauged whether they're being accepted in the field.
22:56You've heard really a radical departure
22:59on the treatment of severe brain injury,
23:02and trust me,
23:04not all neurosurgeons even agree on these guidelines.
23:07So if you have questions,
23:09this is the time to ask the panel about it.
23:12I work at a number of different shops in Los Angeles,
23:15and the practice is very, very variable.
23:17Oh, you mean the neurosurgeons
23:19don't agree with these guidelines?
23:21They don't practice.
23:23Some of them haven't read them, I don't think.
23:25The guidelines are there.
23:27The guidelines are evidence-based.
23:29Those of us in community practice did receive them.
23:31Unfortunately, the neurosurgeons in the community
23:33are of differing generations, let's say,
23:35and there's a resistance that you meet
23:38that I've been doing something for 30 years,
23:40for 40 years, for 20 years,
23:42and it's always worked for me.
23:44There's a resistance.
23:46When I talk privately to doctors,
23:48they say, yeah, I know about the evidence,
23:50but I still do what I do.
23:51Well, that's just not good science,
23:54and I don't think the public wants to be exposed
23:56to this kind of variability.
24:04Like many Americans,
24:06Deborah Ward never thought twice
24:08about standards of care in medicine.
24:10Then, one rainy afternoon,
24:12her daughter was in an accident.
24:15Nicole was driving to field hockey practice
24:18on October 23rd,
24:19and this was the way that she went,
24:21so she had,
24:23she was driving her Volkswagen Cabriolet,
24:25so she would have turned left here,
24:27and right down ahead on the right,
24:29there's a house
24:31with a very deeply sloping roof.
24:33It's a stone house.
24:35This is where the accident happened.
24:37The tree's been cut down.
24:39You can see the stump of it there,
24:41but her car crested the lawn
24:43and went up and hit the tree
24:45on the driver's side.
24:47The impact of the tree
24:49was what caused,
24:51you know, her injury.
24:53There was no,
24:55nothing to cushion her from that.
24:58Her head struck the tree.
25:04Nicole was taken to the ER
25:06of the nearest hospital,
25:08in a coma and having seizures.
25:10Her brain pressure was not monitored.
25:14Sometime later,
25:16one of the doctors said,
25:17it's not probable
25:19that she will make it.
25:22If you are a religious person,
25:24you should contact your pastor
25:26or your priest
25:28and have them come.
25:30We were told clearly
25:32that Nicole's prognosis was terrible,
25:34that there was really nothing
25:36that they could do for her.
25:38And Nicole was administered
25:40her last rites,
25:43which is hard to see.
25:47Nicole was a senior
25:49at Greenwich High School,
25:51captain of the field hockey team,
25:53working hard on college applications.
25:55In a split second,
25:57this had all changed.
25:59But Nicole's mother
26:01wanted her daughter back.
26:03As the evening was progressing,
26:05my husband and I concluded
26:07that we needed to take her
26:09to another hospital.
26:11I guess I always thought,
26:13based upon my family history,
26:15my mom's a nurse,
26:17if you have a big problem,
26:19you go to a big city hospital.
26:21A transfer to New York hospital
26:23was arranged by a doctor in Greenwich,
26:25who by chance had been a roommate
26:27in medical school with Jam Gajar.
26:30Here, Nicole received
26:32the same treatments
26:34that would later be used on Alex,
26:36including a tube in her brain
26:38to monitor and relieve pressure.
26:40What I have learned
26:42subsequent to Nicole's accident
26:44is that in many hospital facilities
26:45around the country,
26:47even trauma centers,
26:49that they do not perform
26:51this simple,
26:53and it's apparently
26:55a relatively simple surgery to perform.
26:57The fact that it is not performed
26:59more routinely is appalling.
27:01And the closer to the time of injury
27:03that it's done,
27:05the better the perhaps outcome can be.
27:08I could at that point
27:10only hope and pray
27:12that we had reacted quickly enough.
27:14Two years later,
27:16on the same intensive care unit
27:18where Nicole Ward was treated,
27:20Alexander enters day five.
27:23He was really awake this morning
27:25when I first got here.
27:27What was he doing?
27:29He was moving his feet and arms,
27:31opening his eyes.
27:33Alexander, open your eyes.
27:44Alex?
27:46Open your eyes.
27:48Great.
27:50Good boy.
27:52Oh, there we go.
27:54Hello.
27:56Hi.
27:58Hi.
28:00Wow, that's great.
28:02Is he following the commands?
28:04Not yet that I've noticed.
28:06Can you squeeze my hand?
28:08Squeeze my hand.
28:10Open your eyes some more.
28:11Open your eyes some more.
28:13Oh, this is the first time he opened his eyes?
28:15Yeah.
28:17Yeah, he was real awake this morning.
28:19He wasn't following commands?
28:21No.
28:23Alex's brain is reestablishing cycles
28:25of sleeping and waking,
28:27signaling a new level of consciousness.
28:30Technically, he's no longer in a coma,
28:33and Gajar is no longer concerned
28:35about the pressure inside his brain.
28:38The chance of Alex surviving
28:39has now greatly improved.
28:41Hi.
28:43So we had some good news this morning, huh?
28:45Oh, is this his baby sister?
28:47Yeah.
28:49Hi, how are you?
28:51Hi, what's your name?
28:53Ariana.
28:55That's a beautiful name.
28:57How old are you?
28:59Three.
29:01How old is your brother?
29:03Nine.
29:05Wow, that's pretty good.
29:07Anyway, so, you know, he opens his eyes.
29:09Then we can take the tube out of his brain.
29:11Hey, hi Alex.
29:13Hi, Alex.
29:19See?
29:21Oh, he grabbed my hand.
29:23He grabbed my hand.
29:29A lot of the people who end up
29:31in brain trauma instances are kids.
29:33So parents are one of those groups
29:35who are advocates for proper care
29:37of their children.
29:39What I thought of was to aim
29:41the PSAs really at parents.
29:43Convinced that there is a right way
29:45and a wrong way to handle head trauma,
29:47Gajar considers taking his case
29:49to the public.
29:51Well, I think we have some choices
29:53to make about how hard-hitting
29:55we want the message to be.
29:57A consulting agency in New York
29:59gives him ideas for public service ads.
30:01This one features a very close-up
30:03shot of a little kid.
30:05So it's so close-up that he's
30:07sort of out of focus.
30:09Now for the bad news.
30:11And the test that would go under here
30:13would be if there's a choice
30:15to monitor brain pressure.
30:17If you don't do something,
30:19there could be an even more
30:21severe outcome.
30:23The ad campaign presents a dilemma.
30:25It could save lives.
30:27But by publicizing a division
30:29in the field, it could alienate
30:31the very doctors Gajar wants
30:33to convince.
30:35And it says the wrong treatment
30:37could hurt more than the accident.
30:39We're not trying to put blame anywhere.
30:41I think the doctors want to do
30:43what's best for the patient.
30:45We're just trying to get the word out.
30:47Okay. All right.
30:49How are you?
30:51Hey.
30:53Can you look at me?
30:55For days after Alex opens his eyes,
30:57the pressure inside his skull
30:59remains low.
31:02Gajar proceeds to remove
31:04the tube from his brain.
31:06Outcomes of intrigalostomy.
31:08This is the tube we had
31:10in his brain.
31:12And there it goes.
31:14It's all out.
31:16Okay. All right.
31:18The first stage is a coma
31:20where they don't open their eyes.
31:22That's about the first week.
31:24Then the second week,
31:26they open their eyes,
31:28but they don't do anything.
31:30And then the next stage is
31:32they open their eyes
31:33and he's no longer in coma,
31:35but he's not doing anything,
31:37so he's just aroused.
31:39He's in a vegetative state.
31:41Now, some people stay there.
31:43Yeah.
31:45We don't want that to happen.
31:47So I want to see something
31:49purposeful from him.
31:51Squeeze my hand over here.
31:53Squeeze my hand.
31:55Squeeze my hand.
31:57About 5 to 10 percent
31:59of all severe head injury patients
32:01end up vegetative,
32:03or dehydrated, or whatever.
32:05Maybe they didn't get enough oxygen in time,
32:07or maybe they have damage
32:09to their parts of the brain
32:11that are really vital
32:13for conscious behavior.
32:15Show me your thumb.
32:17Show the doctor your thumb, baby.
32:19They don't follow commands.
32:21They don't speak.
32:23They don't interact with their loved ones.
32:25And it's a very, very unfortunate outcome.
32:27Open your eyes up.
32:29Open them up.
32:31Can you open your eyes,
32:33please?
32:35When the doctor told me
32:37he's in a vegetative state,
32:39I wanted to die.
32:41You don't want that word being used
32:43in the same sentence
32:45with anyone that you know,
32:47any human being.
32:49My puppy.
32:51I had a conversation with Mom yesterday.
32:53She's becoming somewhat discouraged
32:55because now the progress is slow,
32:57and I told her she has to expect
32:59that things will move very slowly now,
33:01and that she has to measure
33:03the progress rather than
33:05the day-to-day now.
33:07Great.
33:17Back with neurosurgeon Dr. Jam Kajar.
33:19I'd like you to choose a case
33:21that you've worked on.
33:23Maybe we'll talk about a woman
33:25who was beaten over the summer
33:27in Central Park.
33:29Yeah, that was a well-publicized case.
33:31It was a young woman
33:33who was a 4 o'clock in the afternoon
33:35piano teacher,
33:37and she was severely assaulted.
33:40The woman's head
33:42had been repeatedly beaten
33:44against pavement.
33:46She had multiple fractures
33:48of the skull,
33:50a black eye,
33:52a bloody face.
33:54She looked absolutely terrible
33:56because her whole head was swollen.
33:58She didn't look human.
34:00The patient was given
34:01only a 20 percent chance
34:03of surviving,
34:05but no experimental drugs
34:07were administered
34:09or new technologies employed.
34:11Instead, a slender tube
34:13was placed in her brain,
34:15just as in Alex's case,
34:17to monitor pressure.
34:19That night,
34:21the tube rang out an alarm
34:23that something was terribly wrong.
34:25A CAT scan confirmed trouble.
34:27A blood cloud was growing
34:29and dangerously pressing
34:31into the patient's brain.
34:33I knew something right away
34:35because if that big blood cloud
34:37sat there, expanding,
34:39producing a lot of pressure
34:41in the brain,
34:43her blood flow would have been compromised
34:45and she would have suffered
34:47a massive stroke.
34:49When Gajar drilled through the skull
34:51to remove part of it,
34:53the patient's brain was so swollen
34:55it started to come out.
34:57I could see that the whole brain
34:59was completely swollen.
35:01It was completely distorted.
35:03Twice the patient needed
35:05emergency surgery
35:07to remove blood clots
35:09that would have killed her.
35:11And they might well have gone undetected
35:13if the team had not been
35:15diligently monitoring pressure.
35:17We can see there's an immense
35:19concentration of physician
35:21and nursing resources
35:23on these patients.
35:25You just can't plug them in
35:27and walk away and come back next week
35:29because half the patients
35:31are dead.
35:33After the surgeries,
35:35the entire city seemed to wait
35:37day after day for a sign
35:39that the Central Park patient
35:41would come out of her coma.
35:43It wasn't until the third week
35:45that she started following commands.
35:47I asked her her name.
35:49I mentioned her name to her
35:51and I said,
35:53is that your name?
35:55And she nodded her head.
35:57And I asked her,
35:59gave her another name
36:01and she comprehended it
36:03and then followed the command.
36:05That was a great moment
36:07because then we're assured
36:09of some kind of recovery
36:11and she would not be vegetative.
36:13On the one-year anniversary
36:15of her assault,
36:17the patient's community
36:19gathers to celebrate
36:21her continuing recovery.
36:23Cameras are asked
36:25not to film family members
36:27because the patient
36:29wishes to keep her identity
36:31and I know that she'll
36:33continue to make a recovery
36:35and we'll have a true miracle.
36:37Let us pray to the Lord.
36:39It's not a miracle that these
36:41patients recover and do well.
36:43That's the point about this case,
36:45that it's not a miracle
36:47on the Upper East Side.
36:49It doesn't require a magician,
36:51it doesn't require a guru.
36:53It can happen anywhere.
37:02Hi.
37:04How's he doing?
37:06I'm just covering for now,
37:08but he's febrile.
37:10He's febrile?
37:12Oh, you got a chest x-ray on him?
37:14I'm going to order one.
37:16Alexander!
37:19It's now day 13
37:21and Gachar is still waiting
37:23for Alex to show conscious behavior.
37:25He's yawning.
37:27This is a very primitive reflex.
37:29What I'd like to see him do
37:31is track,
37:33follow commands,
37:35that'd be terrific,
37:37but we're not there yet.
37:39There's this period of time,
37:41and it's a few days to a week,
37:43it can even last up to months,
37:45where there's no conscious behavior
37:47and it is the most difficult time
37:49for me and for,
37:51I mean, for all medical personnel
37:53where you're worried,
37:55is this patient going to be
37:57one of those 5-10% of patients
37:59that you have?
38:01He was opening his eyes,
38:03but not following any commands,
38:05not making any purposeful gestures
38:07with his arms or legs.
38:09There was no conscious behavior.
38:12Now we're going to go up
38:14and look at the MRI he had yesterday.
38:17So we usually get these
38:19after a couple of weeks
38:21just to see what the extent of injuries are.
38:23You see, here's the base of the frontal fossa
38:25where the frontal lobe sits,
38:27and you can see if the head moves forward,
38:29it glides across the surface here,
38:31and this surface here is not smooth.
38:33This has ridges in it,
38:35and what happens is the brain hits those ridges
38:37and it causes little bleeding,
38:39little tears, and all that.
38:41These little areas of hemorrhage,
38:43the white areas are little areas of hemorrhage
38:45in the infraspect of the frontal lobes.
38:47The frontal lobes are involved in tracking
38:49and also a sense of self,
38:51and they're an arousal mechanism as well,
38:53so that's why he's having problems.
38:55Where's his teddy bear?
38:57He likes to play with his teddy bear.
39:00It's your friend here.
39:02Look at this.
39:04Look at your friend.
39:06Look over here.
39:08Look at your friend.
39:10He's having a difficult time following things.
39:17You can see here, here's the bruise
39:19where he's hit by the car.
39:21See, maybe this is the bumper of the car,
39:23and he also got hit across his head.
39:25So this is a really significant injury.
39:30When a child doesn't do well,
39:32it affects physicians and nurses much more
39:35than I think if an adult doesn't do as well.
39:38The child is just starting.
39:40Look at what kind of disability they can have,
39:42and it's just a horrible thing to see.
39:44It affects you for a very long period of time.
39:47Come on, Alexander.
39:49Follow me.
39:55The Hollywood version of Cumberland
39:57The Hollywood version of coming out of a coma
40:00is that the person looks beautiful and is asleep,
40:03and that all of a sudden their eyes open,
40:06and it's a beautiful sunny day,
40:08and birds are chirping, and everything's great.
40:11The reality of coming out of a coma is very different.
40:16It's very slow.
40:18Nicole's eyes were open for a long period of time
40:21before she could actually really respond to me,
40:24and that was almost harder than when they were closed.
40:29After the accident, the first thing I remember
40:32is being transported from New York Hospital
40:35to Gaylord Rehabilitation Hospital.
40:39I remember being in a reclined position,
40:43like I was laying down.
40:45I remember two sets of sliding glass doors
40:47that went like that, and that's it.
40:50Because I think I'm going to stay in Boston this summer.
40:52Good.
40:54Yeah.
40:56The predictions were that I would be a permanent vegetable.
41:00I would never do anything for myself ever again.
41:04They never thought that I'd be here at BC,
41:07a sophomore, right on schedule.
41:10Now here's a check of some of the other stories
41:12making headlines today.
41:14At a cable news station in Boston,
41:16Nicole interns after classes.
41:18New England Cable News.
41:20She hopes someday to be a correspondent.
41:22But between that bright future and her car accident
41:25lay the difficult road of recovery.
41:28When I first started my therapy,
41:31there were definitely times, many times,
41:34when I thought, why am I even here?
41:37Why didn't I just die?
41:39Because everything is so much harder now.
41:41It's such a struggle to live.
41:44Why do I have to go through it?
41:47So just write Lawrence Live 9 and 10,
41:50and then Lawrence Live 9 and 10 down here.
41:52Okay.
41:54In many ways, Nicole feels like
41:56she's still emerging from a coma,
41:58two and a half years later.
42:01It's not like sometimes I have to deal with
42:04some of the effects.
42:06It's every day.
42:08Things like walking.
42:10I walk sort of not right,
42:12and I can feel that in myself,
42:14and sometimes after I've said it to people,
42:16then they notice it too.
42:18I always feel a little bit different
42:20than the average student.
42:22I take four classes per semester,
42:24not five,
42:26but I can walk.
42:28I can think.
42:30I can write.
42:32These very basic things
42:34that are taken for granted
42:36are really a big accomplishment.
42:38I'm so lucky, really,
42:40that my mother randomly selected
42:42a doctor out of the bunch
42:44who were standing in front of her
42:46and said, you know,
42:48this isn't right.
42:50I want my daughter to get better care.
42:52What can we do?
42:54And so I happened to be taken
42:56to New York Hospital
42:58where Dr. Jim Gajar
43:01did the ventriculostomy on me,
43:05and that was all happenstance.
43:08It was all luck.
43:15On Friday,
43:17the chaplain was in there speaking to me.
43:19He was saying good morning,
43:20and Alexander all of a sudden
43:22opened his eyes and looked at him.
43:24I was like, did you see that?
43:26Did you see that?
43:28But he closed him right away again,
43:30so I came on to the other side of the bed
43:32where I would be in his view,
43:34and he opened up his eyes
43:36and he smiled at me.
43:38That was like the greatest.
43:40I can't hear you, puppy.
43:42Twenty days after his accident,
43:44Alex recognized his mother,
43:46passing a major milestone.
43:48I can't hear you, puppy.
43:50You've got to get strong again.
43:52I told you, for karate.
43:54I tried to feed him Saturday.
43:56I noticed that he was chewing kind of funny
43:59because he was trying to close his mouth,
44:01but it wouldn't close in the front.
44:03So his jaw's broken in two places.
44:05It's broken on the left side in the back
44:07and the right side in the front,
44:09so it looks like when the car hit him,
44:11it just knocked it out of place.
44:13Is that good?
44:15Hey, how are you doing?
44:17Sit up a little more?
44:18Can you lift your leg up?
44:20Lift your leg up here.
44:22The best moment is when they follow commands,
44:24and that's a great time.
44:26They may even track you,
44:28follow you with your eyes first,
44:30and then say, show me two fingers.
44:32Can you show me all five fingers?
44:34Good. Show me two fingers.
44:36That's great. That's fantastic.
44:38How about three?
44:40Hey, that's very good.
44:42Give me a squeeze over here.
44:44Following commands is a sign
44:46that Alex has finally emerged
44:48from the hospital.
44:50Yeah? We're going to go.
44:52Go someplace that's more fun, huh?
44:56Bye, Alex.
44:58Bye, Alex.
45:00Thank you. Bye-bye.
45:02No longer in need of intensive medical care,
45:04Alex leaves New York Hospital
45:06for a nearby rehabilitation center.
45:09You're welcome to join anybody on the team,
45:12which is all the rehab therapists,
45:14the school teachers,
45:16me, I'm the psychologist.
45:18I'm not involved in any of the therapies.
45:21Now you're going to start swinging.
45:2555 pounds.
45:27He's always been skinny like that.
45:29Now we get to do this once a week.
45:31Every Tuesday we'll be taking your weight.
45:33Do you have any questions for me?
45:37Alexander's a very well-mannered child.
45:40He's a perfect child, really.
45:43And one thing he has
45:45is a lot of respect for his dad and me.
45:48And I've noticed, like, when I speak to him,
45:50I feel like he's ignoring me,
45:52and he would never have done that before this.
45:55So I was wondering if that's, like, part of that.
45:58Will that go away?
46:00Some children lose...
46:02Personality changes?
46:04Yeah, some children, their personality changes
46:06from the accident,
46:08but it's too early to predict anything about that.
46:10Hello.
46:12Hello.
46:13Hello.
46:18You okay?
46:20Now pick up that behind.
46:22Pick it up, pick it up, pick it up. Yay!
46:24Good boy. A little more.
46:26Another quick shimmy.
46:28One more shimmy over there.
46:30Good job. Okay.
46:32We're going to kick Ernie with it, okay?
46:34Give him a hi-yah.
46:36How's that, buddy?
46:38One, two, three!
46:40One, two, three!
46:41One, two, three!
46:43Catch with both hands.
46:45Good.
46:47Hold it up there for me.
46:49Hold it up there.
46:51Maybe they say hi-yah.
46:53Hi-yah.
46:55One, two, three!
46:57Now, can you make a picture of a person?
47:03See it?
47:05You've got to get out of your chair first.
47:07You've got to scoot forward.
47:09All right.
47:17That's a good one.
47:19How about the one down by that couch?
47:21Is that too far?
47:24There's a great difficulty in getting people to realize
47:29that no matter the early gains,
47:31there can be pretty serious long-term consequences.
47:34Changing colors, right?
47:36We don't expect parents to accept all of that immediately,
47:38and we're not in the business of destroying hope.
47:42Hope helps support all the interventions
47:44that are going to be necessary
47:46three months from now and six months from now
47:48and two years from now.
47:51See how I grew?
47:53Newborn.
47:55Go ahead.
47:57Two days old.
47:59Two weeks old.
48:01Six months old.
48:03One and a half years old.
48:05Very good.
48:07Come on.
48:15Alex, come on.
48:20Hey, this isn't the man, is it?
48:22Look, Alex.
48:24Wow, you look terrific.
48:26This is my brother.
48:28It's your brother, huh?
48:30How are you feeling?
48:32Feel good?
48:34You're looking forward to going home?
48:36Show me your fingers, okay.
48:38How about this one?
48:40Hey, that's pretty good.
48:42Do you want me to show you something?
48:44Okay, go ahead.
48:46Whoa!
48:48That's very impressive.
48:50I can't do that.
48:52I know.
48:57Well, it's great seeing you, Alex.
49:00Bye.
49:01Bye.
49:04Children who have sustained head injuries
49:07because of a change in their behavior
49:09and a change in their judgment
49:11have high percentages of secondary head injuries.
49:13And that's what we need to prevent.
49:15So we have to do a lot of educating for Alex
49:17as he grows older.
49:26We have more than 500 people at the conference
49:28from 47 different countries.
49:30Gajar and colleagues now are traveling around the globe
49:32to spread the word about the treatment protocol
49:34they so believe in.
49:36After Dr. Gajar.
49:38Dr. Gajar.
49:40Where are you from?
49:42Romania.
49:44I'd like to thank the organizers
49:46for allowing us to present the guidelines here.
49:48Our goal is to take these guidelines
49:50and apply them throughout the world
49:52so that no matter where you have a head injury,
49:54you will get the best available treatment.
49:57He had a crash.
49:59It was in a motorbike
50:01sitting behind the one I was driving.
50:03So it was intubated on the scene of accident.
50:05Brought him immediately to operating theater
50:07and placed an ICP monitoring in the ventricle.
50:12Monitoring brain pressure is not high-tech.
50:15These things get clogged up.
50:17They don't drain properly.
50:19We always have problems with the drainage
50:21when it's filtered.
50:23You should get ones without filtering.
50:24Once you start monitoring brain pressure,
50:26you're going to start doing things.
50:28It's a lot easier
50:30just to put the patient in the ventilator,
50:32give them some drugs,
50:34and come back next week and see how they're doing.
50:39They're lying there in a coma.
50:41They're not screaming out for help.
50:43They're not saying I'm in pain.
50:45I think if these patients were awake
50:47and say, listen, do something for me,
50:49we'd be doing a lot more for them.
50:54Eighteen, nineteen, twenty,
50:56twenty-one, twenty-two,
50:58twenty-three, twenty-four,
51:00twenty-five, twenty-six, twenty-seven,
51:02twenty-eight.
51:04So we're near the house.
51:06Alex has made a very miraculous recovery
51:08from his injuries,
51:10and that's a good indication
51:12of just how strong he really is inside.
51:14He's a real warrior.
51:16I'd gone to visit him several times in the hospital
51:18when he was in a coma,
51:20and I remember at one point
51:22they told me that he wasn't responding anymore.
51:24He was terrified.
51:26And when I found out
51:28that he actually pulled through it,
51:30I just couldn't believe it.
51:32It was so fantastic.
51:34So, Alex.
51:36Welcome back, Alex.
51:40Okay, today we're going to present him
51:42with his second yellow belt,
51:44which is where we left off
51:46when he last left us.
51:48So, Alex, turn around.
51:50Take your belt off, please.
51:54Okay.
52:11Is that too tight?
52:13No.
52:15Okay, belt.
52:17One, two, three.
52:19Good.
52:22One, two, three.
52:24One, two, three.
52:38Jamaica Hospital.
52:40Yeah, hi, it's Dadi Gajar.
52:42Can I have the CT scanner, please?
52:44What motivates me is
52:46there are deaths occurring
52:48every 10 minutes as we're talking
52:50that are potentially salvageable patients
52:52that can go on to have
52:54a life of their own.
53:04You're going to end up,
53:06when you're in a coma,
53:08in the closest trauma center.
53:10You do not have a choice.
53:12So it comes upon society
53:14to say to you,
53:16you don't have a choice.
53:18We're going to take care of that for you
53:20so that no matter where you
53:22or your child goes,
53:24you're going to be safe.
53:38Alex returned to his elementary school
53:40three months after his accident.
53:45He is slower to learn
53:47and the right side of his body is weak.
53:51But he has been returned
53:52to his family.
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