Appeared in Newsday
BY: Kathy Chu. Kathy Chu is a freelance writer.
EDITION: QUEENS SECTION: QueensLife
DATE: 05-14-2000

AFTER He'd been lying comatose for a month, 30-year-old Gary Davis' prognosis looked grim. Doctors at Elmhurst Hospital, where Davis had been taken after being hit by a car last July, told his family the brain damage was irreversible. The Maspeth resident would probably never walk or talk again, and recover only limited body movement.

The news devastated Davis' close-knit family.

"I just prayed that God's will would be done," said Kathleen Kelly, Davis' mother, a Maspeth resident. "But I was leaning toward him dying. I think that's a terrible existence, not being able to communicate, not being able to walk . . . but that's just my opinion. Gary had been so active."

Davis' luck changed after he started coming out of his coma in August and was eventually transferred to Jamaica Hospital Medical Center's traumatic-brain-injury unit on Oct. 13. During an uphill battle, when his body rejected his mind's will, he learned to talk again, and became what stepfather Patrick D'Angelo now calls "a walking miracle."

Gary, who also underwent brain-injury rehabilitation at Park Terrace Care Center in Corona, went home earlier this month, to strum a long-untouched guitar and to rebuild his life.

Before the 1970s, Davis' chances of survival would have been almost nonexistent. That was before MRI and CAT scans provided glimpses inside the brain, before medical advances improved survival rates and advocacy led to standardized care. And it was before hospitals such as the nonprofit Jamaica Hospital opened up traumatic brain-injury units, legitimizing the medical needs of a once-ignored population.

Indeed, Jamaica Hospital is one of the state's premier institutions for rehabilitating brain-injury patients.

"Jamaica Hospital has accomplished a lot in the field of TBI care," said Veronica Gala, a state-appointed TBI resource coordinator for Queens and the Bronx.

According to Dr. Kathryn Ko, the chief of neurosurgery at Jacobi Medical Center in The Bronx, Jamaica's TBI unit is "the jewel of the community."

"It has elevated Jamaica Hospital significantly as a leader in the field," said Ko, who worked there until 1996.

At the James & Sarah Brady Institute for Traumatic Brain Injury, which opened in the Jamaica hospital's north wing in 1996, patients such as Davis are monitored by 25 therapy professionals and neuro- psychologists. The waiting list for admission to the 20-person unit is often full, and about 1,200 patients have come through since its inception.

Because brain-injury patients are often more aggressive and less inhibited - many curse, hit and become easily agitated - doctors say this population has a greater chance of recovery in special-care units such as this one. Here, staff members tailor medical treatment, counseling, even food to the patients.

"Traumatic brain injury presents specific challenges," said Dr. Angelo Canedo, Vice President of Jamaica Hospital's Rehabilitation Department. "These patients need a quiet, controlled environment."

It's the small, but critical touches that facilitate the recovery of brain injury patients, doctors say.

In Far Rockaway, at Peninsula Hospital Center's TBI unit, social workers track patients for a full year after leaving. It's part of the hospital's "proactive" approach to caring for this population, program director Michael Smith said.

An estimated 5.3 million people - more than 2 percent of the U.S. population - live with brain-related disabilities, ranging from memory loss to paralysis, according to a preliminary study by the Centers for Disease Control and Prevention in Atlanta.

Called traumatic brain injuries (TBI), these conditions result from blows to the head, and cause damage to regions controlling physical and mental functions. At its mildest, traumatic brain injury can boggle the mind for six months to a year; at its deadliest, the condition can paralyze the body and mind for life.

A decade ago, traumatic brain injury patients were an ill- documented and silently suffering population. Community resources were few and specialized medical care was virtually nonexistent. But in an era when TBI, as this condition is commonly known, has garnered more attention than ever before - largely because of prominent supporters and recent legislation - hospitals have become an important gateway for integrating brain-injury patients into society.

For many patients and families facing potentially debilitating brain injuries, quality medical care and the proper environment may make all the difference.

In Jamaica Hospital's Brady Institute, oversized hospital rooms accommodate those who wander, glass observation rooms allow 24-hour monitoring of coma patients and chrome handrails glide across the walls. The clinical aspects of a hospital - the antiseptic smells, the white-clad medical staff - are tempered by soothing violet- and blue-toned colors, splashed throughout the patient rooms, lounges and dining hall.

These colors help patients to focus as they recover, according to therapists, as most suffering brain injuries begin seeing shades of light and dark before faces and objects.

The injured receive a bevy of aggressive therapies five days a week on this 12,600-square-foot floor, including physical, occupational, psychological, cognitive and speech therapy. Intervention often begins in the intensive-care unit as early rehabilitation could speed up recovery, according to Alicia Conforti, who coordinates therapy for brain-injured patients at Jamaica Hospital.

For Salvatore Como, 20, of Middle Village, the personalized care at Jamaica Hospital made the difference between a painful existence with TBI and a mobile life with independence.

On Dec. 31, 1997, Como tried to break up a fight outside a party he had been attending. A severe blow to the head blackened his world for two weeks. As he slowly drifted back to consciousness, Como had little control over his arms and legs. A helmet bound his head, a remnant of an operation that temporarily removed bone to relieve his brain swelling.

Then began a recovery process that would eventually bring back nearly 100 percent of Como's mental and physical capacities. But first, he had to regain control of his body and mind.

Specific needs - a certain kind of food, the thought of wiping away his sister's tears - overwhelmed Como and helped him recover. Therapists at Jamaica Hospital, aware of his poor endurance and his slowly recovering legs, tried a novel tactic, making him a savory offer: Walk the three blocks to McDonald's and get anything on the menu.

Como completed the feat. And, after months more of therapy, he eventually regained body movement, speech and most of his mental skills, though he still experiences intermittent memory loss. He then left the hospital, finished his senior year of St. Francis Preparatory High School in Fresh Meadows and enrolled at St. John's University in Jamaica, where he's still a student.

Today, Como's memory lapses serve as stark and lifelong reminders of the accident.

"I feel very lucky to be where I am," he said.

As much as the TBI unit, doctors' expertise and love for their work also draw patients to Jamaica Hospital.

When not overseeing the unit, Canedo, the hospital's vice president of rehabilitation services, consults on brain-injury patients for the state. Dr. Philip Harris, the hospital's chairman of physical medicine and rehabilitation, prides himself on being able to diagnose even one patient with mild brain injury, but who had never been diagnosed.

And Dr. Jamshid Ghajar, chief of neurosurgery at Jamaica Hospital and one of the country's leading experts on treatment of brain- injured and coma patients, undoubtedly lends weight to the institution's reputation for TBI care. He deals mainly with patients who come into the emergency room, but his work is the foundation for the rehabilitation provided in the north wing.

Ghajar, who also serves as president of the Brain Trauma Foundation, a nonprofit research and advocacy organization in Manhattan, helped establish the first protocol of treatment for the brain injured. New York State hospitals now uniformly use this standard, and it may someday be implemented on a national level.

The 15-chapter "Guidelines for the Management of Severe Head Injury" came about in 1994, after two years of research and review of 3,000 scientific research documents by Ghajar and a group of brain trauma specialists.

Because the Guidelines, as they are commonly known, were based upon scientific findings, most in the medical community welcomed their introduction. The Rolling Meadows, Ill.-based American Association of Neurological Surgeons and New York State approved the standard of care in 1995, regulating treatment of brain-injury patients, from brain pressure monitoring to the use of barbiturates.

Medical treatment and prevention of brain injuries have come a long way since the 1970s.

Today, nine hospitals, including Jamaica and Peninsula Hospitals in Queens, offer rehabilitation programs for this population in the five boroughs.

In the three-year period ending in 1997, statewide hospitalizations related to traumatic brain injuries dropped 8 percent to 13,863, according to the New York State Department of Health. Statewide deaths during this time fell 13 percent to 2,368.

In Queens, 1997 TBI-related hospitalizations dropped 8 percent to 1,517. Deaths dropped 18 percent to 268 from three years earlier, led by declining brain-injury-related deaths from motor vehicle accidents.

Yet brain injury remains the leading cause of death and disability for those between the ages of 1 and 44, mainly resulting from car accidents, according to the Brain Injury Association in Alexandria, Va. And awareness and treatment of this condition still remain scarce in many parts of the country.

"This is called the silent epidemic because thousands of people may be walking around with this, and they have not been diagnosed," said Dr. Gregory J. O'Shanick, national medical director for the Brain Injury Association.

Doctors routinely misdiagnose this condition because of its byproducts, including depression and impulsive behavior, he explained.

The severity of these conditions are also minimized by professional athletes, who propagate the "public perception that mild brain injuries or concussions are not important," according to Dr. David J. Thurman, medical epidemiologist for the Centers for Disease Control and Prevention.

Those who fall and hit their heads often pick themselves up, and without visible injuries, resume playing.

"There's still, unfortunately, a stigma to the concept of being brain damaged, and this has to change," O'Shanick said. "It could happen to any of us."

Receiving specialized care at TBI units, such as the one at Jamaica Hospital, is essential to a full recovery, he said. Otherwise, the consequences could be disastrous.

"Individuals may end up in jail or in the mental health system," O'Shanick said.

Part 2 of this series "The Long, Costly Road Back"

© Copyright 2000, Newsday Inc. Reproduced with permission.
Kathy Chu. Kathy Chu is a freelance writer, Relieving The Trauma / Jamaica Hospital takes a leading role in recent gains in treating victims of brain trauma, Newsday, 05-14-2000, pp G01.