TBI: Seattle’s Harborview Hospital

Harborview Medical Center is the designated Disaster Control Hospital for Seattle and King County Washington, it also serves the states of Alaska, Idaho, & Montana. When you see it on the hill east of the sports stadiums, it’s very imposing. It’s actually at the the top of Seattle’s famous ‘Skid Road’ where logs were sent down into Puget Sound and assembled into floating chained rafts for lumber processing nearby.

More than Grey’s Anatomy TV

Thousands of patients are treated each year in the Neurosurgery Department for disorders of the brain, spinal cord, and peripheral nerves, such as traumatic brain injuries (TBI), spinal cord injuries(SCI), stroke, brain tumors, degenerative disc disease, and spinal disc herniations. The hospital’s orthopedics service has been listed as one of the top 10 services of its kind in the country by U.S. News & World Report. (And, yes, it was the basis for the fictional TV series – Grey’s Anatomy.)

Harborview was instrumental in establishing Medic One, one of the country’s first paramedic response programs & many of Washington state’s emergency medical service technicians are trained there.

And this was where our TBI adventure began in 2024 with a Medic One call to Seattle’s Discovery Park. Since, where an individual goes for treatment of all TBIs can make a major difference in their recovery, we were glad Harborview was his first destination.

That call . .

The ride to Harborview was a blur. After the call to my phone, my mind was racing with too much adrenaline & too much imagination. 

I created the scene in my head: I imagined the Medic One ambulance coming down the service roads close to the trail where the tree hit him, their arrival a surge of adrenaline and relief to his girlfriend and the other morning walkers who rallied to help him. 

Firefighters, their faces etched with concern, assessing the situation with practiced efficiency. The paramedics moving with swift precision, their hands a blur of activity as they stabilized Rory’’s neck and spine. I daydreamed helplessly, imagining them carefully lifting him onto a carry board, then onto a stretcher and into the ambulance.

An hour passed, as Seattle traffic cleared my head, exited I-5, and found the hospital parking garage. As I emerged from underground, a medical helicopter began its windy landing nearby, adding to my chaos.

Finally, after some wrong turns, I walked into his patient room on the 2nd floor’s Acute Care Unit.  The quiet scene was jarring. Rory lay in an elevated Stryker bed, his head & eyes bandaged, and with each limb pinned gently with a pair of pillows.  Yikes – even at 42, he was my little boy. And this looks bad. Helplessness washed over me. I could only hope we were surrounded by experts . . .

A nurse emerged, her face grave but reassuring. “He has suffered a severe head injury,” she began, her words a cold shower of reality. “We’ve stabilized him after surgery, but he’s in critical condition. We’re going to need to monitor him closely. Our integrated Acute Neurology Team is already evaluating him for the first steps in a rehabilitation program. They’ll meet with you in 40 minutes here in the room.”

The Acute Neurology Team we met outlined their integrated & intensive care program to us that included medical, nursing, and therapy care to best address Rory’s complex needs. They emphasized the earliest possible start to his rehabilitation, so that they could optimize his recovery during the first 3 months.

Their focus was five-fold for the unique needs of their dual-diagnosis of traumatic brain injury and spinal cord injury:

1. Maximize arousal and responsiveness
2. Develop new cognitive and behavioral strategies to compensate for any deficits.
3. Improve physical function and mobility to enhance the skills needed to perform daily activities.
4. Overcome the psychological and social problems that often interfere with the eventual adjustment to an independent life at home, work, and in the community.
5. Advanced treatments to mitigate the complex physical, functional, & cognitive challenges inherent in his dual diagnosis.

The hours & days that followed were a haze of fear and uncertainty. I spent countless hours by Rory’s bedside, covering his hand, talking to him, hoping that the sound of my voice would reach him through the fog of his coma. I was also starting to sort out all our priorities the interdisciplinary team had outlined as part of his recovery.

The hospital room became my world for weeks, a sterile, but comforting place filled with the pulsing hum of a breathing machine running under the soft green glow of monitors. For a week at least, he was out of it – just a few vocal groans & the twitches of muscle spasms. Being fully intubated limited everything but the steady assisted breathing. We each read to him from Sherlock Holmes or Robert Frost books. We knew he was in there . . . He was alive. And that was all that mattered right then . . .

Slowly, quietly, Rory began to emerge from his darkness. His eyes opened occasionally, but they were vacant and unfocused. His first clumsy movements were during nurse visits to adjust his position or raise the head of the bed. His voice came last – slurred half-words during a breathing tube adjustment.

The road to recovery was described as long and arduous, filled with setbacks and challenges. The staff used lots of new definitions like trajectory, amnesia, rehabilitation, trauma, axonal, diffuse & hypothalamus. And I heard a few ways to say ‘maybe’, ‘hopefully’, & ‘optimistic’ as well. This new glossary helped me stay afloat as my emotions rose & fell over these first 6 weeks.

We were surrounded by many talented & caring staff members who educated us daily:

• Physicians who managed his complex medical needs & decided on procedures.
• ARPNs who assessed his progress daily and monitored prescriptions & treatments.
• NeuroSurgeons who performed emergency brain, cranial, & spine surgeries.
• Acute Care nurses who provided evidence based care hour by hour 24 hrs/day.
• Physical, Occupational, & Speech therapists who started his first assessments.
• A Clinical Social Worker and a Neuropsychologist for behavioral assessments.
• A Dietician who quizzed us about allergies, diabetes control, & favorite foods.
• And even a Case Manager who coordinated care / insurance / discharge details.

Emergence

Six weeks. Six endless weeks of walking 4 blocks in the early Spring sunshine from the Sorrento Hotel and watching my son fight for his life in the 2 West Unit. The days had bled together, a monotonous cycle of hope and fear. But this week, something was different. He had been moved to another room further away from the nursing station on 2W. The medical team concluded that he was past the greatest risk. COOL!

His breathing was still assisted by a ventilator, but now through a tracheostomy, surgically inserted in his neck rather than the full throat tubing installed during the emergency brain surgery on his first day here.

The rhythmic beep of the ventilator, a constant companion in the hospital room, was finally silent. Rory was breathing on his own. And even more astonishing, he was talking. It was a whisper, at first, a raspy, barely audible sound. But it was his voice beginning to make sentences.

The weeks that followed were a blur of small procedures, physical therapy, occupational therapy, and speech therapy in his bed. Rory was a warrior, determined to reclaim his life. He endured up to 6 hours of grueling exercises with his body protesting at every turn. His speech was starting to improve, each word a victory hard-won. But with every small step, a flicker of the real kid returned, a spark of his former self that ignited hope within us.

By the ninth week, Rory was sitting up in a wheelchair, his arms supported by pillows. His speech was still labored, but he could communicate basic needs and express his frustrations, but we saw some relief after the Botox treatment loosened up his left arm & relieved pain.

He was still frustrated, I knew: trapped in a body that no longer easily obeyed his commands. But he was also determined, a stubborn streak that had always been a part of him. Wheeling him to his 2W therapies cheered him up & he enjoyed the talented staff.

The day he took his first drive with the power chair was a day I’ll never forget. The nursing station erupted in applause, pride showing on my face as I watched him, clumsy but triumphant as he slowly wandered down the hallway. It was a small victory for us, but it was huge for him. It even made the week’s physical therapy sessions in the big gym even more positive. Instead of relying on us to move him, he regained some major control over his life – he could get to his many therapies himself.

Yet, beneath the surface of our joy, a shadow lingered. I knew the old Rory was gone, replaced by a new semi-stranger struggling to find his way back to function & independence. His memory was patchy, and his personality, once vibrant and outgoing, was still muted. I longed for the old self-sufficient Rory, the one with the infectious laugh, fast walk, and the quick wit. But I was beginning to realize during his therapies that person would never fully return. This was Rory 2.0 charting his new course with expert help.

And so, we adjusted as he progressed on 2-West. We found joy in the small victories, to appreciate the body’s progress, no matter how slow. We talked about the broad future, about the 4W Therapy Unit, his girlfriend, some realistic goals, and ultimately about continuing to rebuild a life shattered by a cosmic accident. And as each day passed, I saw a glimmer of the funny guy returning, and that one day, with help he could be independent again. And I saw that the next steps would include working toward acceptance in the Rehab Unit program on 4W.

4-West

The day they moved Rory to the rehab unit was a bittersweet milestone. It meant progress, a tangible step forward. But it also meant leaving the familiar confines of the 2W Acute Care Unit, a place that had become a second home. It was hard to say those brief goodbyes to our favorite staff members and then quickly go upstairs to Harborview’s 4-West. But it all happened in 1 hour . .

The rehab unit was a different world, filled with the sounds of laughter, encouragement, and the determined clicks of walkers & power chairs in the hallways. There was a gym room that took up 1/4 of the floor where residents spent hours working on relearning basic tasks that we all take for granted like using fingers, hands, & legs.

There were patients relearning how to walk using parallel bars or the Zero Gravity device, some using hand or foot bikes, and several relearning to sit up using their core muscles. One of the hardest is using arms to rise from a sleeping position and moving to the edge of the mat to get out of bed. The 2nd half of that is a transfer from the mat to the power chair using just a slide board.

The intensity of his therapy sessions was overwhelming at first, especially on the big blue mats. Physical therapy was a battle against his weakened body, pushing him to his limits. Maddie & Kai led these sessions, and brought a wealth of experience and patience to their work. They also scheduled extra hours to build his strength up with weights too. Both of them had an integrated approach for adding strength, increasing range of motion, and maintaining flexibility that contributed to his steady trajectory. We were incredibly fortunate to have benefited from their persistent expertise day after day.

Occupational therapy challenged his cognitive abilities, forcing him to relearn everyday tasks with frustrating slowness. Speech therapy was a constant exercise in patience, as he struggled to practice swallowing thickened liquids, relearned how to use a spoon, and remember words for conversation. But he was becoming more self-sufficient a week at a time. The daily miracles were adding up . . .

For the daily task re-training in Occupational Therapy, Liz brought a wealth of experience and a sense of urgency to her work. The innovative approach to expanding our son’s action range once he was in a power chair made a significant difference in his self-image each day. Just coaching him to operate the chair brightened his eyes on the way to the gym each day. We were hopeful that her training with tangible goals would eventually see Rory using his left arm at a practical level before he moved to another intensive rehab facility like QLI in Omaha.

The ever-patient Addie & Sara were our speech therapists who re-trained Rory to swallow after being on a ventilator since the 1st week. The tracheostomy was irritating, sure, but tons better for his throat than the ventilator tubing. The family & the team of doctors felt much better when the ventilator went away. That was a great proof of progress . . .

Addie & Sara’s innovative approaches in increasing his awareness and increasing his voice strength soon allowed for significant progress in his day-to-day interactions with the medical staff also. Over the course of about 3 weeks he was answering questions from the medical staff members when they came into his room. And after 4 weeks he was answering questions during assessments in the morning rounds, instead of just a thumbs up.

Each of the therapists paid intense attention to him during sessions in the busy 4W gym, and made the most of their sophisticated built-in tools each day. As you can see in this post’s images, there’s quite a variety of tools for him to increase his range of motion & expand his motor flexibility.

And there’s the psych of TBI to consider too: he had been meeting with the staff neuropsychologist periodically, plus he was followed by the clinical psychologist. Sometimes we’d go on a little PowerChair outing around the hospital where he took the lead up to new floors & new sights. We all benefited from these relaxed moments . . .

But Rory was a trooper. The spark of defiance that had ignited during his ICU stay burned brighter than ever. He pushed himself harder than we could have imagined, his determination was a constant source of inspiration. With each passing day, I saw a flicker of our 42 year old returning – a glimmer of his former self that gave me hope.

His social skills, once a hallmark of his personality, were slow to recover. The guy who had been socially involved was now hesitant and withdrawn. But gradually, he began to engage with other patients, trading banter and sometimes laughter. These were small steps, but it meant the world to us as we tracked him from therapy to therapy each day.

As the weeks continued on, I watched my son transform. The frail, vulnerable man that had survived emergency brain & spine surgeries was slowly being replaced by a stronger, more resilient individual. His physical strength was growing, his speech improving, and his cognitive abilities were starting to sharpen.

It was a journey filled with setbacks and frustrations, but it was also a journey of courage and determination – and he was starting to advocate for himself with us & the medical staff.

I was in awe of his spirit – and I still am. He was my hero then, and he’s my inspiration still. And as I watched him grow stronger every day, relearning basic tasks, I began to believe that maybe, just maybe, Rory 2.0 would find his way back to a new normal.