Surgery For Brain Hemorrhage and Traumatic Brain Injury (TBI)

A 50 years old female presented with hemorrhage in the brain secondary to a stroke. The cause of stroke is because of the heart valve surgery that was done when she was 16 years old. The artificial heart valve can cause some emboli and high blood pressure. Furthermore, she was in blood thinner that can make this hemorrhage worse. The brain hemorrhage occurred in the dominant side of the brain, the left side in the back where people understand, talk and read. She had difficulty in reading, writing, understanding and getting sleepy. She could not be off blood thinner for long. The brain hemorrhage can also be related to tumor. She was urgently taken to surgery; the hematoma was evacuated through the craniotomy and was sent for pathology. The bleeding was controlled and the patient went to intensive care unit and CT scan showed no more hemorrhage. Pathology showed no tumors. She required extensive speech therapy for one year to learn how to talk. Furthermore, when therapist and doctors told her that was done, her two daughters did not give up and at home both daughters and patient were performing many therapies, education, going slowly through language, writing and typing. She was a court reporter. Over the years from 1999 to 2010, she even improved more and learned the new technology devices such as computers, cell phones and she lives independent with clear speech and great wisdom.

Carmel P. had already had two heart surgeries and was on the blood thinner coumadin when she suffered a brain hemorrhage in 1999, likely caused by the coumadin. She had been experiencing a severe headache for more than a week, yet still going to work, when her co-workers noticed she did not look right. In fact, she was so bad that her supervisor actually drove her home. “I realized something was terribly wrong,” she recalls. “But I didn’t know how wrong.”

Carmel was taken to the hospital by her then husband and daughter after she found she could not talk. “My other daughter, who was away in Arizona at college, called, and, though I could hear her, I found I could not respond to her. She called my daughter who lived with me and she came home to take me to the hospital.”

She was admitted with a major brain hemorrhage and was not expected to live through the surgery. Though most of the medical experts called in for her case said they felt continuing care was a waste, Dr. Ghaly said that as long as she showed she wanted to recover, she should have continuing care and rehabilitation.

“Even my then husband (now ex-husband) was ready to give up on me,” Carmel says.

Shortly after brain surgery, Carmel suffered some complications. She had severe leg pain and the doctors thought it might be complications from her previous heart surgeries. She was transferred directly from Intensive Care to the Chicago hospital where her heart specialist took over her care. “I was pretty out of it still,” Carmel remembers. “My sister went with me in the ambulance. She kept reassuring me I was just going for therapy. In reality, I was being transferred because they thought I would need a third heart surgery. The doctor in Chicago did more tests and decided I should have the surgery in the morning. Over night a miracle occurred. By the next morning they did more tests and my heart was fine. I did not need the surgery after all. But because I was already at that hospital, it was decided I should do rehab there. So, for two months, I did therapy there.”

Carmel so wanted to recover that she began teaching herself to read and write again while still in the hospital. “I used the menus they brought each day, and painstakingly copied, printing, not cursive writing, those menus,” she says. “I still have them to this day. My printing looked like something a three-year-old child would do, but it kept getting better. I copied everything. It took a year before I could do cursive writing again. I would sit up at night and practice printing. I had to re-learn my name, and would copy it time and time again.”

Even though Dr. Ghaly was not at the Chicago hospital, he started visiting Carmel regularly. One day she showed him her name, carefully copied. “He said if I wanted to get better that badly, he would make sure there was someplace for me to do rehab,” Carmel says. “He even scheduled his visits to watch my therapy sessions. He put pressure on my therapists, telling them I really wanted to improve, even when most of the medical community said I would not be able to recover from this hemorrhage.”

Carmel was sent home to recover more, spending time as an outpatient at a local hospital doing therapy. “Dr. Ghaly actually found a hospital/therapist who would send a car to pick me up for therapy because I could not drive and my family had to return to work.”

Carmel learned how to walk and talk again, making slow but steady progress. “A friend who was a teacher tutored me three times a week, using flash cards that she used to teach children to read,” she recalls. “I still have those cards, and today use them to help my grandson learn how to read.”

Then, several years after the brain hemorrhage, Dr. Ghaly asked Carmel if she would like to learn to use a computer again. “He sent me to the Rehabilitation Institute of Chicago for that,” she says. “I had already re-learned how to drive, using the church parking lot after services on Sunday. I could drive a little locally, but not into Chicago, let alone downtown Chicago. My children were so good at helping me re-learn things. They taught me how to drive again, and helped with the alphabet and writing.”

But Carmel’s sense of direction was not good any longer, and she was afraid of getting lost. “So I learned how to get to the train station,” she says. “I drove to the station, took the train to Chicago, and then took a cab to rehab. I used a walker at first, then a cane. On the way home, I would have to ask the conductor which train went to Orland Park, but I got there and back. That’s how important rehab was to me!”

The emotional toll of recovery was high. “It was very frustrating, and I would often sit there and cry,” she said. “Later, Dr. Ghaly asked me to counsel some of his patients who had suffered the same kind of hemorrhage. I remember sitting there and talking with them, and both of us crying. It’s still very emotional for me to talk about what happened. I’m only here because of Dr. Ghaly. Every doctor was ready to give up on me. He was the only one who saw any hope. It’s like God is watching over Dr. Ghaly so Ghaly can watch over his patients. I know Dr. Ghaly gets into a lot of trouble with the medical community because he’s doing the right thing. I would be dead except for Dr. Ghaly’s faith in me.”

Being able to read again has been an ongoing challenge for Carmel. “I volunteered to do some filing for a doctor, just to learn the alphabet again,” she said. “Someone was watching over me at first, or they never would have found those files! My children made a huge poster with the letters on it, so I could learn them again.”

Carmel was a court reporter and was forced to retire because she still has trouble with reading. But today, few would see anything unusual about this vibrant woman who so obviously dotes on her grandson, a delightful little boy with the unusual name, Oz. “I still enjoy books,” she says. “I just listen to books on tape! I’ve found ways to overcome any deficits. I tell anyone that they have to try. If they want to get better, they have to try. Be positive. You may never be quite right, but you will get better than what you were after the hemorrhage or surgery. Practice by yourself, with your family, or with people you trust. It will come back to you.”