I’m going to admit that I have been sand bagging this one for a while. Seeing as how my son has returned to baseline from a catastrophic parenting failure, him and I spoke about the incident. He asked me to write a story about it. It warms my heart to know he wanted his story told because he hopes it will “help others.” We all know accidents happen but not all end with injury. Here is the story of Good Friday and the terrible easter that followed.
The Build Up
There is no denying that 2023 will go down in history as an epic winter. Jen and I had been fortunate enough to visit Tahoe, Mammoth, and Brian Head this year. We had so much fun we decided it was time to download our manifesto into the tiny humans the government tells me belong to me. I gave all three children the option: Skis or Snowboards. Like tiny human dominoes they answered one by one “snowboards.” They finally fell into place.
With the financial burden of having 3 small tax havens out of the way, their equipment arrived. We all inspected it and fantasized about the pending easter trip to Brian Head. Everyone was excited… even me. For those of you that know me, I have a hard time showing emotion so the fact I was visibly excited to share this experience was huge.
Thursday
We made the pilgrimage to Utah and eventually up to the resort. The kids were excited to enroll in their second session of snowboarding but with their own gear this time. Jen and I had mixed emotions of watching them take their first steps into a lifetime of calculated risks. I grew up in the action sports world but Jen had reservations. We eventually handed them off to the snowboard instructor and said our goodbyes for the next 4 hours and went on our way.
Jen and I had a great day in the unusually deep and powdery conditions. So much so that we were worn out within a couple hours from digging ourselves out of numerous powdery holes we were fortunate enough to find. My ankle was starting to act up so I made the executive to head back to the lodge and watch the kids take more of a beating than the one I had been receiving all day.
We found a nice table where we could see the entire lesson. All kids were having a blast and somehow doing it with less effort than I ever imagined. This was reminding me of the time when my son finally bested me on video games only now he is doing it with snowboarding…
Thursday Night
After returning from the resort I sat down with the kids in front of the fire. We had a lengthy discussion about their day and what they wanted to do on this trip. Everyone wanted to return for an additional day of snowboarding on friday, including me. However, something seemed off. Historically, my gut instincts have been spot on and I am proud to admit my super power is intuition. I have narrowly escaped certain death numerous times by simply listening to my gut. In this case, no one sustained an injury other than my pride.
I decided that we had enough snowboarding for the season and instead we would go sledding and inner tubing on friday. My thought process was less crowds, and everyone was wanting to do it over the weekend. Although, we also needed to pack in the easter egg hunt in Duck Creek and a parade in Panguitch. So I listened to my gut that was telling me to slow things down.
Good Friday
The morning crept in with the usual call of the 3 year old screaming 2 inches from my face reminding me that “the sky’s awake, so I’m awake.” I laid there reminding myself this was hopefully the last year I ever had to deal with the psychological torture every parent has gone through since Frozen came out. Alas, I rolled out of bed and began the ritual flogging of the day.
After fighting with the kids to get everyone dressed, fed and loaded into the van, we set out for our usual sledding hill. We decided to take a couple of snowmobiles to reduce the fatigue of me inevitably being roped into dragging kids up the hill in their tubes. Also, my son was really wanting to ride them again this year.
We unloaded in the dirt lot and set out to the hill. Everyone was having a great time and the kids began to push higher up the hill until they crested the tree line. My brain initially ignored the fact that there were trees present due to the sparse population of them in anyone’s direct path. I grabbed the smallest child, strapped on a helmet, and began to take her for a ride on the snowmobile while the others tubed down the hill.
Breaking Bad
Alex and I were happily cruising through a meadow when off in the distance I could see my dad and Jen waving their arms. That feeling in my gut I had the night before began to return. I sped over to the base of the hill where my dad was sitting and he told me that “josh hit a tree”. I don’t think anyone was overly concerned at that moment because on first glance it appeared he just took a decent hit but would eventually bounce back.
After taking a brief second to process what was happening, I asked my dad to take Alex off of me. I then took off up the hill at full speed. As I reached the top, Jen was huddled over my son with a panicked look on her face. I rushed over and could see he was holding his head and rolling in pain in the snow. I asked her “what happened?”
Deep Impact
Jen proceeded to tell me that he kicked his tube sideways trying to make it spin and in doing so he veered off course into the tree. She then told me she thinks she caught it on film. I looked down at my son who was obviously in pain and asked him “where does it hurt?” He was alert enough to recall the incident and told me “the back of my head.” as he continued to squint and lay on his side. At this point the medical training took over. I rushed through a series of questions and basic primary assessments to evaluate his neurological status.
As I was feeling the back of his head he had obvious tenderness behind his right ear. There were no signs of bruising or bleeding, just pain. He was able to recall the impact, the approach, and responded appropriately to every question I threw at him. I couldn’t shake that feeling in my gut though. I turned to Jen and told her to pack everything up and lets start heading towards the hospital.
Experience vs. Intuition
Every fiber of my being was screaming something was wrong. On the other hand, every evidence based question or exam I did was overly reassuring. We were roughly an hour from the nearest hospital and I had to make a decision. A decision that could determine his ultimate fate.
As a Sports Medicine Physician, I see thousands of head injuries. The whole point in having my specific education is to recognize when things need more care than what is available at the scene. This was one of those dreaded moments in my profession; do I shut down the venue, ship out the athlete, and ruin their season? Or, do I watch and observe?
The problem with head injuries is that they can worsen pretty quickly. Initial recognition is critical in long term outcome. This is why I made everyone pack up instantly and carried my son to van to begin transport to the hospital. I could feel something was not right but couldn’t put my finger on it.
The Ride In
I sat in the back next to my son. My father was driving. At 5 minute intervals I would ask a new set of questions and check another neurological function. The further we got into the drive, the more alert and responsive he became. By the time we arrived at the emergency room he was essentially at his baseline. The only thing that seemed off was his attitude. He was visibly upset and pissed off.
Normally, he is a very mellow and sweet kid. He was describing a headache with no other symptoms at all but his mood was angry and irritable. I decided we were still going to have the ER take a look at him. Worst case scenario they would tell me I was over reacting, charge me a huge bill, and send me on my way. I could live with that given the alternative.
Second Opinions
The ER doc came into the room shortly after our arrival. He had a full interactive conversation with my son and I. I reluctantly showed him the video my had captured. He then proceeded to tell me that his impression was a “moderate” impact but given his stable and promising condition he was on the fence if imaging needed to be completed.
Over the course of the next few minutes I explained to him what I do for a living and the nature the action sports athletes I work with. I conceded that my son looked astonishingly well and only slightly off baseline. I then proceeded to tell him that something just seemed off on his initial presentation and that I wouldn’t be able to sleep if I don’t insist on the imaging. He completely understood where I was coming from and obliged to get the CT scan.
Initial Imaging
My son had never had an X ray before, let alone a CT scan. He was nervous and scared. I did my best to explain what was about to happen. I told him I would be right there with him the whole time. He reluctantly agreed and off we went.
He climbed off the wheel chair onto the bed and was slid into position. I stood nearby explaining what was happening. He laid as still as possible until the images were completed. We then wheeled him back to the ER room where my father had been waiting for us.
A few moments later the ER doc reappeared. A stern look had replaced the friendly demeanor he previously had. That feeling in my stomach was now so heavy I could barely move. The doc proceeded to tell me “I wasn’t expecting it to be this bad.”
The Burden of Knowledge
The initial report indicated not one, but two subdural hematomas and one sub arachnoid brain bleeds in addition to a broken skull. As a parent of 3 very active kids, I always knew I would have to deal with broken bones but I never thought the first one would be a skull fracture and multiple brain bleeds.
I knew too much at this point. Every possible outcome flashed through my head. I began pouring over the statistics and desperately choked back the fear. I didn’t want my son to think I was worried. If I could hold it together, he wouldn’t be afraid. I swallowed hard and asked if I could see the images. The doc then gave me the keyboard and mouse as he retreated to the nursing station to speak with a neurosurgeon in Salt Lake.
Dodging Bullets
I frantically scrolled through the images taking stock of any imperfection I could find. I wanted the brutal truth so I could figure out how to move forward and solve the problem. There was an eternity of silence while I rocked the mouse wheel back and forth over various images. Eventually I conceded defeat that I could no longer do it. I just couldn’t. I needed reassurance from an outside party to point me in a direction.
A few moments later the ER doc returned. Finally some good news he said. The neurosurgeon in Salt Lake said the bleeds were small enough and if his condition remained stable, we could monitor in house and just repeat imaging later that night. We agreed to stay and were officially admitted to the hospital.
Not Your Average 5 Star Hotel
The nursing staff came to collect us for the journey. We had to move from the ER to an inpatient location. Normally this is several floors and a wing or two away in a standard hospital. However, in a rural setting, we were wheeled 10 feet to a set of doors and immediately on the other side was the inpatient ward. A couple doors down was our ultimate destination.
We were booked into our cell for the night and given the introduction to all of the staff. Literally, everyone working in the hospital that day came by to check on us. Everyone was insanely friendly and genuinely concerned for our well being. My son felt like a king despite the broken skull and bleeding in his brain.
Stuck in the Hospital
An hour or so after the official admit, my son began to feel nauseated and eventually threw up. For head injuries, this is never a good sign. The nurse was alerted to the new development and the doc put in for another CT scan to see if the bleeding had worsened.
My son continued to look at me for guidance. Again, I choked back the tears, buried my emotion and pretended like everything was fine. I could feel the weight of my soul being crushed by grief and speculation. The power of convincingly reassuring someone is solely dependent on your ability to stomach the burden of their pain and hide your own emotions. One of us had to be strong for the others.
My son began to get noticeably scared when they brought out the IV needles. He made eye contact with me and asked what that was for. I calmly explained that he needed a stable place to put medications and to prevent him from having multiple shots, they would use an IV. He submitted without hesitation but asked if I could be the one to put it in for him. The nursing staff laughed when I proceeded to tell him that despite me being a doctor, there are many things that nurses are much better at doing than me. This was one of them.
The Long Night
Like any injury, the first 24 hours are the worst of it. The constant pain, the neurological exams, lack of sleep, and the numerous unknowns weigh on even the strongest minds. Eventually my son fell asleep. I sat uncomfortably in the chair at his bedside. I will admit I have never watched a human sleep before. This was the first time I had ever sat intently watching every breath he took wondering what was happening inside his brain.
The hours went by like my morning commute in LA traffic, slow and aggravatingly painful. There were times where I would feel like dozing off only to hear a cart rustling by outside the door and think I missed an update from the staff. I would be startled into coherence only to be disappointedly subdued back into my zombie like state.
The morning finally came after 2 overnight CT scans. Each one showing stability or small intervals of resolution. The Doc came in to round and discussed his desire to continue monitoring. After a lengthy discussion and reviews of all the imaging we agreed I could take him home to my fathers house. The plan was to stay in town for another 24 hours and then rush home to California the next morning if everything remained stable.
Heading Home
Years ago when Lily was first born, Jen and I took a trip out to a remote river in southern arizona. It involved driving through a sandy wash and numerous dirt roads. Lily must have only been a few months old. I remember driving through the river bed and asking Jen to take a look at Lily to make sure she is ok. Jen took one look and began to panic because she was apparently happily bouncing around in her car seat with every bump in the sandy wash we were driving through. Lily was fine and laughing her newborn ass off, but at the time we couldn’t stop worrying about potential damage from things like shaken baby syndrome.
Lily is now almost 10years old and excelling in school. Her social skills are beyond that of most adults and her emotional IQ rivals my own. I remember loading the van the morning we left and all I could think about was this trip with lily through that wash. What if he begins bleeding again from me hitting too many potholes?
I made the unnecessary decision to have him sit in the front seat the entirety of the trip. I figured it was less bumpy than sitting in the back seat. Convincing myself that if I was pulled over, I would have a valid argument why at his age he was in the front seat. We drove 9 hours making only one stop for gas and him and I had the greatest road trip talking about everything in his life.
Silver Linings
The drive home allowed for some of the most heartfelt and honest conversations I have ever had with a human being. My son thanked me for staying in the hospital with him and I tried to explain that there was no way in hell I would leave him there. I could see the wheels turning as he tried to reconcile the boredom and stress I went through. Instead of blowing it off, he told me that he didn’t want mom and I to worry about him and that he was sorry for scaring us.
For the millionth time in the last 2 days I had to pretend like I was fine and hide the fact that I was seconds away from bursting into tears. I simply told him how proud I was of him and that he shouldn’t feel sorry because he didn’t do anything wrong. The rest of the drive I sat listening to his stories about school and friends and how he wants to help people when he grows up. Out of every bad situation, he seems to take away some humanistic wisdom that he genuinely wants to use to help others. This is not a credit to my parenting, it is a credit to his intuition and character. That feeling in my stomach finally began to subside and I legitimately began to believe things were going to be ok.
The Final Outcome
Over the next several weeks we completed a series of MRI scans and met with various specialists. The imaging was improving and reassuring. The consensus of each specialist was that he would make a full recovery despite having permanent damage to a couple sections of his brain. The sections were small enough and insignificant enough that he would outgrow any issues with them.
Accidents happen despite our best efforts to prevent them. We cannot raise children in a bubble. They must be propelled into the world to experience life and for better or worse, its difficulties. We cannot expect our children to grow into functional adults if they are not given the tools to function as children. There is a fine line to walk with kids though. You want them to run and play, but at the same time we all know they will fall and skin their knee. That injury teaches boundaries. It teaches them how to adapt to their environment. It teaches them to overcome obstacles.
I believe life has a way of giving us what we need at the moments we need it most. It is our job to recognize the opportunities when they present themselves. Sometimes the most difficult moments give us the most beautiful lessons.
