Health case study: Tackling acquired brain injury
What seemed like a simple concussion soon became a medical emergency for Ronan Fitzgerald, 13. His parents tell Joy Orpen they are now appealing to sports coaches to err on the side of caution when it comes to head injuries
As Brian and Sheila Fitzgerald followed the speeding ambulance containing their injured son, they wondered if they would be making the return journey behind a hearse bearing his remains.
Their drama had begun to unfold that morning. It was early November 2012. Brian, a garda, dropped sports-mad Ronan off at the Tralee Rugby Club before returning home to Sheila, who was preparing for Christmas.
About 20 minutes later, they got a call to say their son had suffered an injury during the warm-up – a slight concussion was suspected.
"I wasn't alarmed," says Sheila, a registered nurse. "When we went to the rugby field, I found Ronan lying in a dugout with an ice pack on his head and his legs elevated."
Alarm bells began to sound when Sheila saw that Ronan had vomited and that he wasn't communicating.
When Brian saw his 13-year-old son being led towards the car, he got a terrible shock.
"Two people were holding him up – he looked like a drunk trying to walk, and he was the colour of death. I knew immediately he was in trouble," he says.
It seems likely Ronan had received a bang to the head during a ruck.
The Fitzgeralds rushed Ronan to Kerry General Hospital, where a Cat scan was done.
"He was hypothermic when we arrived," recalls Sheila.
"He was literally dying in front of us," says Brian, the horror still vivid in his mind. It was soon ascertained that Ronan was suffering from an extradural haemorrhage. "In other words," explains Sheila, "he had a bleed between the dura [covering] of the brain and the skull. That's a very serious situation. They had to put him on life support immediately."
Ronan's only hope was surgery at Cork University Hospital (CUH). By now, the Fitzgeralds' other sons, Sean and Ciaran, had arrived, and soon they were all racing behind the speeding ambulance.
"I was wondering would the four of us be following him home in a hearse," Brian recalls.
Gardai escorted the ambulance as it made its mercy dash. All along that tortuous, high-speed, 60-minute journey, two paramedics, an ICU nurse and an anaesthetist battled to keep Ronan alive.
"We heard later that it was such a push, push journey, some of them even got sick," says Brian.
When they arrived at CUH, Ronan's pupils were now fixed and dilated – a very bad sign.
They were met by the neurosurgical team; a woman stepped forward to greet them. "I assumed she was a nurse," says Sheila. "But it turned out she was the surgeon. She's not just talented; she's beautiful, too."
The team rushed their young patient into theatre to try to relieve the bleeding. Now, all the family could do was pace, fret, and pray. "In the meantime, we thanked the paramedics," says Brian. "But, later, I realised they weren't looking us in the eye – they must have thought Ronan wouldn't make it."
Later, Brian and Sheila were heading towards ICU when they bumped into the neurosurgeon. "She was still in her scrubs and rushing to another emergency," says Brian. "We asked how it had gone and she said 'OK', but she said it cautiously," he says. The Fitzgeralds were told that the next 24 to 48 hours were crucial.
Brian took a video of his comatose son hooked up to a bank of equipment.
"I thought, 'if he dies, I'll destroy the video and, if he lives, I'll show it to him'," he recalls.
Miraculously, three days after his accident, Ronan began to regain consciousness. Sheila says, "The work the surgeon and the anaesthetist did was crucial in saving Ronan."
However, the extent of the damage from the injury then became painfully obvious.
"The bleed was so massive, it had pushed his brain against the right side of his skull, and this resulted in right-sided paralysis," says Sheila. "He couldn't do anything for himself. He couldn't walk and he couldn't communicate. He was also suffering from post-traumatic amnesia (PTA), so he couldn't remember anything either."
Though he was now out of immediate danger, the future looked extremely bleak. Brian and Sheila had moved into Bru Columbanus, a "home from home" for the relatives of seriously ill patients being treated in Cork hospitals. They wanted to be close to Ronan.
They were overawed by the kindness they received at Bru Columbanus and from their supportive extended families.
"Ronan's cousin, Sarah, said we were like the Corleone family, except we don't kill people!" Sheila says, laughing.
Meanwhile, a multi-disciplinary team at the hospital went to work and, with their help, Ronan was discharged just before Christmas.
Brian and Sheila then began the painstaking task of putting their much-loved son back together. Ronan returned to school, just an hour at a time. John O'Roarke, the principal at Mercy Secondary School, Mounthawk, in Tralee, made sure that Ronan got the support he needed.
In March of last year, he went to the National Rehabilitation Hospital in Dublin for two months. Acquired Brain Injury Ireland (ABI) then came on board, and sent Mary Keane to act as Ronan's rehabilitation assistant in Tralee.
"She, along with the ABI team, advised us and the school on appropriate tools and techniques needed to help Ronan overcome his specific problems. They devised a tailor-made rehabilitation plan to help him maximize his abilities, and to relearn the skills he had lost," Sheila explains. She has nothing but praise for all those from the HSE, Enable Ireland, ABI, NRH and his school, who all worked tirelessly to help Ronan get back on track.
But she also cautions all those involved with someone who has received a head injury – especially sports coaches and sports medics – to be wary of what is known as the "lucidity period".
"After they get a head injury, they get up and think they are fine – but they may not be. Our message is this: take the child to hospital and let the experts decide."
Last July, Ronan, whose faculties are almost fully restored, ran on to the pitch as the mascot for the Kerry team, who were playing in the Munster final.
It was an unbelievably proud moment for the parents of a very brave young man, who has worked so incredibly hard, and who has fought so bravely to find his painful and arduous way back to health.
"A huge lump came into my throat," says his proud mum. "Mine too," says Ronan's dad.
- Some 13,000 people acquire a brain injury in Ireland every year, according to Acquired Brain Injury Ireland. Their annual fund-raiser, Bake for Brain Injury Week, takes place from tomorrow, March 10, to Sunday, March 16. To register, tel: (01) 280-4164, or see www.bakeforbraininjury.ie
Sunday Indo Life Magazine