Believing in the exception to the rule.

When a patient stays in touch with me months and even years after I have completed their treatment, I am given a unique opportunity to look in on their life and follow their progress. Sometimes this snapshot provides a welcome surprise.

I recently received a letter from the wife of patient I treated in 2009. Steven Hon was involved in a serious motorcycle accident and sustained a large subdural hematoma (brain bleed). After our initial treatment–alleviating the bleed and resecting a portion of the brain–Steve had a score of 4 on the Glasgow Coma Scale, a neurological scale that provides a way to record the conscious state of a person. Typically, over half of patients with Steve’s score die.

Several weeks after treating him in the ER, we replaced Steve’s bone flap and discharged him for rehabilitation. At that point Steve was beginning to follow voice commands. As a brain surgeon, I had done what I could do and now it was the therapists’ turn.

On the one-year anniversary of his accident, Steve’s wife Lauren sent me a letter with some wonderful news. Six weeks after enrolling in a Department of Defense rehabilitation program for those with brain injury, Steve was walking with a cane and had regained his long-term memory. Just recently, Lauren sent another letter letting me know that Steve continues to make progress and is now back home. (Click here to see her letters.) Her pictures show him smiling, visiting with his sons and standing with a cane.

The general rule of thumb is that improvement is made primarily in the first six months and that at a year improvement tends to be the exception rather than the rule. Clearly not all patients follow that rule and some patients over time continue to make slow definitive progress. Steve is proving to be one of those exceptions.

So what makes Steve’s case exceptional? A combination of the timely care he received from emergency responders, the care our team provided him in hospital, and the care he received at the rehabilitation center all played a role. And certainly the determination of his wife and his own determination and courage were crucial to his progress. While we can’t count on the exception to the rule, we are all fortunate to reside in a country with the medical resources that make the exceptional possible. Steve is living proof of that.