Monthly Archives: June 2011

A College Goalie Thanks BMC for His Life-Saving Care

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James Hilaire, who suffered a traumatic injury in a soccer game, visited BMC on the anniversary of the accident to thank his team of talented caregivers. 

As a goalie for the University of New Haven’s men’s soccer team, James Hilaire was a respected team leader and a fearless player in one of the sport’s toughest jobs. Yet he could never have anticipated the much more challenging test of endurance and courage that he would soon confront.

It was September 24, 2008, and New Haven was playing an away game at Merrimack College in North Andover, Mass. James and his teammates were trying to even the score when a Merrimack player attempted a shot on the goal. James slid toward the approaching player in an effort to protect the goal when the opposing player’s knee hit him in the jaw. The game ceased immediately as the New Haven coaching staff rushed to the aid of the goalie, who lay motionless. If not for one of the coaches clearing James’s airway on the spot, the 24-year-old might have died on the field. James was transferred to a nearby hospital, where doctors told his anxious coaches that he “might not make it.”

James’s head coach refused to give up just yet, however, and James was airlifted to Boston Medical Center. When he was admitted to the hospital, he was listed in critical condition and soon underwent surgery to repair his broken jaw. More gravely, he also had a contusion to his brain, which caused major swelling and needed constant monitoring. Breathing with the help of a respirator, he remained in a coma for eight days. When he awoke he had lost the use of the right side of his body.

Though James has little memory of his experience recovering in the BMC Surgical ICU, his family and caregivers were relieved and elated when he began speaking and communicating again, nearly three weeks after his admission. His care team soon determined he could recover more efficiently in a different setting, and his physicians recommended a transfer to a rehabilitation hospital in Connecticut. When James left their sight, he was in a wheelchair with his right side still paralyzed. He spent three months at the rehab hospital, continuing his recovery.

One year to the day after his injury, James, walking and speaking normally, returned to the BMC Surgical ICU to thank all of the physicians, nurses and staff who cared for him during his stay. He said there was nowhere else he would rather have been on the anniversary of the accident. Each of the caregivers he encountered could hardly believe his transformation, and were all gratified to witness how BMC’s exceptional care restored him to an active and healthy life.

“When James left BMC, he had made significant strides but still had a long way to go in rehabilitation,” says Andrew Glantz, M.D., attending surgeon in the divisions of general, trauma and critical care surgery and associate professor of surgery, Boston University School of Medicine, one of James’s physicians during his time in the SICU. “It’s pretty remarkable how he looks now, and we’re all so glad he’s been able to come this far. His was a case of a young and otherwise healthy young man making a great recovery.”

James continues to exhibit motivation, courage and uncommon resilience. His family moved from Jacmel, Haiti, to the United States 11 years ago and he continues to look out for his five siblings in Stamford, Connecticut. Thanks to his hard work toward recovery, including continued physical therapy for his right side every week, he is looking forward to graduating college this winter with a degree in criminal justice. Although unsure of just where his career path will take him, one of his goals is to start a foundation to grant scholarships to injured athletes, to provide education and support materials to students like him who find themselves no longer able to participate in the sports they once loved. No matter which direction he follows, thanks to his strong determination, he is sure to go far.

“It’s a big-time recovery, like I call it, because I’ve been pushing myself and pushing myself to get better, every day,” says James. “Doctors told me [it will probably be] a ninety-percent recovery, but I always tell them, it’s going to be a hundred.”

BMC’s Critical Care Chief Receives Grant for Research Study

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Suresh Agarwal, MD, FACS, Boston Medical Center’s chief of surgical critical care, and associate professor of medicine at Boston University School of Medicine, has received a grant from the American Association for the Surgery of Trauma (AAST) for a research project, “Thoracoscopic Drilling, Screw Delivery, and Plate Fixation.” The award will be presented during the AAST Business Meeting on Friday, September 16, 2011 in Chicago, IL. In addition, progress of the research will be presented at the 2012 American Association for the Surgery of Trauma (AAST) Meeting in Kauai, HI.

 

Related News:

Dr. Agarwal – one of Boston’s “Top Docs” – Read More.

Dr. Agarwal awarded grant from the National Trauma Institute for a lung injury research study – Read More.

 

Abdominal Gunshot Wounds… Wait or operate?

An interesting study out of Massachusetts General Hospital in the current Archives of Surgery titled, “Successful Selective Nonoperative Management of Abdominal Gunshot Wounds Despite Low Penetrating Trauma Volumes”, highlights ten years of data for patients with abdominal gunshot wounds (AGSWs).

The study concludes that a nonoperative – wait and see approach – is “feasible and safe in trauma centers with low penetrating trauma volumes”. The sample size for the study was approximately 125 patients over ten years. Of those 125 patients, 30 percent were managed safely without a surgical procedure. The study concludes that, “nearly 1 in 4 abdominal gunshot wound patients does not need a laparotomy, and nontherapeutic laparotomies are associated with complications.”

The majority of patients seen at trauma centers are treated for blunt non-penetrating injuries, and Boston Medical Center is no different. For those patients with penetrating injuries such as abdominal gunshot wounds, we agree that a nonoperative approach described in the study can be appropriate. 

In the years 2008 -10 we saw approximately 50 abdominal gunshot wounds per year. When we excluded tangential injuries and deaths in the emergency department, analysis of our data reveals that we managed over 50% operatively and successfully treated approximately 4 in 10 (42.8%) expectantly, without operation. 

While we agree with the authors, we think it is important to remember that a majority of patients with 
abdominal gunshot wounds will require surgical intervention. If nonoperative management is to be considered, the ideal setting is a trauma center with the collective experience of a dedicated trauma team and protocols assuring around-the-clock monitoring. To do otherwise incurs unnecessary risk.