“Jake, do you know where you are?”
The 15-year-old’s mother, Laura, wanted to know — needed to know if her son understood.
“I’m at Disney. On a balcony. Watching fireworks,” Jake replied.
But Jake was far from Disney World.
He was in the pediatric intensive care unit (PICU) at Johns Hopkins All Children’s Hospital.
Road rash covered his body. He had a broken collar bone. And most serious of all, Jake had a traumatic brain injury — with multiple skull fractures and contusions on his brain.
“I remember almost nothing from the day of the accident until a couple of days before I was discharged,” Jake says now, almost a year later.
Jake had been riding his electric skateboard along a residential street in Holmes Beach. A cell phone app later provided clues as to what happened next.
“We do know that at the point of impact, he was going 27 miles an hour,” Laura says. “We know he flew quite a distance. He was not wearing a helmet.”
The app shows that at 3:02 p.m. on that day, his movement abruptly stopped.
A neighbor discovered Jake and his wrecked Onewheel and called 911. Paramedics had the option of taking Jake to a local hospital, but quickly realized he needed a higher level of care.
The teen was airlifted by LifeLine, a critical care transport team, to Johns Hopkins All Children’s Emergency Center and admitted to the PICU. His brain was showing signs of swelling.
“The skull is like a closed box,” says Matthew Smyth, M.D., chief of Pediatric Neurosurgery at Johns Hopkins All Children’s. “If you have a brain that is swelling, it really has no place to go.”
With some severe cases, surgeons may operate to temporarily remove a portion of the skull to allow for the brain swelling. Luckily for Jake, the swelling could be controlled with a continuous sodium I.V. drip and he did not require surgery.
But Jake’s brain injury was manifesting in a variety of other ways.
Traumatic brain injury (TBI) can come with a range of physical side effects. It can also result in motor, cognitive, emotional and sensory impairments — and Jake was struggling in all those areas.
He had severe headaches, fatigue, issues with balance, sensitivity to light, and even double-vision. At times, he was confused, disoriented, agitated, even combative.
“Traumatic brain injuries can be very scary, not just for the child, but for their parents,” says Danielle Ransom, PsyD, a neuropsychologist with the hospital’s Center for Behavioral Health.
“They see changes in how their kids are thinking, feeling and acting. It can be hard to understand what’s happening.”
But Jake and his family could find comfort in a dedicated team of specialists — trauma experts, neurosurgeons, orthopaedists, psychologists, physical and occupational therapists and others — all focused around the goal of helping Jake to recover as quickly and fully as possible.
It wasn’t all smooth sailing. Jake would make strides — and then regress, requiring a higher level of care once again. But little by little, he began to show signs of stability and progress — becoming more alert, more communicative, and taking on small physical and cognitive tasks.
Ten days after the accident that changed his life, Jake was discharged from the hospital. But he would soon learn the real work of recovering from his traumatic brain injury was just beginning.
The Road to Healing
Taking her fragile, brain-injured son home felt daunting for Laura at first. The sheer unpredictability of what recovery would look like for Jake seemed overwhelming.
Would he truly be OK? What would he be capable of?
But Laura knew her family was not in this alone. They had first met with Ransom, the neuropsychologist assigned to Jake’s case, when he was in the hospital. She would continue working with Jake, more closely now than ever, to provide the tools and the guidance to healing — a kind of roadmap back to life.
“I would describe Dr. Ransom as our ‘sun,’” Laura says. “We had all these specialty teams, these ‘planets,’ orbiting around Jake. But Dr. Ransom was going to be in charge of the big picture — of Jake’s future.”
Ransom first needed to determine how the changes in Jake’s brain were “mapping” onto his physical, cognitive and emotional symptoms. In what ways were they showing up in his life and impacting his functioning?
That would help inform how his treatment would proceed and how quickly he could make progress.
It was slow going at first.
Jake remembers his mom challenging him with seemingly simple things.
“She got me these sticker books, like paint-by-number, but with stickers,” Jake remembers.
“But my hands were so shaky I couldn’t steady them. I guess I had taken those small things for granted before the accident.”
As a high-achieving student and athlete, the slow progress was discouraging to Jake at times. But he continued to work hard, becoming a little more independent each day.
Ransom describes the “sweet spot” of symptoms her patients should experience — striving not to do too much, but also not too little.
“The nature of the injury is like an energy crisis in the brain,” Ransom says. “Think of it like a cell phone battery that’s only 20 percent charged. If you’re heading out for a full day with just a 20 percent charge, that’s not going to get you very far.”
Over time, the healing brain is able to recruit more energetic “bandwidth,” and the patient can do more.
After a few weeks at home, Ransom encouraged Jake to go back to school, but only for one to two hours at first, with classes that required a lighter cognitive load. His school helped as well, with teachers offering extra time and other accommodations for his injury.
As the weeks and months progressed, Jake could feel himself becoming stronger.
“I was getting a better grip on things,” Jake says. “My anxiety was better and I was thinking more clearly.”
A Path Forward
With support from the hospital’s Institute for Brain Protection Sciences and his family and community, Jake has continued to make a remarkable recovery. He finished out his sophomore year with straight A’s, was elected to serve as a class representative for the following school year, and even enjoyed a spot on the school’s varsity baseball team.
Now, he’s tackling the demands of his junior year with growing confidence.
“I would never want to repeat an event like this,” Laura says, “but if we did, I would want it to play out the same way, with the same hospital and the same people. We will forever be grateful for All Children’s.”
Jake comes out of this experience with scars on his body and his brain that will be with him for a lifetime. He certainly has a new appreciation for wearing a helmet — but also, for how he will strike the right balance in his life moving forward.
“I’m starting to feel like I need to start living life more fully, I guess,” Jake says. “It’s good to have fun in life. You can even take some risks, but just not ones that can end badly.”