University of Virginia Medical Center - June 28, 1995 (Barbara Johnson; Dr. John A. Jane; Benjamin Reeve)
The following press statements were transcribed for the rec.equestrian newsgroup by Clare Aukofer, then the Director of Communications at the University of Virginia Health Science Center. The bracketed explanatory details are from Clare Aukofer as well, not the speakers, to help better understand the medical jargon. This 12:00pm EST news briefing is the final press briefing at the University of Virginia since that morning Christopher Reeve was discharged and transferred to the Kessler Institute for Rehabilitation in West Orange, New Jersey.
Christopher left this morning to go to Kessler Institute for Rehabilitation in West Orange, New Jersey. He was transported by ambulance to Charlottesville Airport and by plane to Morristown where he was met by an ambulance for the short ride to Kessler. His wife, Dana, and son, Will, also flew to Morristown this morning to be with him as he arrived and gets settled in. A very efficient team from this hospital handled all the transportation arrangement which went off without a hitch.
As Dr. John Jane said yesterday on Good Morning America, the acute care phase is over and Chris is entering a new phase in his recovery. Dana, Benjamin Reeve and I all visited Kessler and we are confident that he will do well there. He will be under the personal care of Dr. Marca Sipiski, a physiatrist [Physiatrist is an MD specializing in recovery/rehabilitation of such injuries] who headed the spinal cord injury rehabilitation unit there at Kessler before being named medical director of Kessler's West Orange facility.
My purpose here today as Chris's mom is to express his and the family's gratitude for the superb care he has been given here from the time of his accident a month ago yesterday, to the moment the plane carrying him to Kessler took off at 10:30 this morning. I will not be able to name everyone by name, and I may miss some key people, but it is important for me to try. The list begins with the anesthesiologist, whose name we do not know, who happened to be standing by the jump in Culpeper at which Chris had his fall. His skillful administration of CPR literally saved Chris's life. The four EMTs who got him to Culpeper deserve credit, along with Dr. Bil Maloney (sp?) and the emergency room staff at Culpeper. The handling of Chris in those early moments was crucial to his survival without furather nerve damange. Pegasus [UVa's medical air transport helicopter] brought him here and Dr. Mohan Nadkarni and UVa Medical Center emergency room staff took over.
One of the sweet things was how Dr. Mo, as we called him, took little Will, three-year-old Will, under his wing and cared for him for a while so Dana could be with Chris. Just one of those many kind and caring touches that have happened all along the way.
Chris was very fortunate in many ways that his accident happened here in the Charlottesville Area. As we discovered early, Dr. John Jane is regarded as one of the top neuorosurgeons in the country. In addition to being highly skilled, he was always very straightforward with Chris and with us, and we appreciated that. That was also true of Dr. Scott Henson who personally was a great help to me at a difficult moment. I myself have not met all the other doctors involved in Chris's care other than his anesthesiologist during his long surgery. I did get to meet several of the ICU nurses, however, and they were wonderful. I'm in awe of their skills, their profesionalism. I remember particularly Cathy, Joy, Jani, Susan. I understand from Chris that I should also mention Molly, Helen, Sue, two Jackies, Lois, Stan--there may be a host of others of them. They were very skillful, very caring and highly competent. Also the respiratory therapists--I am going to be mentioning names that Chris gave me--Stephanie, Barry, Gary, Bill and I think there was also a Paul. Dr. DiBenedetto was his physiatrist and Meg Kritchart (sp?) his physical therapist and they both care very much for him and about him. I was very appreciative of the hospital chaplain, who was very helpful to me personally.
In addition to Chris's care, what we need to mention is the care of the family, and this was extraordinary. Rebecca Lewis and her staff, Barbara Duffy and Janice Brock. Rebecca is patient care services administrator. And they have been fantastic. They looked after us in just an unbelievable way. We were sort of unable to look after ourselves, I think, but they were facilitating, coordinating, arranging and taking care of things with tact and a high degree of professionalism. We were well looked after. There were rooms made avalable for us in which we could congregate. There was always a pot of hot coffee, juices, fruit. All kinds of amenities. Telephones were made available for us, a fax machine. It was just wonderful. Security! I think those security guards were some of the most pleasant people I have ever met. They sat long hours, making sure that all was well with us. I should also mention Miss Jan of the play school. After all, it was a tough situation for a little three-year-old and Will very much enjoyed going up to the 7th floor [Children's Medical Center] every day, and Miss Jan enjoyed having him up there. And the few moments when at times he needed a little extra entertaining, especially Susan Gibson and David Mercer who became very fond of him.
Chris being who he is there were volumes of mail and I'll have some more to say about that in a moment. And the volunteers who trundled the mail up to us each day. I believe it's Bruce Shifflett who sorted that--I mean thousands of pieces of mail. We've been packing up a lot of that in the last couple of days and sending it on to the next place. And volunteers Janice and Debbie helped me slit and sort. There were flower deliveries--my, the florists you have in Charlottesville do an especially nice job. The media--Marguerite and Katherine have done a wonderful job in handling the media. I don't know the names of the people at the front desk who handled the many phone calls that came in. Everyone has just been very professional. I think that's the word that keeps coming to me over and over again. Very tactful, very understanding. Just superb. I think an awful lot went on behind the scenes that we the family perhaps weren't aware of. I hope I can convey that we're just very, very appreciative.
We are grateful to the people of Charlottesville. Several people have offered us to stay in their homes, or arranged hospitality for us at clubs. It's just such kindness. I think we've also noticed that when we walk down the street, people here nod and smile. I hope this is a trait that you all keep. There were several restaurants that offered to provide meals. I'd like to mention C&O and Rococco's. Chris has this kinda gourmet taste now! He didn't have a very good appetite, but they were wonderful about preparing meals for him in the evening.
My plea, I think, at this moment, is to the world at large--it is to continue to keep him in your thoughts and prayers--but to hold the mail! I'd like to say that as tactfully as possible but as clearly as I can. He is going to a rehabilitation center; he says it is like going to be a little like "boot camp." He will have to be working very hard there. There really isn't time in the day for him to read or be read to, each and every piece that comes. We all appreciate the mail and the sentiments that have been expresssed in the letters. The high regard in which Chris is held by people all over the world has stunned even his mother! That has bouyed him and cheered him--but let's do it with thought waves, perhaps, from here on in, and maybe not burden Kessler or his family any more than is necessary.
Chris is entering a new phase. His fine mind and great heart are intact and working as well as ever. I know that he will work hard to become whatever he can or wants to become, using that fine mind and that great heart.
In closing, I just want to address one of the questions that is often asked of us--how are his spirits? His spirits are good; he has low moments, as anyone would with an injury as severe as his. But he also has some very good moments. The other day, in his room, we were looking at a photograph on the wall--of a Buddhist temple with many, many steps that are going up, and there is blue sky above. It was taken by someone who, I think, has dedicated this to Chris. Chris has really glommed on to this. He said to me "I can visualize this." It is what I think really will be in his mind as he goes through rehabilitation. Those little tiny steps leading up into blue sky at the top. It's a nice image. I just want to thank all the people here in this hospital in Charlottesville for helping him get to this point, and helping him start on the way up those many steps. Thank you.
Dr. John A. Jane
I'd like to begin by thanking you, Mrs. Johnson for your kind remarks about the University of Virginia.
The family has asked me to provide a little more detail about the medical management of Chris, and I am happy to do that.
[Dr. Jane referred to some drawings, which obviously cannot be reproduced here...Clare Aukofer will describe as best as possible.]
The injury was at about C1-C2 [First and second cervical vertebrae, the top two in the neck.] We know that the phrenic nerve is intact [goes from brain to diaphragm]. He does not have conscious control of his respiration, but the mechanism is there. The second thing is that the nerves to his trapezius [muscle just behind the top of the shoulder] are working quite well on the right side. So both of these pieces of information combined with a third thing, namely that he has sensation, an imparied senstaion, on the left side of his body, and he has quite good sesnation to about C4 over his thorax. All of that together tells us that the injury to his spinal cord was not complete; his spinal cord has not been severed. And that is confirmed by the MRI, that shows that the damage is mainly on the left side of the cord.
He has what we call a modified Brown-Sequard syndrome. So that is good news. Every once in a while we think that he is showing some contraction in his pectorals, as well, and that would really be another level down around C4 and C5. And what we next want to see is some phrenic nerve activation. So that is his injury and his current medical situation.
Now, what we did to repair the damaged vertebral column: Injury was mainly to C1. He has what is called a type 1 odontoid fracture and a type 3 odontoid [means shaped like a tooth] fracture, and the type 3 was not the usual impacted type of injury, but rather distracted. He had instability between C1 and C2 and also probably had an occipital atlantal [docspeak for a bone at the back of the skull, and for the C1 vertebra] as well.
So our operative procedure was to put wire underneath both lamina -- the bony covering over the spinal cord--we took bone from his hip and placed it in between and then stitched this down--squeezed it down--to get a solid construct between C1 and C2. Once we were confident that it was solid, we took a titanium ring (and the reason we used titanium in this operation was becuase it was compatible with the MRI, the imaging study that we do). We then took a titanium ring and fused that with the sub-laminal wire to C1 and C2. And then we drilled holes in the skull and passed the wires through again to get a solid fusion.
We've done a CT scan--last Monday--and it shows that the bone taken from his hip is in place, and there is no further distraction of the elements of his vertebral column. So we are pleased with the way it looks. It is too early to tell if the fusion is complete. The fusion will be evaluated at Kessler in in about eight weeks. So that is a summary of the medical situation.
I have only to say that my mother speaks for the family as a whole and we feel as she described that we do. We are very grateful to the University of Virginia--the hospital here and to everybody who has been very good to us during our time here. My mother says exactly the truth--we've taken the first steps and today we begin the second steps in what is certain to be a long journey. But we are all looking toward the further progress of it. We are looking to the time when Christopher again has a public career. In order to do that, we are going to need the good will of many people.
ANSWERS TO SOME OF THE QUESTIONS:
Brown-Sequard syndrome due to hemisection of the spinal cord.
"Sensation" means that he can feel, not move--he feels touch quite normally and he feels when his limb is moved on the left.
No prognosis. No pain.
He speaks over the ventilator. It is a little tiring, but he speaks whenever he wants to. Takes advantage of the expiration and uses it to speak. Quite audible. Sounds like his voice.
He has sensation over his clavicle.
Eating: He is fed, but swallows quite well.
Injury is at C1-C2, but recovery takes place in sort of a downward segmented way. His injury is high, but he is recovering below that injury. [When the cord is severed, there is no recovery below the site of injury, nor any hope for any. This is another sign that the cord is not severed and gives hope for even more recovery].
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