Tuesday, December 15, 2015 12:00 AM

Expert trauma care, neurosurgeons are a blessing for teen

Ryan Gravelle looked like a casualty from a war movie when he knocked on friend’s door in the darkest hour before dawn. The 19-year-old’s face and forearms were bloody, his hair was matted with mud and blood. He was dazed and barely coherent. He had just walked half a mile from a car crash with a broken neck, multiple facial fractures, a huge gash on the back of his head and a potentially fatal hematoma swelling in his brain. 


 
20151206_truama_ryang_studying.jpgIt was 4:30 a.m. on Aug. 1 when the phone rang at the Gravelle house. Ryan’s mom, Karen Gravelle, heard “Don’t freak out but Ryan has been in an accident and he seems okay, but there’s a lot of blood.” But Ryan was screaming in pain by the time he was wheeled into the Kaiser Permanente – Fresno emergency room and a CT scan a few minutes later clearly showed Ryan was far from okay, Karen said. 

 
“The doctor came out and said ‘We can’t take care of him here. We aren’t equipped for it. We are sending you to the trauma center right now,’ Karen recounted.
 
Lucky for Ryan, Community Regional Medical Center’s Level 1 trauma center was only a few minutes away and a team of 15 was waiting for him. 
 
“It makes me have goose bumps to talk about it,” Karen said, describing how she and husband, Richard Gravelle, stood in the corner of the trauma bay as more than a dozen nurses, respiratory therapists and doctors surrounded their son. Then Neurosurgeon Armen Choulakian grabbed their shoulders and told them: “Okay we have about two minutes to do this. Ryan is going in for a craniotomy. We have to sew up the back of his head – right now as a matter of fact. And tomorrow we’ll do the neck surgery.”
 
The gash on the back of Ryan’s head took 75 staples to close and was dangerously deep. The next day, Neurosurgeon Daniel Miller took over. Dr. Miller took bone marrow from Ryan’s chest and encased it in wire mesh to insert it between the fourth and fifth cervical vertebrae, which had broken completely through, Karen described. After two days in Community Regional’s intensive care and another in a step down bed, Ryan was transferred back to Kaiser where he has his medical plan. And a week after the accident, he was back home.
 

• 3,714 trauma patients were treated at the Table Mountain Rancheria Trauma Center last year - 1,074 (29%) of them transferred from 25 outlying hospitals.

• Only comprehensive Level 1 Trauma and burn centers between Los Angeles and Sacramento, serving 2.5 million people in 9 counties.


Three months after his nearly fatal accident, Ryan is taking a full load of community college courses and driving a newer, nicer car with more air bags. He’s cleared to go back to work at a pizza restaurant and hopes to begin training again for body-building fitness competitions.  

“Ryan is standing here today with no residual effects from a motor skills standpoint; you would never know this happened. You can’t even see the scars, other than the one on his chest,” Karen said. “You guys fixed him up good!”
 
Karen had high praise for the surgeons’ skill, the team of therapists who worked with Ryan immediately after his surgery and especially for Ryan’s ICU nurse, Jeremy Graham. “The only person who could get through to him and bring out the true humor that is Ryan – and within five minutes after they met – was Jeremy,” Karen said. “I truly believe that was a large part of why he recovered so fast, because he and Jeremy had a real connection.”
 
Ryan chokes up when he talks about his time at Community Regional: “I hear so much great stuff about these guys from my mom and I’m just upset that I don’t know what they look like. I can’t remember talking to any of them. And I don’t remember Jeremy’s face, I just remember his voice, which should be on the radio or something.”
 
The Fresno teen also doesn’t remember how he ended up dazed and bleeding in the passenger seat of his Nissan Altima, which had rolled down a steep embankment, ending up on its side. He knew his head hurt, he was in the middle of an empty stretch of Herndon Avenue east of Highway 99, and that it was likely no one would find him for hours. He barely remembers crawling out of the broken sunroof and lying in mud outside the car for a bit before deciding he needed to find help.
 
“The doctor said if he hadn’t got up and walked for help he might have died because the hematoma was quite large. That was the immediate concern if it burst,” said Karen. She’s amazed, as are the doctors, that the hematoma didn’t burst and that Ryan’s spinal column wasn’t damaged as he moved around with the bones encasing it cracked all the way through.

 Karen is grateful at every step the fates aligned that night to keep her son alive. She’s mostly grateful for the expert medical care available minutes away from where they live. “I’ll never leave Fresno because of what we have here. It’s been a blessing.”
 
Erin Kennedy & Ashlie Day reported this story. Reach them at MedWatchToday@communitymedical.org