1 June 2009
Dr. Saraswati Dayal remembers, to the moment, when she turned from more comfortable medical options to the life of the trauma surgeon, on call at all hours, among patients in the most dire emergencies and their still-spilling blood and open, sometimes hideously gaping wounds, the urgency of relatives and the in-pressing presence of death..
She had just started her first rotation in D.C. General Hospital in Washington as a third-year medical student at Howard University, and her first patient came in with a gunshot wound to the heart. The chief resident said, Cmon, Sara, cmon over here, hold the heart, Dr. Dayal recalls, and the heart was, like, pumping, and I was, like WOW. This is amazing! I cant believe Im doing this. I realized that I love trauma. The life force just grabs me.
She remembers, just as clearly, first setting eyes on Diane Nachbaur. As nearly all medical care workers do, she keeps a set of protocols that tell her which patients to treat, though, she says, Id pretty much accept all of them. Many never reach her. If events and locations hadnt fallen into place, she would not have accepted Diane Nachbaur. She would have considered her beyond human help.
This was the morning of New Years Eve, last day of 2007, just after 9 a.m. Paramedics lifted Nachbaur off the NORTHStar (Northern Shock Trauma Air Rescue) helicopter and across the roof of the New Jersey College of the Emergency Medical Services Building at New Jersey College of Medicine and Dentristy (UMDNJ). The flight paramedic, Nancy Orlowski, did not expect her to live. Flight nurse Joan Ridarick put her survival chance at .001 per cent. Diane had already died once, in clinical terms, en route. Ridarick and Orlowski restored her heartbeat with handwork and a shot of epinephrine. On the way into NJCMDs shock trauma unit, her heart stopped again. Hospital staff stepped in to restore the beat.
The accident had been, by all accounts, horrific. Rescue personnel rarely use such a word. Their jobs prescribe positive, action-oriented attitudes, and nearly to a person they focus on the immediate response, the next step. No self-indulgence. Beyond basic compassion, no close emotional contact with a patient. Some have learned not even to let exposed skin so much as brush against a patients, to avoid feelings that would interfere with their work.
Still, this one shook them.
On that last day of 2007, Diane Nachbaur woke her oldest daughter, Haley Longman, then 20, and her youngest, Melissa, 10, and helped load luggage into the familys 2005 Lexus RX330 SUV. Haley was leaving on a flight for a weeks vacation in Florida, and her mother was driving her to the airport in Newark. Jerry Nachbaur, Dianes husband and Melissas father, was getting ready for work, and Dianes middle daughter, Adminel, 17, was staying with her father, Howard Longman, in Livingston, N.J. and planning on another day at a private Hebrew school in Paramus.
Diane and Haley debated leaving Melissa home. I was, like, I dont want Melissa to come, Haley says, but she (Diane) said, No, shes coming. They left the family home in Woodcliff Lake about 6:30 a.m., still in darkness, to catch a Continental Airlines flight to Miami, departing from Terminal C, Liberty Airport, Newark.
The 24-mile drive via state and local routes is routine for a suburban family and for a woman who routinely described herself as a typical soccer mom, a stay-at-home mom, though she held a bachelors degree in psychology from SUNY-Stonybrook and a Masters from Adelphi University in deaf education.
That morning, though, Haley says, something was wrong with her mother. She was, like, moving between lanes, Haley says. I was, like, Mom, pay attention! Youre swerving! People are honking at you, and she was, like, Im OK. Im OK.
Diane and Melissa dropped off Haley at the terminal, lifting out her luggage at curbside. Haley had worn a jacket and, thinking she wouldnt need it in Florida, tossed it back into the SUV. Call me, her mother said, when you get there. They hugged. Haley watched the SUVs tail lights swim back into the traffic stream headed for the Garden State Parkway, northbound, and home. That night, she knew, the family planned a New Years Eve dinner in a Japanese restaurant in Nanuet, New York. She would be going out in Miami with a girlfriend from school. Adminel had set up a dinner with friends. From different places, they would all planned to watch the crystalline ball drop into 2008 in Times Square on national TV. The flight left on time, 8:30 a.m.
Just a few minutes later, a desk phone rang in Jerrys office at Medco, a healthcare management firm in Franklin Lakes, N.J., where he works as an IT project manager. He did not recognize the callers number. All I hear at first is screaming, he says. I thought it was a prank call or something. I couldnt tell it was Melissa. It was just screaming. But eventually I guess she calms down, and she told me she was in a car accident with mom and mom was hurt really bad. Then a woman takes the phone from her, I guess from the car behind her, and she tells me I should get down there right away, my wife is in really bad condition. So I get the information from her, and I go.
The crash, he was told, had happened right at Exit 155-P (Clifton, Paterson, Route 80 west, Route 19 north, Broad Street Clifton) northbound, Garden State Parkway. It had come at the height of the morning rush, all four lanes thick with cars, vans, SUVs and the full array of trucks, including 16-wheel tractor-trailers. All of them managed to steer clear. The SUV had drifted left, onto the left shoulder, then jerked halfway back, slamming through the yellow sign angled with black warning stripes on the butt end of the guardrail and crumpling the steel railing 10 feet in.
Surrounding drivers had a clear look at the vehicles leftward meander, the sudden smash, the driver snapped out of her seatbelt and hurled a full lane over, into the center. None of the oncoming vehicles hit her. Six or seven pulled over onto the right shoulder, drivers and passengers walking toward the prostrate figure and then stopping still or turning away. Diane lay in the center lane, curled up on her right side, blood pooling from a torn mid-section and from the tangle of what had once been her left leg.
Arriving minutes later, emergency personnel found her wide-eyed and talking. Is my daughter all right? she was saying. What happened to my daughter? Shock and adrenaline, medical personnel say, are a powerful, if momentary, pain-killer.
Jerry Nachbaurs route from work took him south on the Garden State, and within minutes he found himself walled out. Southbound was a hopeless jam. Just north of I-80, I see on the other side theres no traffic, he recalls. Nothing coming northbound at all. Not one car. Both sides of the Parkway, normally throbbing with traffic at the height of the morning rush, would remain closed more than a two and a half hours. Jerry steered his car onto the shoulder and continued south, and a few minutes later he saw the first flashing lights a patrol car came up and the officer waved him down. Turn around, he was told. Thats my wife in the accident, Jerry said. Officers let him through. He arrived at the scene just in time to see the NORTHStar helicopter taking off from the middle of the three northbound lanes. When another officer approached as he stepped from the car, Jerry said, Where is my daughter?
The family SUV stood angled nose-first from the left shoulder into the fast lane. From the passenger side, it looked eerily intact. A view of the drivers side showed it torn away to the back seat, crushed into folds and jagged fragments. Oil had leaked onto the concrete. A puddle in the center lane was blood. Jerry felt an awful numbness, a lightheadedness, a weakness in his knees. Then, through a cordon of emergency workers, he saw Melissa, being helped into an ambulance. As Jerry approached, she turned and reached for him. He drove behind the ambulance to the hospital.
As she recalls the crash, Melissa Nachbaur, now 11, seems unusually poised. Her diction is crisp, and she gives no hint of distress. Her father describes her first tones on the phone to him that day as hysterical. Those at the scene, though, more easily recall her frustration and determination.
With her account, Melissa dispels any sense of a frightened child.
On the way there, my mom kept, like, swiveling out of lanes, Melissa says. You could tell she was, like, tired. So my sister, Haley, kept opening windows and, like, making the radio louder. Then we got to the airport, and we dropped her off. And then, on our way back, we were just talking about getting breakfast at McDonalds, like any ordinary discussion. And then I got really tired in the car, so I put my seat back and everything and fell asleep. And then I woke up, and I put my seat up, and I was just, like, opening my eyes, and we were in front of the guard rail, like, going off to the side. And I just looked at my mom and she was, like, down in her seat, and her head was to the side and she was sleeping. And then I just, like, tried waking her up, and she turned the wheel, and then we crashed.
And then, like, the whole left side of the care was, like, GONE. Theres nothing there. No drivers seat or anything. The thing in the middle, the console, was, like, laying on my seatbelt, so when I tried to open the door, I, like, couldnt get out. And, like, people had to, like, help from
the cars behind, and they unbuckled me, and my mom was, like, in the middle of the road. I, like, ran to her, and some man stopped me. Like, she was all in a ball. She was, like, trying to move and things, so I thought that she wasnt, like, too hurt. I tried going to her again, but the man pulled me back. And then I took a telephone from a woman and called my dad, and then we called the police.
Police and emergency personnel already had been called, from the cell phones of several motorists. Within minutes, a half dozen law enforcement and emergency vehicles reached the scene. Not far behind them came the helicopter.
Emergency gear in hand, Orlowski and Ridarick quick-stepped to Diane, administered CPR and an emergency blood transfusion, carefully cosseted her into a stretcher and hoisted her into the helicopter, their log shows, at 9:01 a.m. She was so torn up, Orlowski says. If she had been in (cardiac) arrest at the scene, we wouldnt even initiate CPR.
The helicopter lifted off for the hospital at 9:04, landing there at 9:14. On the hospital roof, Dianes heart rate dropped from 130 beats per minute to below 60, and she didnt have a pulse. Quick action revived her, for the moment. We didnt think wed see her again, Orlowski says. UMDNJ hospital personnel restarted Dianes heart a second time as she was wheeled through Emergency to the Trauma Units shock trauma room and into Dr. Dayals hands.
The wounds were extensive, result of extreme blunt force trauma. She was in multi-system organ failure, Dr. Dayal says. Her lungs were shot. Her kidneys were shot. Broken pelvis, broken ribs. The torn mid-section. The left leg. All the blood loss. As nearly always in trauma care, the doctor faced an immediate, life-and-death decision.
I was happy that she was awake and alert, Dayal says, But when I saw the amount of bleeding and then she tipped over into the shock state, I thought, Should we rush her into the operating room? Does she have a critical head or chest injury? Is she stable enough to go to a CAT scan? If you go to a CAT scan and the patient arrests, youre dead. I had no X-rays, nothing had been done at that point. You have your heart in your mouth, basically. When a patient is that sick, as she was, and you make the decision the wrong way.... Thats how much tension there is in the
room. The best thing is theres so much support, so much nurse support, so much resident (physician) support, but ultimately its my shoes on the burner.
I decided on the operating room. There was too much bleeding. I felt, the gut feeling, that she wouldnt wait.
They started with transfusing blood and put her on a respirator, inserting a breathing tube into the trachea, then began cleaning out extensive wounds to the mid-section and the leg, wounds shot through with dirt and fragments of metal and glass, and binding together what they could.
We didnt think she was going to live, Dr. Dayal says. That was very clear.
By then, Melissa had gone through a medical checkup and been cleared, and she and Jerry had been joined in the waiting room by Dianes middle daughter, Adminel, brought there by her father. Jerry called Dianes mother in Boynton Beach and then reached Dianes half-brother in suburban Miami, Henry Levy, who called Haley and left a voice message.
Picking her luggage off a carousel at the Miami airport, Haley turned on her cell phone and found four voice messages, one from Jerry; one from a friend, Esther, back home; one from her grandmother and one from her uncle Henry. She called her uncle first.
I just met my uncle a couple of years ago, Haley says, so Im not really close to him. It was a little weird. He said, There was an accident. Its pretty serious. I think you should go home. My friend Melissa said my sister (Ariel) had been crying in school. Somebody said my other sister (Melissa) was OK, but my mother was hurt. Badly hurt. My uncle and grandma were trying to book a flight back for me, so I went over to my cousins house, where they were, and had something to eat. Nobody really had any information. I was just in shock.
She could hardly imagine her mother in trouble. Her mother, she says, usually rescued the rest of them.
Haley arrived back in New Jersey about 9 p.m., New Years Eve, with her mother still in surgery, met by her father, Howard Longman, and sister, Adminel. She spent the night with them at her fathers house in Livingston, a 15-minute drive from the UMDNJ. A friend came over to watch the ball drop on TV, as they had since childhood. I wasnt in much of a mood for that or anything, Haley says. I didnt want to hear Happy New Year.
Sound-alike news reports of motor vehicle accidents render them routine, fixed in time and space. Major media nearly always focus on the most catastrophic or unusual accidents, three killed when car hits tree, five die as bus overturns, 36 injured in chain-reaction crash on foggy bridge.
In their lifetimes, nearly all drivers and passengers experience at least a fender-bender and often a more serious accident.
Few, though, comprehend their frequency. In New Jersey alone in 2007, the Department of Transportations latest reporting year, motor vehicle crashes on municipal, county, state, interstate and toll roadways demanding law enforcement action totaled 263,525. Nationally in 2007, according to the National Highway Traffic Safety Administration, the number of men, women and children killed reached 41,069, and more than 2,491,000 were injured.
In an opinion piece in the Washington Post, under the headline The Deadly Story We Keep Missing, Peter J. Woolley described the traffic toll as staggering, even if it is absent from the agenda of most public officials and largely ignored by the public. Of the relative handful of crashes reported in the media, few merit a follow-up, and even fewer accounts go beyond the next day or two. Most accidents go unreported.
If you laid out, side-by-side, 8-by-10 photos of all those killed in crashes this year, the pictures would stretch more than five miles, Woolley says. As a professor of political science at Fairleigh Dickinson University and executive director of the schools Public Mind, a public opinion research group, he has taken a special interest in the motor vehicle toll. Gruesome crashes are reported just one at a time, each as if it might never happen again, he says. Little attention is paid to the aftermath.
By evening and New Years morning, the Nachbaur crash and its Parkway-closing aftermath made the local newspapers. This is the account that ran in the Record of Bergen County:
CLIFTON A driver was left with serious leg injuries and traffic was snarled for two hours following a crash on the Garden State Parkway this morning, police said. At about 8:30 Monday morning, Diane Nachbaur, 49, of Woodcliff Lake slammed her car into the guardrail on the northbound Garden State Parkway just before the Exit 155P ramp to Route 19, according to Sgt. Stephen Jones of the state police. He said no other vehicles were involved and that Nachbaur may have fallen asleep at the wheel. Nachbaur was airlifted to the University of Medicine and Dentistry of New Jersey in Newark, where she was undergoing surgery, police said. One witness, who didnt want to be named, said she saws a woman with a mangled leg lying face down in a pool of blood on the highway. It looked like her leg was torn off, the witness said. It was horrifying. A man and a young girl stood by watching, but it was unclear if they were related to the driver.
Save for a brief account in a church newspaper, no one covered the aftermath. By the time the Record story ran, Dianes left leg had been amputated below the knee. Survival was still in doubt. Whatever her outcome, the family had a first glimmer of how much all of their lives would change.
Recovery often shows in measurable improvements, in physical and emotional milestones. Diane Nachbaur has no memory of her first milestone or, in fact, of the accident itself and its immediate aftermath. The first milestone was continuing to live. After 24 hours of vigorous medical intervention, against great odds, she still showed a pulse and respiration. Bleeding from multiple wounds and internal organs had finally been stanched, her middle had been cleared of torn muscle and literally stapled shut, and her severely broken hip was rejoined with metal screws and held in place with a girdling brace.
Doctors were still hoping to save the rest of Dianes left leg. Dr. Dayals greater fear was biochemical and body-wide. Unlike, for instance, a knife or gunshot wound, blunt trauma crushes organs and muscle. Medical staff facing the most dire emergency cases are accustomed to dealing with penetration wounds and fractures, with focusing on the ABCs, airway, breathing, circulation. Few, though, appreciate a toxic danger: creatine phosphokinase, or CPK.
So many of her muscles were injured, the doctor says, and muscles, when they become crushed, release CPK, and that goes into your bloodstream. As it gets elevated potassium is released, and it produces acid that can hurt the heart, that can cause you to have an arrest. Trauma surgeons know what to do.
For the family, the second day brought an upswell of optimism. In the morning, Haley came to the hospital with her father, Howard, and met Jerry, Melissa and Adminel and her step-sister, Cheryl and Cheryls boyfriend. The doctors said she was better, Haley says. At that point she looked pretty much like herself. She was, like, mouthing words and looking around. She kept saying, like, Sorry I ruined your trip. The doctors said they might not have to take the rest of the leg. We were, like, happy.
Then the first wave of serious infection hit, attacking surrounding tissues and the kidneys. Doctors decided to induce a coma. She talked to me, Dr. Dayal recalls, and I said, Were going to put you out. She said, Save me, doctor! Save me! That sent chills down my spine.
It also reassured her. We knew when we heard her talk that her brain was OK, that there was somebody home, the doctor says.
With Diane on a blood supply, feeding tubes and a respirator, the medical team, including an orthopedist and a vascular surgeon, focused on cleaning wounds and removing dead tissue. Her lacerated kidneys and liver and broken pelvis and two broken ribs had been stabilized as far as possible. Was there a damaged organ they had missed?
An even more urgent question was, when and where would the next infection flare? An infection sets in, and youre back to square one, Dayal says. Now she has pneumonia. Now shes got pelvic sepsis. What do you do? And her left leg....
On the third day, Dr. Dayal took Jerry aside. She said they had to amputate right up to the hip, Jerry recalls, and, as a result of that, Diane will never be able to walk again. It was take the entire leg or shes going to die. The infection was just too much. When I heard that, I just started crying. I was still crying when I told Haley, Moms never going to walk again.
Haley cried, too. She spent most of the three weeks of her winter break from Rutgers at her mothers bedside. I was the only one who wasnt in school, and my father was working, she says, It was hard for Adminel. She gets so emotional. She didnt want to go in, ever (though she soon was visiting the hospital at least every other day). I got really scared being there alone, if, like, God forbid, something happened, so I would call my Dad or my aunt, who was nearby, and they would just sit there with me, and my friends would come sometimes.
Ahead of Diane lay 33 major surgeries, most to salvage internal organs and clean out infection and dead tissue and then to graft skin, and nearly 80 smaller procedures. Dr. Dayal performed all of the major surgeries herself. I needed control, she says.
In the midst of anguish and uncertainty, meanwhile, Dianes family tried to regain some sense of routine. Jerry couldnt leave his job. The girls couldnt quit school. Medical leave plays out quickly, and the sympathy of bosses and acquaintances often goes with it, though Jerry says his employers were patient and helpful.
The greatest immediate help came from the Hebrew school and from a nearby Jewish chabad, a religious community group whose members and staff brought cooked meals and consolation at least every other day.
Nobody could forecast the future; the family did its best with standard reassurance.
Melissa and Adminel experienced that, most vividly, at school. I know they were just doing what they can, Adminel says, but it was, like, that first day back, my guidance counselor was saying, Everythings going to be OK, but she didnt know. How could she? Shes not a doctor.
Its, like, you can scream and cry about it, you can talk about it, Melissa says, but thats not going to help at all. You get, you know, numb. My teachers would gather kids from different classes who would come in and make cards and stuff. I mostly talked to my friends about how I was feeling, and after awhile I became friends with a couple of kids who had been through a similar situation. At first, we just felt lost.
Family and friends would tell Haley, later, that it wasnt her fault. How could she have known, or changed things? Better that she had left the car at the airport, had waved goodbye, had walked quickly into the terminal and up to the gate and into the plane.
Haley Longman blamed herself, anyway. Guilt can root deeply and spring up at a touch, and every day in that first month brought another jab. I DID feel responsible, she says. And I was so torn. Im the oldest, and I felt that when I wasnt at home I should still be doing something to help.
She was at her mothers side, from morning to night every day after for the next two weeks. Through the nest of tubing her mothers face was pale and swollen, and her breath rasped through the ventilator. There was no answering voice, no familiar reassurance or teasing challenge, to what Haley would whisper, I love you, I miss you, Youre strong, Youll come through, please, please come through, please God. I wont take you for granted, any more. Just open your eyes and talk to me.
She had other feelings, too. Why did this have to happen? Why did I have to go to the airport? Why did you take that stupid pill?
That stupid pill.... The pill proved central to the familys effort to answer why? The single greatest cause of motor vehicle crashes, Woolley points out, is not alcohol (dire enough and involved in at least three crashes in every 10) but inattention. The night before, Diane had followed a doctors prescription to help her sleep. The medication was potent; a quarter of a pill taken two days before had, in her words, knocked her out. The night before she took half that dose. They had not been told or read, the family say, that drowsiness would continue into the next day.
Haley wished she would have insisted on the way to the airport that her mother pull off the Garden State and call Jerry or someone else for help, even if it meant missing her flight. Haley felt so responsible, Howard Longman says. And shes been really resourceful, really dedicated to her mother.
Haley needed at least six months to come to terms with guilt over her mothers accident. I just felt very bad, she says, and I needed time to get over it.
Meanwhile her relationship with her step-father, never warm, suffered. Haley, halfway into her sophomore year at Rutgers University in New Brunswick, worked and attended classes and studied during the week, then drove the 30 miles up to Newark and back each weekend, usually staying with her father and Adminel in Livingston, much closer to the hospital than she was in Woodcliff Lake.
Jerry Nachbaur needed help, meanwhile, and he had nowhere else to turn. His parents had long since died, and he had no relatives in the area. Starting with Dr. Dayals fusillade of daily, early morning phone calls asking permission to operate again on Diane, he became the beleaguered knight-in-residence. Jerry had so much to deal with, Dr.Dayal says. It was bad news that whole first month. He would pick up the phone on the first ring, any time of day, and he was there in the hospital mornings and evenings. Hes a good man.
More than anyone, Jerry had to navigate Dianes entanglements with medicine, insurance, the legal system, solicitors of various kinds, home health care, and arrange physical and structural adaptations including a wheelchair ramp and stairway lift, while handling his own feelings about his wifes distress, holding down a demanding full-time job and doing his best to chauffeur their daughters and run a household.
He nearly buckled under the burden. Im taking care of Melissa and arranging for rides for her, Im working, Im going to the hospital every day, and Dianes kidneys are shutting down, and the infections getting worse.On the third day, Dr. Dayal called and said, We need to take the rest of the leg. This was a high amputation, leaving barely a stub of bone below the shattered pelvis. The early conclusion was that what remained would not support an artificial leg. When I heard that, Jerry says, I didnt think I could handle it any more.
He thought, he says, of his children, especially of Melissa, who needed him at home, and of his other daughter, Cheryl, living in Massachusetts, and of Haley and Adminel. I had to learn to take one day at a time, he says.
Each day, meanwhile, more of Dianes torn and infected middle was lifted away. Every day we had to take out dead tissue, Dr. Dayal says. Bacteria are eating it. We had to keep her as clean as we could.
Finally, early in February, doctors felt that Diane was ready for what would be a rude awakening.
Diane did not simply snap out of the induced coma. Consciousness was a firefly dancing through a tangle of bull-rushes, a night moon winking sporadically through heavy overcast. Family members can cite a number of exchanges, greetings and questions about school or home, a reaction to a trip Adminel took to Canada.
Diane remembers nothing, nothing of the accident, nothing of her first month in the hospital, a circumstance Dr. Dayal calls a good thing.
Toward mid-February of 2008, Jerry recalls, doctors began taking off sedatives. Initially, she didnt know who we were, he says. That was hard. But toward the end of February she started becoming herself.
Diane remembers being doped up on morphine, in-and-out, in-and-out.
Diane left the hospitals Intensive Care Unit on Feb. 15, and a big landmark came on February 21, Haleys 21st birthday. I was going in for surgery on that day, Diane says, and the night before I told the nurse it was my daughters 21st birthday, and I have to call her. The next morning she woke me up, and she was holding the phone.
Diane spoke, then, with a breathing tube, a trake,still uncoiled down her windpipe. Her daughter, she says, cried on the phone. Haley remembers the call this way: It was a Sunday morning. I hadnt heard her voice in, like, two months. There was times I thought I would never hear it again. And she said, Im going into surgery now, but have a good birthday. I love you. That was a big deal. And then she was in surgery the whole rest of the day.
At that point, Diane didnt know her full condition, and the family dreaded telling her. Finally, in late February, accompanied by a medical team including doctors and a psychiatrist, Jerry sat at her bedside and told Diane, Youve been in a serious car accident, are you aware of that? Yes, she said. Well, physically youre OK. Except for one problem. Silence. They had to amputate one part of your body. Silence, staring. Your left leg.
Diane doesnt remember that. She DOES remember Haley telling her a day or two later. Then, Jerry says, Once it actually hit that she didnt have a leg anymore, she got very depressed.
The full return to consciousness signaled not the end of Dianes struggle but the start. It brought prolonged pain and a flood of emotion. A morphine drip and anti-depressants could ease them, but no one had a quick cure for despair. Dr. Dayal faced a fresh set of challenges, what she calls the psycho-social.
When she finally woke up, the doctor says, Diane started saying, Why are you letting me live? Why are you doing this to me, Dr. Dayal? I look like a monster. I dont want to live like this. Kill me.
She knew that her leg wasnt there, and thoughts about being out with her family and thoughts about her husband, whats he going to think of me, how can I be a wife to him...socially she had a lot to go through. Deep inside Id cry with her, because I know what shes going through. And I put myself in her shoes as a mother, also.
Says her daughter, Adminel, You cant tell her everythings going to be OK. Her leg is gone. Theres so much surgery and scarring. We would tell her she still has her heart and her brain, thats shes still and always our mother.
In her sixth week in the hospital, in mid-February, Diane underwent the first in a series of surgeries to graft skin from her back and right leg onto her abdomen, its skin and muscle nearly gone. From Dianes other leg, and from her back, doctors harvested skin.
Diane found herself coping with a new and strange collection of hardware, too, the first of a cavalcade that would take her from bed pans and bladder bags and to a wheelchair and crutches, constant reminders of her dependence.
Still, even in extremis, Diane showed a strong will. Hospital personnel were calling her Miracle Woman. Says Dr. Dayal, There was a dip when she first came in, and then, like, multiple dips, and patients who have multiple dips often dont come back. She came back every time.
Quickly, the doctor discovered a way to motivate Diane. As she puts it, Just tell her she cant do something. Id say, Diane, get your catheter out, and shed say, no, no, I cant, and Id come back and she would have her catheter out.
Awareness also brought Dianes own explanation for a lingering mystery: her survival. Those in medicine point to a sequence of top-flight care administered at the right time. Nancy Orlowski puts it this way: Ive seen people, despite nearly everything going wrong, who survive. And some who should survive dont. Most of the time, what you think is supposed to happen happens. Diane was supposed to die. She lived.
Why? In getting immediate medical care and being close to help, Dr. Dayal says, everything went right. The cell phone calls immediately after the accident and quick response of law enforcement and the NORTHStar team, the nearest hospital, UMDNJ, having a trauma unit, the quick actions and proper decisions by medical personnel, all worked in Dianes favor.
Diane offers another answer: My father. I was going to the next life. I mean, I didnt see light or anything, but I was going. My father pushed me back. He said, You have three children. They need you.
Herman Levy had been especially close to his daughter. I was an only child, and he was my whole world, Diane says. He died at age 55, of a massive heart attack, and my world was shattered.
What he pushed her back into, once she was awake, she says, was an everyday, ongoing battle with infection, pain and depression. Seemingly upbeat and energetic much of the time, she still struggles with her altered life. Its been very hard to ask my family to do things for me, she says. I was always the one who helped everybody else.
I had a huge depression for a long time, you know? I looked at a bottle of pain-killers and thought, That would be a pretty easy way to go.
A major part of her recovery, Diane says, came in looking ahead, in setting her own goals, something she says she had not done, beyond daily to-do lists, before the accident.
The most urgent goal was getting out of the hospital. She set the target as her birthday, March 8. Too ambitious, doctors said. No, thats the day, she said. She understood that she would be transferred to another facility, Kessler Institute for Rehabilitation in West Orange, researched and arranged by Jerry, who knew that injured celebrities such as Luther Van Dross and Gregory Hines had recovered there.
She left on a stretcher, in an ambulance. She had entered the hospital at UNDMJ the day before the new year; she left on March 6, two days before her 50th birthday. I still had open wounds, Diane says. I couldnt sit up. I couldnt feed myself. But I was moving on.
On his first long visit to Kessler, Diane told Jerry he had lied. She was in a shared room and, on this day in late February, she wanted out. He told me Its not a hospital; its like a hotel, she said, later. I get to Kessler and I see the nurses station and I think, He LIED to me! It IS a hospital.
No, Jerry said. They have nurses because people need care and medication. At that point, he was still dealing with a nearly daily tumult of bills and questions about insurance and impending modifications to the house. He had already replaced outdoor steps with a ramp, and there were a stair-lift and an elevator to install, and a step-van to buy, and home nursing to arrange.
He didnt share anything negative with his wife. He knew, as the care-givers knew, that one of Dianes greatest enemies at that point was depression.
Among the attending nurses, a young man from the Phillippines, Dean Pasatiempo, took a special interest. Even three months after the accident, he says, Diane was the most seriously injured patient he had ever seen.
She was crying all the first day, he says. I had to do everything for her, the dressings, the medications, take her to therapy, all her needs. I had to take my time; there was so much infection. On a given shift, he had eight or nine men and women needing his care. He spent most of his time on Diane. She was the hardest patient I ever had, he says. I was just drawn to her struggle, to how much she needed us, me and the other nurses and aides, Christine Gorman, Maria Camacho, Eleanor Allen. Whenever I was with her, I was doing everything I could to cheer her up.
At first, Diane seemed almost catatonic. Her birthday bolstered her.
My kids came, and they said, Come downstairs to the lobby, Diane recalls. I said, I dont wanna come downstairs. I dont feel good. I cant walk. They said, Please, please, you HAVE to come down. The nurses said, Just do down for five minutes. So finally I said, OK, and four people had to lift me out of bed and put me in a wheelchair. They wheel me down, and they have in the lobby, like, a section thats marked off. They had balloons and a banner that said HAPPY BIRTHDAY. They made a surprise party for me, right in the hospital, and my husband arranged for food from Joels Malibu Kitchen in Ridgewood, my favorite restaurant. They gave me presents. They sang.
She still cries in retelling it. I didnt know what to say, she says. So many people in my life were there for me.
For the first month at Kessler. though, she barely managed a smile. She found herself, at least, in the hands of a cadre of outgoing, can-do, positive thinkers: physical therapists. She can recite their first names, Michael and Christina. Sometimes, she says, they really pissed her off. It was like a boot camp up there, she says. Most of the time, they joined Dr. Dayal in her collection of Gods angels on earth.
Any heavenly help would be welcome, because, especially at first, the pain was hell. Childbirth had been severe, but the pain she endured for six months and more ranged far more widely and dug more deeply into marrow and sinew, into sharp sparks in her nerves. She spent much of her time sleeping.
Besides the care-givers, her most potent allies were drugs. In the hospital, her last resort had been morphine. She realized that she had to wean herself or risk addiction, so she began insisting on less pain-killers, on percoset and then Motrin.
At Kessler, optimism was, gently, enforced. They worked me and they worked me and they worked me, Diane says, and I said, I cant do it, I cant do it, and they said, We dont wanna hear the word cant. Every time I used it, I had to pay a quarter. So I looked up words that meant cant. Id say, Im unable to do that. I dont think I can do that. This will be very difficult. She laughs. I started to answer back.
The rehabilitation staff began calling her Rocky, fighting back against impossible odds, and for as she was wheeled in for each of her daily and sometimes excruciating sessions, they played Rockys Theme on the facilitys CD player.
Somewhere, she turned a spiritual or emotional corner. She thinks, she says, of an exchange with a Vietnam veteran who helped refurbish the family home. He's completely paralyzed from the waist down,she says, in a wheelchair 28 years. Im crying and crying, and he says, You have one good leg. You can stand on it. You can eventually walk on it. I cant get out of this chair. I would KILL to have one good leg. To him, hey, theres nothing wrong with me..
I knew she was back, Dr. Dayal says, :when she started fighting with me.
Diane took to telling staff a new joke each day, many of them related to her condition. What do you name a woman with one leg? she would ask. Eileen.
Dean Pasatiempo was her mainstay. He would take up to two hours each day to change the dressings to her severely damaged middle, and he listened and encouraged her. As I saw her personality, I just became attached to her, Pasatiempo says. He left notes on the bedside table, including a set that read How to Change Dianes Dressings for Dummies.
She also, she says, met war veterans who had lost limbs. They traded jokes. Im going to work at the iHop, Diane said, and the veteran said, I can be the short order cook.
Diane set her target for leaving Kessler as Mothers Day, May 13. Then she learned that her step-daughter Cheryls engagement part was set for May 11, and she moved up the goal.
As her discharge from Kessler arrived, Dean played one last joke. He had a talent for them.
One day, Diane recalls, he woke me up and he said, Diane, youre late for therapy! It was supposed to be for 2 oclock. I looked at the clock, and it said 3. I said, Dean, why didnt you wake me up? He said, I was busy. Busy? Theyre gonna make me work harder! And then hes smiling and he says, Dont worry, Diane. I changed the clock. You have plenty of time. He really made me laugh. And he was SO good, so good to me.
On the day of her departure, she was told that Dean was off that day. I said, oh my god, I cant leave without seeing Dean! How could you do this to me? I was sick, absolutely sick.
About 10 minutes after that I hear a knock on the door, and its Dean, in his jeans and his jacket abnd his sunglasses, and he comes in and says, Hi, Miss Diane. He always called me Miss Diane. And he hands me a bouquet of flowers. And he says, You think I would let you go without saying goodbye? I just fell apart.
On May 6, 2008, two days before her 50th birthday, Diane came home. She had dreamed, through her two months of consciousness, of seeing the dogs, again. Frasier, the Jack Russell terrier mix rescued from a shelter, was her energetic sidekick, and she called Mugzy, the brindle bull terrier, my baby. She used a sliding board to lift herself from the car into her wheelchair, and Jerry pushed her up the ramp hed had built and through the houses back sliding door.
I said, Hi, boys, she says, and I started crying, I came in, and Mugzy, hes like my shadow all the time, he wouldnt come, because he was scared of the wheelchair. It was heartbreaking. He wouldnt come over to me for a long time.
Diane wanted, right away, to resume her household duties, to cook, to clean, to arrange, to chauffeur. She couldnt. Her lost leg took away her balance, physically and emotionally. The lift was not yet installed on the stairs, and she found herself still sleeping in a hospital bed in her own living room.
She had been home only a day or two when she declared, I want to go back to Kessler! Wheres Dean? Take me back!
On a rainy day in mid-July, 2008, she sat in her living room to talk, for the record, about her experience. Another of her angels on earth, her home health aide, Mariana Cabrera, hovered attentively nearby. Diane had not talked in detail about her struggle. Three times that day, she would have to say Im sorry and motion urgently to Mariana to be taken out, to the bathroom to throw up or to the open door for air. To postponing the interview, though, she said no.
In a split second my life changed, she said. I cant say no to that.
She had already overcome an emotional hurdle: driving. You ask me a month ago, I say, no, I dont wanna drive, she says. But I learned how to use the sliding board as a passenger, lifting myself from the wheelchair into the car seat and back, these little steps. So, two weeks ago, I just moved to the drivers side. I got into the car, Im relaxed, driving with Mariana beside me. No problem. Then I got back, started up the driveway, and, oh my god, it hit me. I called my children. I drove!.
That July day, she had just taken delivery of a Chrysler Town and Country van, specially rigged for hand operation with an extending platform to lift her into the drivers seat. By the end of the week she would be driving alone. Living in suburbia, I dont have a choice, she said I need my independence back.
Her infections all-but-conquered, her systems recovering, her thoughts on a positive track, Diane started asking about a prosthetic, the artificial leg that doctors at first had vetoed. Dr. Dayals assertion that she would never walk again stung her. .
With Jerrys help, she looked for alternatives. She found what she was looking for with Mitch Hirsch of Mayfair Orthotics & Prosthetics. He was knowledgeable, positive, action-oriented. And he told her what she wanted to hear: we can a find a leg for you. We can help you walk again.
We had some issues with alignment, and she had some scarring, Hirsch says. Everyones unique. But we knew we could find a way to help her.
On a morning in September, 2008, Diane sat on an examination table facing Dr. Dayal in the doctors Hackensack, N.J. office, with Mitch Hirsch alongside for a consultation, and confronted her: You said Id never walk again!
The doctor smiled and said, It worked, didnt it? Now tell me...
I think I have another infection, Diane said, and then, to Hirsch, said, She told me on the phone that I didnt SOUND infected.
Well look at it, Dr. Dayal said, smiling again, and then asked Hirsch about progress on the prosthetic through three fittings. A cast had been taken of Dianes torso, and from it Mayfair had fashioned a socket of silicone and laminated acrylic resins to hold the leg.
The leg is made of titanium components, carbon fiber and aluminum alloy, Hirsch said. Flexible. Very strong. Articulated at the ankle, knee and hip.
And it has a microprocessor, Diane said, so I can bend the knee. I can wear high heels.
We have a component that we placed on it where shell actually be able to sit cross-legged, Hirsch said. Pretty cool. And the foot we put on her can adjust for heel height, ,so she can wear high heels.
The leg would weigh nearly 15 pounds, so Hirsch said, You cant step on scales any more.
Hey, Ive lost 40 (pounds), Diane said. Im still ahead of the game!
The days concern was black fluid leaking from Dianes middle, still bound with a kind of corset. After a quick look, Dr. Dayal rendered a verdict: rust. I found a (surgical) staple in there, almost one year later, she said. We put more than 30 of them in there. The metal oxidizes, so that was the black stuff. Eventually the body will get them out.
You look VERY good.
I look skinny now, right? Diane said. My husband says were going to a party Saturday, and we can make this (corset) really, really tight. I can just see it POP! All over the place! Everyone winced. As she was leaving, she called back to the doctor and her staff, Thank you for allowing me to be alive!
In the hospital, in therapy at Kessler, at home with family and with friends and neighbors, all of the help and good company havent entirely banished her despair. She has seen herself, at times, as a monster. Even now, she invites an immediate, urgent rebuke from any friend or family member by suggesting that shes a burden.
Though she knows the relationships are more complicated, she also refers to the household as one big, happy blended family, and her lows always rebound into optimistic highs. She has already danced with Jerry and can join him for a stroll on the Boardwalk. She is taking Mugzy and Frasier our for walks and to the dog park again. She runs all her own errands, cooks the familys meals, sees friends and visit the hairdresser.
Her story, though, is not the simple fable that might satisfy a shared appetite for happy endings. She will never be the same, she says, and that can translate to never being as whole, as healthy, as confident. She might be nearly the same mother to her children, but she can never be the same to her husband, to her friends and relations. She leans slightly as she walks. Her mid-section will never be entirely restored.
She also understands that, in some ways, she is better. If the cliche whatever doesnt kill you makes you stronger has truth, maybe whatever DID kill you makes you nearly invincible, at least to the petty concerns of everyday life. Shes not sure. Her children and friends and those she has met tell her, KEEP telling her, that she inspires people, helps them put their own mostly smaller troubles in perspective, gives them a wider sense of what human beings can endure and overcome.
She might be this years favorite for the Kessler Institutes most coveted prize, the Triumph of the Spirit Award.
She adds this: we all carry wounds with us, scarred over or not entirely healed. Shell always feel the loss of her father. Even as she gets to know her new leg and its marvels, shell always feel the loss of her left leg. Sometimes that feeling is literal, and it tingles, or hurts. Sometimes I can still feel it, she says. The phantom limb.
She cant, though, live a phantom life, not with daughters, a husband, dogs, a household, friends, a community. And goal-setting, goal-meeting-and-exceeding, is now in her marrow. In May, she walked up an aisle at Rutgers to meet and hug Haley, coming down from a stage with her college diploma. Adminel graduated from high school in June, and in July Melissa will go through her Bat Mitzvah. September will bring the marriage of Dianes step-daughter, Cheryl. I WILL be walking for all those events! she says.
Others whose lives intersected with Dianes during the last year and a half take away benefits of their own. In early September, the staff at UNDMJ invited her to a hospital seminar featuring emergency care personnel, including NORTHStar helicopter crews. Jerry wheeled her into a lecture hall, and she turned to face an emergency medical crowd including flight nurse Joan Ridarick and flight paramedic Nancy Orlowski and several on the hospital staff who had revived and helped save Diane on first entry, among them emergency room nurses Carolyn Reinoso and Ingrid DSouza and ICU staff Edward Van Wagner and Bill OBrien. The encounter was vivid and emotional, with hugs and smiles and outcries of delight.
We almost never see or hear from people weve saved, or even know what happened to them, Ridarick says, and Orlowski says, In our work, over and over, you see the death and destruction of people routinely. When you encounter someone who says thank you, it helps erase some of the bad things. Something we did, me and my partner and everyone at the trauma center, went really right. And you think someday that can happen again.
Dr. Dayal continues to examine Diane at least once a month and follows her progress. Medically it was a miracle, the doctor says, and seeing her come out of the traumatic stress disorder, the depression, that was a miracle, too. It made me feel so happy for her, and for me!.
Those closest to Diane, meanwhile, see her in a new light. Her first husband, Howard Longman, says, Im been extremely impressed with Diane. We werent always on the best of terms, but shes shown that shes got deeper inner resources and has really fought this.
Her daughters found comfort in their mothers steadfast love and concern for them through the ordeal. This changed our whole perspective on what people can do, Melissa says, and Adminel says, We learned not to take each other for granted.
Haley, newly graduated and living now in Manhattan to pursue a magazine career, found lasting lessons. Im so much more appreciative, and I dont complain about little, stupid things any more, she says. At any moment, everything can change forever. Lets value what we have right now.
Jerry Nachbaur continues to cope with the outwash from nearly two million dollars in medical bills; he recently fielded a bill for $40,000 on what should have been a maximum out-of-pocket of $10,000. The leg alone will cost more than $65,000.
Dianes figurative and literal strides, though, have bolstered him. Its been hard on all of us, he says. Through the whole thing theres such a mix of emotions, the anger, the sadness, the happiness, you know. Every emotion imaginable. Itll never be normal, but its getting better. Were stronger now.
Much of their prior life has resumed. In spring, 2009, Diane joined Jerry on a dance floor, and not long after, during a family visit to their beach house in Long Beach, N.J., she walked up the three flights of stairs on her own. Two more goals had been met.
Some of what she and the family have lost, though, she says, will never come back. Medical and insurance questions still haunt them. Diane, determinedly upbeat and looking ahead, still struggles at times with depression and weariness.
And, when were on the freeway, she says, Melissa wont let me drive in the left lane. When she passes Exit 155-P on the Garden State Parkway, Diane says, she keeps her eyes straight ahead.
Through the accident and its aftermath, the family thought nothing could surprise them. Then, not long ago, in the mail box in Woodcliff Lake, the family found a letter from the New Jersey Turnpike Authority, addressed to Diane. It was a bill of $4,200 for destruction of state property: the guardrail she mangled by running into it.