UAB Medicine News
UAB Patient Walks Again After Near-Fatal Dive
It was a classic case of “should’ve known better.”
UAB Medicine patient Richard Lewis, a trained lifeguard and athlete, was enjoying gorgeous days at Lake Martin with some friends and their family members. Just before midnight on September 3, Lewis and two friends walked down to a dock, where he decided to dive into the lake. Lewis sums up that decision in a single phrase: “It was a major, disastrous lapse in judgment.”
“It was the first time I had been to that lake house,” says Lewis, who was 25 at the time. “We had not been in the water there, and we were not familiar with the dock area. We didn’t consider the drought or that the lake was being drained that time of year. Plus, it was very dark. I know how to do shallow dives, and I’ve dived from docks a hundred times. But as soon as I dove into the water, my hands struck the bottom. It sounded like a gunshot had been fired behind my head, between my shoulders. Being a trained lifeguard, I knew I had to get out of the water quickly. But my legs would not respond.”
During the summer months, we often see efforts to increase awareness about lake and pool safety. But no matter how often medical experts, lifeguards, and various health care and safety organizations urge caution for activities in and around the water, people take risks. Those risky moments often lead to difficult lessons that, only in retrospect, lend weight to all the advisories, rules, and regulations.
After Lewis made that fateful dive, he was close enough to the surface to see lights shimmering near the dock, so he tried paddling in that direction. That’s when he realized his ability to move his hands was also limited.
“I knew I was in a lot of trouble. I was able to hold my breath for a long time, until that final, overwhelming urge for oxygen hit me,” Lewis recalls. “I tried to scream for help, and of course I began taking in water. The first inhalation was the most terrifying thing I’ve ever experienced, because I was fully aware that I was in the process of drowning. Eventually my lungs filled and I sank to the bottom. Being face up, I could feel the sensation of the lake bed on my back, and I think I blacked out at that moment.”
As Lewis later learned, one of his friends on the dock soon began sensing that something wasn’t right, especially after seeing mud swirl to the lake surface. She asked another friend about Lewis’ whereabouts and was told that he had a habit of diving, then swimming under a dock, and popping up in some other area of the water. But he entered the water to look for Lewis just in case, and he immediately discovered that the lake at the dock was only waist-deep.
He somehow caught Lewis’ leg and pulled him out of the water, noticing that he was completely unresponsive. After resuscitation efforts, Lewis returned to consciousness on the dock, unable to speak legibly and in excruciating pain. Assuming that he had suffered a concussion and suspecting that he still had water and mud in his windpipe, Lewis’ friends turned him over so that he could spit out water and debris. Lewis says he recalls being only vaguely aware of all that was transpiring, but right away he attempted to process the extent of his injuries. Lewis asked his friends to squeeze his foot to determine if he had any sensation. “I wasn’t drowning anymore, but I knew I was still in big trouble,” he says.
After 40 minutes of winding their way through the back roads near the lake house, emergency medical technicians arrived and began treating Lewis. Upon assessing the situation, the EMTs recognized that they were probably dealing with a spinal injury. Lewis was taken directly to a helipad at Russell Medical Center in Alexander City and airlifted to UAB Hospital. Lewis recalls waking up in the Critical Care Transport helicopter.
“I was strapped down and couldn’t move, but I could hear the engine,” he says. “I was thinking that this was really bad, but all I kept saying was, ‘take me to UAB.’ My parents have instilled in me and my little brothers, since I was a kid, if you are ever in serious condition from an accident, ask to be taken to UAB. I found out later that my mom received a call from my friends informing her I was being airlifted to a hospital. My parents were in Orange Beach that weekend. I still think about what an awful call that must have been to receive.”
Lewis’ parents drove to UAB Hospital, where they learned that he had suffered burst fractures, an injury in which the vertebral body is compressed onto the spine with enough force to crush the vertebrae and compress it in all directions. Such compression can cause various types of neurological damage, including paralysis. UAB Medicine neurosurgeon Mamerhi Okor, MD, would perform several procedures to address these injuries. These included a laminectomy to enlarge the spinal canal to relieve pressure on the spinal cord, as well as an open reduction and internal fixation (ORIF), a two-part surgery in which the broken bone is reduced or put back into place, then held together by an internal fixation device (screws, plates, rods, or pins).
Confusion and Complications
Like many patients with serious spinal injuries, Lewis faced some extreme post-surgery challenges.
“I woke up in the ICU with no idea what was happening,” Lewis says. “I couldn’t move my legs; my arms were restrained because I was on a respirator. No ability to move or talk, I was under lots of medication, so all my senses were diminished. I didn’t even know why I was in this room. I remembered the dive, and all the stuff at the lake, only as a bad dream. Maybe the medication caused some of the confusion, but I imagined I had been kidnapped, and actually wondered if whoever was responsible had plans to kill me. My nurse for that evening tried to comfort me after I attempted to ask him, while crying, if he was going to kill me. He patiently explained everything that was going on at the moment, as well as the events that got me there. I barely recall those first few days after surgery. I now know that at least 100 of my friends came to see me, because afterward I would see someone and they would say, ‘Wow, you look so much better than when I visited you at the ICU,’ but of course I had no idea they had even been there at all.”
Lewis soon learned about complications from his accident. During his impact on the bottom of the lake, he had ingested sediment and debris, which also entered his lungs. That led to a complicated form of pneumonia, which eventually required a long period on a respirator. He was restrained while sleeping so as not to pull out the respirator. He communicated with the care team, friends, and family by facial expression or silently mouthing words around the respirator tube. Lewis’ mother, a schoolteacher, eventually brought a dry erase board, although Lewis had little coordination in his hand.
On the ninth day in the ICU, Lewis’ care team removed the ventilator, which he says had been his primary concern from day one. “Of course I wasn’t always thinking clearly, and at one point I actually bit the tube in half,” he recalls. “I was crazy enough to think that doing so would force them to take me off the ventilator. I was miserable. And along with my discomfort was the constant worry that I might not ever breathe again without some kind of apparatus.”
The Big Question
He was thrilled to learn that he could continue without the apparatus – and that he could hear the sound of his own voice. A “high-flow” device used to force the right mix and pressure of oxygen into his lungs replaced the ventilator, and Lewis regarded the change in treatment as major progress. But that revelation was tempered by the response he received upon asking whether he would walk again.
“This had been on my mind for obvious reasons,” Lewis says. “But so much had been happening that I hadn’t really focused on the future. I was thinking that if my lungs were functioning now with less assistance, then surely the rest of my body was recovering as well. I have always led an extremely athletic lifestyle, I run and swim every day, and I ran track in school. So as soon as the respirator was out, I asked one of the physicians if I would ever use my legs again. The answer was, ‘We can’t say yes, and we can’t say no.’”
The uncertainty about the use of his legs was, as Lewis puts it, “genuinely hard to swallow.” Still, he handled the news better than he expected, mainly because throughout his recovery in the Intensive Care Unit, his father offered a specific kind of encouragement each time he visited.
“He would lean in right next to my ear so I could hear everything he was saying,” Lewis recalls. “He would say, ‘Right now there is nothing I or anyone else can do for you. This is between you and God, so you have to work this out.’ He said nothing else, but he told me that same thing every single day during my recovery. There were days when I didn’t want to hear that – not at all. But when it was just me in that room at night, I reached out to God. Not asking to be healed; instead, I sensed that I should give thanks for all the good experiences in my life so far and express thanks that I was still alive. But now, looking back, I am certain my father’s words sort of established a tremendous drive in me to get past this. A lot of my recovery was definitely going to depend on my attitude and willingness.”
Infection from the material he had ingested from the lake, coupled with the trauma to his body, had Lewis battling pneumonia while in the ICU. Secretions building up in his lungs had to be suctioned out. He couldn’t adjust himself in the bed, and the sense of helplessness was overwhelming. But it was in tackling the complications of a spinal injury that Lewis’ determination – rooted in his Dad’s early encouragement – began to grow and yield results.
“Believe it or not, I figured out a way to use my elbow to push the bed position control,” Lewis says. “I was also slowly getting more grasp ability in my right hand, so I used it as much as possible. Then one morning, during one of the daily procedures that helped remove mucous from my lungs, I realized I could move my ankle left to right. Lung function was the goal of my stay in the ICU, and I totally understood the importance of that. But that small bit of movement was beyond exciting for me. I was already thinking down the road to where I would go to begin rehab.”
When Lewis arrived at Spain Rehabilitation Center, he had mobility in his right leg and both arms, and some dexterity had returned to his right hand. He was experiencing “mostly normal” sensation and movement from his ribcage upward, but he still had no movement from his torso to his knees. His left leg and left hand were unresponsive.
“This was better than paralysis, I knew that, but after having an athletic lifestyle, I was not even close to where I wanted to be,” Lewis says. “I was ready to do anything to get back to normal.”
Relying on Faith
The first days at Spain Rehabilitation Center were intensely frustrating, as Lewis was deeply troubled by his inability to move his left leg. Soon, however, Lewis and a physical therapist filling in from UAB Hospital-Highlands connected over something that Lewis says was essential to his recovery: their personal faith.
“She told me to close my eyes and imagine that I was moving my leg, and to pray about it, and to believe that it could be done,” he recalls. “She said that she would offer the same prayer with me. Suddenly I could push my leg against her hand. Not just once, but several times and with a small amount of force. I began crying, she was crying, and everyone in that gym stopped what they were doing. A member of the Spain staff asked the therapist if she could see another patient who had arrived, but she replied: ‘Not now; miracles are happening over here.’ I knew right then that I was going to walk out of that hospital.”
Each day, Lewis pushed beyond what was expected and attempted to do things that, as he puts it, “maybe physically I wasn’t ready to do, but mentally I was.” At first he was being hoisted out of bed to a wheelchair. Then he gained the strength to perform a slide transfer to the chair. All along, he was determined to use his own leg strength to move to the wheelchair, and he was resolved to staying ahead of schedule.
“That was my thinking throughout the rest of my time at Spain,” Lewis says. “I’m eccentric and silly at heart, so I guess I brought an energy to the clinic. I was always being comical, possibly getting on some people’s nerves. I think I might have been scaring some of the therapists. But that enabled me to add a touch of humor to my inclination to push things. I am impatient that way. And after 46 days in the hospital, and especially after those rough days when I was wondering if I would walk again, I had made my own plans. I was going to walk out of that building.”
Lewis ultimately did walk out of Spain Rehabilitation Center, though he still has some residual effects from his injury. He lacks a continuous neurological connection to his left foot, so sometimes it drags when he walks. He wears an ankle-foot brace to keep that foot in position while walking. He continues aquatic therapy in the pool at HealthSouth Lakeshore Rehabilitation Hospital, where after several laps he finds that he can raise his legs higher and move them with greater ease. Overall, he’s seeing tremendous improvement in muscle response and neurological connection.
In light of his difficult experience, Lewis says he wants to share what he’s learned about gratitude and perseverance.
“I have incredible friends and family,” he says. “Someone was visiting me every day, and it was not the same friend or relative each time. I am blessed to have that many people who care about me. I also owe so much to my surgical team and Dr. Okor, the nurses and the rest of the care team, and my physical therapists. And right now my therapist at Spain, Katy Deaton, is my favorite person in the world. Re-learning those motor skills was a huge challenge, and she is truly talented at helping me maintain a spirit of perseverance and a positive emotional state during all those weeks. There’s no other way to say it: She taught me to walk again.”
Lewis says he also is thankful for a life without serious health issues.
“To have that taken away for a short time taught me that, first of all, 25-year-olds don’t always make the best decisions,” Lewis says. “The other lesson is that perseverance is the key to living the life you want to live. God can provide the miracles, and your family and doctors can give you the breaks and the guidance. But how far you succeed in getting through the big problems, that’s up to the individual attitude. Of course, you can get a head start on all that by not doing something really dangerous.”
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