September 9, 2003
Tucker Everlasting: Brandon teen's triumph over brain injury serves as cautionary tale
By Susan Christensen
Health and Research News Service
BRANDON, Miss.—Tucker Hoge didn’t have a driver’s license, car insurance or any business being behind the wheel of a car.
But when you’re 15 – and the’67 Chevy truck in the driveway is destined to be yours anyway – a little spin around the block can seem like no big deal. At least, it didn’t until the spring day Tucker took the truck for a test drive and promptly lost control. “I dodged a mail box and a ditch, but I hit a tree dead-center,” he said.
After Tucker made it back from the hospital fairly unscathed, his mom, Dawn, had the battered truck towed to the front yard as a reminder to play it safe.
Eight months later, Tucker received a more graphic reminder – a thick scar that runs from the top of his head to behind his left ear. It marks the spot where a neurosurgeon sawed open his skull after a Jan. 18 car crash left the Brandon teen with a life-threatening traumatic brain injury.
Tucker was not behind the wheel that Saturday morning, but he was in a situation that was an accident waiting to happen: five high-spirited teenage boys, crammed into a new Chevy Malibu on a curvy road known to local drivers for its “thrill hill.”
“There’s a little curve over the hill where they went off the road and the driver over-corrected,” said his dad, Cam. “He lost control, hit a tree, hit another tree and the car flipped upside down. They had to cut Tucker out of the car.”
Tucker can’t recall what happened that day, and much is a blur to his parents, as well. But his mom does remember the call from a friend who had overheard news of the wreck over a police officer’s radio. “She told me Tucker had been in an accident and I needed to get to North Street quickly,” said Dawn, her eyes tearing up at the memory. “On the way, an ambulance flew past me.”
A police officer drove Dawn to the University of Mississippi Medical Center (UMC) in Jackson, where a paramedic told her: ‘I think he’s going to be alright, but we had to resuscitate him twice.”
Today, 16-year-old Tucker roams the hallways of Brandon High School like some modern-day Lazarus. Just eight months after the wreck that almost killed him, he’s back in the classroom and is even vying for a starting position on the school’s football team.
He’s so alright, in fact, that some might see Tucker’s success as a story about the invincibility of youth. But those who sat by his bedside willing him to breathe would rather his story serve as a cautionary tale.
“God spared Tucker for a reason,” said his mom. “I think it was to help kids wake up and realize that life is a gift. It’s not something you can take for granted or throw away by being careless.”
Before his injury, nothing about Tucker had ever been run-of-the-mill – from his athletic skills to his strong will. But the wreck put the teen in the ranks of an all-too-common group – adolescents whose brains have been battered in a motor vehicle crash.
“Vehicle crashes are the leading cause of brain injury, and the risk of traumatic brain injury is highest among adolescents, young adults and those older than 75,” said Lauren Fairburn, coordinator of Methodist Rehabilitation Center’s Think First statewide injury prevention program for teens.
"Mississippi leads the nation in traumatic brain injury (TBI) deaths," said Joe Surkin, with the state Department of Health, Office of Epidemiology. "From 1991 to 2000, the
highest number of TBI deaths in Mississippi occurred in the 15 to 29 year-old age group."
Health and safety experts say adolescents and young adults are at heightened risk for TBI because of their penchant for risk-taking and their reluctance to use seat belts and helmets.
“As far as kids in that age group, a large number of our head trauma patients this summer were unrestrained drivers and four-wheeler drivers without helmets,” said Frances Spinosa, a neurosurgery nurse specialist with UMC’s department of neurosurgery.
In an attempt to cut down on the carnage, Dr. Domenic Esposito, chief of neurotrauma at UMC, does presentations all over the state pushing for a primary seat belt law. To make teens more aware, Fairburn travels the state with speakers who have been seriously injured as a result of not wearing a seat belt or other reckless behavior.
“We know the program is powerful and encourages many teens to change their behavior,” Fairburn said. “But reaching teenage boys is especially tough because many think they are bulletproof.”
“That’s what I thought before,” said Tucker. “And I found out I could get hurt.”
In the close-knit community of folks who live and breathe select soccer, Tucker stood out as a happy-go-lucky kid who could charm you one minute, and put your heart in your throat the next.
So when word came of his severe injuries, the news spread quickly along a cell phone chain usually reserved for confirming rides to practice and plans for weekend road games. Soon UMC was filled with teary-eyed kids and parents who formed impromptu prayer meetings in the waiting rooms.
In the trauma area, Dawn frantically waited for some contact with her husband. Cam had been fishing in the Louisiana marshes that morning, and it took hours for someone to find him. When he finally began the long drive to Jackson, he feared the worst. “The whole time I was thinking about this dream I had that Tucker was dead and I was hoping that wasn’t the case,” Cam said.
In more rural areas of the state, Tucker might not have survived or had such an excellent chance for recovery. But he was less than 30 minutes away from UMC, a Level 1 trauma center staffed by neurosurgeons who follow the latest in evidence-based medicine guidelines for traumatic brain injury treatment.
Tucker also benefited from his close proximity to Methodist Rehab, a hospital that is one of only 16 Traumatic Brain Injury Model System sites in the nation and is home to Quest, the state’s most comprehensive community re-integration program for brain injury victims.
“A key part of his recovery is he got early rehab as soon as he was medically stable,” said said Kristi Goodson, a nurse practitioner for the brain injury program at Methodist. “That allowed us to take advantage of the healing brain. You usually see the most rapid improvement during the first six months.”
When Tucker arrived at UMC, doctors pronounced a CT scan of his brain one of the worst they had ever seen. His brain had been bounced like a hackey-sack, causing damage to the frontal lobe and the left side of his brain.
In addition to the primary injury from the wreck, Tucker also faced secondary injuries due to swelling in the brain. “The brain is enclosed in a hard case and there’s no room for expansion,” Dr. Esposito said. “If the swelling creates pressure in the brain stem it can immediately kill you. That’s why timing is crucial in the treatment of brain injury,”
To reduce the pressure building in Tucker’s brain, Dr. Esposito removed a portion of his skull. He also induced a coma and paralysis and reduced his body temperature – all measures designed to combat further swelling.
For about a week, doctors kept the Hoges from Tucker’s bedside for fear their presence might agitate him. “We would just stand in the door and look at him,” Dawn said. “And we slept in the hall under a cubicle so we would be right there.”
Two weeks after the wreck, Tucker was brought out of the coma. “We didn’t know if he would know us,” Dawn said. But he soon showed signs of his old self, even though a trach tube kept him from speaking.
“I remember when I knew that Tucker was there,” said Cam. “His girlfriend at the time had a saying: I love you bigger than the sky. He would reply: Too. She said that one day and he held up two fingers.”
“The first day of rehab, a bunch of his friends were there and I said: Do you recognize anybody?” remembered his mom. “He wrote down everybody’s name. Those kinds of things let you know he’s there, we’ve just got to get him out.”
Dawn and Cam kept journals of Tucker’s recovery and the pages are full of encouraging entries. Tucker threw a ball. Tucker kissed me. Tucker’s reading. But there also were trials and tribulations – yanked-out catheters and feeding tubes, a sudden fear of needles and uncharacteristically combative behavior.
“Thankfully, a nurse told us what to expect about anger before we went to Methodist Rehab,” Dawn said. “Otherwise, I would have thought my child’s personality had totally changed.”
The consequences of a brain injury are far-reaching because it can affect people cognitively, physically and emotionally. An eloquent preacher might have problems recalling simple phrases. A star athlete might be spastic, uncoordinated or tired all the time. A normally cheerful person might feel agitated and depressed.
The frustration for the families is no one can tell them if or when their loved one will get back to normal.
“The brain is one of the slowest organs to heal, and everyone’s brain heals differently,” said Dr. Risa Nakase Thompson, a neuropsychologist at Methodist Rehab. “We’ve had people with totally normal CT scans have horrible outcomes, while someone with a bad scan went back to work. The picture doesn’t say it all.”
To survive a brain injury, it helps if you’re young and in good health prior to the injury, Thompson said. As someone who had been playing sports since age 3, Tucker was in top condition. He also had the personality to persevere. “Pain has never been an issue for Tucker,” Cam said. “He played soccer and football with a broken foot. When we were at rehab, I knew he was going to beat this thing.”
Support from family and friends also plays a big role in the rehab setting, and Tucker had that in spades. At more than one meeting, Methodist staff worried aloud whether the Hoges were going to crash and burn from the number of hours spent at their son’s side. And on many days, it looked like Tucker’s fifth floor room was Brandon High School’s new hangout.
The support carried into the community, as well, spawning fund-raisers and prayer chains moving many to write cards and letters that buoyed the Hoges during the long days of rehab.
As Tucker worked with physical, occupational and speech therapists to improve his abilities, staff began educating his parents about what to expect. “The day they get here, the biggest issue for parents is: Will their child be able to go back to school?” said Goodson.
Many times the answer is yes, but staff members generally recommend a conservative time frame for a return to the classroom. “We don’t want to send someone back if they are not ready to benefit,” Thompson said. “If we put someone back in the 12th grade and they’re functioning at 8th grade level, we’ve set them up to fail,” Goodson added.
To help get back up to speed, Tucker followed his stay at Methodist Rehab with a stint at the hospital’s Quest program. He worked in the gym on his physical stamina and in the classroom on his cognitive skills and endurance.
“He had to build back to higher levels of attention and memory,” explained Quest speech therapist Cassie Means. “After a head injury, we say you have to ‘remember to remember.’ He was taught strategies such as using a day planner, written cues, checklists, repetition and visualization. He admitted he had horrible study skills before. So he would always say I’m going to be better than I was.”
“We’ve laid the groundwork for a smooth transition back to school,” said Quest admissions coordinator Joyce Leverenz. “In addition to working with Tucker and his family, we’ve also provided the school staff with recommendations on how best to work with Tucker during the school year. And we’ll continue to check on him periodically.”
Leverenz said such advocacy paves the way for a better outcome, and is one of the best benefits of a community re-integration program. “Our experience with school systems is you have to have a strong advocate to get what you need, but you also have to know what you need. Doctors might not think to let teachers know that a patient might need more time to take a test, or a study class to work on notes or a cassette recorder to tape lectures. It’s the school integration component that sets Quest apart.”
At a recent “graduation” ceremony at Quest, Tucker shared his hopes for the school year with fellow brain injury patients, but the topic wasn’t academics.
Tucker wants nothing more than to return to his position as a kicker for the Brandon High School football team. Brandon Athletic Director and football coach Dan Davis said Tucker’s neurosurgeon has cleared him to kick field goals and extra points and he’s in the running for that position.
“He had one of the strongest legs in the state and he’s got a kicker’s mentality,” Davis said. “He’s as carefree as anybody I’ve ever come across and that’s a great characteristic for a kicker. When you have everything on the line, you want someone with ice water in his veins.”
For now, Tucker’s helping out by kicking balls in practice and serving as a source of inspiration for his team mates, who took his days in ICU particularly hard, Davis said.
“The whole time, I don’t think a day went by that he wasn’t mentioned by somebody. We all refer to him as the miracle man. He is very fortunate to be here.”
Davis would like to think Tucker’s experience might inspire his peers to be more cautious. But he’s afraid it might be wishful thinking. “Something like what happened to Tucker might shock them on a Monday, but by the next weekend, if there’s no real discipline, they’ll be doing it again. You have to remember the most unpredictable animal in the world is a teenager.”
Tucker said he doesn’t like to talk much about his brush with death. “I can’t stand hearing about it because I feel sad for my family having to deal with that stuff.”
He does say, though, that he has learned this lesson: “Don’t goof around in a car, don’t drive fast and don’t think you can’t get hurt.”
As his dad can vouch, tragedy is just a heartbeat away. “We just need to get across to kids that five minutes of joy can cause a lifetime of misery.”
Today, 16-year-old Tucker Hoge roams the hallways of Brandon High School like some modern-day Lazarus. Just eight months after the wreck that almost killed him, he's back in the classroom and is even vying for a starting position on the school's football team.