As she headed into her final few weeks of high school, Karina Escalante was at the top of her game: An honor student and two-sport athlete, she’d been accepted into college and was cruising easily toward graduation. There was no reason to think that staying up late one night could threaten to derail her entire future.
But after that late night the 17-year-old was sleepy when a friend picked her up for the drive to school the next morning, so she climbed into the back seat and let her younger sister take her usual spot up front. And instead of buckling up as she normally did, she neglected to fasten her seat belt so she could lie down and snooze more comfortably on the drive.
It was 7:30 in the morning when Karina’s mom, Lucy, got the call. The driver of the car could barely get the words out, and Lucy couldn’t quite follow what he was saying. But she heard “accident” and “Karina” and “unconscious.” The car had struck a guard rail on the parkway and spun out of control. The teenage driver and Karina's sister were more dazed than injured, but Karina was in an ambulance that was racing her to NewYork-Presbyterian Queens.
Lucy phoned her husband, John, who was about to walk up to the start line of a 200-mile relay race hundreds of miles away. (“Five more minutes and I would have lost connectivity for the day!” he exclaims.) John would miss that endurance event, but his frantic trip back to New York ended up being a marathon of its own sort, as it took nearly nine hours in taxis, trains, and subways to reach his family at the hospital. As he made his way home, the news from the emergency room seemed to get more grim with every phone call.
Karina had suffered a severe traumatic brain injury (TBI) when she was thrown around the back seat of the car. When paramedics arrived on the scene she was suffering repeated seizures, which continued until doctors in the hospital’s trauma unit put her into an induced coma to calm her disorganized brain activity and try to prevent swelling. Even in the coma, Karina’s brain began to swell from the trauma; she needed a hemi-craniectomy to remove a section of her skull to give her brain much-needed room to expand — to reduce the pressure on her brain as well as her risk of permanent neurological damage. Dr. Ning Lin, Weill Cornell Medicine neurosurgeon who works at NewYork-Presbyterian Queens, was called in to do the surgery.
“I was completely numb,” says Lucy of those first hours and days. “We gathered the family, we set up camp in the hospital, and we somehow figured out a plan for our other children.” Family, neighbors, and members of the parish rallied to help care for Bryanna, 15, and Justin, 8, and to prepare meals for everyone — Lucy says she can’t believe how lucky the family was to have such an amazing support system when they needed it.
“We tag teamed it,” Lucy recalls. “John and I didn’t even sleep in the same room for two months — one of us was always by her side.”
Karina remembers nothing about her many weeks in the NewYork-Presbyterian ICU. She remained in a medical coma for a full two weeks while her family kept vigil and her medical team tended to her. Trauma Program Manager Mary Ellen Zimmermann, RN, remembers feeling cautiously optimistic about Karina’s chances of survival, but says the team was worried what her future would hold.
“Karina had very serious injuries,” says Zimmermann. “The odds of neurological damage in a case like this — let’s just say we were concerned.”
“Our parish priest came to the hospital every day,” says Lucy. “We even signed a DNR, but we still never thought we’d lose her. At a time like that, you just function, you just keep going.”
Two weeks after the accident, Karina’s brain swelling had gone down enough for doctors to bring her out of the coma. Still, it was clear that Karina would have a long road ahead of her. Serious TBIs create a constellation of challenges for patients, including muscle weakness, speech difficulties, memory issues, and cognitive and emotional changes. Karina would need several more weeks of hospital care followed by months of in-patient rehabilitation, including physical therapy, occupational therapy, and speech therapy. And with a large portion of her skull gone, she’d need to wear a helmet to protect her brain until the missing bone could be replaced with a custom prosthetic bone.
Karina had a long road ahead of her – she missed a year of school while undergoing rehabilitation and recovering her strength, and she needed yet another surgery so Dr. Lin could repair an aneurysm she developed in her brain. In September of 2016, however, more than a year after the accident, she started her freshman year of college, where she is studying to be a Physician Assistant.
John and Lucy say they have a new understanding of how one family member’s health affects everyone. “Bryanna was so scared,” says Lucy. “Karina’s her big sister, and they’re very close. Justin was too young to really understand how scary the situation was, but his world was turned upside down. His parents weren’t there for him, he was being shuttled around from one cousin to another, and it was hard for him.” Both of Karina’s parents took leaves from work so they could stay by their daughter’s bedside, and both were fortunate that understanding employers and protective union representatives were there to help them navigate those months without having to worry about money.
They also know just how lucky they are — if a family that’s gone through this experience can ever be called lucky. “One nurse told me that maybe .02 percent of people who have this kind of brain injury walk out of the hospital on their own,” says John. “Karina’s young, she’s strong, and she’s resilient. And she’s going to be fine.”
The former athlete knows that her days playing basketball and soccer are over, as Dr. Lin has taken all contact sports off her list of activities. Karina doesn’t seem to mind that. With dreams of a career as a Physician Assistant back within her grasp, Karina’s head is in the right place.