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From Shattered to Restored

Children's Hospital provides reconstruction surgery and rehabilitation to Bakersfield teen


Edem and Mary Udoh’s youngest daughter, 14-year-old Iquo, rode in the back seat as they drove from their home in Bakersfield to Iquo in hospitalPorterville on July 9, 2011. One month earlier they attended Iquo’s eighth-grade promotion, where her middle school presented her with an all-around achievement award to acknowledge academic, athletic and citizenship success. Doctors at Children's Hospital Central California would later credit Iquo’s intelligence, physical health and positive attitude as playing a role in her remarkable recovery from the motor vehicle accident that wrecked her family’s world that evening.

“I saw Iquo briefly at Kern Medical Center before she was airlifted to Children’s,” said Mary, who survived the rollover with minor cuts and bruises. “I’m a nurse and I have seen so many things, but I had not seen a patient that serious that came out OK.”

Mary drove to Madera, leaving her critically injured husband behind. “I broke my C3 through C7,” said Edem of the fractured vertebrae in his neck. “I wore a halo for 11 weeks.”

“He wasn’t supposed to walk again,” said Iquo, grinning at her dad with dancing eyes. Neither father nor daughter showed obvious signs of the traumatic injuries they had sustained. At one time, the severity of Iquo’s head injuries offered little hope of recovery.

“The outward look was not good,” said Dr. Gary Magram, medical director, neurosurgery, Children's Hospital. “What was lucky was that her face absorbed most of the impact so her brain was spared the full force of impact. Whatever swelling she had, the fact everything was already cracked and shattered served as a little bit of a protective thing because it decompressed the injured brain and pressure never became dangerously high.”

“Iquo had a high-impact crash,” said Dr. Peter Witt, medical director, plastic surgery. “She had a cranial facial disjunction, which means that the face is detached from the skull. Hers was easily the most shattered face I’d seen.”

Iquo in hospital“They weren’t sure she would make it,” said Mary. “I wondered, ‘If she does make it, what kind of life will she live?’ I think I lost hope at that point, but the doctors and nurses were very supportive. Dr. Lehman came in with the transport team and said they would do everything they could to save her.”

Dr. Samuel Lehman was Iquo’s admitting physician at Children’s. An expert in pediatric critical care medicine, Dr. Lehman drew on his experience to stabilize Iquo. “A lot of credit goes to our PICU team,” said Dr. Witt, referring to the doctors and nurses in the pediatric intensive care unit. “They saved her life.”

“When I got to the Hospital there was a lot of family already there,” said Ekeate Udoh, Iquo’s older sister from Santa Barbara. Other members of her large family had assembled in Bakersfield where her father would undergo surgery. “When we went in and saw her she was still bleeding,” said Ekeake. “We didn’t know how severe the brain damage was. They told us she’d lost too much blood for surgery.” While PICU staff attended to Iquo, her family prayed not only for her survival, but also that she would soon be the same vivacious, funny young lady she had always been.

Iquo’s first surgery occurred six days after the accident. “This was a major reconstructive undertaking in which the timing of surgery was weighed against the morbidity of her brain injury,” said Dr. Witt. “We needed to allow enough time for healing of a cerebrospinal fluid leak, but operate soon enough to treat facial deformities before they developed fibrous synostosis, in which case the shattered bones fuse.”

For this reason, Dr. Witt planned two surgeries. “My first priority was to start with the stable bones in her face and move to the unstable, so I fixed the jaw first.” Dr. Michael Dunham, medical director, Iquo in hospitalotolaryngology, joined Dr. Witt. “He had to give her a tracheostomy because of the type of injuries to her face.” The second surgery, slated for July 26, would jointly address the craniofacial disjunction and fractures to the naso-orbital ethmoid (NOE). The NOE includes bones around the sinuses and eyes. “Without surgery hypertelorism can happen,” said Dr. Witt, referring to abnormally increased distance between the eyes. Injuries to this intricate anatomy present one of the most challenging areas of facial reconstruction.

Prior to the second surgery, Dr. Lehman assessed Iquo to determine if she was strong enough for the complicated procedure. “They were worried by her irregular temperature,” said Mary. “So they tried to wake her two days before her second surgery.” Iquo had been unconscious since admission to Children’s Hospital, but Dr. Lehman succeeded in rousing her. She was able to follow his commands to open and close her eyelids and wiggle her fingers and toes.

“I remember waking up one day and seeing that I was in a really nice room, but I didn’t know where I was,” said Iquo. The teen was once again sedated and cleared for surgery. The procedure, known as open reduction internal fixation (ORIF), involves reconstructing bones with plates and screws. Dr. Witt performed plastic surgery on Iquo’s face while Dr. Magram repaired the damage to her skull. “She has over a dozen plates and screws in her skull,” said Dr. Magram.

“When she came out of the second surgery she didn’t wake up for a week,” said Ekeate. “She finally woke up the last Saturday morning in July.” After three weeks in a coma, questions remained about Iquo’s cognitive abilities. “The biggest thing was that I asked her to spell something and she could spell it,” said Ekeate. “That was overwhelming because I knew she was all right.”

Iquo in hospital“The saddest thing is when you wake up and you touch your head and realize your mom’s hair is longer than yours,” said Iquo, proving her sense of humor was also intact because Mary keeps her hair closely cropped to her head.

“I remember up in the PICU Iquo surprised everybody with how well she did,” said Randy Mack, physical therapist. “She made a quick and remarkable recovery.”

“Randy came up to see me in the PICU,” said Iquo. “They were going to start me with physical therapy and we were playing a game with a ball. That really gave me hope because I knew that if I could do this, then I could do everything I used to do.”

“Iquo had to learn how to do everything again,” said Mary, nodding slowly. “Everything.”

“No I didn’t,” she replied with a sly grin. “I didn’t have to learn how to annoy you. That came naturally.”
Iquo’s witty response brought a wide smile to her mother’s face. “I give praise to God for the miracle of Iquo's recovery,” she said. “God heard our prayers and answered us.”

The Udohs acknowledge the important role their church family played. “They kept constant prayer vigil on our behalf and sent members to see Mary and Iquo there in Madera,” said Edem. “They also took turns visiting me in the hospital in Bakersfield.” He noted a special contribution given by the church. “One of Iquo’s friends made wrist bands that read ‘IQUO, EDEM AND FAMILY, SURROUNDED BY PRAYER,’” said Edem. Family, friends and even a few staff at Children’s wore the bands throughout Iquo’s rehabilitation.

Iquo in hospitalEdem’s recovery also defied the norm for cervical-spine fractures, which typically result in paralysis. “We hadn’t told her about my injury,” he said. “But when I skyped her she saw the halo.” Iquo saw the halo again when Edem was released from the Bakersfield hospital and traveled to Children's to support his daughter’s continued recovery.

Iquo was transferred to the Hospital’s pediatric rehabilitation center August 3, where she spent three hours a day, six days a week in one-hour sessions equally balanced between physical, occupational and speech therapy.

“This family wrapped themselves around her with such love,” said Juliann Zermeno, licensed clinical social worker. “They would embrace her every effort toward recovery, whether she accomplished something or not. Every little step in Iquo’s recovery Mary would say, ‘This is God’s plan.’”

“Recovery continues to happen for up to two years after a brain injury,” said Mack. “In the first year you’ll see more quantitative changes – gaining the ability to walk and talk. The second year involves quality changes – developing greater endurance.”

“The family had high expectations, but not unrealistic,” said Zermeno. “Iquo did, too. She had this sense of self-determination. That was part of her recovery. She had goals she wanted to meet before being discharged.”

Iquo in hospital“When Iquo first got home she would need to hold the railing going up the stairs,” said Ekeate. “Then a week or two after discharge she was dancing.”

“Iquo is that rare case everybody remembers that shows what can happen,” said Dr. Magram. “That’s why we do all we can for every patient with a traumatic brain injury, because you never know.”

“I thank everybody for what they did,” said Mary. “I don’t know what the outcome would’ve been if she hadn’t come to Children’s Hospital. I think it was God who brought us here. Anywhere else I don’t think she would do as well as she’s doing. I could not ask for a better group of people. They saved my daughter’s life for me.”

Today Iquo remains self-determined. She’s accelerating her high school studies with plans to graduate early, she hopes to break her own high-jump record of 5 feet 2 inches, and she wants to make time to respond to the call she received about doing some modeling.

“Hope is restored,” said Mary. “Through all this I realized that when you call on God He is always there. It may seem like the end of the tunnel, but God can deliver through anything.”