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TheThe tale tale ofof an an LI LI miraclemiracle NEWSDAY PHOTO / MICHAEL E. ACH Bobby Palange, 3, jumps rope in the kitchen with his brother Jacob at the family’s home in North Bellport. COPYRIGHT 2006, NEWSDAY INC., LONG ISLAND, VOL. 66, NO. 176 2 NEWSDAY, SUNDAY, FEBRUARY 26, 2006 www.newsday.com C emylo ieayohr3ya-l u ob aag,se eewt i itrMgna oei ot eloti h al slcyt eaieatrhsdad his after alive be to lucky is fall, the in Bellport North in home at Megan sister his with here seen Palange, Bobby but 3-year-old other any like look may He T T u eas hr ees many. so were there because But Palange. Bobby struggle save the to in moment defining one was there any because Not well. alive remarkably is and boy 3-year-old the later, year One head. son’s young his crushes accidentally and February in morning a snowy on driveway the down family’s Durango his Dodge backs father Bellport North he u eas hr ees many. so were there because But Palange. Bobby struggle save the to in moment defining one was there any because Not well. alive remarkably is and boy 3-year-old the later, year One head. son’s young his crushes accidentally and February in morning a snowy on driveway the down family’s Durango his Dodge backs father Bellport North he

C www.newsday.com NEWSDAY, SUNDAY, FEBRUARY 26, 2006 ESA HT IHE .ACH E. MICHAEL / PHOTO NEWSDAY backed over him in their driveway a year ago.

4 K K NEWSDAY, SUNDAY, FEBRUARY 26, 2006 www.newsday.com C h accident. the before Palange Bobby Everything Presidents AT1 PART Monday. apart Day. falls na on i rafs,h’ att go to want he’d breakfast, him exas- peration. mother’s his to tractions, and lit- gloves shovel. own tle his coat, towing and a cap bun- knit in him, up into after dled head driveway that should the natural toddler only on the It’s of works car. set Robert the play when a tools around even carting everywhere, him follows was he old. since weeks eight attended has center he care day at Time or Tutor the home pitcher’s at uncanny whether motion, that run- in a throwing ball always or jumping Or seemingly ning. is he ments. Snoopy. named flop- dog a py-eared Bear, animal, his stuffed with favorite “Brown nap to or Bear,” fa- Brown book, his of reading vorite a to through coaxed sit be her might Bobby day, with same wife the Windstar. his Ford so do driveway out can it the Dodge back of and family’s first He the Durango plan: free a on will agree now and relationship, they rough their in a Palanges spell after regrouped The have driveway. four blanketing the the snow wet away of inches shovel to be- gins heads and afterward soon outside husband, 30-year-old while children, oldest three 2 her with dentist the five visit of will mother 35-year-old The Jefferson. Charles Port St. in at her Hospital department to radiology returning the before in off job duty day secretarial rare jury a of herself month allows a and finished just has Polly-Palange im ooe ac nNrhBlpr iewyt reigrain. freezing to way give Bellport North cream- in her ranch by colored floating snowflakes the a.m., 8 At however. ride. the for along go will — birthday first his past week 1 H’ oei,adIdfeed I’d and in, come “He’d dis- of plenty are there But and father his adores Bobby motion, perpetual in boy A mo- those of one not is This the of moment quieter a In Kim’s Palange, Robert noengtsosomhscmlctdhrplans, her complicated has snowstorm overnight An / 2 ya-l ob n i one rte ao one — Jacob brother younger his and Bobby -year-old YBY NELSON BRYN BY i a eidte20 Duran- 2001 the behind dad his driveway. down the to white and walk the brackets gin- the their gerbread with past columns the porch door, happens from what bounds front Bobby out after figure to me.” to them bring your are Where gloves?” gloves. dentist. least the to at for trip ready or the is — else everyone good until for in him asks. Kim in?” in. let be to nose wait- ing missing, back, gloves he’s dripping, bathroom Then a like mirror. which up door, fogged glass out has outer the back es go to jacket, his again.” want off take he’d I as to soon recalls. as started and Kim in, come again,” “He’d out back iw,eeins accounts eyewitness views, oieofcr n medical and officers police foesreyaddozens and surgery one of edentfn i lvsor gloves his find doesn’t He week a about Kim take will It and gloves your get Go “OK. daddy.” “By your get Go favor. a me “Do lure to tries mother his outside.” go So to want I “No stay you don’t why well cold.” “OK, are hands my “Oh, clos- Kim and out runs Bobby eot,drc observation direct reports, hsacuti ae on based is account This ovrain r based are Conversations fitriw ihfamily with interviews of ogIln institutions. Island Long eia eod,police records, medical TF WRITER STAFF nosrain,inter- observations, on ebr,neighbors, members, esne rmfour from personnel n oierecords. police and h story The ae n h a i yshave eyes his way the and face, something. now?” do he did what think- “OK, is son. ing, she and their blood is holding There is husband facedown lying driveway. hor- the his is on To Bobby look. a ror, take to out be- time tire. front this left the again, neath But is up. it back reasons, there to he continues bluestone, and of pile tire. rear left the the with hard shifts reverse. and into SUV in 2.2-ton ignition key the the turns Durango, the be shut must inside. has Bobby back He door Surely notes front again. away. but the Bobby that shovel see he’s doesn’t his where house, put the of side chil- vanish. young essentially can it, dren call advocates inch bumper. one ex- rear and the spot from feet testers blind 19 a tending the off Du- marked Limited, Dodge 2004 rango a like driver in 8-inch Robert vehicles. 5-foot rear cone a various For or of traffic mirrors window 28-inch the through a could drivers see well how tested disappears. utility but all sport and vehicle the behind waits and soon look. there Bobby be help will dad surely But his been street. the now to has cleared path a where go, u hnsese e son’s her sees she then But into getting always Bobby’s her and door the opens yells. he Kim do?” I did “What gets and vehicle the stops He a or snow leftover be must It something over runs Robert into gets Robert a.m., 9:33 At the from returns Robert as zone,” “blind this Within recently Reports Consumer toddler the meantime, the In e OB n7 on BOBBY See

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www.newsday.com NEWSDAY, SUNDAY, FEBRUARY 26, 2006 ESA HT AE IE STABILE WILES KAREN / PHOTO NEWSDAY With the scars of skull surgery still visible, Bobby sits on his mom’s lap less than three weeks after the accident.

6 NEWSDAY, SUNDAY, FEBRUARY 26, 2006 www.newsday.com intensive care unit. Bobby istaken tohospital’s 3:25 p.m. another half-hour. under observation for about barbiturate coma andkept which Bobby isplaced ina about three hours, after Surgery beginsandlasts Noon for surgery. operating room toprepare Bobby istaken toan 11:30 a.m. department. to thehospital’s emergency Bobby isofficiallyadmitted 11:05 a.m. Brook University Hospital. Ambulance arrives atStony 11 a.m. transferred. about anhourbefore being Brookhaven Hospital for hospital. Bobby stays at Ambulance arrives at 9:50 a.m. Medical Center. Memorial Hospital home for Brookhaven Ambulance Palange departs 9:43 a.m. Bellport. North Palange homeisin end oftheblockwhere the Ambulance arrives atthe 9:41 a.m. Ambulance enroute. 9:38 a.m. South Country Ambulance. dispatcher makes acallto Suffolk County 911 9:37 a.m the Palange home. Accident at 9:33 a.m. approximate. times listed are and more. Insomecases, hospital workers, doctors police, ambulance and a coordinated effortfrom on Feb. 21,2005,involved near-fatal autobackover Bobby Palange from a The miraculous rescue of Six frantic hours from accident MINUTES Brookhaven to arrival at THE ORDEAL 17 hospital transporting Bobby 18.6

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Laboratory loyd National P k w y . 27A 7 www.newsday.com NEWSDAY, SUNDAY, FEBRUARY 26, 2006 The accident was the lead story in Newsday on Feb. 22, 2005. See BOBBY on 8 Brain cells instigate it by fir- Extra sodium causes brain This forced expansion into Unless the pressure is re- Bathing Bobby’s brain cells He’ll need far more aggres- During the seven-minute Price and Johnson crouch intracranial pressure. ing in unison,surroundings blanketing with their like a burst confetti- ofcals signaling known chemi- asters. Amid the neurotransmit- ensuing free-for- all, glutamateters neurotransmit- latchting onto from the receptors cells,chain jut- setting reaction up that a evicts potas- sium and sends sodium rushing in as a replacement. cells to retainwere water billions as if ofUnlike they tiny a sponges. knee, however, sponge the brain is orfined con- by swollen theof the bony skull, restricting parameters theing bulg- mass in everycept direction ex- downmen through magnum, where the thestem fora- meets brain the spinal column. new territory,progresses or aspressure the herniation, intensifies. Blood intracranial sels ves- andpressed nerves and become arteries strugglepump com- to blood-borne glucoseoxygen and back toneurons the of 100 thedelivery brain’s billion service. message Herniation can eventually asphyxiate theand brain crush theing brain stem, turn- offcommunication the channelsbanks neuron-mediated of like lightswarehouse. in a darkening lieved, deathdamage or is nearly lasting inevitable. brain with oxygen inambulance the may back of helpheightened the meet energy the demandsbattered of neuronspairs and re-equilibration. seeking And it may re- compensate for the difficult passage of oxygen to thesecells, brain reducing the rateing of swell- andpressure, accompanying perhaps rise buying himlittle in more a time. sive measures and Priceahead radios toemergency warn department Brookhaven’s impending of arrival. an Lifesaving moments ride, Navratil sits in atain’s gray cap- chairBobby’s as head and shepediatric neck collar and with stabilizes her a hands. “Bobby, hold on! Bobby, stay They’ve nearly made it to Salinas jumps out, and the of- The Durango’s tire treads Salinas gingerly carries him to Driving 17.7 miles to the hos- Curry and Mudzinski escort After strapping the patient to The human brain, like other ing, contrary to theinitial dispatcher’s report.stop, Then the breaths thelow, become and cries the shal- officershave know little they timecarry to him from lose his asents stunned par- they andtheir into police car. the backseat of with me!” they both say.thing “Every- is going to be OK!” the enda.m., of the whenfirst block, responder South at vehicle rounds the 9:41 Country’s corner,emergency with medical technician SalinasAmy and Price in theEMTs back. Fellow JamieNicole Navratil have followed in Johnson ambulance 5-42-16. and ficers hand him the limp boy. have left ugly markstoddler’s across right the arm and leg.by’s Bob- right eyebut is his swollen leftthe shut, ominous pupil sign is of abrain dilated traumatic injury. — the side doorwith of his the hands and ambulance armsthe bracing boy’smust head be and stabilizedthe spine. poor quickly weather rules He out and acopter heli- flight to Stony Brook Uni- versity Hospital, Suffolkty’s only Coun- Level I trauma center. pital through slushyonly roads will delay thetion Bobby medical urgently atten- Salinas needs, instead so directsbulance the am- towardMemorial Brookhaven Center Hospital in Eastthan Medical Patchogue, 3 less miles away. A race against time the ambulance north on Station Road and westHighway, as along their Sunrise ers fellow offic- begin closingand side Kim streets, close behind and in the Robert Durango. follow a yellow-framedpediatric stretcher board, and thecrew ambulance places amask plastic over bag valve Bobby’snose, mouth delivering and form of hope pure oxygen from anboard in on- tank. the parts of the body,injured. swells With when injuries, traumatic though, brain thethreat arises principal from the spike in 2 / 1

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It won’t be a routine one, Kim is cradling Bobby on the While her husband frantical- He has a heartbeat and is cry- She screams. The morning crew at South As one of Suffolk County’s Through their pagers, the Suffolk County Police Offic- AREA OF DETAIL S blocks from the Palangewhen they house hear the same call. they sense, and they immediate- ly ask for assistance5th from Precinct their colleagues toa clear pathmix of through snow and the rain. tapering walkway bywhen the thethan officers front a arrive, minute door red less later. leads back A to the trail Durango. of ly relayed the accidentoperator, to a Kim 911 stanch the had flow oftowel. blood tried But with a it continues— to to from flow Bobby’shis head, nose, his his eye, ears. BOBBY from 4 rolled up into histhe head. There’s Durango atdriveway the and she end knows. of the THE CALL COMES IN AT 9:37 A.M. Country AmbulanceBrookhaven is Co. settinging up chairs fold- in andResusci hauling Anne out and Resusci the ior Jun- mannequinsing’s in the second-floorBrookhaven’s build- Boy classroom. Scout Troop 4 is dueminutes in for little a moreaid community than and CPR 20 first course. busiest ambulance companies, with an averagehandled of in each 2,500 ofyears, the calls past South five Countrya relies on roster ofteers 126 and six trainedMiglino employees. volun- Greg Jr.,chief, describes the thetine daily as rou- company’s by “boredom a mad interrupted dash.” crew members receivefolk the County Suf- 911 dispatcher’sadvising call them of amatic child cardiac in arrest trau- after acle-pedestrian vehi- accident.Salinas, the company’s Luis operations chief of andsupport advanced supplyonly life think manager, “Oh, no” asdown can the he stairs rushes and out the door. ers BrianMudzinski, Curry and classmatesthe county police Robert academy from partners and for thestopped past at year, are a traffic light 2 North Bellport PHOTO BY HOWARD SCHNAPP NEWSDAY PHOTO / MICHAEL E. ACH NEWSDAY PHOTO / MICHAEL E. ACH From left, Beth Anne Brauneisen, Dr. NASSAU SUFFOLK THE FIRST TO HELP Suffolk County Police Officers Robert From left, emergency medical technicians Jamie

THE TRAUMA TEAM Robert Ehlers, Audrey Georgakopoulos,Leroy Lorraine Reid Lomonaco, and Serina Fahie of Brookhaven hospital. Johnson, Luis Salinas andin Nicole an Navratil ambulance gave during aid the to drive Bobby to Broohaven hospital. THE EMTS Mudzinski and Brian Curryto were treat first Bobby to Palange arrive after on the the accident. scene THE POLICE

8 NEWSDAY, SUNDAY, FEBRUARY 26, 2006 www.newsday.com C opudtedanger. the compound dramatically inter- could bleeding aorta, nal descending such the vessel as blood has major fracture a sug- pelvic torn any bruises If gest. developing marks and tire the that injury a pelvic monitoring and Bob- arm right splinting the by’s Price to and oxygen sec- mask deliver three to every onds once bag der laven- stretcher, a squeezing the Johnson with of sides the over 7 from BOBBY h xenlbedn from bleeding external The oabakhnhl eie The device. handheld cord black a the left to connects Bobby’s and to at- earlobe probe he up a one, taches For sets monitors. and two response crew’s side. his to back gently arm his arm Price lowers head. splinted his his touch mask. lift and to oxygen tries the He fights and ly exam- stethoscope. lungs a with his the ined of and bandages, condition sterile and pressure be steady with must controlled wounds head Bobby’s aia oriae his coordinates Salinas soft- cries he conscious, Barely et atratra nuyor injury an after heart faster the 130 beats but to minute, per 80 beats from ranges toddler ambu- the cabinets. green built-in above lance’s counter of a on screen small succession a traversing waves heart a his into of activity the Bobby’s translate electrical they to where chest, stickers electrocar- diogram color-coded affixes three also Salinas reach- cells. his ing oxygen blood-borne amount measure of and rate heart will boy’s the oximeter pulse h etn er aefra for rate heart resting The e tafrseprrt hnin than rate steeper far a at plum- met can pressure the Miglino but says, pressure, a of blood maintain stable still percentage and blood greater their a can lose Children adults.” shrunk- just en-down not “They’re says. later. says Miglino maintain pressure,” and a blood more de- liver and shock trying for is compensate body to the that “which you 178, tells and the 100 between bounc- During es rate brain. heart Bobby’s the ride, to oxy- gen more pump to trying when Kd r eywid”he weird,” very are “Kids aino ain’ uncon- patient’s Glas- the as a Known sciousness. of du- and ration depth routinely the gauge to checklist used a through score crucial A often very chance.” second not a you he do give late,” “Kids too be says. let will will it them and of loose one time, one at systems these all monitoring and to ability over- body’s compensate. loss the blood whelms once adults ihhsce,Slnsruns Salinas crew, his With this, of top on not you’re “If C www.newsday.com NEWSDAY, SUNDAY, FEBRUARY 26, 2006 LUNG PARTIALLY COLLAPSED COLLAPSED See BOBBY on 10 Someone calls out in surprise, A drawer near the middle The two doctors confirm the Another drug shoots through In the meantime, Bobby re- “Are you here for the baby?” and prevent critical mistakes. holds theEhlers and laryngoscope Winslow willpeer use that to downand Bobby’s thecurved blade trachea; metal andbling handle, a device long-handled a that shoehorn resem- willHere is the open flexible endotrache- al tube that that willthrough airway. deliver the oxygen airway to hisand lungs; a urinary catheter foring drain- urine from his bladder. position of the inserted endotra- cheal tubeflows and pure throughbursts, oxygen first itbag from and a then incal from handheld a quick mechani- ventilator.tion, Ehlers says, Hyperventila- canlevel lower of the carbon dioxide intissue brain — andsure maybe building the pres- constricting within the it sizevessels — in the of by brain and blood ing decreas- the blood flow. the IV: vecuronium, to holdboy the in a temporaryralysis state during of his pa- intubation. Another ambulance ceives another unexpectedAn lift. ambulance hasmoned from been Stony sum- versity Brook Uni- Hospitalhim to there for transport gery, emergency but sur- arolling gurney through issliding Brookhaven’s doors, already sentond with ambulance a to sec- critical take heart a patient non- Brook for to some tests. Stony EPIDURAL TEMPORAL, HEMATOMA OPTIC NERVE OPTIC DIFFUSE BRAIN IN PELVIS SWELLING AND SWELLING SPHENOID AND ARM DAMAGED RIGHT DAMAGED FRACTURED A blood pressure cuff is Brauneisen selects a large Even then, he seems to pull It’s still a fight, though the A dire prognosis. Through the IV, Brauneisen in- To the right is the pediatric FRACTURED RIGHT FRACTURED BRUISED RAMUS BONE RAMUS EYE SOCKET BONES He suffered a series of injuries, some life-threatening, a series of injuries, some life-threatening, He suffered that included the following; Bobby’s injuries Bobby’s ing. Good. wrapped around histhe right arm, injuriesright to eye and arm his andamined. pelvis ex- headknown and Specialized as computedphy scans, X-rays tomogra- or CT scans,vide will multiple pro- scenes ofken his bro- body to confirmsuspicions. the staff’s bore intravenous catheter from a drawerbeled in theCART” pushcart “IV and inserts la- inner it AND near bend the elbow, opening of a BLOOD the key central portal Bobby’s veins to in his left arm. away a little from the sharp jab. Emergency action wire-framed clock onwall the refuses back togow slow. Coma His Glas- Scorefrom has seven dropped tothe four, slightest with physicalgiving response only the unconscious boy one point above the minimum. jects two drugs: Atropine, a com- mon lead-in fordries anesthesia up saliva that andcretions bronchial and se- counteracts the low- ered heart rateaccompanies that the insertion sometimes ofendotracheal an breathingand the sedative tube; Versedvent any to more physical pre- protests. crash cartPatchogue donated Kiwanis,nine color-coded drawers. with by Each drawer its the containsemergency a suppliesdren for stash within specific chil- es, size of a rang- design meant to save time 9 Duffy 13 4 8 Egnor 12 3 20 16 19 Salinas holds Bobby’s pediat- After the hand-off, Salinas lin- He thinks aboutHe his remembers own how Bobby Salinas thinks to himself, and “You watch . .He .” waits. And he watches. The department swells with “Kismet,” she says later. Bobby’s airway is open, he’s Trauma Room 2 fills quickly: More than 60,000 patients will How then has this one hour Registered nurse Beth Anne Everyone feels it. “Of course, everything chang- They do because they must, ma Room 2. ric collar inboy’s place, head bracing and the neckBrookhaven’s as assembled he emer- tells gency team whatseen his and crew done while has en route. gers at the edgesroom, of watching the anxiously. trauma 8-year-old son. fought against the oxygen mask on theHow he way had that to energy. thethen hospital. tells his crew, thatwill either the have boy severe anding last- disabilities, orcompletely that he’ll recover be remem- so bered for years. Brauneisen and EhlersJason and Winslow; five Dr. otheres nurs- and twoand emergency nursing department sec- assistants; retary Audrey Georgakopoulos, who remembersheld the how child’s head Salinas so long. a sea of concern. Amidmotion, the com- Brauneisen marvelsthe at staff’s lockstep movements, the unity of mission. “The flow —team.” everyone was a breathing and his heart is beat- TIME IS THE ENEMY IN THIS ROOM. pass through Brookhaven hospi- tal’s emergency2005 department in —with 60,000 their own urgencies. clocks ticking become so ingrained inry? memo- The knowingdrugs glances, delivered, the time that the still separates so rushly neat- into stop-motion of scenes? Brauneisen remembersremarkably being clearheaded,Bobby’s as if crisisher has focus to a sharpened shining point. es when it’sRobert a Ehlers, child,” whoadrenaline says recalls and urgency. Dr. the “Every- body steps it up a notch.” because the boy isparents the in child the of anguished hallway, whose faceswith Ehlers have months later. stayed 15 18 2 7 11 17 14 1 10 6 THE OPERATING TEAM Beg 5 The Stony Brook University Hospital emergency surgical team and surgical support staff that worked to save Bobby Palange: 1. Registered nurse James Cassar 2. Registered nurse Kim Fenster 3. Surgical technician Chris- tine Neuwirth 4. Registered nurse Mary Zegers 5. Registered nurse Valerie Bagnasco 6. Dr. Tazeen Beg 7. Dr. Margaret Parker 8. Dr. Michael Egnor 9. Physician’s assistant Dennis Duffy 10. Registered nurse Katherine Morales 11. Dr. Richard Scriven 12. Dr. Rich Dickinson 13. Registered nurse Juan Serna 14. Registered nurse Kathleen Culver 15. Registered nurse Kathryn Sheriff 16. Registered nurse Jamie Farruggia 17. Registered nurse Bill Dempsey 18. Paramedic Ian Mauro 19. Paramedic David Sterne 20. Dr. Favid Visram Seven out of 15 points,Bobby reaches a the brick col- Through the double set of To the left again, past the but his motor responses deterio- rate to the pointsigns that three Salinas out as- of six points. score thatbrain suggests injury. a severe umns of Brookhavenambulance hospital’s bay atminutes after 9:50 the a.m., accident. 17 sliding glass doors.and To down the a brightly left of lit linoleum diamonds. hallway frosted glass window of Trau- NEWSDAY PHOTO / MICHAEL E. ACH

Although harder to assess in young children, ain lower each score categorycreasing impairment. indicates Verbally, in- Bobby is making incomprehen- sible sounds,out giving of him five possibleeyes two points. open His only intermittently, in but responseout to of pain:Bobby two four withdraws points. from Initially, pain, gow Comasystem Scale, covers three the types ofsponse scoring re- andsomewhat provides subjective clues to vitalpatient’s a condition. if

10 NEWSDAY, SUNDAY, FEBRUARY 26, 2006 www.newsday.com C ht al,ecp o h venti- the for except then table, white and left. the right to hallway the a down to quick few a steps just room, Brookhaven’s their scan CT to wheel patient hospitals small two of the for patient. heart instead come will hind, be- half-hour a perhaps bulance, am- second the Brook’s Stony through door. walks the he change moment priorities his Room and flight Trauma 2, to transport heads nurse, care critical 8 from BOBBY h o isvr tl na on still very lies boy The forces combined the so And ambulance’s the Serna, Juan h aag oesotyatrteaccident the after shortly home Palange The Woodbury their into back- it was ing Greg as vehicle toddler utili- ty sport X5 BMW the family’s 19, the behind unnoticed Oct. when slipped on 2002, Cameron 2-year-old their son lost Leslie, just “It’s shock.” Dr. Gulbransen. pediatrician Greg Bay says Oyster it,” explain there t parent, words no a are as it of trauma push laws. safety the car in better for point Is- focal a the land made and voices their found have parents trage- several dy, unspeakable so. of nearly out child’s fourth But a a and in death ended have Is- Long land on accidents similar discovery. awful And the vehicle. then utility backing sport relative a up or parent A toddler. unseen An way: same laws safety vehicle new for push The ubasnadhswife, his and Gulbransen the through go you “When three 2002, October Since the begin all stories Their g.Adte en so the on is reporting phone, Serna wall-mounted then And age. wreck- internal accident’s the of accounting a 5-millimeter-thick each the room, in control screen glassed-in pop computer a images on up of Dozens pelvis: drugs Vital avoid radiation. to the wall a lead-reinforced behind of dash staffers array de- partment emergency an the while and for scans, tube mask IV oxygen and collar diatric pe- the his with into along ring slides oversized body His his chest. of fall and rise lator-assisted ed ek hs,abdomen, chest, neck, Head, h aa fsft advo- safety of on radar barely the phenomenon accidents, aware- a backover more of ness for and pressing in fundraisers Gulbransens organizing the joined Muttontown. in outing ly fami- a a during in Expedition Ford toddler the over backed ly accidental- father Cavallaro her after died later, Agatha months 2-year-old Two 2004. April 24, on toddler the killed tally acciden- driveway fami- Hills Dix the ly’s of a out backing Explorer relative Ford months a 16 when only old was Alec son says. he story,” my through epidemic. an as for views he concern what of out but continues doing hates he — something times of dozens story his ed night. the for driveway h esn aesince have Nelsons The Nelson’s Adriann and Bill have. already Others go to anyone want don’t “I recount- has he then, Since ESA HT IHE .ACH E. MICHAEL / PHOTO NEWSDAY tneue oca chewing coat to used sub- The stance cells. brain from away moisture wick can that diuretic the is a cross mannitol to barrier, able blood-brain drugs of few One the grams. 120 of drip a slower then mannitol, as al- known sugar cohol a of grams Thirty IV: the few these moments. frantic within forged as well, them friendship between a developing but is sight, by Brauneisen only knows Serna do. need to they what know and other years. four for known whom has he Ehlers, and with Brook consulting Stony to results the oeduscus through course drugs More each at look to able are They ersntoa transporta- national year’s of quantify. to the hard lack made problem has a statistics good but “bye-bye the syndrome,” it calls Fennell them. compels anxiety ration sepa- when driveway the run into to the enough old recognize but danger to young too for bumper rear be- drivers. shorter feet the 40 hind than ex- more that tend zones” “blind have which of some trucks, and pickup minivans SUVs, popu- of larity the tracked have says, three or two higher. is times toll believes real past Fennell the the years. of more each two in with 100 tracks, than she fatal- the ities of half than more for Kids group Cars. And nonprofit president the and of Fen- founder Janette in nell, says alone cars,” left hot being kids then back was with dealing were ’90s. late the in cates htmycag.I last In change. may That toddlers, are victims Most she numbers, rising The account now Backovers we thing one number “The and rear-view mirrors orthrough thebackwindow. ends atthepointinwhichadriver canseethetopofa28-inchsafety cone intheside- vehicles for small-andaverage-size drivers. Thebeginsattherear length bumperand Illustration below atrightshow andchart rectangular blind-zone ofselected lengths What drivers don’t see oebyi itdfo the from Brook’s lifted Stony onto is table white boy is coma- tose the then mannitol And out. the forcing to fluids cart, crash collect the from trieved used commonly infections. staphylococcus against derivative lin penicil- a nafcillin, then and axone ceftri- called deficit antibiotic an that flows for infec- in up off make To ward tions. to ability the with body’s interfere can but mation inflam- brain suppresses likewise brain. Bobby’s within building pressure intracranial and the swelling reduce the may reverse to stickiness help prevent to gum eot nomto ntebidsosfrms ye fvehi- of models. types most and for makes spots cle blind the on information Reports Visit ihteLn sadChil- Island costumed and Long Museum dren’s the with Halloween, On cars. new all in standard systems warning back- up as make such measures to safety manufacturers bile automo- require 2005,” would of which Act Safety Kids Cars And Gulbransen “Cameron the co-introduced (R-Seaford) on them. and preventing of backovers gather ways on to data Safety Administration Transportation High- National way the re- language quiring inserting in ed succeed- advocates bill, tion nge h rn ahtrre- catheter urine the goes In that steroid a Decadron, And atMy e.PtrKing Peter Rep. May, Last Newsday.com/bobby ocekotConsumer out check to omk talareality. a all it make to helped Cameron brother their on features old car. single seeing every safety and are drive back-up children to enough two his when dealership car a to about going It’s tell. to like Gul- he’d different story a co-sponsors, envisions bransen more er Senate. in the bill similar co- a Clinton of sponsorship her Hillary announced back- (D-N.Y.) Sen. a drop, as trick-or-treaters xet e o olive. to son her expects time. more see one to him allowed are Palanges so the and trip, the ev- survives before Not eryone away. pauses Bobby whisking crew bulance recalls. Curry horrific.” “It’s shoes,” their in Police the from Association. Benevolent chaplain Palanges a the to introduced have Mudzinski and Curry corridor, parents. his toward sliding doors, the toward into hallway, back the wheeled and gurney RNNELSON BRYN — n hnh’ elte that them tell he’d then And gath- to work supporters As i nw o htn one no that now knows Kim am- three-man Brook’s Stony yourself put to try just “You lit brightly Brookhaven’s In DURANGO LTD 2004 DODGE C www.newsday.com NEWSDAY, SUNDAY, FEBRUARY 26, 2006 See BOBBY on 12 48 70% Nerve cells at this spot nor- 60% go is theshaped brain survival stem,controls reflexes a such bunker as breath- stalk- ing that andrate. digestion Sometimes andbrain’s reptilian heart calledof core because the the governs, primitive the functionscontains brain it a stemEdinger-Westphal site nucleus. also known as the mally jointhe forces pupil to inbut constrict because response of the to intensesure pres- light, bearing downthe oculomotor on nerve that part origi- nates of here, Bobby’s pupils have Kids and Cars estimate of estimate Kids and Cars accidents backover fatal a 1999 in which since of or close relative parent the victim is driving. of estimate Kids and Cars accidents backover fatal 1999 involving since and minivans SUVs, trucks. pickup Disease for Centers and Prevention Control estimate of number of admitted to children hospital emergency nonfatal for rooms injuries backover-related week. every “I was very concerned that he From extensive research, Stony Brook University Hospi- tal admits Bobbygency to department at itsThe 11:05 emer- hospital’s a.m. chiefric of neurosurgery has pediat- beenparing pre- for another case,urgent call but diverts an his attention toward the young boy. would not survive.cerned I that was weEgnor recalls. were con- “To have too yourpils late,” pu- fixed and dilatedget to when the you O.R., itmore doesn’t severe get than that.” any doctors knowtized that brain begins a to dieries in trauma- of a se- steps. Among the last to 24 FEET 24 BLIND ZONE 5-foot, 1-inch driver 5-foot, NEWSDAY GRAPHIC / ROD EYER GRAPHIC / ROD NEWSDAY 5-FOOT, 1-INCH DRIVER 5-FOOT, Dr. Michael Egnor has fin- THE MORNING RUSH HAS ALREADY BEGUN. ished his roundsgreen and is surgical in his scrubs when Bobby’s nose, down the backhis of throat, down hisand esophagus intochildren his are stomach.tend to When swallow intubated, air, helater. explains The they nasogastric tube, con- nected to suction, removescess ex- airdomino and effect of helps extra pressure that prevent begins in the a abdomenends and in the brain —sure where is pres- still building. 102 101 BLIND ZONES ZONES BLIND 91 19 FEET BLIND ZONE 5-foot, 8-inch driver 5-foot, 69 5-FOOT, 8-INCH DRIVER 5-FOOT, Palange) of Robert (Size SOURCE: CONSUMER REPORTS CONSUMER SOURCE: 0123456789101112131415161718192021222324252627282930313233343536373839404142434445 Instead of a stop-and-go Behind them, in the ambu- 52 ing keystreets south of off-ramps the LongExpressway. Island and To the side other north, 15 an- cars fromcinct are the doing 6th the Pre- same. drive west on Sunriseand Highway thenRoad, north thethrough the on ambulance 15.8-mileabout blazes Nicolls route 11 in have minutes. impounded The theas police Durango partand of so their thethe investigation, Palanges back followMudzinski’s in lead seat car. of Currylance, Serna and has threaded aible flex- nasogastric tube through Feet Fatal incidents Fatal children involving and younger 15 years dramatically. increased have 28 20 2004 Chevrolet Aveo LS Aveo 2004 Chevrolet Prius 2004 Toyota EX (4-cyl.) Honda Accord 2003 2.5i 2005 Subaru Outback LTD 2004 DODGE DURANGO LE 2005 Nissan Frontier LR3 V8 SE 2005 Land Rover 2006 Hummer H3 F150 XLT 2004 Ford

Backover deaths Backover SOURCE: KIDS AND CARS KIDS SOURCE:

“Whatever happens to him,” Serna will not allow himself In the nine years he has trans- Bobby’s run makes itCurry three. and Mudzinski have she says, “Ifeel don’t the want pain.” him to to dwell on theing around emotion him swirl- orpoor on prognosis. the boy’s Hebrain knows the willhe’s emotional herniate orsurgeon not, whether who and can the still prevent nearly 16 it miles is away. ported patients, Sernaceived two has full police re- escorts. again called for help,of and many the 10from the squad 5th cars Precinct are recruited block- 2005 2004 2003 2002 2001 2000 1999

12 THE INJURY 13 BOBBY from 10 creating a super-highway for sphenoid bone just behind the suction tube through a small inci- tible to external blows. space available to the swelling Stony Brook in 1991. shapen as the skull tries to ac- Beg’s delivery of a critical drug socket as at least one of the tires sion between two of Bobby’s But children aren’t completely brain and thereby delay or pre- About seven years ago, Egnor commodate the growing brain. remained dilated and fixed. cocktail. angled across his head. Later ribs, draining air from the pleu- defenseless. The higher water vent a lethal rise in the intracrani- was confronted by the death of a Before Bobby, Egnor had per- AREA OF “So he was very close to tests suggest that the fracture ral cavity and allowing the lung content within a developing al pressure. The surgery, now Long Island boy who — like formed the new surgery on six INJURY death,” Egnor says. “My sense of A glimpse of the damage also squeezed the right optic to re-inflate on its own. brain may help to resist compres- known as a decompressive Bobby — had been run over by a children with traumatic brain it was that it was a matter of min- The boy is already uncon- nerve in its channel, perhaps sion and the skull’s compliance, craniectomy, never proved its close relative in his driveway. At injuries. Five survived, but all utes.” scious, but Beg dispenses low damaging it forever. Reinventing a procedure perhaps exaggerated in Bobby’s mettle in large clinical studies the time, Stony Brook University of them were older. And none At 11:30 a.m., Bobby is wheeled doses of the anesthetic sevoflu- “It was almost like an earth- Egnor is needed to address the case by the cracked temporal and languished for decades Hospital had at its disposal a of them had sustained a crush- by a pediatric surgery team into rane, the pain reliever fentanyl quake, where the ground shifts,” larger danger. and sphenoid bones, may allow while other advances largely pi- range of standard procedures to ing injury like his. Operating Room A on the hospi- and the muscle relaxant rocuro- Egnor says. At birth, the human skull con- more room for the brain to swell geonholed it as a measure of last control brain swelling and intrac- “My sense is that most kids Skull tal’s fourth floor. nium to prevent any unexpected Darker regions of brain tissue tain 45 bones, most held together after an injury. Likewise, cold resort. ranial pressure, but its surgical never make it that far,” Egnor Anesthesiologist Dr. Tazeen movements during surgery. on the CT scans from Brookhaven by flexible joints, or sutures. weather can help to reduce both Despite lingering doubts orthodoxy for such cases didn’t says. He can recall only one Temporal Beg, just finished with another Even a cough could raise the indicate diffuse brain swelling, By adulthood, enough bones swelling and the brain’s metabol- about the procedure’s effective- yet encompass a partial removal other instance in his career: a surgery, rushes in to retrieve pressure within his head to precip- with a lighter area pointing to an have fused together to drop the ic demands, a phenomenon often ness in adults, a handful of small of the skull. young girl rushed to the Univer- bone child-sized syringes and reset itous heights. So could the deliv- epidural hematoma: The skull frac- skull’s tally to 28: six middle ear invoked in dramatic survival sto- studies within the past decade “That case kind of haunted sity of Miami Hospital survived Sphenoid the anesthesiology machine to ery of too much medication. ture has ruptured a vessel and left bones, 14 facial bones, and eight ries involving children. have pointed to more positive me, kind of haunted us all,” after her head was run over in bone child-appropriate doses. The The full scope of the accident a pool of blood on top of the dura, bones comprising the cranium. Even so, the crushing injury is outcomes in children when the Egnor says. her family’s unfinished drive- surgical team, led by Dr. Rich- emerges from the battery of CT the outermost of three protective Egnor likens the bony helmet, as severe as Egnor has ever seen. surgery is performed within He believes a host of complica- way, where soil may have soft- ard Scriven, threads a central scans, medical tests and observa- brain coverings. The hematoma is charged with protecting tissue For an intervention, he says, hours of a severe injury. tions would have stymied even ened the impact. line, or catheter, through the tions: The force of the Durango pushing down on his brain as the only somewhat firmer than Jell-O, “anything short of radical had no “I feel in situations like this major surgery, but the boy’s Perhaps, he muses, snow in boy’s subclavian vein at a point fractured a branch of Bobby’s pel- swelling tissue presses up against to a pressurized vessel that can chance of succeeding.” that it’s worth trying,” Egnor death led him to reassess his op- the Palanges’ driveway acted in near his shoulder, through the vis known as the ramus and his skull. And a rib has punctured plumb the ocean depths without Medical success is often firm- says. tions. Soon, he had developed a much the same way. superior vena cava and into the bruised his right arm but fortu- and partially collapsed his left collapsing. ly rooted in tragedy. A century While a resident at the Univer- technique based on a partial “Even just a few extra milli- right atrium of his heart. Within nately left its bones intact. The lung like a balloon, allowing the A child’s more pliant skull — ago, American neurosurgeon Dr. sity of Miami, the neurosurgeon skull-removal surgery for infants meters might be enough to take this upper chamber, the cathe- intense pressure fractured the leaking air to fill the pleural cavity only one-eighth as strong as an Harvey Cushing introduced the routinely saw severe head inju- with craniosynostosis, a condi- that pressure off,” Egnor says ter can monitor the body’s hy- right temporal bone of his skull between his lung and chest wall. adult’s — has yet to acquire its modern concept of removing ries. His current strategy, tion in which the sutures be- — maybe just enough to spare dration levels by tracking trends and his right eye socket and split To address this last complica- quarter-inch-thick plating, ren- part of the skull after a traumatic though, didn’t begin to evolve tween skull bones close prema- A The crushing injury fractures Bobby’s right eye in the blood pressure, while also a wing of the butterfly-shaped tion, the surgical team inserts a dering the brain far more suscep- brain injury to increase the until well after he arrived at turely and leave the head mis- See BOBBY on 14 socket, damages his right optic nerve and cracks the temporal and sphenoid bones of his skull. FIRST SURGERY

1 Catheter Cerebrum THE INITIAL PROCEDURES A hole drilled into Bobby’s skull allows doctors to thread a catheter tube through his brain and into a cavity, or ventricle. Cerebrospinal fluid is drained from the ventricle to allow more room for swelling. 2 After shaving away some of Ventricle his hair, an ear-to-ear incision REMOVING then allows doctors to gradually expose his skull. THE SKULL WEDGES With a special saw, Dr. Michael Egnor cuts out four Optic triangular-shaped pieces from Bobby’s skull, exposing the nerve dura, or the uppermost of three membranes protecting his brain. Cerebellum SKULL WEDGES With a Cesarean section-like incision in Bobby’s abdomen, the EAR-TO-EAR INCISION surgical team creates a makeshift pouch for safe storage of ON SCALP HEAD the skull wedges until they can be safely returned to their PARTIALLY SHAVED appropriate places. B The brain begins to swell as pressure builds in the cranium, but the skull’s rigidness limits upward expansion.

SKIN PULLED BACK TO EXPOSE SKULL

DURA MEMBRANE (One of three covering the brain)

www.newsday.com SCALP PULLED Edinger- FORWARD AND Westphal nucleus CLAMPED (Not shown)

Brain stem

C The swelling is forced downward and impinges on the brain stem, where functions such as breathing, heart rate and dilation of the pupil are governed. The pupils of Bobby’s eyes become fixed SKULL WEDGES STORED and dilated, a sign of imminent death. WITHIN A POCKET CUT INTO NEWSDAY, SUNDAY, FEBRUARY 26, 2006 ABDOMINAL TISSUE 14 NEWSDAY, SUNDAY, FEBRUARY 26, 2006 www.newsday.com C Visit Duffy him. for well worked had belly?” the in don’t it Why put that? you “Why doing you asked, are Duffy when hospi- tals, many for choice of con- tainer the nitrogen, can- liquid a of ister in piece each store rarily storage Unorthodox bi- a called craniectomy. surgery parietal a her of in sides skull the two from away sections cut in Egnor Mineola, Hospital Win- throp-University from re- transferred had cently who assistant phy- sician’s certified accident. Duffy, and Dennis registered car of a aid a the With from head severe injury ar- a with oper- room girl Brook ating again Stony his 15-year-old in rived a changed when neurosurgeon’s technique the accident, worst. very the patient his 13 from BOBBY otr sdt aetechild. the the save that to steps used the doctors of explains model and a head through Bobby’s you walks that Palange’s injury Bobby of re-creation interactive Bobby’s scalp. used toclosetheincisionon sutures and37 staples are Finally, acombination of pressure readings. doctors totake regular Bobby’s skull andbrain allows pressure monitorboltbetween ofanintracranialInsertion gap toprotect thebrain. placed over themembrane room, withalayer ofcollagen to allow more expansion cut away withineachquadrant Part ofthedura membrane is brain below. impinging upontheswelling bone, preventing itfrom remaining cross-like strutof Egnor cutsallfour endsofthe THE PRESSURE AND MONITORING EXPANSION ROOM CREATING MORE go se fteprocedure the if asked Egnor tempo- to preparing was He Bobby’s before years Two 3 Newsday.com/bobby FIRST SURGERY (CONT.) niina bttiinwould obstetrician curving an same incision the with ginning be- repository, similar will a belly become Bobby’s hours, three says. Duffy things,” cells. holding potential bin than other complications abdominal range- of-motion or the cosmetic fewer poses reloca- as short-term tion, the about right- their positions. to ful returned they before be them can losing contaminat- and or of ing body risk the the avoids outside so the stow bones doing to may need But the abdomen eliminates unusual. the seem open slic- by ing created pouch a within Egnor since. and ever it had used has it that replied osean see to na prto atn about lasting store operation an to In place good a “It’s forget to seem patients Most fragments skull Depositing MONITOR BOLT INSERTED INTRACRANIAL PRESSURE (Monitors pressure in thebrain) aae—Enrwl saw cross- the will of ends Egnor the through — brain to leading damage of likely edge — rough way bone a on its catching spaces or open forcing skull’s the through from brain escalate. in- to the pressure and tracranial can pool to vein blood brain. cause this the of of Compression out blood sagittal that vessel ushers blood superior major a the sinus, on pres- sure relieve of may top skull the Bobby’s from tri- pieces four angular away cutting that rea- sons Egnor sides, the from bones bone. of wedges stashing surgeon the for tissue pocket the a create fascia, can connective as known of underlying bands from fat of abdominal layer By upper the section. apart Cesarean teasing a for use opeetteswelling the prevent To skull removing of Instead over thebrain leftintact membrane layers Two other DURA MEMBRANE LAYER CUTBACK REMAINING SKULL FLOATING ‘CROSS’ CUT TO FORM A hscltam ftebone-re- the of the trauma from and physical recover must veins, boy the key surgery damage The could infection. could to dura lead the Opening risks. pressure.” to in change need a you get volume surprising little “It’s how percent. 20 by volume brain’s the swelling increase can But pres- says. isn’t Egnor sure,” that there all if be not dangerous, may brain the of while will protection flexibility. incisions providing some four laid offer the gently over collagen- substitute A based window. the tri- each angular of edge dura, outer the along covering, the outer leathery brain’s open slicing allow but below. expansion above the for room shield from will brain The cross behind. floating left bone shaped i taeyi o without not is strategy His swelling that is theory “Our from come will room More SCALP REATTACHED AND STITCHED (Not shown) es wytebyssap and scalp, boy’s the away tease room. more a as known ventriculostomy. procedure a in cerebrospinal drain fluid the and of some — away — ventricle cavities a brain called his of one catheter into a the insert to allows team surgical skull left Bobby’s pa- the of into small side drilled hole his A from tient. of hair patch a blond away shaving be- by Egnor gins as A Room Operating pain.” in want be don’t to just him “Whether I not, him. or lives he tells Kim do,” best. his do to pledges sur- and the gery the no explains offer but can promises assessing He injuries. boy’s after mother or death.” impairment severe is later. neurological alternative says the “But Duffy disasters,” process. moval cle n ocp u and cut forceps and brain scalpel A his give to Anything in mounts apprehension The to have you whatever “Do Bobby’s with meets Egnor potential with fraught “It’s PROTECTIVE COLLAGEN LAYER OF C www.newsday.com NEWSDAY, SUNDAY, FEBRUARY 26, 2006 But the police are forced to Out of respect for the family, With her husband gone and On Feb. 11, 1978, not long after It was too close. She stepped backward over And again on AprilKim 17, 1999. was separated from her And now, again. A mantra forms in Kim’s “He needs his stuffed ani- It’s all she can thinkKim about. and her first cousin, As she watches over the boy, But not Bobby, always hiding She speaks to him now in a “We’re going to make a deal “Me and you,” she says. They havethe since truth in admitted a secondthough to interview, no charges willbecause be filed Robertout of never his driveway in drove the SUV. arrest him anyway. Bypresence his at very home,violated a Robert court-issued order has of protection that Kimtioned for had the prior peti- has August. He been livingher consent at for months, home though the “stay with away” order technical- ly remains in effect. the police allowhis Robert son — to to see knowalive. that He he’s and still Kim sayand goodbye, then he is led away. her son in criticalanguished mother condition, now an facesoverwhelming an sense of deja vu. a snowstorm, Kim’s olderLori sister walked out ofIsland their home to Middle make ancall evening from adeli. phone The booth 19-year-oldcross Route by 25 began but a stopped to way mid- when she saw aeast. car heading the yellow linethe and white pickup neverin truck saw the heading otherpronounced direction. dead She on was John T. arrival Mather Memorial Hospi- at tal in Portof Jefferson, massive head the injuries. victim first husbandworried at when the he failedup time, to show for but their a children, Chuck and scheduled Becky. He’d visit been taken with toUniversity Stony Hospital Brook instead, the victim of a traumaticry brain after inju- falling atin a Selden Waldbaum’s andhead. cutting When his hemedically awoke fore- induced from coma, his hetemporarily had forgottenchildren. he had mind, perhaps to keepthoughts all at other bay, asher she comatose watches son. mal,” she says.puppy.” “He needs his He won’t sleep without it. JoAnn Fowler, spend thein Bobby’s night hospital room, while JoAnn’s daughter Feliciafamily and a friendother stay fourNorth with children Bellport. the band, back JoAnn’s in hus- Snoopy Brian, anddog has the joins the dingy vigil. retrieved white JoAnn thinks about howchildren have Kim’s bonded soly close- with theirthey “Aunt know JoAnn,” her. as behind Kim’s legs andher avoiding gaze. soft voice,while Kim holding sleeps. his hand here,” she says. “You’re goingpull through to and me andgoing you are to be bestwake buds up.” when you DURA COLLAGEN MERGES WITH MERGES NEWSDAY GRAPHICS / ROD EYER GRAPHICS / ROD NEWSDAY (Not shown) AND STITCHED The day turns darker when His license had been sus- Kim is in a daze, unable to SCALP REATTACHED the police return to theand hospital arrest Robert at 4:53 p.m. pended, and Kimdetective told during an a initial police inter- view that sheDurango at was the driving time ofdent, the the acci- out ofband fear would that spend her thejail night hus- instead in of with their son. blanket will maintaintemperature his body below at 98.6round-the-clock degrees, or aided Tylenolpositories. by slightly His sup- intracranial pres- sure is now well withinmal the nor- range, buthis an body increaseraise in temperature thespurring the brain’s could blood vessels metabolism, tolate di- in anand effort to ratchetingback keep up in the pace the process. pressure think properly, unsure whether she’s at BrookhavenBrook. or The immediate Stony may be danger diminishing, but nocan one yet say forher certain son whether will recoverbrain — function or he what will retain. bone Cross-shaped As his staff inserts the last of More mannitol will help keep After a half-hour of observa- SUTURES ed asthe a pressure relativehead. measure inside of Bobby’s The operation ends the 37 staples thatboy’s will hold scalp the heals, together he examines while Bobby’spils pu- it and notes,tion, that with they are gratifica- lated. no longer di- Fiveafter and the accident, a theis pressure finally half beginning to drop. hours the pressure off,ers and the Beg first dose deliv- ofcalled a barbiturate pentobarbitalsend that Bobby intopended will a animation. sort Thebarbital of coma will pento- sus- keep his meta- bolic activitymum, to a greatlybrain’s bare workload while mini- reducingand it narrowing heals, bloodreduce the vessels the to swellingthe and pressure. relieve tion, Bobby is wheeled totensive the in- care unitwhere at nurses 3:25state of induce p.m., hypothermia. A a cooling mild Holes drilled in and wedges bone cross-shaped Skull wedge NEWSDAY PHOTO / MICHAEL E. ACH In the right arm of the trade theirtions within anatomical thestacks posi- skull within for themen. two boy’s The abdo- bone remaining is then cross set adriftdura, of above newly his opened. cross, the surgicala team second drills holeintracranial and pressure insertsbolt, monitor an threadingfiber-optic through cable itinto that place a screws and between the skull. the Theerted pressure dura ex- onswelling the brain cable can from be record- the

holes skull lash the LATER return SIX WEEKS

the skull expose his re-open they

team then uses “I’ve seen swelling where it’s Those are the patients who al- But now, with Bobby’s crani- Four wedges of bone soon space, its former close up the incision. Bobby arrived at Stony90 Brook minutes University after Hospital the about accident. an air-drivencuts craniotome through the saw bone beneath. horrendous, almost explosive,” Egnor says later. most never survive. um open,finds that the the initialless than swelling neurosurgeon he is had feared.so He to says his surgicalboy staff, may that have the after a all, better andto chance the brighten. mood begins and its bone-free To quadrants. the four retrieve inside. tucked wedges Then scalp to each triangular wedge the bone separating quadrants. He drills matching Egnor and his surgical cut open team first abdomen to Bobby’s Egnor drills a small hole the sides that through adjoin the cross-shaped PUTTING THE PIECES PUTTING THE PIECES TOGETHER BACK to itself, the cross through him to allowing bones together with — eventually, sutures on will reattach they their own. The and staples sutures to

16 NEWSDAY, SUNDAY, FEBRUARY 26, 2006 www.newsday.com C onParaskevas John Daniels, Meredith Cassidy, Robert Contributors Teleha Barbara Garraffo, Joe Designers McCarthy Jonathan Editor STAFF WEB THE otr sdt aehim. save to used doctors that steps the explains and injuries Palange’s Bobby through you walks model interactive An it did they How Features Online nBbytedyo h accident. the of day the surgery Bobby lifesaving on the performed Dr. who Brook’s Egnor Stony Michael with interview video a Watch h a fteacdn n o ob a improved has Bobby how then. and since accident the of day discusses the Polly-Palange, Kim Paraske- mother, John Bobby’s Newsday’s vas, with interview video a In Bobby. saving in role a played all and who doctors more workers, of hospital effort and coordinated ambulance the police, at look interactive an Take hours frantic Six to scene the hospital. from the trip immediately harrowing Bobby their treat describe to and did they what Rob- Cassidy Newsday’s ert to explain Co. South Ambulance the Country from responders first and Paramedics agility. Bobby’s test help to hospital toys the uses how explains Nelson Bryn therapy. Jef- Newsday’s physical Port undergoes in Bobby Hospital where Charles ferson St. from video a Watch better getting Bobby oehn radical” something W edt do to need ”We ItakGdo al basis" daily a on God thank "I call" serious a was it knew "We

C www.newsday.com NEWSDAY, SUNDAY, FEBRUARY 26, 2006 ESA HT AE IE STABILE WILES KAREN / PHOTO NEWSDAY See RECOVERY on 18 When the Stony Brook staff A few hours later, the pres- Whether he’s had a seizure, a Kim sees a blur ofShe hospital knows enough to stay But he doesn’t. With more Versed and Pavu- make it through the first 24.” begins to wean Bobbypentobarbital from the on Saturdaythen and from the Versedphine and mor- andSunday breathing morning, tubeworst is on maybe behind them. the sure within his brainSo shoots up. doeswithin the hisheart carbon rate blood, dioxide andfall and while blood he struggles pressure for his air. common complicationhead injuries, likely after be will determined. never Butcial coma keeping the him in artifi- icated a torpor med- has dissipated too soon, and his body is rebelling. staff running into his room. out of theirshake way. But the she thoughtto can’t form that in begins hergoing head. through Instead it of nightmarish back all and again, forth,suffering, the the maybebetter it for him would to just be . . . go. lon and morphine andsertion of the his rein- breathing tube at 3 And yet the intracranial pres- Robert has rejoined Kim at And he has, staying busy Kim’s cousin JoAnn has be- And then, “All right, let us conclude the childvived. hadn’t sur- Withinmass depicted the inmerly the scan, darkened sharp for- detailsmarks and land- scured, are as if snappedfocused completely by camera an in un- dim light. ob- sure wassuggesting essentially that ation normal, between rare swelling and separa- pres- sure had beenpanding achieved the by ex- spaceBobby’s available injured brain. to their son’sthe morning bedside, afterwith the released a accident not-guilty plea inCounty Suffolk Criminalcharges of second-degree crimi- Courtnal contempt on forrestraining violating order. the Anorder amended of protection hasted permit- the home improvement con- tractor to help care forple’s the other cou- four children. with themand and bills withwhelming sense to errands of guilt at keep bay. thecome over- after cautiously her ownfor optimistic, a fervent few prayers morethe hours of boy: life “God, for through the let first 12.” us make it The anti-inflammatory ste- Drugs to control blood pres- Kim Palange has left the hospi- “If God doesn’t take him It has, despite a CT scan He has received a small pharmacy’s worth of medicine. roid Solu-Medrol outconcern (later dismissed) of that he initial might have a spinalDilantin cord injury. toMorphine to prevent fightand pain. Ativan seizures. to Versed sedate him andvulon Pa- to relax his muscles. sure. Antibiotics to fighttion. A infec- blood infusion andfrozen fresh plasma and— the Factor same VII treatmenthemophiliacs given — to to fightplication a com- thatbody’s can blood-clotting cascade. disrupt the tal only to runher errands or other ready while children her mother-in-law for watch- es school, Bobby. But Kim isfor never away more thantime. three Her anxiety hours won’t allow at it. a today, he isn’trow going to either,” tomor- sheprays. She thinks hasn’t permitted as her- self she to focus on anythingher except comatose son and thebers num- telling her the pressureside his in- head has eased. taken at Stonyafter Brook his surgery thebrain that day so shows badlybelieves a swollen Egnor reading any only the neurosurgeon scan would n the six days since the accident, hearmy has of been medical seen specialists: by anesthesiology, a emergency small med- icine, neurosurgery, neurology, ophthalmology,pediatrics. radiology,

PART 2

I I on a

Bobby Sunday. wakes up Bobby clings to his mother, who talks about the operation as Dr. Michael Egnor, who performed the surgery, looks on at a March 2005 news conference.

18 NEWSDAY, SUNDAY, FEBRUARY 26, 2006 www.newsday.com PHOTO BY HOWARD SCHNAPP ak h odr fher if wonders or 2 She talk to unable walk. be if will dread Bobby of she sense though a Kim, with turn, wonders calm in to Robert and helped has pital Hos- Charles St. at working from unknown. left much so and until 2. March coma of morning medicated the his ters re-en- and stabilizes Bobby p.m., 17 from RECOVERY 1 / eia nweg gleaned knowledge Medical accident, the since days Nine 2 ya-l o ilb iea like be will boy -year-old us rciinrNancy pediatric practitioner until least nurse at too, wanted her. who with do to boy nothing the Bobby, too, boy. JoAnn the at gaping And literally is who up. his making light is face who and often him for so babysat has there’s who Felicia, and mother, his ognized smiles. helpless. again, newborn ei mln h etday, next the smiling is He her. to responded has He rec- has he and but first, at Weakly up wakes he Instead, oewt w staples. two the with closes hole and device the re- moves Strong as tears his ex- soothe done cept be to and nothing there’s scare, so recent espe- his after procedure, sedative cially minor much the too for him giving pressure. moni- intracranial his to tor surgery initial the ing dur- inserted had surgeons that bolt monitor “Fran- ICP the kenstein-like” removing of thank- job the less with arrives Strong ob’ otr r ayof wary are doctors Bobby’s needed. longer no It’s ln ihtefinsadfami- and friends the with along his name, of by remember classmates all Time recall Tutor can doesn’t he uni- but them, He police a form. in a with Bobby Build-A-Bear present and visit a for by stop Mudzinski and Curry then him. with And there is Robert immediately. most wants. he what knows he afterward. sobs his quiets tape e asltr officers later, days few A al- says he Daddy,” want “I but indistinct, is speech His “Barney” inserted quickly A idayeiec fmissing last- of of signs other or evidence tissue brain any find to unable is Egnor however, Despite dent, acci- his bones. of reminders physical skull the his re- attach to surgery second a and tation is assistance. he with walk though to feet, starting un- his he’s on And dam- steady the nerve. to optic due aged eye vision right some his lost in has and first at room. his in pictures of forest growing the populating ly ob ae ek frehabili- of weeks faces Bobby arm right his move doesn’t He

19 www.newsday.com NEWSDAY, SUNDAY, FEBRUARY 26, 2006 ESA HT IHE .ACH E. MICHAEL / PHOTO NEWSDAY -week stay at St. 2 / 1 See RECOVERY on 20 The first time JoAnn sees There are others. He becomes Bobby loves to play hard, espe- But even when he’s uncoop- “Those big blue eyes,” Tan- A bit past 8 a.m., midway matic injuries intions by certain leaving strategic direc- toysplain sight, in increasing the chanc- es thatgrasped by at an eager hand. least oneSmall milestones will be Bobby bend over andball pick up and a thenhallway, kick she it notices down howbly the wob- he is,milestone but nonetheless. she knows it’s a increasingly proficient at “swim- ming overwhich he the crawlscushions over bolsters,” while rowstween in of reaching themfrogs. He for can be- stand for longer redriods pe- beanbag placed while on higher surfaces.ers Tow- playing of building blocks teeter less. games cially with Spider-Man toys.is prone He to tantrums, just likefore. be- And he loathestive the dark blue protec- helmet thatonly allows his earsholes on to the sides pokeers and through that everything cov- face else except —when his the he’s not in helmet hisand hospital bed which he he wears move often tries by tostraps undoing beneath re- his chin. the Velcro erative, Bobby hasability an to uncanny charm. ner says. “You just melted.” through his 3 At first, Bobby turns away “I want my mommy,” Bobby “You’ve got to have the trust An uninterrupted 15-minute “Is your name Bobby“No!” Pan- the boy protests. “It’s But he is smiling. Even so, words like “thera- “We’re here to play,” Tanner Eventually, Bobby does and “They pick it, and we try to his feet andty improve his to abili- standing go position, from to walkrun a and sitting andmovements to become climb more a nat- ural. so Each therapist will thatan spend hour the a daymating with him, their accli- new routine. patient to the when he sees Cunningham walk- ing toward him and clingsmother. to With his gentle prying,boy the finally consents to gobut along, the hour-longabruptly after session 15 minutes. ends insists andonly oblige, Cunningham guiding him tofor can Kim some brieffore consolation the be- therapy resumes. with them,” Cunningham“Hopefully, says. if youcan gain lose it it, back the you next day.” session becomesthen 20 25, then 30. minutes, cake?” Cunningham teases. Bobby Palange!” py” are verboten. says instead. “Doplay you with me?” want to the toys hebecome part gravitates of each toward session. make itsays. therapeutic,” Often, therapistschildren Tanner can recovering lead from trau- -year-old boy faulty or just 2 From Kim’s recollections of His short-term memory is one Physical therapist Bill Cun- Bobby’s first session with “If he was sitting on the floor But the therapists estimate He seems uncertain. But is the / 1 underdeveloped? Physical limitations his daily activities,pists the know thera- than Bobby other children is hislowing smarter age, al- themspot neurological to deficits. more easily of them, unliketerm his recall. sharp long- ningham begins his firstwith session Bobby byacross scattering the toys has gym’s trouble floor. seeingtoys Bobby the at smaller with a the partial distance, losshis of right consistent vision eye. When in hesits squats to or retrievebarely the toys, get he up.crawl, can When he askedAnd is he to especially has troubleone fearful. foot standing and on reaching for a toy. Melanie Tanner, a pediatric oc- cupational therapist,Play-Doh includes to test hisfaulty somewhat fine motorgame skills of hide-and-seek andther test to a his fur- memory. with allwould the otherwrong,” think she kids, says later. you nothingthat was he willweeks need to four become to steady six on Semel-Concepcion, thetal’s hospi- director ofcine physical and medi- rehabilitation. short-term memory2 of this THE THERAPISTS The long road to recovery for Bobby included many hours under the care of, from left, Melanie Tanner, occupational therapist, Bill Cunningham, physical therapist, and Dr. Jennifer Semel- Concepcion, at St. Charles Hospital in Port Jefferson. Long Island’s only intensive Evaluation and therapy must And so the white linoleum If the children in this room mo- A team of therapists will eval- “Bobby, what did you have limited assistance, though he occa- sionally loses his balance.lost He some has strength in hishis wide legs gait and suggests he iscovering still from re- a pelvic fracture. rehabilitation centerously for seri- injuredtreated youngsters childrenmatic with brain trau- injuries has from stemming strokesfrom near drownings andaccidents. and car cancers, Butchild’s deficiencies and assessinging devis- a course ofdifficult a rehabilitation is when dealing withattention the span of aold. 2- or 3-year- Mostare standardized all but useless. tests be disguised as child’s play. flooring within the gymtrapped has a en- blue octopus,turtle, a a green whitesea whale and creatures, other scenes while driftThere’s even nautical across a red-stripedhouse light- its whose light walls. spinsin response around to a pushed button. mentarily forget they’rein staying a hospital whenpilot’s they wheel turn the or climbof a the platform stairs with rope-adorned railings, all the better. uate Bobby hereall to that he determine hasmight lost regain, and with what family he inter- views giving themhis a mental sense andties before of physical the accident. abili- for breakfast?” asks Dr. Jennifer Bobby gives his mom, Kim, a hug at last June’s fundraiser for his mounting medical expenses.

On the morning of March 15, a On Friday, March 11, with “It’s definitely a miracle,” she young patient walks to St. Charles Hospital’s third-floor gym with THREE WEEKS AFTER THE ACCIDENT. ing brain damage. Bobby clinging to her,fully Kim tells tear- a crowded roomporters of that re- her sonto is fully recover. expected says.

20 NEWSDAY, SUNDAY, FEBRUARY 26, 2006 www.newsday.com uce otbga hrps ilCniga watches. Cunningham Bill therapist as Bobby bag scores; soft Bobby a watching, punches protective father from special his break his with a shows headgear; during close-up embrace a an baskets; and shooting Robert kiss father a Bobby’s him at top, gives sessions From rehabilitation Hospital. Bobby’s Charles of St. one from clips Video H REHAB THE IE MGSCUTS FS.CALSHOSPITAL CHARLES ST. OF COURTESY IMAGES VIDEO oto session, go rehab Bobby’s watch To Newsday.com/bobby. etsos rjs hammering reach. just within anything at or away cor- slots, the rect through triangles squares and and circles wooden ing declares. he gym,” the it’s “I when scheduled. not even therapy wants recovery The down hand. in walking hand hallway, father the his and here?” leave we when He cheek. Yeah.” the on people. son his cars and kisses got it, It’s asks. on ferry. Robert the way?” “That’s this in ing Jeffer- Harbor. Port son toward out looking on.” Come “Yeah? asks. dad light button. red the spinning presses he its when with obliges one. green a then one, blue then a cushion, red and head. a the kicks hoop, Bobby on a him kisses in Robert ball orange an him. at smiling and key floor kneeling the on is the who Robert, gives to chain a then into pail, frog toy green a throws boy the is him, father. beside with his there, And playing chain light. key and Semel-Concepcion’s shirt Spider- gym, and Man the helmet in his chair wearing small Bobby a session, in sits therapy one of it. without hospital the leave every it. with easily plays he more time light the ulate manip- can at he batted that — notes She impatiently eye away. it’s left until his over least paper hand of a piece or a puts anoth- therapist while er light the eye with right play to his in he vision that enough observes has She car. her lo- her cate help to chain key cepcion’s Semel-Con- to attached light blue a pen. irresistible an has ingly into side. passenger’s getting the help practice to designed patients car door mock a the of opens abilities. repeatedly He growing his onstrate re- will fine nicely. patient cover his her that of knows she moment, use this At skills. apt motor the notes hands. cover both glare with computer’s the off office. her in some work Semel-Concep- to computer attends by she while chair cion a fidgets he in and school returned for home ready at His yet everyone getting helmet. from hasn’t foam his mother in rest- less growing is boy the Charles, 18 from RECOVERY egautst h outdoor the to graduates He hammer- at adept proves He Bobby week, third the By Bobby with ends video The boat that on go to want “You com- boat white the see “You arms, his in is Bobby then his And outside?” look to “Want lighthouse the course, over. of pushes And, he one last The dunk to up stretches Bobby suggestion, Cunningham’s At video hospital-produced a In won’t he that knows also She with smitten particularly is no. He say possibly cannot They it?” want says. you Bobby “Oh, that,” like I “Oh, seem- therapist or nurse Every dem- toys impromptu Other calmly announces. Semel-Concepcion he it,” broke “I yanks and up reaches longer. no Bobby still sit can He att oto go to want aho tyognzdo play learn or organized to stay or unable math proves bright otherwise child an when dent, acci- an after well truth welcome brains. fast-growing their by required connections all critical of lasting the because to are damage 5 susceptible cognitive or more 4 of far age the before Chil- dren opposite: the just suggested recently more have that studies of and Principle. monkeys Kennard the called with on based research notion damage, a the to according sidestep to or adapt rapidly rewire than The can brain adult. better developing an far of those injury traumatic could a brain after abilities back bounce cognitive intellectual or child’s a that lieved be- once doctors skills, physical him. accompanies someone balance. his improve to slide plastic the red of double side playground’s one up walk him Cunningham im- has so ramps, steadily down indoor and to up has walking at likes proved and Bobby climb falls. pected soft unex- cushion can where matting of black trees, trio locust a black beneath playground aet a icvrti un- this discover may Parents slew a spawned principle The of recovery the with as Along long as run, even can He i ok ihBbya oei ot eloton Bellport North in home at Bobby with works Kim ao ugclmilestone. another surgical major pass still must though, net answers. definitive may more with some Egnor collaboration Brook’s a Stony and inter- her est, heightened Stony only progress has at rapid often Bobby’s Brook. most Charles — have dures proce- St. similar undergoing who half- after through a children passed than more dozen of itation rehabil- been successful the by struck has Semel-Concepcion afterward. children re- of re- covery long-term been the has about little ported very than inju- but head it ry, severe a from after benefit adults to more surgery are likely children the that suggest address directly decompres- a sur- craniectomy. as sive the known and gery therapy tensive in- intervention, rapid of “miraculous” nation combi- potent the toward or points de- “re- markable,” “unbelievable,” have as his scribed providers of all medical nearly a that But recovery Bobby. for store in what’s hot. as temper seemed a never that control or others with hi xrodnr patient, extraordinary Their years, few past the Within that reports medical few The sure for say can one No 21 www.newsday.com NEWSDAY, SUNDAY, FEBRUARY 26, 2006 See RECOVERY on 22 Duffy assumes the responsi- The surgeon’s scalpel sends “So, you’re having your Egnor separates scalp from The outline of a hole remains 109 beats per minute. Egnor has peeled away Bob- The boy will heal well with- No, sutures will be enough, “We’ve gotten fancier now, Egnor threads the suture line As he works, the discussion bones disappear into asolution foaming of hydrogenwithin peroxide a small metal pan. bility of cleaning the nowfree bone- stitching abdominal it back up again,Egnor space while quickly shiftstion and his to Bobby’s atten- head. the first trickle of blood downward to- the boy’sAs he blond cuts, Egnor cowlick. ries requests of a banana-colored se- clipspositions and them inthe a severed row endsscalp, along clamping of back the thered flow with of growing boy’s arcs of yellow. house built?” theFenster, surgeon who is asks now overseeing the plastic clips andof a table instruments full besideof bubbling the hydrogen pan peroxide. A wastebasket fills with bloody pieces of gauze asher they impending discuss move. skull and sears the tissuecautery with a tovessels, seal as off he didabdominal the with incision. Bobby’s blood Theof the front boy’s scalp isover now his folded hairhead. toward There his istle surprisingly fore- lit- blood asbone begins a to appear, a roughing glisten- cross pink of four surface pockets of bordered deeper by red. in thewhere left a arm catheterhis of had cerebrospinal the fluid. drained in A the cross, right hole arm, wheresure the pres- monitor hadtially been, visible is as well. par- by’s scalp overpanse, a adding four-inch to ex- theof twin rows yellowOne clips bone-free asthen quadrant, he and works. twowhere the brain’s gradually exposed dura covering pulsates in appear, time toboy’s the beating heart. out theplates, Egnor decides, as need hegerly gin- inspects the for cross-shaped bone dividing the titanium quadrants.February, In he had cutloose this cross fromskull, freeing the it toswollen float surrounding above a brain.committees of fibrous Now, cells and cartilage have search alreadyacross reached the dividesbone back to to its lash moorings. the and thefront surgeon left matches wedge,with the still dripping peroxide,sponding to gap.marks, its Two two corre- holes, partially careful through and drilled thepreparing then piece a shell for as he a mobile. though but drills sometimester,” simpler he says. is Hein drills bet- the two corresponding holes arms ofbony the cross, with Duffymetal lever prying beneath a each edge to shield Bobby’s brain. through thewith a matched curvedthe wedge, needle then holes the — cross. first turns to Pope Johnthe Paul publicly II released and contents NEWSDAY PHOTO / MICHAEL E. ACH At 8:50 a.m., Egnor injects In adherence with the hospi- Egnor begins his work in the The surgeon soon exposes a 108 beats per minute. All four skull bones are cut surrounding thescar smile-shaped below his belly button. Bobby’s scalpfirst with at the lidocaine, veryand top then of along his the head, scar. tal’s safety rules, Beges announc- theand case: Egnor “Bobby politelybefore Palange” injecting thanks more her lidocaine into the boy’s belly. lower window, whereand teases he away cuts theskin abdominal and underlyingscalpel fat and with forceps, then a usescautery a to sealsels. off A puff bloodfrom of ves- smoke the curlsbrief incision up site, butsmell and emanates outward. a pungent burning Putting the bones back half-inch-thick slab of skinfat, and under whichskull Bobby’s four fragmentsstored. A havethe metal skin clamp been flapsing keeps separated, leav- awhere the tight smile disc-shaped had been. opening away from thesue and abdominal pried tis- outby of 9:03 the pouch a.m. One by one, the A heating pad and blanket Egnor enters the room and “This is going to be much eas- The boy’s belly, only slightly Bobby’s heart rate isA now 111. blue cloth secured with a end of the normal range. have replacedand Bobby’s green diaper one-piecewhile his pajamas, bluefilled eyes have with been shut drops to keeping and them to their from lids. taped It’s stick- precaution, a necessary Arangurensince general anesthesia says, to tends dry them out. delicately shaveshair away that some the has scar re-grown seeminglythe connecting along sedated toddler’s ears. ier than the firstDuffy, surgery,” says whoroom as has well. entered the distended from thestowaways, skull receives a bone full Beta- dine scrub. Asand falls, his the disinfectant chestbelly in button rises his quivers slightly. skin staplerline follows across his head, the whileond a sec- cloth scar draped overand his stapled face them in both the parallel lookHis of gives pale a burqa. completely body sheathed soon inblues becomes except sterile for the upperdow win- and its lower counterpart “Look at the green balloon. He turns his head to seeWith for the mask over his The IV catheter directs a “That’s for after surgery,” says A laryngoscope verifies that His heart rate registers 130 It’s a green balloon,” she coos. himself. mouth andceives pure nose, oxygen, then ature Bobby mix- of oxygen re- andto sevoflurane lull himslumber into and antion allow of anesthetic the an otherwiseinto inser- painful the IV back of his left hand. flow ofrocuronium, the the painkiller fent- muscleanyl and hydrating relaxant fluids.secures Tape the tubing to whiteding pad- beneath his left arm. Ricardo Aranguren, the chief phy- sician’s assistant. “He doesn’t un- derstand that the IV isSo his when friend. he wakescrying, up flinging around and . . starts .” Bobby’s airway isbreathing open tube, andmore tape, secured a ensuresreceive that with the he right will mixand of oxygen anesthesia.around A his upper right greenmeasure arm his will blood cuff pressurea and pulse oximeter on hiswill fingertip monitor the oxygenationhis of blood. beats per minute, at the upper

weeks ago. Kim knows all this,

2 On this Friday in April, less Only two more hours until a res- Let it be over“It’s soon. just a sticker, just a stick- An oral dose of the sedative As Beg, the anesthesiologist, / 1 exercises designed to strengthen the eye that was injured in the accident, as big sister Megan toys in the background. RAIN HAS FALLEN STEADILY ALL MORNING. than an hour afterPope the burial John of Paulface up II, on an a operating table. boy lies olution that seemed6 so unlikely as she sits with Robert infloor waiting a room fourth- at Stony Brook hospital, but shephysical frets trauma and about potentialfections the in- or anesthesiations complica- from astands surgery is necessary. she under- er,” says aRoom nurse A in asBobby’s Operating she affixes chest,trodes one will listen to in where ontrical the elec- activity elec- ofreport his their findings heart backelectrocardiogram and to monitor. an Versed isthrough his body, alreadycro while strap a encircles coursing Vel- his waist. and other members of thecal surgi- team preparegen Bobby’s mask, oxy- registered nurse Kim Fenster directs his attention to- ward a partiallyon the inflated anesthesia machine. bulb

22 NEWSDAY, SUNDAY, FEBRUARY 26, 2006 www.newsday.com ey”Dfysy,adteboy the and they says, Duffy sur- gery,” so after immediately up wake anesthesia general and pajamas. a diaper hospital-issued green receives blue-winged He new gauze. thick of a by wrap and followed site, in- off, cision stapled the covers come tape more eyes Bobby’s says. he solid,” pretty it’s — back in bones those put we where head. boy’s remarkable body’s ability. healing the evi- of says, dence Egnor location, its toward initial al- back piece moved The has ready force. to due ward out- popped bone the where bone, sphenoid the of wing right greater brain “The normal.” perfectly says. looks he damage,” on box light wall. a back the to affixed scans have don’t fine.” they’re they pain, much once kids, “where- as than says, he anxiety, operation have more Adults says. an Egnor adults, after ter abdomen. and head ban- his finishes daging team as surgical the removal the tube for prepares endotracheal Beg and blue says, in. the is staple last The beneath shroud. first the stirrings feels he as announces, anes- nap. his morning from thesia-induced rouse he to as just begins minute, per beats 104 stapling Egnor, line. suture begins with the over Egnor unison while in says room?” this what in discuss and we — do politics or religion discuss “Never says. Duffy rule,” head. boy’s the they up while sew pope the replace will off. clips right: yellow the in, on sutures curved Duffy and left the on begins a Egnor end. forms either at and pucker middle the in gether catch a head. into Bobby’s beneath the drips bag over and washes bones fizz- solution the ing and hy- peroxide of full drogen bulb blue light a left with back one. right back the the and wedge, Then tached. completed Surgery make radical.” anything doesn’t do to “It sense remolds,” says. in body Egnor “But the apart. children, suture bone’s the Du- natural popped the tire of rango’s pressure where initial split, the partially has bone a by ends. the three finished snips and with knot, square knots suture the granny ties er, him. speculation replace will the who and over will his of 20 from RECOVERY Iely o ieenough give you “Ideally, covering tape of strips The give little very “There’s the feels he table, the at Back the in split a shows scan One brain of signs any see don’t CT “I of sheet a to walks He bet- much heal often Children Fenster Bobby,” OK, “It’s Duffy up,” waking he’s “OK, registers rate heart Bobby’s he politics,” and “Religion cardinal my break always “I who on odds the discuss They to- scalp his ties stitch first The site entire the rinses reat- Egnor soon is wedge The of wedge right front The minute. per beats go. 91 to Three down. One togeth- bones the lashes Egnor hog ako lus and quickly. drying clouds, is pavement of the bank a through joy. mother’s recovery a by greet- ed the are cries his into where room, operating and the room of out wheeled possible. as moving soon know as are again patients the to their near want that or doctors in brain, surgery After wail. full-blown a displea- than of mostly sure whelp a more still foot. — cry plaintive a eyes issues left Bobby closed, his his on if Then, wiggling as again cue, move to begins w idpoet htgath- that protests mild — ow, ow” “Ow, an with removal their sta- see?” Wanna got head. my “I in ples says. Bobby now.” asks. BOY. YOUNG A STREET SEES THE ON GIRL A nbtenalterhbltto okadvst ovrosdcost hc nhspors,Bbygt nsm eaaintime relaxation some in gets Bobby progress, his on check to doctors various to visits and work rehabilitation the all between In yno,tesnhsbroken has sun the noon, By over. It’s is Bobby a.m., 10:49 At says. Duffy sign, good a It’s e asltr emarks he later, days few A OK I’m but car a by hit got “I she you?” to happened “What aears h driveway. the with across yard gate a front they’ve their in and his fenced over vision concern uncertain of Palanges out of backyard the trees their so, cleared play- have Even during time. returns con- his and fidence hair blond son’s of her mass beneath recedes scar Hospital. Charles St. to at returns job her she and Tutor care their day to Time Bobby back routine: go Jacob familiar and a de- to return- she by ing so therapy and own her long prescribes rives for it on doctor ing stay- about worries she but Her Xanax, jags. ar- have torrent. a emotions in rived her discov- that Kim long, ers remaining so for after routines strong And broken mended. and soothed be must chil- feelings hurt when five dren, few among be first must redistributed attention these when in weeks, salve more out.” they’re de- good, “Oh he clares, though, to Afterward, begins cry. he until strength in er stewesavne the advance, weeks the As crying dreams, bad Flashbacks, require will wounds Other hnh ot o h door, the for though, bolts is him, he She follow when to marveling. half,” a quick and says, size a she hospi- grew the he in tal, was he “When spurts — growth Bobby’s with up amazing.” watch “Totally they by. go as him another to says blink. blink, Blink, again. ning bunch a room. the around from scattered balloon green often. is when which blink moves, all he They back. the sides, on the — on straps, lights Velcro the red on and and yellow shoes feature tennis pictures His head. the for on pats poses tiently impa- in- attraction star by the covered surance, not expenses medi- cover cal Palanges Felicia the help and to JoAnn Station, by Jefferson organized Port in Lodge 16 hit now get car.” a could by Jacob, “You old. months tells Bobby i a enual okeep to unable been has Kim woman one amazing,” “It’s run- is and yells he go!” him. “Let restrain to tries friend A a with playing begins He Elks an at fundraiser June a At road,” the into go “Don’t os,fo htIsaw.” I this what from past house, it made have shouldn’t “He sentiment. the echoing later, charge. former his of says Cunningham moment. the recalls he as friend.” my “That’s seat. car his of Chapel. Jesus front Infant hospital’s in the sitting patient another Cunningham with spies Kim to and Robert from handoff rou- tine a for afternoon one Hospital child miracle A $4,200. about cars. their behind to see drivers cam- allows rearview that a system era is One overwhelm- her. ing fundraiser, the items for donated have individuals lot. parking lodge’s the sidewalk entry- toward short a and down and foyer way the through na mtoa hn call, phone emotional an In says Kim God,” be gotta “It’s side,” his on angels had “He smiles therapist physical The from shouts boy the “Hey!” Charles St. to returns Bobby nets forward. moving is fundraiser Life the all, In and businesses 160 than More 23 www.newsday.com NEWSDAY, SUNDAY, FEBRUARY 26, 2006 Four months later, paper In one of her rare moments “It’s something he’ll always Even so, she’s thankful. She On a sunny winter after- And that, for now, is enough. A surgical procedure, hearts inbeen red taped and toand pink the windows. have frontping Bobby door is inSnoopy nap- and an a blanketed easy of quilt- trains chairday” while with “Freaky playsroom’s oversized Fri- television. on theof relative peace, Kim living that confides her flashbacks have notsubsided. yet Norband’s has struggleyond her to his overriding hus- moveeven sense that be- now,him for everyone what happened. blames remember,” she says. knows they’re among theones lucky and she can’theartache imagine of the child a didn’t make parent it. whose noon, the tow-headedfast asleep toddler in her livingfers room of- the quietassurance that and nearly remarkable anything, for them, is still possible. Maintaining body tempera- A major blood channel that runs The pressure within the cranial A scoring system used by medics A clear, water-like fluid that bathes, Also known as an EKG or ECG; a A flexible tube that delivers oxygen A major nerve that arises in the A condition in which one or more A tube inserted through the nose and The delivery of oxygen in quick The insertion of a catheter into a The tissue-lined cavity between the lungs A catheter tube inserted to monitor the J. Stephen The abnormal expansion of an organ or Rod Eyer A protein fiber that dominates the connective Richard Loretoni Timothy Hughes A band of fibrous tissue that covers muscles and Also known as the dura mater; the leathery and ventricle of the brainand to relieve drain intracranial away pressure. cerebral spinal fluid between the brain’s leftcollects and and right drains hemispheres, blood wheresels. from it a variety ofVentriculostomy: smaller ves- and the chest wall. Superior sagittal sinus: into the stomach toach’s deliver contents, liquid or food, draw removepressure. out the air stom- to preventOculomotor a nerve: buildup of midbrain and governs nearlyPleural all cavity: eye movements. to assess a patient’straumatic condition brain and injury; prognosis the followingbal, scale a motor includes and scores eye-opening forHerniation: responses. ver- part of the skull,brain which within may its rise confined dueNasogastric space. to tube: swelling of the from a hand ortient’s machine-operated airway pump to through the aFascia: lungs. pa- some organs, offering bothGlasgow protection Coma and Scale: structure. tissue out of itsHyperventilation: own space or cavity. bursts, to lower theand level reduce of pressure carbon by dioxidevessels constricting in and the brain decreasing size tissue the ofInduced blood blood mild flow. hypothermia: ture at or belowcooling 98.6 blankets degrees, and sometimes Tylenol withswelling suppositories, the and to aid intracranial keep of pressure brain Intracranial to pressure: a minimum. Life-saving terms Central line: central venous pressure —— and, and by to extension, provide hydration Cerebrospinal a fluid: portal for drugprotects delivery. and nourishes theflows brain within and the spinal brain’s cordCollagen: four and main cavities, ortissue ventricles. in skin, tendons,providing ligaments, strength, cartilage elasticity and and bone, Craniosynostosis: support. medical test that recordsand the detects heart’s abnormalities. electrical activity Endotracheal tube: sutures between the skullleave bones the close head prematurely misshapen and the as growing the brain. skull accommodates Decompressive craniectomy: often done after ainvolves traumatic removing brain a injury portion orlieve of stroke, the the that intracranial patient’s pressure. skullDura: to re- outermost of three membranesElectrocardiogram: that cover the brain. Through his wife, Robert has If only she could put her fin- Maybe it will return. Someday. has been a science writer at medical bills as theycan arrive, only but guess at a total cost. rejected repeatedtalk requests about an to accidentweighs that heavily still onstruggling him. to Hesays, while is move she is on,find still the trying Kim to partlost after of the accident. her that was ger on what’s missing. Copy Editor Graphics Editor Smith Graphic Artist Art Director The Reporter Bryn Nelson Newsday since April 2000. Heabout has the written Human Genome Project,therapy, stem wildlife cell biology, archaeology andWest the Nile virus. He wasIsland: a Our writer Natural on World,” “Long aabout yearlong the series Island’s natural wonders. Staff photog- Jane Hwang Steve Wick Friday in mid-Sep- Story Editor Photo Editor Photographers raphers MichaelKaren E. Wiles Ach Stabile, andtributor and Howard con- Schnapp Before, Kim says,But “danger his pitching form is re- “Good,” he says. “Couldn’t ask Egnor has presented this case “Bobby, I’m so proud of you,” Some scars are fading fast. But It comes back to her in an in- Two days later, Bobby Within the two minutes that “A telephone!” Bobby says, A stuffed dog and pony show Despite the happy chaos It may never beShe whole. tries to keep up with the noises, and tires outceding by the 8 bedtime p.m., his younger battles brother. to was his middle name.” turning. Theties bone in his irregulari- skullthemselves will largely sort outEgnor reasons, eliminating overneed the for further time, the neurosurgeon surgery. sees scant And ev- idence of the initialCT injury scan in of a and his surrounding patient’sthe brain outside, skull. blond hair From haslargely now concealed thesurgical handiwork. doctor’s for more.” in detailleagues to at UCLA, but neurosurgery the extraor- dinary col- outcome is communicat- ed far more powerfully whentells he Kim heher won’t son for need another six to months. see he says, beaming. not all. On a tember, Kimwork fields from a16-year-old a daughter call is still mothercovering at re- whose fromshe sustained head in atwo injuries car accident yearsidentify ago. herself, butsay Kim is with able doesn’t what to you’re certainty, going through.” “I know stant. The call ends andsolves she into dis- tears at her desk. agrees to playhis “patchies” with sister Megan,looks while on. Jacob adhesive Kim bandages retrievesone two and over Bobby’s puts his good left eye eyedoes — — the while sameeye. Megan over her right the gameKim holds positions him his by thetopped attention, glass- coffee tableing in room and the points toon liv- pictures a sheet of paper. correctly, then stumblesthe over next fewbounding tries with before“A a re- resounding, car!”struggles Game to removedage. over, the as ban- he in the living roomsisted and jump-rope scarf-as- session inkitchen the offer far morethree fun, children and soongiggling fall heap on into the a floor. around her, Kim readilythat admits her familysame, isn’t isn’t yet whole. quite the NEWSDAY PHOTO/MICHAEL E. ACH The same day, JoAnn receives “What a handsome boy!” ex- “Walk back to mommy. Can Bobby runs to Kim in aHe few still lacks some vision in by Kim tothird celebrate birthday, theirhours son’s bouncing Bobby inBounce an spends House inflatable and while neighborsaround relatives a talk grill in the backyard. and laugh a call fromtives her in husband’s Sanher rela- Antonio, Bobby’s recovery whofeatured in has tell the day’s been “Ripley’s Be- lieve It or Not” cartoon. claims Egnor at a check-up ingust. Au- The picture of calm inral a flo- tie isshy smiling 3-year-old at buryingin a his suddenly the face basetable. of Bobby thewhen peers Egnor exam-room asks out himthe to warily wall. walk to The doctorhim to gently the lifts wall instead. you walk back to mommy?” efficient steps. A nice stride. his right eyeaged optic due nerve, to but ato the strategy dam- patchforce his aHe good partial is more compensation. eye cautious, fears may loud

In July, Robert resolves the “It’s just — he was a miracle Serna, Stony Brook’s critical “Everything clicked. This kid “Kismet,” Brauneisen says. With Bobby back in North at home with brother Jacob and sister Megan. charges filed against him by plead- ing guilty in exchangetion for and proba- a fine.at Later that an month, ambitious party organized she has also thankedSouth Salinas of Countyone Ambulance of — dreds the who ensured that first herhas son made among it home hun- again. baby,” Salinas recalls.lined up “Things and it wasful just thing.” a beauti- care nurse, seesher Brauneisen post in at Brookhaven’s emer- gency room fromand time to time theywarmly with greet alike hug and each they’ve ayears. been kiss, They other look friendsand at remember for each little other Bobby. was a miracle,” Serna says. Bellport, officersMudzinski make Curry regular house calls and to check“The on stars his seemed to progress. for be this aligned kid,” Mudzinski says.