Local couple grateful for life after traumatic brain injury
For Nathan and Melissa Franklin, progress is measured in small steps on a long journey.
Some of those steps have included Nathan squeezing Melissa’s hand to let her know he was still alive, Nathan feeding himself again or being able to move his right leg during therapy.
On this day, Nathan remembered the name of the neurosurgeon who saved his life on a fateful night two-and-a-half years ago.
“Babe, I’m really proud of you for thinking of that on your own, I just have to let you know,” Melissa said, smiling at her husband.
“Things like that are what he’s been doing more of lately.” she explained.
More steps remain for the Franklins as they confront the continued challenge of helping Nathan recover from a traumatic brain injury. It’s an odyssey that shows signs of reaching a good destination.
When the unthinkable happens
The journey began when Nathan fell out of a golf cart on June 15, 2013, and hit his head on the ground. Melissa was driving.
They had been married two months earlier on April 27 and were living in Jefferson City. Nathan was a safety manager for Alberici, a construction company. Melissa was a preschool teacher.
They grew up a few blocks from each other in Lake Saint Louis, but didn’t meet until they were high school seniors. “He cheated off me in Spanish class,” Melissa said.
She was 26 and he was 25 when the accident happened.
They were visiting his brother at Incline Village, a golfing community near Foristell where golf carts are used to get people around the course and even from house to house.
Melissa and her sister-in-law wanted to go for a ride. It was near the end of the day and, at first, Nathan didn’t want to go.
“I gave him the pouty face and he said ‘OK, one last ride,’” Melissa said.
They were all sitting in the front seat. It was raining.
“We turned around to come back and he went off the edge,” Melissa said. At first, she thought he had jumped. “I slammed on the brakes, saying ‘what were you doing’ and started yelling at him. And he was just lying there, just bleeding out his ear.”
Somehow, Nathan, who was riding on the right side of the cart, turned his head during the fall. The left side of his head struck the pavement, which fractured his skull. His eyes were closed and his respiration was gurgling.
“It sounded like he was snoring,” Melissa said. “He wouldn’t talk to us, he wouldn’t open his eyes up. I grabbed his left hand and asked him to squeeze it if he could hear me,” she said. “Every time he squeezed it, so I knew he was there.”
Because of the rain, Nathan could not be airlifted out. Instead he rode by ambulance, stopping at SSM Health St. Joseph Hospital – Lake Saint Louis, where he was intubated because he was having trouble breathing.
Nathan next was taken to Mercy Hospital-St. Louis in Creve Coeur.
The neurologist on call at Mercy told Melissa that a surgeon would have to remove part of Nathan’s skull cap because his brain was swelling – a condition known as a subdural hematoma. The doctor couldn’t promise that Nathan would make it through surgery.
“I only caught that he might not make it through surgery,” Melissa said.
Dr. Justin Sweeney, a neurologist at Mercy, said extensive surgery was needed, though, to remove a blood clot and areas of injured brain tissue. A large portion of his skull had to be removed to allow the brain to swell, thereby reducing pressure. Sweeney said such pressure can have a cascading effect on other parts of the brain that initially weren’t affected by the original injury, such as portions of the brain stem that affect the ability to remain awake.
“There are people who never wake up from something like this,” he said.
Eventually there were multiple surgeries- including ones dealing with spinal fluid that was not being absorbed and replacing the bone covering his brain with a plastic-like material because the bone had begun to deteriorate. It’s not something Sweeney has seen often.
Following surgery, Nathan was in a coma.
“It’s not like a broken arm; they couldn’t tell us that he would heal like this in a month or you should expect this. I think that was the hardest thing for us to grasp,” Melissa said.
Nathan began to wake up a week and a half later, twitching and coughing.
“It’s not like it is in the movies,” Melissa said. “At that point, his doctor said ‘this may be who Nathan is, he may just twitch and move randomly for the rest of his life,’ We weren’t going to accept that as the truth.”
For the first two weeks, Melissa said she asked God not to take him.
“I don’t really know if it’s possible to make deals with God, but I remember asking ‘don’t take him. I will accept him however he is, don’t take him.’”
In sickness & health
Three weeks in ICU at Mercy Hospital and further Mercy therapy and care was the prelude to a long journey that eventually took the couple to Omaha, Nebraska, and places in between. Insurance allowed them to spend four months at Quality Living, Inc., a therapy center in Omaha that emphasizes a homelike setting for patients.
Nathan had his own room, television and bed. It was not a hospital setting.
“It was amazing,” Melissa said. “Nathan blossomed. He started talking when we got there.”
In time, he was able to learn to feed himself.
The next stop was to be the Missouri Rehabilitation Center in Mount Vernon, Missouri, but the couple’s insurance coverage ran out. Melissa said she kept being denied Medicare coverage because Nathan had been living out of state for a month. To become eligible for insurance coverage, Nathan had to spend time in a nursing home before going to the rehabilitation center for six weeks.
“I had to put my husband, then 27, in a nursing home,” Melissa said. “It was one of the hardest things I’ve ever had to do.” She said it was not a good nursing home. “They didn’t even know he was there the first day.”
After he came home, the therapy continued, but it remains a hard journey.
Even though his doctors and wife say he has made remarkable progress, Nathan’s recovery has been slow. He needs a wheelchair and cannot communicate like he once did. There have been continued surgeries and medical complications. It was suggested that Nathan be placed permanently in a nursing home. That didn’t happen.
“I just decided, OK, we’re going to do this,” Melissa said. “Nathan always was a really strong person. I always called him my iron man before the accident because he never would get sick. He was my iron man and we’re going to do it. Giving up was never an option and it still isn’t.”
To love & honor you
She’s always there, Ivie said, with what he calls her “beautiful smile.” In therapy, he said, she is Nathan’s “greatest cheerleader.”
“She is the one I really believe God will use to bring the recovery back to Nate that God will provide to him,” Ivie said. “The most important recovery he has, though, is that journey of recovery emotionally and mentally. When you’ve got a partner like this at your side the whole time, the journey is not as lonely.”
“Nathan’s progress is so slow,,” Melissa said. “On paper it doesn’t look like he’s improving, but if you look at the last couple of months or years, that’s when you see progress. Insurance doesn’t always approve therapy. They [insurance companies] tried to tell me a long time ago to put Nathan in a nursing home. No. They don’t dictate what we do. We find a way.”
That way, in terms of therapy, Sweeney said, is maximizing Nathan’s recovery. He hopes Nathan will continue to get better.
“The classic dogma is that people plateau around a year, and after that we don’t see as much as far as large steps and improvement,” Sweeney said.
Physicians look for things like whether a patient can move the left side of his body and get words out, he said. Some of the more subtle things – such as whether the patient’s personality is back, whether they can joke with you – are harder to see in a brief office visit, he said. Spouses see those things.
“The neurons and brain cells that die, they’re dead. They are not going to come back,” Sweeney explained. “But the way that we learn and grow as humans is that we make new connections in the brain. So you can stretch and make new connections between existing neurons and that’s how we have recovery.”
That often happens with stroke victims. For younger patients, making those new connections can be easier.
Melissa said she doesn’t believe that Nathan can’t get progressively better.
“If each of us is still able to learn new things, why isn’t it the same for Nathan?” she asked.
But it’s less of a question and more of a declaration.
From this day forward
Coming home presented new challenges.
Melissa found that their first “handicapped accessible” apartment in Lake Saint Louis was a bit of a misnomer. The doorways weren’t wide enough for a wheelchair. Nathan had to brush his teeth in the hallway for eight months, because he couldn’t get into the bathroom.
There was the need for a lift for their van that would allow Melissa and family members to take Nathan to his doctor appointments and therapy and just to help him get around.
But at each step of the way, their families and friends have provided a firm support system, which also includes St. Charles River Church.
“God has been present in every step of Nathan’s recovery,” Melissa said. She added that their faith has broadened. “There is a reason that this happened [though] I don’t know if we will ever know it.”
Ivie said that every time something good happens to Nathan the congregation gets to cheer for them.
“They are so convinced that their best days are ahead and so are we because of the progress they’ve made,” Ivie said.
But while a lot can be done for the patient, sometimes there isn’t much help for the caregiver.
“As far as support, there’s not and, to be honest, what caregiver has time to look for themselves?” Melissa said. “I don’t even know what I like to watch on TV anymore.”
Still, early on she realized it was important to meet with a therapist.
“It’s so important to talk to somebody,” she said. “I don’t think anyone should be ashamed about that. I think a lot of people feel like ‘I’m crazy if I have to take to a therapist.’ You have to do that.”
She is now involved with a Facebook support group for wives of traumatic brain injury victims. “I’ve come to the realization that I was so controlling,” she said, because of the anxiety.
Ivie added, “I think I see her more open to making sure others are part of Nate’s recovery now.”
Melissa said they want to share their story.
“Don’t give up, don’t let the disability define what you want to do,” Melissa said. “We still do so much, we’re so busy. Yes, it takes us a bit longer to get to places, it may be a pain to get in and out of peoples’ houses, but we do it. We don’t stop doing anything.”
Therapy is life.
Melissa uses many of the techniques she learned as a preschool teacher to work with her husband. They sing to each other and scream with each other.
“We’re really weird, our neighbors probably really hate us,” she said. “Nathan is a lot quieter since his accident. So we lay in bed at the end of the night and I say ‘alright let’s have a yelling contest. Let’s see who can yell the loudest,’” she said. “Its things like that, you have to have fun with it, that’s so important. You can’t just look at it as work.”
Through all of this, Nathan said he remembers very little of what happened. His most remarkable strides have been made in the last year to six months. He’s back to fishing and hunting again.
Melissa is working as a waitress in a restaurant in Chesterfield. They live in a small but more accessible apartment near O’Fallon.
They’re grateful for the lives they have now – together, Melissa said.
“It’s a great Christmas story, it really is,” Ivie said. “They know today that Christmas is truly being with the ones you love most.”