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Life can change in an instant. On a beautiful Sunday afternoon, 12-year-old Ryan Korengel went golfing with his friends. That evening, Ryan was having brain surgery at Cincinnati Children’s. Part of his skull had been crushed, and he was fighting for his life. Shelly and Don Korengel, Ryan’s parents, never expected to get the frantic phone call from Ryan’s friend. Ryan had been hit by a tree, and they needed to get to the golf course right away. The tree that struck Ryan had been hurled his way by a sudden, unexpected and severe windstorm – the result of Hurricane Ike – that hit the Ohio Valley. Shelly and Don remember racing to the golf course, dodging scattered debris from the storm along the way. When they arrived, they saw Ryan lying on the ground unconscious. As Don knelt down next to Ryan, he realized something was seriously wrong. “When I touched the right side of Ryan’s head, it felt like a crushed eggshell,” says Don. Miraculously, another golfer had seen Ryan go down and had rushed to his aid. She kept him breathing until help came. The paramedics rushed Ryan to Cincinnati Children’s, where the trauma team worked quickly and expertly to assess Ryan’s injury and get him ready for the operating room. “Cincinnati Children’s was amazing,” says Shelly. “Within minutes of his arrival, Ryan was prepped for surgery.” The impact had shattered the right side of Ryan’s skull, damaging about two thirds of the right side of his brain and coming within a millimeter of hitting his carotid artery. Pieces of Ryan’s skull had crushed into his brain, tearing tissues and blood vessels. Before Ryan went into surgery, Don and Shelly met with pediatric neurosurgeon Todd Maugans, MD, who would lead Ryan’s operation. Because of the extent and severity of the damage, Ryan’s initial prognosis was very poor. It was possible he could die before the night was through.
The skilled neurosurgery team worked for five hours to save Ryan and stop the bleeding. During the operation, Dr. Maugans removed pieces of Ryan’s skull, giving his brain room to swell after surgery. If this was not done, the brain would expand against the skull, and, with nowhere to go, cause death. Over the next few days, everyone waited for Ryan’s vital signs to stabilize. Ryan’s parents and older sister, Megan, stayed with him by his bedside in the ICU, watching all the different monitors and machines hooked up to Ryan as they beeped and flashed. “We really lived not one day at a time – it was one hour at a time,” Shelly remembers. Even though Ryan was unconscious, he could not tolerate sound or light – it would cause him to be agitated. So his family waited by his bedside in the dark, and they spoke to him while he lay in a coma-like state in his bed, and asked him to wake up. “I asked the doctors and nurses whether they thought Ryan could hear us, and they all said that they thought so,” Don says. Through it all, Ryan and his family have appreciated the warmth and compassion they received by the staff of the medical center. “Everyone at Cincinnati Children’s has been wonderful,” says Don. “I could go on for a long time about Dr. Maugans – he is a wonderful surgeon. He has great compassion and bedside manner. Everyone in the surgery group said we were lucky to have him.” Dr. Maugans is quick to credit the entire team at Cincinnati Children’s with Ryan’s survival and continued recovery. “Ryan’s case is an example of everything coming together to optimize an outcome,” says Dr. Maugans. “No one person is responsible – a team approach is what we have here.” Cincinnati Children’s takes a multidisciplinary approach to care, bringing together experts from multiple areas to provide the best possible care for patients. The trauma team is no exception. Trauma patients benefit from the combined efforts of emergency room physicians and nurses, pediatric trauma surgeons, radiology and imaging, orthopaedics and rehabilitation, among others. As the only Level I pediatric trauma center in the Tristate, Cincinnati Children’s offers the most comprehensive care available to patients like Ryan. After a week in intensive care, Ryan had stabilized to the point where he was no longer considered critical. His breathing vent was removed, and he began breathing on his own, with a little assistance from an oxygen tube.
Don and Shelly soon began to see proof that their Ryan – a sweet, funny kid who loves sports of all kinds – was trying to come back to them. Ryan had begun to move his hands around, and at first they thought it was because he was restless. They quickly realized he was spelling out words to them – Ryan had taken a sign language class in the fifth grade, and was trying to communicate. Soon after this, when Shelly leaned down and told Ryan, “I love you,” Ryan pointed at her and, eyes still closed, motioned, “You, too.” He would give doctors a thumbs-up in answer to their questions, and he began writing to communicate. He wrote “Miami” for his favorite Miami University pillow and “Megan” – he wanted to see his sister. On Ryan’s 11th day in the hospital, he was checked out of ICU and into the Rehabilitation Unit. Unlike many other facilities, the Cincinnati Children’s rehab unit is located at the main hospital. Because of this close proximity, Dr. Maugans was able to visit Ryan daily and keep close tabs on his progress. Ryan embarked upon an intense schedule of physical, speech and occupational therapy to relearn basic skills – how to swallow and eat, how to keep his balance, move around, how to process and retain information, how to speak. For 49 days, a team of therapists worked with Ryan from 7 am to 5 pm six days a week to help him get stronger and relearn all of the skills that his body had forgotten. “Rehab is kind of like boot camp – it’s very intense,” says Dr. Maugans. The intensity of therapy, coupled with Ryan’s determination, has served Ryan well. Even though Ryan’s doctors initially thought he would be paralyzed down his left side, Ryan told everyone from the very beginning that he would walk out of the hospital. Two months later, he did just that.
After Ryan’s discharge from the hospital, he continued an intensive therapy schedule, adding to the regimen aquatic therapy and electric stimulation therapy, in which electrodes are placed on the skin to contract the muscles, build strength and promote blood flow to the area to aid healing. “We can’t say enough good things about all the people in rehab,” says Don. “His therapists are just great. I have seen week-to-week progress with Ryan.” Ryan’s road to recovery hasn’t been without bumps. Ryan’s initial injury had caused a breakdown of the skin on his scalp, which left it weakened and vulnerable to infection. Ryan also developed hydrocephalus, an excessive buildup of fluid in the brain. He had surgery to clean out and remove infected tissue, and had a shunt inserted in his brain that would help decrease the fluid leak. The shunt will remain in Ryan’s brain and will be monitored for the rest of his life. The ordeal was a setback for Ryan, as he was not able to continue with his therapy regimen and lost strength and some of the progress he’d made. But, now home, Ryan is working on regaining lost ground and keeping a full schedule of school, therapy and coaching first base for his baseball team. He is working toward a big goal: to get well enough to someday return to the golf course to finish out the game he started the day of his injury. “I think he’s only going to get better as he continues his therapy,” says Dr. Maugans. “I used to be more pessimistic earlier in my career, but that has changed. I never cease to be amazed at how well kids do. I have come to be humbled by their amazing ability and fortitude to get better.”
Ryan’s and his family’s lives have changed. Ryan now has a titanium plate to replace the missing section of his skull and his vision is impaired. He will continue to visit Cincinnati Children’s on a regular basis, and physical and occupational therapy will remain a big part of his life for the foreseeable future. Despite all that, Ryan has kept his quirky sense of humor and quick wit. Recently, when technicians moved equipment around on Ryan’s chest during a sonogram after a procedure, he asked them: “Is it a boy or a girl?” Ryan’s parents say they are proud of their son and all he has accomplished since his injury. They have chosen to be open about Ryan’s physical progress and to freely share his amazing story. Shelly says people ask about him all the time and if he will ever be “normal” or “100 percent.” “Ryan lives a new kind of normal,” says Shelly, “and he is 100 percent our Ryan.”
The injury impaired Ryan's vision and impacted his ability to control and move the left side of his body. Ryan uses a robotic device at Cincinnati Children's to build strength in his left leg.
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Ryan, now 15, suffered a life-threatening brain injury.
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