Surviving a whirlwind nightmare

Trauma Survivors’ Network brings people together to battle dark days

by Leslie Hast

Despite a traumatic brain injury and extensive memory loss, Hillary Coltharp’s story has remained remarkably consistent:  After she was ejected from her convertible at 75 miles per hour, she says she felt three angels come to her rescue. Two female angels sat on her left and right and lifted her up while a male angel pressed a hand to her back. Their spirits spoke to hers, she says, telling her God had sent them and they were there to give her peace and she was going to be all right.
Just as the angels promised, Hillary survived, and now a different group is arranging itself around her and other trauma survivors, providing the resources and support they need to recover.
The Trauma Survivors Network (TSN), developed by the American Trauma Society and launched by Vanderbilt in July, helps trauma patients and their families navigate the road from crisis to recovery.
 “The moment trauma happens, you’re doing the most normal things, but suddenly you’re in a whirlwind nightmare. No one knows what they’re going to go through with trauma, but TSN tries to eliminate some of that nightmare,” said Hillary’s mother, Shawn Coltharp.
The moment of Hillary’s trauma, Shawn, her husband Paul and other family members were sitting in a Paducah, Ky., restaurant with an appetizer that was getting cold. They had spent the 2007 Labor Day holiday on Kentucky Lake and were waiting for 26-year-old Hillary to join them for dinner.
When she didn’t arrive, her father, Paul, and brother-in-law, Billy, went out to look for her. They noticed that Interstate 24 was backing up with cars.
“I told Billy the good news was she was coming eastbound and all the traffic was westbound,” Paul recalled. They didn’t know then that Hillary’s car had flipped at least three times and crossed over to the westbound lanes, her body landing 75 feet from the car in the emergency lane.
The first person on the scene was a policeman, who noticed a cloud of dust rising on the road ahead. He immediately called an ambulance, and they called for Vanderbilt’s LifeFlight helicopter. By the time Paul and Billy got to the scene, Hillary had already been taken to Western Baptist Hospital.
After Hillary was loaded into the helicopter for transport to Vanderbilt, Shawn overheard one nurse say to another, “She’ll never make it there.”
“I gave her up to God in the helicopter,” Shawn said, “but when we got to Vanderbilt, I took her back because the doctors gave us hope.”
Hillary had broken bones and a subdural hematoma that would require a craniotomy, but she was still breathing and had good vital signs.
In the coming weeks and months, as Hillary transferred from the Trauma Unit to a rehab facility to home care, the Coltharps struggled through their whirlwind nightmare. Initially, they wondered where to shower and what some of the terms they heard swirling around them meant. Then they worried about choosing the right care facility and how to clean a feeding tube.
Shawn, who now works with the Trauma Survivors Network, hopes to use her personal experience to help other families survive the trauma nightmare.

The Division of Trauma and Surgical Critical Care’s implementation of TSN is a direct response to the Vision 2020 goal to extend the walls of the Medical Center.
“It’s fine to save a patient’s life, but our real goal is to return them to a functional lifestyle in their home community,” said John Morris, M.D., director of the Division of Trauma and Surgical Critical Care. “The Golden Hour slogan says ‘Give us an hour, we’ll give you a lifetime.’ We’re expanding on the concept of lifetime by moving into the post-hospital environment.”
Morris said TSN is made possible by Vanderbilt’s expertise in informatics and builds on the concept of family rounds established by Rick Miller, M.D., professor of Surgery in the Division of Trauma and Surgical Critical Care.
“Families could hear the discussion and see the magnitude of resources brought to the patient, and they had the ability to ask questions,” Morris said. “But rounds were often early in the morning, and we needed the ability to do that education in a time frame tailored to the needs of the family rather than the medical staff.”
So, building on content already developed by the American Trauma Society, the Division of Trauma and Surgical Critical Care established, a Web portal with links providing support and resources through all phases of trauma recovery.
“Trauma is a disease just like cancer or heart disease. It has predisposing factors; it’s not random or accidental. We needed to think about trauma in the same ways as other diseases and put an infrastructure in place to help families cope,” Morris said.
The first phase of trauma recovery is immediately after the trauma occurs. The patient is in medical crisis and the family is in social disarray. During this phase, TSN mainly targets the family, providing information about the hospital and the patient’s care.
 “The family goes through the crisis as a disjointed unit,” Morris said. “We want to send the message ‘You are not alone. There is a process, and we can help you navigate it.’
“There’s a whole new set of information you need in an immediate crisis,” Shawn said. “You might not know where to take a shower or access e-mail or find a place to eat.”
The Web site offers information on restaurants and lodging, as well as information on what to expect in the hospital, including descriptions of various medical staff, the procedure for rounds and a narrative of a typical day in the trauma unit.
There is also “traumapedia,” an online encyclopedia of injuries and procedures free from medical jargon.
“We had stuff told to us in the first 24 hours that I still have no idea what it was,” Paul said. “On the Web site, you can do your own research when you’re ready.”
At this time, families also need to start investigating the next destination for the patient, so the Web site offers information and recommendations for rehab facilities and home care.
 “Medical care is a continuum that can take multiple pathways,” Morris said. “We want families to understand that the patient won’t be in the hospital until they are well. We recommend a group of post-acute care providers with capabilities for managing the unique needs of the trauma patient. Now TSN can offer more information to families and travel with them to whatever their next destination point is on their journey to recovery.”
Shawn said she was reluctant to leave the incredible care offered in the Trauma Unit, but having these recommendations from TSN will make families feel like they are still part of the “Vanderbilt fold” after they leave.
In this first phase, families are also introduced to one of the most important components of TSN, peer visitation. This program organizes trauma survivors and their families to talk with patients and families with similar injuries. They can discuss what to expect with the injury and get support from someone who has experienced the same trauma.
“It helps to have someone call to say ‘Here’s what happens and here’s when it happens.’ Just to say ‘Oh yeah, we’ve been there. Hang in there. What you’re facing is hard but you can do it,’” Shawn said.
Peer visitation continues into the second phase of recovery—reintegration, when patients transition from the hospital back to their home community. Because Vanderbilt serves a wide regional area, TSN hopes to eventually have an extensive network of peer visitors that can continue to offer support in their hometowns.
“Someone told me that the most alone day you will ever feel is when you’re waiting for LifeFlight to take your child to Vanderbilt. But the second most alone day you will ever feel is when your child is coming home. None of us are prepared for the next steps,” Shawn said.
Shawn had a personal friend who provided the support she needed on that first day home, but peer visitors will also be able to fill this role.
Hillary has already made a peer visit to another family.
“The reason I want to keep visiting patients who have been severely injured like I have is so I can show them how far them how far I have come since my terrible accident.  I also can see how far I have come when I see them, since I can't remember much about being in the hospital when I was in such a long coma,” Hillary said.
Resources for the reintegration phase focus mainly on emotional healing. Next Steps, a program distributed nationally by the American Trauma Society, helps patients and their care givers accept life after trauma, including lessons on setting goals, coping and managing pain and anxiety.
“Next Steps helps individuals begin to manage their own pain and depression and their many individual challenges,” Shawn said. “It is also for families. There’s a second trauma to every trauma—the family—and it’s a way to do a self-directed journey through your new life now.”
Shawn says Hillary still has “dark days,” and her frustration with her injury is evident when she calls her wheelchair a “stroller” and says she feels like a child who has to have a babysitter. But through Next Steps, Shawn says Hillary is close to accepting her trauma and embracing her new life.
The third phase, advocacy, seeks to create an informed, focused and active constituency to improve public health.
 “We want to create an army of advocates who have been impacted by trauma and who are educated about it,” Morris said. “We can inform people in the network to contact their legislator when pieces of trauma-related legislation are proposed, and through that, we can lower the impact of this disease on society.”
Shawn says she hopes patients and their family and friends will dive deep into this third phase.
“1.4 million people are diagnosed with cancer each year, but there are also 1.5 million trauma cases. We’ve got to do something to get ahead. We’ve got to educate about prevention and support and promote advocacy,” she said.
Hillary is already working on the advocacy phase—her mantra is “Wear your seatbelt,” and she repeats it to everyone she meets.
Morris also hopes the third phase will jumpstart the philanthropy effort around trauma. Because TSN is not supported by insurance, the program relies wholly on funding from donations and grants.
Students at Harpeth Hall in Nashville donated seven laptops for families to use to connect to the TSN Web site. They hope to have students volunteer occasionally to help less tech-savvy visitors navigate the site.
Since its launch in July, TSN has had a warm reception, but organizers insist it will continue to grow with time. Focus groups are currently evaluating the website and changes will be made based on their feedback. Traumapedia content will be expanded, including interactive help files, and groups are forming to serve as advocates or peer visitors.
 “I hope it ends up being a resource and connecting link where we remain part of the patient’s and family’s lives and they remain in ours,” Shawn said. “Vanderbilt has clearly shown that they don’t want to let go of a family when they leave the hospital.”

It’s been more than a year since Hillary’s car accident, and she is still steadily recovering. Because her right brain was injured, she has movement issues in her left arm and leg, and she is hoping to transfer to Stallworth for better rehabilitation with those extremities. She is slowly reconnecting her memories and rebuilding her personal history.
“She’s a hairdresser, and she just washed my hair at a professional salon. She’s never hit a plateau. She continues to improve every day,” Shawn said.
On a visit with her LifeFlight nurses, Hillary freely offered hair advice and chapstick.
“I was always happy helping people feel better and look better,” she said.
Hillary’s son, Max, 6, who splits his time between her and his father, is now crazy for helicopters. He watches for them in the sky, has helicopter toys and received his “wings” on a recent visit to the helipad. He thinks he might want to be a LifeFlight pilot or nurse when he grows up.
Shawn says they owe all Hillary’s success to the LifeFlight and Trauma Unit staff.
“Those are the people who propped us up in the darkest days of our life. We still feel such a closeness and bond to those nurses and doctors. In spite of our crazy family, they became our family. We’re never going to let them go,” she said.